Medicaid pending; comfort care or move to hospice?

Check with the Hospice facility that Medicare will pay for both the Hospice care and room and board in the Hospice facility. They are two different things.

NH won't let hospice care come in? Why not?

MediCARE pays for rehab (post hospitalization) & pays for hospice, and both as a Medicare benefit. There could be a overlap of the time that could factor in having total Medicare coverage. It can be confusing.

However..... In my experience, hospice did NOT cover the daily room & board costs of being in a facility if their a LTC resident. All the medical care costs were billable to Medicare (& were substantial as once on hospice there will be equipment changes like pneumatic bedding, gerichairs, nutrional drinks even bibs all billable to MediCARE) but not the daily room&board. R&B is viewed as a custodial service and so MediCARE doesn’t pay for, as MediCARE is about hospitalization and medical costs not the costs of daily living. R&B could be several hundred $$$ a day. My mom was on hospice for 18 long, l...o...n..g months and in a NH. She was a LTC on Medicaid resident at the NH for a while (& had been Medicaid Pending for 5 1/2 mos), then one day she fell forward (was pulling her wheelchair by the seat), shattered a hip then became bedfast and onto hospice. She did not go to the hospital but was X rayed at the NH & the medical director MD, the assistant DON, SW & I had a emergency care conference call and the decision was made to have her stay there but Segway to hospice. I live in another state. The Hospice group “on call” for that day filed with Medicare for her & started the next day; there was a flurry of phone calls, faxes & scans that first week. But mom went onto hospice relatively seamlessly. For her, MediCARE paid hospice BUT MedicAID paid daily R&B. So both needed to cover costs to be in a facility.

But for my mil it was different, she was in a NH and Medicaid Pending and got very ill. She was hospitalized & got discharged back to the same NH but as a post hospitalization “rehab” patient, so covered under Medicare rehab benefit for 20/21 days. So Medicare paid 100% all her care costs as standard rehab allows for 20/21 days to kinda determine “progress” in rehab. She didn’t progress, so went off Medicare but back onto applying for Medicaid and being Medicaid Pending. It was within 30 days so it was not exactly new application per se. (btw all this stuff is super time/date sensitive). Now while in the NH under rehab, the NH got paid 100% by Medicare and medicare pays about triple for rehab what NH would get paid from a Medicaid daily R&B, so the NH is super happy. Mil in NH a few more months and got very, very ill once again and back into hospital. But this time she’s gone super septic & mil doesn’t get discharged back to the old NH but instead to a free standing hospice adjacent to hospital. She died within 3 weeks so still totally on Medicare but if she had taken longer to die there would have been an issue as the hospice did not take LTC Medicaid. The vast majority of the residents at this free standing hospice were younger cancer patients on black box type of drugs, a couple on vents, a couple isolated with precautions entry. Their stay was paid by private pay or health insurance like BCBS.

I’d suggest you clearly find out what coverage is paid before moving him from the current NH to a hospice in a neighborhing town.

MIL died still Medicaid Pending. One son dogged the application and she was finally eligible almost a year later. NH held her personal needs allowance trust account during all this period. NH send bills, delinquent notices, collections letters. But everybody out of state and nobody signed off to be personally responsible, so nothing they could really do but hold the PNA. Please realize that IF you sign off on any paperwork in just your name, the hospice, hospital, NH etc. will seek you out personally for mom’s debt. You kinda need to always & on all signature lines sign “Jane Smith Jones in her limited capacity as DPOA for Ann Smith” or however it needs to be for your states legal.

Is there any reason Medicaid will be denied?

My FIL passed away last month. He was in the hospital when we found out he wouldn’t recover. Sepsis from a pressure sore he got while in the hospital. We made the decision to move him to hospice, but medically they could have kept him in the hospital. We were assured by the hospital discharge planner and the Hospice that Medicare would pay 100%. So far we haven’t gotten a bill. The care he got was AMAZING! Sometimes, you do have to think about money issues, even when death is staring you in the face. Money is one less thing to worry about, he can have visitors as long & often as he wants, and it’s a MUCH more peaceful environment.

My understanding is that Medicare does NOT pay for Hospice room and board.

Thank you for all the answers!!!  This is SO complicated.   I will have to do my homework before I do anything.  It always sounds good until you hear different things... 

