My grandmother was in a nursing home for 10 months. We pulled her out due to poor care and she has been living with us since 1-26-2017. She is covered by Medicare/Medicaid and between both of them, they were paying the nursing home $1950 per month for her care. She has to be cared for 100% by me for bathing, dressing, teeth brushing, meals, dressing and all of her PT, OT and speech therapy. I am her medical POA and take care of all of her appointments, medications and appointments in our homes as well. She is a two person assist anytime she gets out of bed as well. My days average about 14 hours per day with her. I am a photographer and own my own business but have had to close things down for me to be able to care for her. I have been told that I could possibly get paid for caring for her by a few people I know, but I do not see the state of Ohio on the list that was provided. I have also been told that she is not able to pay me anything while she is on Medicaid and that if she did, I could possibly have to pay that back to the state. Is that true? It seemed a little odd to me that if she agreed to pay a certain amount to help go towards what would have been her normal expenses anyway had she lived on her own, that it should not be a problem. Such as: amount towards a house payment, utilities, food and so on. I don't want to do anything that is going to cause an issue with her receiving benefits for Medicaid but also am seeing that it is going to cause an issue for me to not receive income from my own personal business. If anyone has any experience dealing with this issue, please feel free of offer advice for the state of Ohio.
When I see a situation of one person taking care of a senior who is reliant on someone around the clock for all of their daily needs, I ask, what would the family member think if they hired someone to take care of their LO and that hired person was going to be the sole caregiver for your LO 24/7, 365 days per year. Even if the person was a strong 29 year old, I would consider this an unrealistic attempt. How can a normal person sustain so much work and the mental strain. If she's a two person transfer, how do you do it alone? And what if there is an emergency? How would you handle that without help?
If you do attempt it, I'd try to get outside help to come in. I'd check with PACE or some other kind of program.
Does Medicaid realize that you have removed her from the NH? I'd consult with her case worker and they can normally explain what will happen and if she would stay on Medicaid Medical, though being taken off Medicaid LTC. Once that stops, the Recipients income normally goes directly to them and not the facility any longer.
https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
IRS bulletin 2014-7 is a good place to start research. It is deemed as 'difficulty of care' and adult care is deemed the same as child care. State administrative codes also cover the exemption of 'third party vendor payments'. (good search term for your state research). It is not generally understood or applied by the state agencies because it is way deep in the codes.
It is time for you to get back to your career of being a photographer before you are overwhelmed and burned out, as it can take almost a year before you feel like going back to work.
I realize you want to do what is best for your Grandmother and I commend that, but in reality Grandmother needs a higher level of care, otherwise she wouldn't been placed in a nursing home to begin with. You need to seriously think about this. Medicaid will pay for her care.
Plus caregiving can ruin your health as many on this forum can attest. One gets so busy dealing with an elder's doctor appointments that you will keep putting off appointments for yourself. I know I am behind almost 3 years on seeing various specialists for myself :P And don't get me started on the stress.
And VBaker, it is not true that she cannot pay for her room and board if she is on Medicaid. Not even the government expects people to live with no expenses. While she was in a nursing home, almost all of her income went towards that cost. Now she can use that money to pay her room and board.
My mother was on Medicaid while she lived with my sister. Sis charged her the same amount she was paying for her subsidized housing, with no additional charge for food. And the Edlerly Waiver program paid my sister for caregiving. (Not a lot, but Sis said it made her feel "official.")
These are things you can talk to the case worker about.
Many states do have an Elderly Waiver program that provides some in-home care for people who don't need a nursing home. Those programs really won't work very well for individuals living alone (in my opinion) but they often make it possible for family to keep their loved one home. Medicaid will pay someone from an approved agency to provide various kinds of care. In many (most?) states they will pay a family member. They have the family member take training and go through the preferred agency. In most locations they do not cover anything near 24 hour coverage, because if someone needs that much coverage and family can't fill in the gaps, then a nursing home is a more cost-effective option.
Since GM is already on Medicaid, ask her case worker for a needs assessment and to discuss what kind of in-home services would be available for GM.
You are right. They were paying a lot of money for the nursing home. They should be happy to pay less to help the elder stay out of the nursing home. In most states they are.
Do look into this option. But I think in the long run the best thing for GM (and everyone else) is placement in a GOOD nursing home.
Find another nursing home which provides better care and accepts medicaid.
Where are your grandmother's children in all of this? Why are they not doing anything?