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Hi all -My mother's been there over a month now and as of last week contracted COVID. She was in a general state of decline anyway so this just exacerbates her physical and mental decline. The facility told me she would have to stay an additional 2 weeks AFTER her symptoms are gone, so I anticipate she'll be there quite a while.
Besides dealing with that, an immediate problem is I need to continue to pay the AL facility which is part of the same complex, and after this week we'll have to start paying for the rehab side too, since insurance coverage will stop. The more I think about it the angrier I get - she contracted COVID there, will be forced to remain there, and PAY for both sides indefinitely.
I have a meeting scheduled with admins from both sides this week that was scheduled to talk about where she can live, and would appreciate any suggestions on how to 'negotiate' with them on a reduced rate or any other points I can raise, under the circumstances.

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We just found out yesterday that my Mom tested positive for covid, and she is in skilled care - private pay.  They transferred her to a newly formed wing - Acute Care/Covid Isolation Unit.  Because they aren't taking any new patients, they are holding her room until she recovers.  AND the Cares Act pays for the acute care via her Medicare A.  Check out the Cares Act to see if your Mom can utilize this coverage.  Apparently, it is fairly new support for covid patients.
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cherokeegrrl54 Dec 2020
Good to know that bit of information. Thank you
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I know my mother's place charges less to hold her place if she was not there receiving care for a period of time. That only seems fair. Her rent vs. her care are two very different expenses. You should only be paying rent, not for any extra care she'd normally receive.
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I would beg and plead rather than taking the angry stance. They are angry about covid, as well, you know. The virus is devastating their facility and its residences and its workers and they are scared to death.
Your mother needs more care now. The rules for payment at my brother's ALF were pretty cut and dry. First of all, the amount of care you need is the amount that you have to pay for. When all the money is gone so are you. That is the long and short of saying something that can be stated perhaps more kindly, but remains a fact.
Rehab is reimbursed by Medicare to the extent it is. I don't know if there is anything special re covid? I really don't know.
I would plead. I would say "Mom has only this much money and it is terrified to think she could outlive her assets and be dumped to live the remainder of her life somewhere so much less nice, with people who don't care as much. I know you are all suffering here as well, attempting to keep the illness at bay and to protect all, but is there ANYTHING that can be done. Any way you can work with us".
I think that you will hear "No, I am so sorry, but there isn't; everyone is suffering the same circumstances you are; and we cannot give someone a special deal and not give it to someone else."
This is all so tough. I am so sorry you are going through this and you are doing EVERYTHING you can. I would say that the anger is not your friend. This is a pandemic. This is what is happening to so many. I couldn't be sorrier, but that doesn't change a thing. Best of luck. If you have a good outcome hope you will let us know what magic your worked in your Mom's behalf.
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Try calling your legislator and see if you can get some help there. If you have a local newspaper try to get the story out there. It calls for public awareness. I hope something works out for you.
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I would deffiently not pay for both!
That is not fair and if the meeting doesn't work out in your favor of paying for one or the other, I would contact a news service and they would not like the bad publicity.

