What if I didn't pick Dad up from rehab?

BlueRidge - so who signed Dad into the facility? Whomever did will be the first person that the NH bills once Medicare stops paying. At 8K a month for just the basic room & board costs, plus all the incidentals, you are looking at 30K in 3 months easily. It is enough for the NH to turn over to collections.

This can get ugly too. At my mom's NH#1 there was a lady who's son refused to pay her bill. He had applied for Medicaid for her, but was declined at about month 4 in the state's Medicaid application process as her home had been sold by Sonny and he did not use the proceeds from the sale for her care and so there was a pretty good transfer penalty. So although she was now impoverished and qualified for Medicaid, she was ineligible for any Medicaid payment till the transfer penalty was worked through. Son (a real Ahole imho) just flat refused to deal with it; I had been there other times when he was visiting and lots of yelling and demanding by him on staff not doing their job.... NH contacted APS and lady was placed under emergency temporary guardianship by the court. The guardian then moved her to another NH. Son - as he was not her guardian - was not told of the move either. It was some kinda ugly, police called and all sorts of threats by Sonny. NH turned lady's account over to collections too and all was in Sonny's name.

Now all this is extreme. But my point is you don't want the situation with the NH to become adversarial. If you private pay a couple of months, it gives you time to plan just how to divest dad's assets & NH is happy. I would also suggest that you do a smallish personal needs account ($ 200.00) for Dad @ the NH too - like for barbershop. Dad because of his assets will not qualify for Medicaid. You probably are very limited to just what you can do with his assets but you want to do whatever to maximize things that are best for his needs. Another reason not to apply for Medicaid right now is that once he is declined by Medicaid, it will be in the system and he will be toast on getting into any other facility unless it is private pay with a signed contract by family.

The only other option is you have to move him back home (email me your address, I send you a case of Prosecco). And that is just not feasible, now is it?

Really find a experienced elder law attorney asap; start culling through Dad's paperwork; get binders going on all his assets to stay organized; and keep the lines of communications open with the NH. Good luck!

BlueRidge - what likely has happened is that the rehab reports for your Dad @ the NH show that he is "not progressing sufficiently" & so MediCARE which is paying for his stay @ the NH will not continue. For post hospitalization discharges to a NH for rehab MediCARE routinely pays for 3 weeks and can go to 100 days (with a co-pay, although there has been a change in what "progressing" means but if a patient is non-compliant they will be discharged without appeal). For a NH, Medicare is great as the reimbursement is set by the feds & pretty good and fast. But as Dad is not progressing sufficiently, he is about to go off Medicare and the NH needs to figure out & fast, how they are now going to get paid.

Therefore the 5 year documentation time-bomb. Now since like 70% of all NH residents are on MedicAID, the NH just assume that Dad will need to apply for Medicaid. So therefore you (as I bet you were the one who signed Dad into the facility…more on that in another post) have gotten the list of documents required for the state's Medicaid application & also what the NH wants to see to determine IF they (the NH) will accept Dad as a "Medicaid Pending" resident. The NH doesn't know just what Dad's financial situation is, they just assume he will need Medicaid as most do. NH costs between 5K - 15K a month and they cannot be left with a non-paying resident. The NH will have no choice but to take some sort of collection action if Dad does not apply for Medicaid or private pay or family does not sign off a payment contract.

If Dad has non-exempt assets over 2K and income over whatever your state has as it's monthly income ceiling, he will NOT qualify for MedicAID. Like for my mom in TX, when I did her application she had about $ 1,500 in bank account & $ 1,800 a month from SS and retirement so she was under the 2K in non-exempt assets and under the $ 2,094.00 in income allowed. She still has her home (exempt asset) a prepaid NCV funeral policy, a smallish term life policy and that is it. Basically for Medicaid, they have to be "at-need" which financially means impoverished. If they live long enough, imho, they will eventually run out of $$, the caregivers will run out of ability, and they will need to apply for Medicaid unless they are generationally wealthy or plan a decade ahead (which most just won't do).

