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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
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I think a lot of what your options are will be interdependent on how much of a transfer penalty it is; what the transfer was; and how your state does appeals and it's "ward of the state" approach. Whatever the case, you need to file an appeal as it buys you time to work things out if possible.
So Willy - how much of a penalty are you looking at? Like if this was in TX, their Medicaid reimbursement rate for room & board is about $ 155.00 a day. So a penalty cause grannie gave her 8K car to her nephew would be 52 days of penalty which family would need to private pay the facility - & probably manageable, so you'd sign an agreement to pay and grannie stays in the NH and then on day 53 state Medicaid program starts paying. Quite different than gran gifting her 80K home to nephew, which is 516 days of penalty. For big penalty, family is left with few choices: either someone private pays OR the elder moves back in with family for the rest of the days left in penalty period AND they negotiate to deal with the outstanding bill. You kinda need to deal with the bill too otherwise the elder will likely be toast on getting into a better NH in the future.
When a penalty is issued, the state sends a letter to the individual, to whomever is on file as their point person or DPOA; the local NH ombudsman AND the facility. NH knows penalty issued and they seem to them issue a "30 Day Notice" to family. What the NH can do depends on how the admissions contract reads and who signed it. Whomever signed them, will be the first ones sent a bill by the NH. How aggressive depends on facility and your state laws.
What I've seen happen at my mom's first NH was quite ugly. Son transferred home to his name and penalty issued. He refused to deal with outstanding bill of several months. NH contact their state Medicaid person and the lady was made an emergency ward of the state with probate court appointed guardian who then moved her to another facility. As there is a now a guardian, all decisions now under their purview. Son - who imho a real Ahole - was on a rant a couple of times when I was there before too. The last time - when he found mom gone - police called. I'm sure the NH (a chain) went after him personally for the debt.
NH collecting on bad debts probably is somewhat low. But if they turn it over to collections, it will make your life hades in addition to caregiving stress.
I'd try to negotiate with the facility on the penalty. If they like your elder (like their care plan is easy for them to do and your elder is likable), they might be ok with your paying them over time and at the state reimbursement rate rather than the significantly more private pay rate. If your going this route, you need to make sure that the elder is doing their co-pay or SOC to the NH from their SS & retirement like clockwork and that their personal needs trust fund at the NH is current and with funds.
Good luck. Out of curiosity how much penalty & for what type of transfer?
If indeed a penalty is imposed every state has "hardship" provisions in their rules which will allow benefits to be received if lack of care would adversely impact the health and safety of the applicant. This would be the "fall back" position. Application of the hardship provision may require an appeal after an initial denial.
Short answer without exact description of continuing care If individual is penalized for money spent in 5 year look back then either individual or family or friends will have to pay DEPENDING on the kind of care. Medicare will cover certain medical and skilled nursing or hospice expenses. If nursing home custodial care is what you are asking about, better have generous friends and family willing to repay whatever resulted in penalty. Medicaid is intended for indigent or very poor persons without means to pay independently. Since Medicaid comes from government i.e. Taxpayers it makes sense to have standards to have persons pay their own way to the extent that they can. It is terrible that care is so expensive that Medicaid must be considered. But if everyone is on Medicaid with no restrictions the programs would collapse faster than they already are.
That's the problem with using abbreviations. We get confused and then we can't help as much. I think the generic answer would be - anyone who has the money. She could pay out of her funds if she has any left (I'm assuming if you mean Medicaid that she doesn't), you could pay, any member of the family or a collection of friends even.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
So Willy - how much of a penalty are you looking at? Like if this was in TX, their Medicaid reimbursement rate for room & board is about $ 155.00 a day. So a penalty cause grannie gave her 8K car to her nephew would be 52 days of penalty which family would need to private pay the facility - & probably manageable, so you'd sign an agreement to pay and grannie stays in the NH and then on day 53 state Medicaid program starts paying. Quite different than gran gifting her 80K home to nephew, which is 516 days of penalty. For big penalty, family is left with few choices: either someone private pays OR the elder moves back in with family for the rest of the days left in penalty period AND they negotiate to deal with the outstanding bill. You kinda need to deal with the bill too otherwise the elder will likely be toast on getting into a better NH in the future.
When a penalty is issued, the state sends a letter to the individual, to whomever is on file as their point person or DPOA; the local NH ombudsman AND the facility. NH knows penalty issued and they seem to them issue a "30 Day Notice" to family. What the NH can do depends on how the admissions contract reads and who signed it. Whomever signed them, will be the first ones sent a bill by the NH. How aggressive depends on facility and your state laws.
What I've seen happen at my mom's first NH was quite ugly. Son transferred home to his name and penalty issued. He refused to deal with outstanding bill of several months. NH contact their state Medicaid person and the lady was made an emergency ward of the state with probate court appointed guardian who then moved her to another facility. As there is a now a guardian, all decisions now under their purview. Son - who imho a real Ahole - was on a rant a couple of times when I was there before too. The last time - when he found mom gone - police called. I'm sure the NH (a chain) went after him personally for the debt.
NH collecting on bad debts probably is somewhat low. But if they turn it over to collections, it will make your life hades in addition to caregiving stress.
I'd try to negotiate with the facility on the penalty. If they like your elder (like their care plan is easy for them to do and your elder is likable), they might be ok with your paying them over time and at the state reimbursement rate rather than the significantly more private pay rate. If your going this route, you need to make sure that the elder is doing their co-pay or SOC to the NH from their SS & retirement like clockwork and that their personal needs trust fund at the NH is current and with funds.
Good luck. Out of curiosity how much penalty & for what type of transfer?
Application of the hardship provision may require an appeal after an initial denial.
If individual is penalized for money spent in 5 year look back then either individual or family or friends will have to pay DEPENDING on the kind of care. Medicare will cover certain medical and skilled nursing or hospice expenses. If nursing home custodial care is what you are asking about, better have generous friends and family willing to repay whatever resulted in penalty. Medicaid is intended for indigent or very poor persons without means to pay independently. Since Medicaid comes from government i.e. Taxpayers it makes sense to have standards to have persons pay their own way to the extent that they can. It is terrible that care is so expensive that Medicaid must be considered. But if everyone is on Medicaid with no restrictions the programs would collapse faster than they already are.
We get confused and then we can't help as much.
I think the generic answer would be - anyone who has the money. She could pay out of her funds if she has any left (I'm assuming if you mean Medicaid that she doesn't), you could pay, any member of the family or a collection of friends even.