How to switch Nursing Homes?

Consult an elder attorney. You want to make sure that the nursing home doesn't view you as responsible for your mom's debt/bills. A good elder attorney will know what you should do.

To echo my2cents, do not forget that (if you can add the expense) you are allowed to send your own people as well to supplement your loved one’s care, and as s/he said to also help see that things get done. I’m doing that at my mom’s memory care and yes it increases the cost but (I pray that) we’re not talking years here, so I need that peace of mind.

Be very cautious with Nursing Homes. The one that my late mother was in told her that she too well to stay there. They were wrong - DEAD wrong as less than 48 hours after that statement, my poor mother suffered an ischemic stroke there and she did not live.

I had to move my mom five times in two and a half years due to poor care the expensive one she almost died in.

Short staffed is probably more the norm these days. It's all about the profit and not a lot about good care. When they do get a few good employees they use and abuse them with duties that exceed the time allotted and what can 'reasonably' be done in a certain period of time.
If you are really going to move her and you've found a place - then go for it. If you have people who can be w/your mom at the current facility to observe what is going on until move is completed, I h-i-g-h-l-y recommend it,
When you're ready to move, you can transport yourself or call a medical transport company or ambulance to move her - depending on if she needs to be laying down for travel or can sit up

GetKick - for your ?, to me this is about being able to best direct “now” how funds are spent & so that it works best for elder “later” & post death.

For the “now”, follow me on this.... so mom enters a NH & kinda OK on competent & cognitive to do the assignment for NH to be new payee. NH has documents needed & quick & easy signature & filing to SSA. NH gets income & set up an in-facility PNA trust account (personal needs allowance) for them, from which NH automatically deducts their beauty shoppe visits, phone, cable, etc & from which family or resident can draw $ from in person. So if DPOA wants to buy clothes, POA have to go to billing office at NH to get $. The overall takeaway is $ now under control of NH, which may have corporate HQ somewhere else, even another state.
There’s no more need for old bank account, which she’s likely had for years as there’s no more $ going direct deposit into it. Bank likely has monthly service charge, which as per Medicaid rules cannot be more than 2k as that’s the max limit for individual on LTC Medicaid. So maybe can’t meet the minimum balance threshold to be free. It’s probably costing $ to keep account. So bank account in their name & perhaps that has you as a signatory on it & you as POD (pay on death) gets closed. Like it had $678.90 in it and you buy her new eyeglasses for $678.90 and close bank account.

Then months from now, everybody hates NH or you move to another city in the state, whatever... so you want to move mom to another NH. You have no access to her monthly income as its NH who is payee. It will need to get changed. And for total fun in this, SSA does NOT recognize DPOA. Mom will herself need to go to SSA office OR stay on the phone with SSA to get this done, and she has to totally be competent and cognitive to get this all done. So good luck on that. PLUS as she’s now in a facility, SSA is going to want you to become her new representative payee, which means opening a new bank account for this & do whatever reporting SSA now wants for representative payee. Opening new bank account for elder who cannot actually go to the bank with you to do this, may not be easy.
Now while all this is getting done, old NH is still the payee for her... so each month that SSA$ goes to them & stays that way till this clears for new rep payee approved by SSA & SSA$ starts to go into the new bank account. Could take a few months. But under Medicaid compliance, they must pay required co pay each month. You’ll have to basically do a bridge loan to the new NH to pay those months. Then once dust clears, the old NH finally pays mom the overage & she pays the new nH. New NH that you paid directly then repays you. You can’t pay mom $ each month for the new NH copay, as that throws her income & assets off for her Medicaid eligibility. And good luck on quickly getting overage paid from the old NH back to your mom. But each mo new NH must get copay. If copay $1800 & takes 3 mo to clear, that’s $5400 to front.

Imo keeping their bank account & paying NH the exact copay due each month & setting up their PNA to be a sensible amount for their spending needs (we did abt 2 mo of beauty shoppe) allows POA to be in control of $ & ability to easily move them if need be. I moved my mom within her first year to a much better NH. Set it so that it was right after mom got her SS$ & retirement $, so that each NH got their exact to the penny copay. I had cleared out old NH PNA couple months before as well. No need to ever deal with old NH to get a cent back.

For “later”, if your POD on account, that $ is yours. It’s not asset of estate or subject to estate recovery. It’s yours just as soon as you give bank your ID & their death certificate. If your opening probate, & you were signatory on it now & Executor later, you might be able to use account for estate. We did. It’s pretty sweet for organizing as you’ll have 1 account for all pre & post death $; & a plus should anyone challenge your proper fiduciary duty.

I moved my mom in November from a subpar facility to a five star one. It took being on a waiting list for many months, but when the new place finally had an opening (I called monthly to inquire), I had to get the old place to fax over medical records to the new place, The new place handled everything from there, including picking her up in their van.

