My cousin is in assisted living because she suffered a stroke in 2016. I have helped her with her financial and medical needs since she has speech and memory problems. Long story short, she will be out of funds in exactly 2 months. I have applied for Medicaid for her since Oregon will pay for assisted living but so far she has been unable to qualify due to her evaluation of needs for her care. The assisted living facility isn't helping matters because they aren't giving her the real care she needs because they insisted on at least one years out of pocket funding before she applied for Medicaid. I believe they did this to receive more money for a longer period of time since they knew Medicaid would not pay as much. My problem now is, what will happen when she runs of funds and hasn't qualified for Medicaid. I have read that it can get ugly if she is evicted and I don't respond to go pick her up. My name of course is on the contract because I am the one that found the assisted living facility for her. I am concerned because I may be held liable for payment even though technically she is not my responsibility. With that being said, what will happen when she runs out of money, hasn't qualified for Medicaid and I don't go pick her up? Will Medicaid then step up to the plate?
Found a great site just today for everything you could possibly want to know about Medicaid.
https://www.medicaidplanningassistance.org/transferring-medicaid
Transfer requirements for those living in AL can be pretty nonexistent as it’s “assisted living” so in theory they should be able to do for themselves with some help. If they are in AL, they are expected to be ambulatory with perhaps some help sometimes. It’s not a NH which means they need skilled nursing care 24/7 & is required by state regulations to provide for safe transfer.
If you've let the AL know that under no circumstances will you be coming to get her, what is likely to happen is that the AL will find some reason to call EMS to have her go to the ER. Like it appears she has had a TIA - transient ischemic Attack- or some other very subjective health care issue. EMS gets her & she is now a problem for the hospital /ER discharge planner to deal with. The old AL will refuse to take her back. The discharge planner (usually a SW) will contact family to see who will come and be responsible for moving her into a new place or take them into their home to live. You have got to be clear & firm that you cannot provide the level of care and oversight that she needs. If they are insisting that it’s your duty as the DPOA, you can say that you’ll relinquish your dpoa to let her become a ward of the state. Yeah, it’s extreme but sometimes it can the best path as a state appointed guardian can get her evaluated & moved into a skilled facility quicker than you ever could. If she has no assets and you’ve been transparent in your handling of her $ as her POA, there should be no repercussions to your relinquishing your POA.
Good Luck and come back and update us. We learn from others.
ALs are usually privately owned. They need to have certification to except Medicaid and Medicaid can take that certification away anytime. It happened where I live. Other than the state inspects them, they have no say in what their criteria is.
I found there is a lot of misinformation when dealing with the "sales" person at an AL. Yes, I was told after paying at least two years, Mom could then use Medicaid. What wasn't said was that if they haven't met the % of residents they allow on Medicaid. If they had, she would have to find somewhere else to live.
I think there was some miscommun-ication on the part of the AL. A year of self-pay sounds reasonable.
Now for Medicaid. What do her doctor's reports say. With a stroke does she have a neurologist? Have the doctors orders state that her health is such that she needs 24/7 help and not able to live on her own? That LTC is her only option.
You may need a lawyer to get u thru this and he can be paid with her money. But then she really doesn't have it.
So. You have a 76 year old disabled person living in an ALF. The ALF agreed to take her as a medicaid recipient from September, waiving the extra three months question. So the ALF's issue is with funding for July and August, only?
There's got to be a way through this. You are not responsible for your cousin's care; so looking at her a stand-alone individual, what would the ALF, OHP and the rest of social services do with her if you didn't exist?
Have you tried this page? https://www.oregon.gov/dhs/seniors-disabilities/LTC/Pages/index.aspx
I've got the phrase "Medicaid pending" buzzing around in my head but I'm afraid this really isn't my subject. Fortunately there are some past masters on Medicaid on the forum, and I'm sure they'll have helpful information for you.