If only the Medicaid application would get approved!!   There is no reason for it not too... it's just that the state of CT layed off so many state workers that the staff was cut and there are too many applications waiting for caseworkers.

BarbBrooklyn - The NH will let Hospice come in.  Hospice will not come as we are Medicaid Pending.

I'm not understanding why " Medicaid pending" would be a problem for Hospice. Did they explain why?

Aged care is very complex as well as very expensive. It’s like taking a university degree super-quickly and under pressure. My daughters have just used an aged care consultant to find appropriate care for their father’s last months, and were very happy with the result. She knew every possibility, for best care and also affordability and potential subsidies. In view of the high costs involved in care, a small investment in a consultant might be money well spent.

What other insurance does your dad have? In Michigan, many people who worked for the autos, who have something called the “fifth level of care”. If a person is on hospice, this secondary blue cross (which provides this fifth level) will pay the nursing home room and board at 100%. Otherwise, I doubt Medicare actually pays room and board. Either way, I would encourage you to enroll your dad in hospice as soon as you can. There is so much benefit for him and you.

Our experience with my FIL was that medicare paid for 100% of hospice care, but did not pay for room and board. Room and board was $1750/wk.

We had to pay for my Mum to be in Assisted Living. When she went into renal failure I moved her to hospice. Medicare paid for everything except the ambulance transport. Hospice was fabulous.

Hospice can work wonders in many ways. It is possible that they could help the application process along.
Medicare will pay for Hospice and Medicare will also pay for Respite. It is possible that the transfer to the Hospice In Patient Unit would first be classed as "symptom management" and Medicare will pay for that, and as far as I know there is not a limit on time..the classification might change to "respite" or they may find another medical reason to keep him in the In Patient Unit a bit longer.
Personally...I would go for Hospice. My Husband received such good care from Hospice (he was at home) As I have said many times here I would not have been able to do what I did without the help from Hospice.

move him to the hospice facility. Costs/ money is ALWAYS a factor, and not in a bad way and don't let anyone let you feel guilty. Its like affording two households. Everyone does not have that luxury. You move Dad and have that financial burden lifted. God bless.

Medicare does not pay for facility care while on hospice. Please check further. They will pay for nurse and attendant visits, medications, special beds and wheelchairs. If you find they do pay for the facility, let me know where you live.

It's really sad how slow Medicaid is. We live in Kansas and it is a nightmare. You send in the materials and two months later, you get asked to send in some of the same documentation again. As long as Medicaid is pending and if you have a spend down where assets are divided, you get to pay the nursing home. Ive been told I need to get a lawyer to help me with the process of application and the run a round.Call toll free line to medicare to verify what I told you about room and board.

I see you’ve gotten quite a few answers. I just wanted to stress that you are not being selfish. Rather you are being practical. Keeping dad comfortable is actually a financial decision. Be gentle with yourself, you are doing the best you can. Hugs to you.

Remember nursing homes are a "business" looking out for profits, not their clients. Choose hospice for caring, wonderful people who will make your loved one's little time left more comfortable for them and less stressful for you.

Hospice is a Medicare covered service. This would be paid 100% in any location, even if hospice staff came into the nursing home to provide services. The room and board would not be covered by Medicare (possibly not even by Medicaid). That would need to be paid privately, unless you talk to social services and they can help with some kind of housing assistance.

I question why Hospice won't serve him in the NH. Could it be just that they want him in their own facility for the money?
My FIL had Hospice in the NH for months. Our local hospice providers have several NH patients.
Look around for a different hospice provider.
We were a couple months on Medicaid pending. I'd just go talk to the NH office and tell them that they'd get paid when Medicaid got approved. Our attorney kept them informed of expected dates, too.
If you are happy with where he is, I wouldn't risk a move to an unknown place. Especially one that refuses to give him care where he is; sounds callous to me.