As dad owns rental property (a nonexempt asset), NO Medicaid for Dad. I bet he has over 2K in the bank too and likely other investments, so NO Medicaid. You can go ahead and apply but it will come out and he will be declined. Personally I would suggest that you do NOT apply for Medicaid but instead contact a elder law attorney and get all those documents together and take them so that you can get some insight on just what Dad's options might be. You might as well tell the NH that Dad has too many assets for Medicaid & pay the huge private pay for the next couple of months so that Dad can continue to stay @ this NH. This period of time that the private pay covers is what you use to come up with a plan (based on what the elder attorney suggests) to deal with paying for Dad's NH. I hope you have DPOA with finances for your dad or you have a sibling who does, otherwise you will have to go the guardianship or conservatorship route first and that is a pretty good expense (i'd say 10K - 15K alone for a G/C).

My guess is that, if you didn't pick your father up, they would transfer him to a Medicaid nursing home. Some are very good. Others are awful-- people lying unattended for hours on end, stuff like that. If you're motivated, you might want to be involved in the process of choosing where he goes.

My suggestion would be to investigate using a geriatric social worker. They're very expensive (here in NY a good one is $200/hr-- like a good lawyer), but a good one can make an incredible difference in terms of stuff like understanding and applying for benefits and knowing about the best local services that are available for your father. If you're planning to spend down, this might be a good place to put some of that money. In terms of looking for a geriatric social worker, your local Alzheimer's Association is probably a good place to start.

You know, you might want to think about the language you're using to describe your situation and feelings. If your father is 87, with the problems he's got, it's obvious you have done a lot for him-- perhaps even more than he did for you as a father. And "that I've put myself in a lather trying to figure out what to do with him" shows that you still care, and that you're a responsible adult. I understand that you're angry and frustrated. It's a frustrating no-win situation that isn't fair to you. But you're the good guy here who should maybe put some effort into getting people to sympathize with you.

An Alzheimer's Association might be a good place to start venting some of your feelings about your predicament.

To Camp BJ, hugs, hugs, hugs! This is my refuge, too.

Correction: I was given permission to give the permission to move her.

I am glad to see this question! I have asked in myself many times. My Aunt Iris, whose has no contact/relationship with her own children -don't know why, but I suspect- fell and was in the VA hospital. I was out of town and didn't know. (There was only one person who could have called and I will never understand why they didn't.) Long story short, I was to given the permission to give the permission to move her to rehab. (Read that again, if you like.) Eventually, I got the POA and began the journey of being responsible for her care. Questions abound; what should I do, how should I do it, when, where, what if!!? I have often wondered, what would the hospital have done, if I had not stepped up? As best as I can remember, the care manager, a lovely lady who was so glad to see me enter the picture, gently explained that they would have sent her to a state facility wherever there was a bed. It's quality would have been questionable, perhaps, but she would be there and I suppose, some poor soul would have been assigned her case. The state would have taken whatever actions suitable to their needs. Certainly, I could have gone to visit and just nod my head, but also, could have said, Sorry, Aunt Iris, I can't do anything for you, or about your situation. I can only visit you. Would I have saved myself heartache and sleepless nights? I'm not sure. Certainly, now I must see this through and wait to see if the "cousins" will come after me later. I have been assured they will. Kind of sorry, isn't it? So, BlueRidge, I feel for you. It's a tough call. Ask any caregiver here, "does it get any better?" (no) You've got good advice from ba8alou above. One step at a time. Good luck. P.S. I'm in NGA and my Aunt is in FL. If I had brought her here (against medical advice) she wouldn't be any different in her situation or attitude, but at least I could see her more often. I did hire a Visiting Angel to see her 3 days a weeks, but it's a financial struggle, but certainly gives me the ability to step back and breathe.

I am having the same issue with my husband who I left 14 years ago. He is 61 and after numerous detoxs that didn't work has alcohol related dementia, combined with a new head injury that has left him with 3 blood clots on his brain. After I left he took up residence with a wonderful woman whose also left him after too many years of his abusive drinking. He has no one, so we are working as a team. We got him placed in a nursing home where he is getting the proper care. Now I'm dealing with them saying he's competent enough to transfer our home over to me, this way medicaid won't get it. You are allowed to transfer to your spouse. I'm trying to save it for him,the money. He wants out of the nursing home but cannot take care of himself and neither I nor his girlfriend feel w are capable and frankly he spent too many years damaging our lives already. We are concerned that when he is ready for discharge he cannot live on his own. Maybe a group.home or leave him there? We are so lost at what to do. Finally we've gotten him to a place where he is safe , warm, fed and cleaned. No more drinking. Once released he will start again as he's been through 6 or 7 detoxs. The nursing home has Discharge Planners so I guess we'll.look to them for assistance. It is a horrible position to be in.

