Medicare and Medicaid Care

Government Aid?

Medicare (U.S. government funded) and Medicaid (state government funded) do provide a lot of care to those who need them. However, there are obstacles along the way if your senior has assets (even miniscule assets), a mental illness, or an illness that prevents them from improving quickly enough to provide care for.

For instance, my senior was in dire need of skilled nursing along with physical and occupational therapy so this person could regain strength in their legs and learn how to sit properly, get up properly, and pull themselves out of the floor if they should fall before they learned how to do everything else. This was a hard decision for this person to make but decided the help would be helpful sooner than later since the falls had only started happening recently at that time.

After spending over a month calling my senior's doctor's office to get them to recommend my senior to a facility, getting copies of all the senior's assets, talking to people at the nursing home (who told me that Medicare would cover the first 20 days' stay in full, the next 21 to 40 days with a fraction out-of-pocket payment for my senior, and the the last 41 to 100 days, if needed, fully paid by Medicare) and a lady who handled nursing home entry for 5 local nursing homes, I was told that a medication on their list for mental illness would not allow my senior to enter the nursing home from their private home. Thus, a senior with a mental illness has to get admitted from the hospital. First of all, why did it take a month and all that work for all these people, who work on this daily, to discover this medication - that somebody in this group had to know would be kicked back? Secondly, why didn't they ask that question up front? That would have saved a lot of work and time that we needed to be able to go through the proper channels.

Image courtesy of Tanya Dusett via Unsplash

Now, this dead end happened because all the information I was getting for the nursing home and that the doctor's office was sending to them was to get Medicaid assistance if my senior needed help beyond the 100-day Medicare assistance. So, I asked if we could just get my senior in on the Medicare help for 100 days and not worry about the Medicaid help afterwards. My senior was determined enough that I felt 100 days would be enough to get the therapy and other help needed. I was told by a staff member that question had never been brought up before and they would have to find out. I never got a call back on that one. 

So, I told my senior the next time they fell, which was only a day or two later, to go to the ER to get the ball rolling on that admission from the hospital to get the skilled nursing and therapy they needed. Because of Covid, my senior declined to go to ER for about 7 months. And this person also said they didn't remember wanting to go to the nursing home - insisted this was my idea for them to get skilled nursing. That's another reason why time and having the right information is important. Too much time allows the senior to change their mind.

Long story short, the falling continued and was more frequent, Covid was on the decline, and the EMS workers made my senior go to the ER, where the doctor deemed it necessary for this person to go to the nursing home for skilled nursing and therapy that was needed so badly.

Finally, my senior was in the nursing home, getting the care they needed. About 2 weeks later, we had a meeting with the staff to determine the strategy for their care. Within a couple of days, I got a call from a lady at Medicare telling me that because my senior wasn't improving - after only about 12-15 weekdays of  therapy - they were going to send my senior back home, or the senior could stay and pay with private pay. No mention of how much private pay would be ever came about - which is about $7,00 to $8,000 a month as I found out 5 months later.

Of course, I did cry, "foul". I told the Medicare lady what I had been told about them covering the first 100 days and that 15 days wasn't enough time for anyone to show signs of real improvement. She said those were the rules and that a lot of people hear about the 100 days, which is only covered when the senior is improving. She was a nice lady, and she was sympathetic to the situation, but my senior was going home or would be making private payments within a few days of that conversation. When I explained this to my senior, the decision was made to go home.

I hope this is helpful for you to know before you or your senior starts down this road, only to discover after weeks to months of work that the road only leads to a dead end if you don't know the proper detours to take along the way. As a matter of fact, if you start out on the right road, there are no dead ends and fewer detours. 

And by the way, if your senior has assets, they will need to spend those on nursing home care before Medicaid will pay anyway. And if a a house is involved, Medicaid becomes the owner of that house upon the death of the nursing home senior and the spouse who is living in that house. There are ways to prevent Medicaid from gaining ownership. So, talk to a lawyer several years before the senior will need nursing home assistance. Have questions? Just ask. I'm happy to help if I can.

May God bless you on your journey,

Patricia