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Got the first bill yesterday around $8000 / month. Does using POA (regular and medical) create responsibility for said POA ?

How did they enter the NH? Most come as a post hospitalization rehab patient. If so, and elder in a SNF has ceased being on rehab patient stay (which is a health insurance benefit) and has now run out of $ in a SNF, the elder has become a custodial care resident and this is private pay, LTC insurance or if they are impoverished enought file for LTC Medicaid. Sounds like she is at impoverishment (which is 2K in nonexempt assets and income under $2829 for most States) if so, the POA should / should have already filed a LTC Medicaid application and gathered together the items needed to accompany the application to the State AND the elder remains there as a LTC Medicaid Pending bed with almost all the elders monthly income (like SSA $) paid to SNf as their required Share of Cost. POA works with admissions office at the Nh for all this, usually the NH social worker acts a a bridge btwn you two.

That the NH participates in LTC Medicaid and that they have an open LTC Medicaid Pending bed is very important. That they were placed as a rehab patient is also kinda important as those medical records factor in as to when billing switches out.

Has all this been done?
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dkmczfs Aug 28, 2024
Have read one too many nightmare stories about Medicaid-friendly facilities and am focused on finding a personal care home under $5k a month. Even if Medicaid-friendly facilities didn't have terrible reputations, their amount of ridiculous requirements just make no sense to pursue it.

per the SK she is currently in " is a personal care assisted service, licensed by the Texas Department of Health and Human Services. It is a private duty non-medical home health provider. Unfortunately, personal care services are private pay only. Medicare/Medicaid/Private health insurances do not pay for this service line. There are medical home health providers which is covered by insurance but is limited in scope, it is not used for daily or multiple times a day assistance with activities of daily living."
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I saw your reply to me. Wish you had mentioned her husband had donated 700,000 in hopes it would cover her care. You would have gotten different answers.

This is a lawyer thing. I would hope her husband had an agreement written up by a lawyer on why this money was donated. Did he have a guarantee that the facility would care for her till she died. Was that money put in an interest bearing account? How was this all set up?

My Mom passed 7 years ago. The cost of the LTC she was in was 10k a month. Thats 120k a year. That 700k would only last about 5 years now. She has been in the facility for 20 years? Maybe she has gone thru that 700k?

Facilities change hands and in doing that original agreements may go by the wayside. You need to prove that by donating that money, Mom was guarenteed a lifetime of care. Then your problem is if there are new owners, are they legally obligated to uphold that agreement. The cost for private care has risen a lot in 20 yrs.

Being a licenced facility has nothing to do with how they run their business. That just means the State comes in and inspects them To make sure residents are being well taken care of. The building is being kept up. Medication is being dispensed correctly, etc. But the state has nothing to do with them keeping or not keeping a resident.
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dkmczfs Aug 29, 2024
She's only been in SK rehab for the last 2 months for a bone fracture. She lived 100% independently at this complex for the last 20 years.

Her and husband (now dead for 15 years) have been using the same lawyer for 20 years. I just spoke with this lawyer who said they can't locate the records of his $500,000 gift even after looking in their archives. Their accountant (also used for about 20 years) said the only records are the large $125k deductions mom claimed the years after her husband's gift.
Any ideas on where else this $500k donation could be documented and obtained ?

Also, when her husband died in 2009 she was disinherited (texas is the only state that allows a spouse to do this) since his brother (who had absolute contempt for mom) was named executor of the will. It was a really ugly situation that I had hoped would never need to be rehashed again, but here we are.
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No. Your mother's income and assets in her name are what's responsible for her bill in the care facility (nursing home, rehab, assisted living, hospital). You are not personally responsible for ANY of her bills.

If you are her financial POA and she is incapacitated, you are responsible for administering her money to pay her bills and expenses. You are also responsible for taking care of other business matters pertaining to assets like real estate, bank accounts, or insurance policies.

Any and every document you have to sign on behalf of your mother, sign your name with the letters POA after it. Always make sure POA follows your name on everything.

You DO NOT SIGN ANY document at the nursing home or rehab with your name only or ANY documents that you haven't read thoroughly.
If there is a document they want you to sign that you don't understand, tell them that you will have a lawyer look over it first and you will return it to them.