Thank you CampyBj, my faith is restored.

I see no problem with what you want to do. You just need to do things in the proper order as ba8alou and others suggest. I have no criticism for you, as I (caretaker of my husband with dementia) get terribly depressed, angry, mean and am frustrated. I have no one to talk to as both sons live away and I don't like to complain to them - he's their father. I don't want to complain to other family and friends since I don't want to be labeled as a complainer and don't want to start wallowing in self-pity. There are times (yesterday was one of them) that I actually fear for my sanity and/or physical health. I have little time to care for myself. On the other hand, my mother, who also suffered from dementia, was in Personal Care and then Skilled Nursing. We visited her 3-4 times a week -took her to lunch or had lunch with her there - and I could remain in a better state of mind. Therefore, I feel that I was kinder with her than I am with him. No one who is not in your shoes has a right to criticize and I have learned that the Caretaker needs as much help (if not more) than the patient. God bless you and HUGS TO YOU!

It was my impression that this was a "safe' forum to talk about how we feel and get constructive advice and feedback. I read over and over again from people who have been beaten down emotionally and, sometimes, physically, at the hand of the person they are caring for." Don't be ashamed of your feelings" we say, "you're not alone", "There is no shame in admitting when you are at the end of your rope". Those of you who are shaming this person for their feelings and the way they chose to express them have obviously not been "in the trenches as long as some of the rest of us OR you just like to condemn. Either way, please try to meet people where they are and try not to judge. Wow, seriously dissapointed in what I've read.

Wow. Have you seen an eldercare lawyer? In some states to put them on medicaid you must pay back all that the parent has given you in the last 5 yrs. (those tax-free gifts, i.e.) They are allowed to keep their home and in 1994 it was $75K, not sure what the amt is now.

Your health and sanity come first w/o them you cannot take care of anyone. What a depressing situation... Has your doctor prescribed an antidepressant. Make time for exercise, eat nutritiously and if you can take a yoga class to meditate. All these suggestions will help you cope during these difficult times.

Read pamstegman's posts !

Good point, Pam, about not selling the rental properties. Blue Ridge, you should really get some good legal advice if you haven't already. On your dad's dime, of course, because you need to maximize HIS ability to pay for his care.

Blue Ridge, the good thing here is that you can get him into a better facility by entering as a private pay. He keeps the rental property because it generates income. If he is a veteran, you may be able to get the VA to pay part under Aid and Attendance. You may make ends meet for longer than you think. Much longer.

'Fraid so. You'll feel better about it if he's getting decent care for his money, though. You seem to have all the logistics in hand; I just want to add I respect your recognising the end of your tether when you've got to it. Good decision.

To answer the main question: He owns a home and rental property. I've kept finances separate. I try to spend his money on his expenses, but if you put in my gas, groceries and stuff that I pay for, he's actually spending some of my money - I don't care. I make a good living. Not a problem. The problem is that he is a difficult person made more difficult by dementia. My spouse and I have had him at a senior apartment nearby, but caring for him every day - cleaning, laundry, cooking, medication, incessant phone calls and demands. We are both exhausted. Now we have my spouse's mother having difficulty physically and financially at age 78.
I guess I just sell his assets, get the paperwork together as best I can and watch a lifetime of work (and a lot of my work quite frankly) go away at $8,250 per month. Sigh....

At this point, you private pay until you can't. Whether you pick up dad and enroll him at at NH or the hospital does, the process to pay for services is at a high level, the same. If the assets were not protected years ago, they are now fair game to pay for his care whether you are his guardian or the state is. Having said that, there are a lot of variables in the rules that vary by state. Ultimately, you can't hide assets or avoid their disclosure by not picking dad up.

The other issue is the dysfunctional relationship between you that certainly justifies you not caring for him directly. A lot of us are in that boat now. I will not have my mother in my home at all. Not even for Christmas. But, I am her Dpoa, and take care of all her mail, bills, and arrangements. My face to face time with her is very limited now due to the past events.

