My 76 year old aunt had a stroke and went to NH for rehab. They keep hinting that she doesn’t need nursing level of care, but can’t ever be left alone due to cognitive issues. She has no children and no husband. No house. No assets but an old car which she will never drive again. Her only income is SS and a modest pension, and she will probably qualify for Medicaid, IF she is deemed to need care that Medicaid covers. so, we are waiting as the application is in process.
Nobody from the family signed with the NH as a responsible party to pay. (all she has is an elderly sister with no money, and two nieces, there is no one else)
So my aunt got a letter from NH (forwarded from her old address which no longer exists, to her sisters address) confirming Medicaid application is pending and of course presenting her with a $19K bill to pay. I anticipate that they will want to become a representative payee for her SS and garnish her SS. Is that what they will ask the family?
Trouble is, she has no one as POA. That didn’t get done before her stroke. And due to COVID and her aphasia and cognitive issues, a notary and witnesses could not be found to execute a POA. (Niece was willing to be POA) Due to her speech issues and comprehension issues it seems doubtful a notary would agree to notarize her, they might not believe she is competent (although I feel she is, she is highly nervous around strangers and her speech ability plummets.) So I cannot act as POA to authorize anything with SS for the NH to be her representative payee.
Considering seeking guardianship but this requires 2 doctors’ affidavits that she has incapacity to make decisions - again, hellishly difficult to find doctors who will examine her, she didn’t have a regular doctor at the time of her stroke. COVID also complicating everything because she is in NH and until recently could not have visitors.
What’s going to happen with the NH’s bills while she is Medicaid pending? How does this get paid? Does she have to pay while she is pending? What are the Medicaid rules about this?
She can sign checks and knows what she is signing in my opinion; she paid her ambulance bill, for example. Should she just sign checks to the NH? (Not enough money in her account to cover the 19K-and-counting…so should SHE sign papers to make them representative payee, if NH insists?)
And what if Medicaid denies coverage because she somehow doesn’t qualify for nursing level of care? It’s so unclear, they say she has cognitive issues and can’t live alone, yet she seems quite mobile and works hard on her ADLs. She can’t afford assisted living or memory care. What happens then? Does she get dumped to the curb? (Frankly I think she’d love that, as she hates this NH) I would try to take her in and refit my house for her, but her elderly sister (my mom who I live with) also needs care and is very hostile to the idea. Also, my mom has life estate in our house and so it’s basically her decision on how the house is used.
What can we expect with the rest of the process with the NH and Medicaid, and what are the options and things to avoid?
That said, I understand that she is fiscally responsible for herself and I have taken care to not get involved more than is legally required. But as humans we also owe more to family than just legalistic behavior. A fine line to walk.
Currently (and now that visitation has become open again) it seems easier to follow the model of “she can sign her own stuff.”
If she does, NH should be billing them, until the days she has with them are exhausted
She was living on her own in an apartment before her stroke. Got flooded out of this apartment in August, was in process of finding new apartment and she then had a stroke. So she has no home to go back to even if we could find someone to sit with her all day and night.
I just want to be able to anticipate what comes next now that the NH has sent her a bill while stating she is Medicaid pending.
The State may take over her care if no one steps up. A State guardian will take over and then you can ask that she be placed in a better place. Its too late for a POA if she does not understand what it means. My Mom was perfectly healthy but her Dementia made her 24/7 care so I was able to place her in LTC. The NH cannot discharge her unsafely.
Well, there was never an admittance process or sit down. The hospital discharged her to NH. They just wanted her out of the bed as COVID was making the beds everywhere fill up - it was the week that the NY mandate to vaccinate health care workers was hitting and nurses were quitting in droves and so they had to close beds due to lack of nursing coverage. The NH snatched her upstairs so fast that I didn’t even get to see her and I arrived 10 minutes after hospital transport. As her medical contact person, I didn’t receive any papers in the mail until 9 days later, when her Medicare continued coverage had already been denied. I don’t think they ever talked to her. I don’t know because I never even got an update on her care until 12 days after she was admitted and I had to demand it.
They don’t have anyone’s signature on file, not even hers probably, but I don’t know - her speech has gotten better but it’s hard to tell if the business office ever talked to her.