It is your right as POA to be billed monthly (as in a written bill) for your mother's LTC facility bill. You can pay them by bank or cashier's check if you don't want them having her account and routing numbers.

Before you pay any bills, check and see what Medicare has paid. A care facility will always try to collect it in cash from a resident even if insurance paid in full. Make sure you always check this. Then you pay them only what they are owed.
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My understanding is : No, as long as you signed the financial responsibility documents as “dkmczfs as POA/attorney for Mom” or the like—then it’s as if *she* signed. And she will be the responsible party.

If you signed the financial responsibility documents *as yourself*, then you may be responsible for them as I understand it.
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My question is...is Mom in rehab where Medicare is paying for her care? Because Medicare only covers 100% the first 20 days. 21 to 100 days, 50%. If that other 50% is not paid by Moms supplimental, she owes it. Just an example, if 50% = $300 a day, Mom could chalk up $8000 in a month. She is responsible for this 8k. If the POA signed the papers as POA they are not personally responsible. The 8k comes out of Moms money, if she does not have it and you can't pay it, you can apply for Medicaid.

Some States have Medicaid vouchers where they can get placed into an Assisted Living. Yes Medicare only has intermittent care. And Medicaid has limited hours in their in home program. If Mom needs 24/7 care and can't afford to pay privately her only option is Medicaid or you caring for her. Its going to be hard to find a personal care home for under 5k.

There should be a Social Worker at this facility. Talk to that person about what you would like to do. They should be able to tell you what type of facilities are near you.
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cover9339 Aug 28, 2024
Hope the facility has a decent SW, though SW should have reached out to you before this bill was sent.
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You answers are so confusing. Again, if Mom is now in rehab after a fall Medicare is paying. First 20 days 100%. So lets say Moms total days are 60. 20 of thoses days were paid 100%. The 40 only 50%. So Mom owes the other 50%. If 50% of the daily cost is $300 then Mom will owe 12k if her supplimental will not pay all or part of it. If she had no money to pay this, then you need to talk to the billing dept to see if Medicaid can be applied for. Rehab has nothing to do with Mom living independently anywhere else.

If Mom cannot pay for her independent living facility, your going to have to place her somewhere that takes Medicaid, move her in with you or pay out of your own pocket. We cannot help you sort out the donation of 700k. We are not lawyers.
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Mom and her husband. Don’t be foolish and use your own money.
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Just so everyone is aware. Seems there are two facilities involved here. One Mom resides in and the other rehab. Two different problems. See response to me from OP.

If in Rehab 8k seems about right for the amount of time she has been in the facility. IME, supplimentals rarely pay the 50% that Medicare doesn't after 20 days.

The other problem is the place she has been residing in. That is a problem we cannot solve. OP needs a lawyer to sort that out.

To OP, just had a thought, the facility that Mom is living in is not responsible for her care in Rehab unless that was in a agreement her husband made with the facility when he donated the money. The only time she may not be responsible for the bill is if she had Medicaid for her medical or she was on Medicaid in LTC.
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You need to contact a Certified Elder Care attorney in Texas because this situation where " Her dead husband gifted this same complex $700,000 before he died about 15 years ago with intention that she would never have to go through a financial nightmare like this" is out of the realm of a forum's depths. Too bad the husband didn't give your MOM $700k instead of some facility who is now billing her. The attorneys who want nothing to do with this, are they Certified Elder Care attorneys? If so, I guess mom will have to pay for these services herself, or find an a facility for under 5k, but good luck with that.

It's too bad you're in such a predicament and I hope you can resolve it asap.
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dkmczfs Aug 29, 2024
Contacted about 6 different "certified elder law lawyers". Only one was interested, but did a full stop when telling them the trouble we are having with lawyer and accountant who handled the gift not having the records anymore. Mom's income tax deductions of $100k for several years after the gift do exist but they said that would not be good enough.
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POA is responsible for decisions and paying bills from mom's resources. If mom does not have enough resources to stay in her current location, research for less expensive options. Also speak to social worker, case manager for assistance.
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