BlueRidge big hug to you for having the courage to post your question, no judgements here should be had we all have reasons for what we do. I work in the health care system in Canada and if this were to happen here (and yes it does happen) the person is unable to care for themselves or make their own decisions is placed under a court appointed Public Trustee. This professional person is appointed by the courts and takes over the patients finances and makes all health care related decisions including hiring private care if finances can afford and if living at home is a viable realistic safe option. If your dad has appointed a POA and that person or you has enduring POA that will need to be revoked prior to be placed under Public Trustee. Please don't feel like you have to hide from the medical system or his caregivers if you choose to do this. You still have the right as does your dad to have a relationship with you. Parents can place kids up for adoption, adult children don't have the same luxury when we know we can't 'parent' our parents. Take care

Blue Ridge, sometimes family members just can't do it any more. You tell the rehab you can't take him back, you don't have access to his financials and you let the social worker and discharge coordinator take it from there. They will set the legal process in motion to have the court appoint a guardian. You are allowed to decline guardianship without penalty.
On the other hand if you just don't show up, I can foresee problems.
If you are POA, you resign that immediately, while he is still in rehab.
If you are living in his house, out you go, immediately.
As for the five years of bank statements, I sincerely hope his money was in a separate account and not thrown in with yours, because if you have been living on his money, as some do, it will be revealed, and you will be looking at a very grumpy Judge in the Illinois Surrogate's court. People who can't remember where the money went get an 8x10 room they will never forget.

Clarify for me, are you living in his home? Does he own a home?
If you are not there and live elsewhere, I would inform anyone that contacts me, that he can no longer live alone.

By the way, I support you. Crazy is crazy, no matter how you dress it.

Reading through the answers I need to respond: The social worker works for the NH, so she wants me to generate the mountain of paper. Part of this is that he actually has a good-sized estate, so I'm afraid there's a profit motive here.

OK, I am crazy burnt-out and do not want daily custody of him. I have had enough of him - sane and demented. But I'm not abandoning him. I know that eventually he will end up in this nursing home on the 'memory floor' anyway. (he's on the rehab floor) I've had control of his finances for about 18 months, but they want records back 5 years - good luck with that. When I turn over the records (I figure I'll have to take a week of vacation from work) , they'll 'spend down' his assets. So I get to declare what he has and then they take it all. What if I just don't do anything? Will they keep him and apply for medicaid themselves? My assumption is that they'll keep him there. He won't know the difference either way. He'll be upset that I don't see him for a while, but that's OK - he's been upset with me for almost five decades. It's really a financial question. Does anyone know?

Just to be clear. My response to the OP was not meant in a negative, not at all. Just that the OP was very tired, wore out and wanting their life back without the father.

Without knowing more of the circumstances it's hard to say what she can or cannot do and what Like who owns the house, who lives in the house and who has been the primary caregiver before the NH. If you look back on the other posts that were made, it appears the father has been with the OP for quite some time and the OP has been wanting OUT for quite some time.

None of this is easy and my heart goes out as well. However, most of us volunteered for this job ( probably didn't know just how much h*ll it was going to be) and to me, if I was ever to want to dump my mom, my conscience wouldn't allow me to do it in a heartless way. I'd have to bite the bullet and do it in the best way possible. Besides, I'd be scared to death of the Karma when I get elderly!

Emjo, thanks for the additional clarifications. My experiences thus far have all been that we've wanted to bring family home, so I don't have the insight that others in more complex situations have had. But with the exception of when my sister had cancer, the return home was after rehab and they were well enough to come home.

The most intense caregiving has been for my father, but he's also been strong mentally and very independent, so the issues I've faced are not (yet) ones of alternative placement.

With a lot of volunteer help, we've struggled by thus far, although I would like to get some help in to give me some relief.

It is good to be aware of the alternatives if that ever becomes the issue in our situation.

Again, I appreciate your insights and comments on my posts.

I think your feeling like this ***now that he's in rehab*** is significant. It's only when you've briefly stopped banging your head against a wall that you can think clearly enough to see what a bad idea it would be to start doing it again. I'd guess you've been overstretched for a terribly long time.

So, what if you refused to pick him up from rehab? That is the right question: find out what the next steps are, based on the firm premise that his coming back to your care is Not An Option.

Also, re-reading, it sounds as if there may be no problem. If the NH has set the financial process out for you, and you're content to comply with it, is there any reason you can't just go along? And further if you're happy with the NH's standards and they also provide long term care, so much the better: long-term solution, right first time. I'd call that a result.