To have the option to be able to move her, & to make this way way WAY easier, you -in my experience - need to control her monthly income. To do that you go the paying the NH the copay each month via a check from your moms bank account that gets her direct deposit of her SS$ &/or other monthly income. This is what Rocketjcats posts are about too. Believe us, you don’t want the facility to become the direct payee..... ever.
I’ve found (7 facilities between mom & mil) the facilities will heavily impress upon you that they just must have a direct deposit to them.... or they must become the direct / rep payee of moms income... or they tell you that if you want to retain the responsibility to pay the copay each month, you (yeah you not mom) will have to sign off on a private pay rate contract... none of these are tru. You’ll hear “it’s so much easier to just have them become the payee”, & that may be somewhat true but really, you have to just get yourself & her checking account organized & pay her bill by the 5th of the month with no maybe manana excuses.

To me, as your mom just went in & just filed her LTC NH application, you can’t really move her. She’s in limbo till she’s approved for Medicaid, which could take 2months, 4 months, whatever. My moms took 5.5 months. If the current place wants to go all Mean Girls / Heathers on her & you they can.... like foot dragging on her health records or be difficult on her taking her medications or state that she’s noncompliant for Medicaid rules if she’s a minute late on her copay or you don’t show up for a care plan meeting. To me, you gotta wait till she’s totally eligible with the acceptance letter from the state AND state has paid the Medicaid reinbursement back to day 1 AND you’ve gone thru 2-3 of the required care plan meetings.

Cleo, you mentioned you were concerned about understaffing due to only 1 nurse for 20-30 people. Do you mean 1 RN? 1 LPN? 1 CNA? How many staff members actually are there? I know this is a new situation but please observe this over a few days after you get to understand who’s who. There really is no need for more than 1 RN for that many residents as long as there’s sufficient support staff. I was at Moms NH daily and documented the staff coverage in my notes. Her floor with 35 residents had 1 RN, 2 LPNs, and 4-5 CNAs on 1st shift. It could have used more CNAs, but the actual nursing staff seemed sufficient. Can you clarify? Every facility will seem to be understaffed when we dream for one-on-one care for our loved ones, but it’s just not possible. Are there other concerns you have about the current place that you can share with us so we can help you navigate, before you go through a big upheaval, to only find the next place may have the same or other issues?

I would follow your gut feeling and move her out of there. However, most nursing homes are short staffed. There is not enough licensed staff in the U.S. to cover all the vacancies in nursing homes. She will be neglected in the nursing home you describe. Contact your local social services agency to find other options. In addition, contact your local ombudsman and voice your concern on the staff issue. They should be cited for that or at the least, investigated.

I understand your dilemma...I felt similarly about the first nursing home I placed my mother into. It was not good, despite it's 5 star rating my Medicare! It was understaffed. Go with your feelings, and work behind the scenes to get your mother moved.

How to move your mother? Secure the new place first. Then, talk to the new place about how you should make the move. It's nice to have an ally, even if you are doing everything yourself. People do change nursing homes. DO NOT BAD MOUTH THE NURSING HOME YOUR MOTHER IS CURRENTLY IN. Simply say you want a place closer, or more practical matters as that. Based on her health, are you able to move her in your car or will you need medical transport? Get everything arranged prior to the move, then act on your decision. You may not get any money back if you move her in the middle of the month. I moved my mother the very end of the month and had already paid for the following month. They did give me the money back, but I wasn't going to fight it if they didn't. I was just glad she was out of there!

How did I change locations? I asked to talk to the director and said that I decided to move my mother to a new location that was closer to her old neighborhood so my mother could feel more at home visually. (Which was true). I think they were used to changes: she said "Ok, will be sad to see (your mother) go," etc. etc. I paid for medical transport to get her out of there -- and had her delivered to the new location on the last day of the month. The actual move was easier than I thought.

This is a very stressful situation, I know. Stay calm and work methodically to make the change. Be professional in your dealings. Best of luck.

Yes, have the current place send a bill each month and write a check with her funds.

In terms of moving her... personally, I would contact the place where you would like to send her and express your concerns about the current standard of care where she is right now. I would think they would honor your confidentiality if they will get getting your business at some point?

And, take online reviews with a grain of salt... my understanding is that people are much more likely to complain than they are to post a compliment.

Cleo, yes they sent me a monthly bill and I paid it. Worked fine for the 3 years she was there and I always knew it was getting paid. My friend made her moms NH her payee and somehow SS decided her Mom had died and stopped paying. She found out when the financial lady tracked her down and told her she owed $60k and they were evicting Mom. It took months to get it straightened out. When you pay it yourself theres less chance for screwups

My first recommendation is not to sign over the SS to them. You don’t have to do it. I never signed Moms to her NH, they just sent me the bill for her share of cost and I paid it with her SS and pension funds. If you do decide to move her, it might be a financial mess to have current NH assist you in getting a different NH paid.
Im sure others will chime in with more specifics of how a transfer works. I did move Mom but it was a lateral transfer between affiliated homes and was easy.