I fact if at the meeting they don't agree to you only paying for one, I would tell them you will be speaking to the News about it.
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cherokeegrrl54 Dec 2020
Or her attorney.....sounds like another greedy business trying to get what they can. These situations really irk me! Best of luck in the meeting!! I say stand your ground!
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You don’t need an attorney. Have you considered taking her home sooner? They can’t force her to stay. Otherwise just tell them very matter-of-factor that they won’t be paid for the extra 2 week stay, that she has no money. They will probably change their tune real quick & work something out in your favor.
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AlvaDeer Dec 2020
She is in Assisted Living, though. For me that rather infers that she does have assets. They likely will take costs out of her assets, or attempt to for the rehab care uncovered by medicare. Can get a judgement against her estate in future for any costs.
And of course if they don't follow the rules at the ALF she will be asked to leave. Most ALF don't keep you there if you don't pay. ALF don't have to follow rules and laws that Nursing Homes and etc. do, as I understand it. They are not regulated in quite the same way, unless I am mistaken .
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You wont know unless you ask....use the anger you feel...channel it into a firm attitude and go from there.
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This does seem unfair, but it is true that assisted living facilities do not have the regulations which nursing homes have. I used to work with the elderly and the ALF s sprung up after the more stringent federal OBRA act was passed. I worried that the ALF did not have the FEDERAL OR STATE oversight to protect their residents. Nursing homes used to be basic OR skilled and they are now all skilled. I saw, once again , medication being passed by unskilled workers who often missed untoward effects of the medication they passed. When I had my first job in a nursing home in the 1960s it was before OBRA and nurse’s aids were irrigating Foley catheters and they often just threw the drainage tubes on the floor. As an RN, I requested administration to allow me to train them in sterile technique and was refused because “a class would take them away from their duties.” In those days almost every incontinent patient had a catheter. I explained to the administration that my nursing ethics would not allow me to work there under those circumstances. After OBRA, I saw big changes in nursing home care. More RNs, better food, better living conditions, and attention to sterile technique. Then the ALF came into being and I could see that corners were being cut to cut costs and was appalled to learn that these facilities had no oversight. LPNs were often in charge of care and they did not have the education of an RN. To my knowledge it is still that way. Public awareness of this situation should be a priority. There are some very good ALFs but certainly many are not.
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LittleOrchid Dec 2020
Thank you for your professional insight. I am very troubled by the extent that health care facilities have become profit-making enterprises. It seems to me that as long as the main goal is making money rather than providing care there will always be an incentive to cut corners in as many ways as possible. The only way to counteract that is in increased regulation and oversight. I much preferred the community-based and community-supported hospitals and "rest homes" of bygone eras. They often had shoestring budgets, but the primary intent was always to provide true care. Even though individuals in these profit-based centers often care very much about their patients, the administration is always focused on the numbers. Unfortunately, they quickly seem to lose the fact that some of those "numbers" are people. Bless you for caring about your ethics as a professional and for your patients.
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The trouble in dealing with health care institutions is that they pretty much have the right to charge whatever they want and the law gives us no right to challenge those prices. Definitely something that should be addressed by congress, but there is little in the way of short term solutions. My guess is that there will be a whole lot of bankruptcies in the coming year, with unpaid medical bills both a contributing cause and a continuing result. This will be bad for the bottom line for medical institutions and there will be no room for charitable forgiveness.

I think this serves as a warning to the rest of us that aging loved ones should always be booked into medical facilities in their own name and with their own name as responsible party. You may step in and pay those bills anyway, but if you have not signed as responsible party they cannot force you to pay. That gives you some leverage. Once you sign as responsible for the bills you have no leverage. What they charge is yours to pay.
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disgustedtoo Dec 2020
Someone else posed a separate question about signing NH documents and one person replied several times that signing as "responsible party" just means you have access to their medical care! NO! I replied to several of the posts this person made with links to an elder law Q&A which explicitly says NOT to sign that way. IF one has POA, then clearly sign your name WITH DPOA added. Cross out the "responsible party" and initial it.

The Q&A suggested having a legal review before signing, as who knows what's in the fine print (sometimes it can be worded such that we the uninformed might miss something.) If one can't get legal review, certainly read EVERY word, question anything that might be suspicious terminology and sign it as the "resident's agent" instead. Links are below, but here's part of it:

sign "...as the resident's agent. Signing the agreement as a responsible party may obligate you to pay the nursing home if the nursing resident is unable to. Look over the agreement for the term "responsible party," "guarantor," "financial agent," or anything similar." Never accept them saying this is just "standard" stuff...

https://www.elderlawanswers.com/am-i-financially-liable-if-i-sign-a-nursing-home-agreement-for-someone-else-15051

https://www.elderlawanswers.com/should-you-sign-a-nursing-home-admission-agreement-6360
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Hopefully your meeting will work this out. Other threads that dealt with the topic of rehab (not covid related) and having to pay for AL to hold their place did have some promising responses. Not all places are the same and therefore their decisions and rulings will vary, but at the very least they should be understanding and be able to reduce her AL cost for the time she isn't there.

Certainly they should not be charging for any "add on" care, meaning care that isn't covered in the base AL price. If the base price includes meals and cleaning her room, they should cut you some slack there too.

Hoping also that what someone else said about the CARES Act is true.

It is difficult to keep the virus out completely, so unless the rehab place was being extremely lax, it probably isn't their fault, but it also isn't your mom's fault either, so why should she be penalized? If nothing suggested helps, you could file an appeal with Medicare. At least that would defer payment, if the appeal is denied.

Hoping for the best for you!
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