Hi. You and your family need to make a big decision and soon. You can do medicare, hospice or nursing home care. I would not tell anyone what to do but I will tell you that I was in the same position with both parents at the same time. so I really feel for you. I was not lucky enough to have anyone to help me make the decision. son, and husband gave me there opinion as to what they thought but final was on my shoulders.
I did my homework and decided that hospice at home was the way to go. they wanted to go home. I couldn't afford anymore copays per month of close to 3500.00 each, nursing and care place. medicare leads you to believe they pay all and they do not. The Hospice care are wonderful. they pay everything. medicine, diapers, hospice beds, trips required elsewhere, doctor visits which they come to your home. etc. the worry of how am I going to pay the bills was no longer an issue. the best part of hospice is they treat the patients like they were their family. they are so wonderful and loving to their patients. they will be their 100 % for you and your family.
so I decided after speaking with hospice that their dignity
was not being taken away from my parents at the end of their lives.
they are their 24 hours a day for you.
It was painful to watch parents decline in life but they were treated with golden gloves and given everything they needed to be pain free and begin there new journey in life.
dad passed and mom passed three weeks later.
I am still in touch with hospice and they call me regularly to see if
I need anything. with hospice you cant go wrong...

Adding to my earlier comment: when the NH billed us during the pending period, I'd go in and pay the amount the attorney said we would owe monthly once Medicaid was approved, and tell them we'd take care of the rest if Medicaid was denied--from FIL's funds, not mine. Don't sign anything making you personally responsible.

Remember, NH have a vested interest in keeping their beds full.

Medicare does pay for hospice I used them for my late mother make sure they are aware of the families final wishes regarding your father.

I want to echo Melissa's comment. You are not being selfish, in fact I would venture to guess that your dad would be very upset if he were aware enough to know you were thinking about stretching yourself thinner financially on his behalf. Both choices sound like ones that will be good situations for your dad's end of life, they each have their pluses and minuses and I don't think you can probably go wrong. You obviously love him very much and I'm sure he feels the same way about you so difficult transition or not I feel pretty sure that he would rather know you weren't overly stressed about money on his account if you don't have to be. That said sounds like there may be options to prevent that while keeping him where he is if that's what you really prefer. I don't think you can go wrong and you will make the right decision for everyone, one your dad would approve of because your leading with your heart but not ignoring your common sense. Let yourself off the hook here, you have nothing to feel guilty about. In fact your financial sensibility would probably make your dad very happy and proud.

Move him to where 100 percent will be paid by Medicare! They — the nursing home, don’t “care” about anything except $$$ & that is why they’re being “nice” so they can get paid privately. Move him ASAP!!!

Sure they come to see him. They want to convince him to stay. Once he's left they'll quickly forget him.

Hospice is wonderful. They took good care of her in my home. She graduated today to heaven. Hospice were with me every step of the way.

My husband has LBD and had to be hospitalized due to not eating and dehydration. The skilled nursing facilities he was in, did not seem to care if he ate or drank. I would see his food trays being returned untouched and his water not being touched. Instead of seeing improvement, all I saw was decline and extreme weight loss. I finally decided to bring my husband home with hospice. My husband is now eating, drinking and has gained 30 pounds that he had lost. He is also walking with and sometimes without a walker and using hand weights and ankle weights for excerise. Hospice is 100% covered by Medicare, they furnish everything the patient needs: hospital bed, shower chair, beside commode, wheel chair, walker, bedside feeding table, mattress pads, pull ups, gloves and prescriptions are delivered to your home. Depending on the patient needs, you will have a nurse that comes out, CNA's to shower patient atleast 3 times a week, social worker, chaplains, etc. They even have respite care for the patient and taken to a facility so you can have time for yourself. You can schedule respite care as many times as you need and they take care of picking them up from home and returning them back home. I understand there are many caregivers that do not have the luxury of being able to stay home and care for their loved ones, but for me, this worked out better than watching my husband decline when there wasn't a need to. God bless you on this journey, these journeys are not easy, but atleast I won't have any regrets, we can only do what we can.

Don't feel bad about the money issue. Unless we are all Trust babies, everyone worries about how/what they're going to do both about Mom/Dad as well the money.
Stay on top of Medicare/Medicaid. They will put you off for as long as possible. Go to their office and stay on top if it until THEY get so tired of you they'll get the paperwork done.
Does Dad still own his home?
If so, do not go to the State for help! They will tell you all about the lollipops and cotton candy when what they're really telling you is "we'll help, but we're going to place a lien on the house so we get our money back"!
What retirement benefits does he have, veteran's benefits?
I'm sorry to say this, but everyone has come late to the party.

Gooh luck

Hospice is so fantastic. They will ensure that the move is careful - I would say GO to the facility if you can. do not hesitate. esp if Medicare is covering.The things that they will do for him and for your family are so important right now.