You need to talk with a social worker through the rehab. Tell him/her you can no longer care for your father. He should be able to get medicare and be placed in a nursing home. Basically what you are doing is turning his care over to the state. Sometimes this has to be done especially if you don't have DPOA to make decisions for him. If you go this route, the state will step in and cease control of all his assets including his home so hopefully you are not living in his home as you will be locked out.

This is a very difficult situation and I understand because I also have a PD mother (personality disorder) who also has Alzheimer's. My heart goes out to you.

GA - as I understand it once a person is in hospital and they do not have anywhere to go - i.e. the caregiver will not take them back home because they cannot provide proper care, a hospital must find an appropriate alternate placement for them. Also, as I understand it from other posters on other threads, the hospital staff, social workers etc. will pressure the caregiver to take the care receiver back home, but if the caregiver stands firm and says no, another placement will be found. Your point about not being able to provide proper care, as opposed to just not wanting to, is well taken. I don't think that saying you cannot provide proper care any more will be construed as being that you just do not want to do it. At least, I have not seen that happen in the few years I have been on this board, but have seen instances where impossible situations have been rectified when the caregiver said they could not continue to do this. In those cases, the care receiver has been evaluated and placed appropriately. I am not so sure about who does the Medicaid application. If BlueRidge has POA financial then she probably is responsible for that. However she can get help in doing that and pay for that help, if needed, from her father's account. It is complicated but the local Agency on Aging can probably give some direction, or and elder lawyer.

Emjo, I appreciate your clarification. I thought that's what I was trying to say as well!! Perhaps I did misunderstand the issue of providing alternate placements until there is nowhere else for the patient to do, as it isn't the responsibility of the facility to find a placement.

Perhaps it is an issue of semantics, but I did want to emphasize that I thought any refusal of the OP to take her Dad home could be misconstrued as just not wanting to tak care of him.

Thanks for your insight.

gardenartist -the point some of us are trying to make is that the way the system works is that if you say you cannot provide adequate care and stick with that and that you cannot take him back home the system is obliged to find a placement for him. If you take him back home and tell them you cannot provide care, you, by the very act of taking him home are implying that you will continue to care for him. In many cases, you can say you cannot do this till you are "blue in the face", but no one will provide an alternate until the care receiver does not have anywhere to go. This type of advice has been given to and followed by other here. Maybe we are not disagreeing and it is just a matter of semantics.

DON'T tell anyone you don't want your father back with you!

Tell them YOU CAN'T take care of him physically, medically (and maybe emotionally).

Just don't refuse outright to care for him. Take the position that you've been doing this, you no longer feel you can provide adequate care, and that it's physically impossible for you as a human being to continue it.

Make the home care issue a physical one of your capabilities and don't even mention the abusive personality.

I have mixed feelings about raising the abuse you've suffered because independent parties can treat this subjectively - it's your conclusion, not theirs, unless you've called the police and there's documentation for his abusive behavior.

My point is that don't get yourself in a situation where nursing home staff or any authorities they call in to back them up can say that you "just don't WANT to care for him." Don't give them the option to re-interpret the situation.

They can't force you to take a medical exam, and so have no way of knowing what physical limitations you have that may prevent you from caring for him.

Also, on the Medicaid issue...what's the status now? Did you sign any acknowledgment of financial responsibility for him when he was admitted to the rehab facility?

Does he now have Medicare? I'm confused why they would be considering Medicaid if they're even considering releasing him, which from your queries sounds as if it may be the case.

Maybe this will help:

1. Find out from someone in authority at the rehab facility what his progress has bee, when his Medicare day payment will be exhausted, and why they feel that Medicaid is necessary.

2. Don't let them force you into direct answers. Say you're in a data gathering stage to determine options. Let it go at that.

3. Talk to the physician who treated him for his surgery and authorized his current placement about his progress and appropriate potential placements. If his doctor concurs that he needs institutional placement, that's leverage for you.

4. It sounds as if the rehab facility is expecting you to apply for Medicaid for him after you go through the spenddown. Get as much information on their intentions as you possibly can.

You might want to start researching elder law attorneys in your area in the event you need one to protect yourself and ensure that your father doesn't come home to your care.