Mom lived with us for four years before she finally qualified for LTC through Medicaid. Dementia and some blood pressure issues are her only dx. Last year, when she qualified, she was doing things like going outside, taking her clothes off, or going outside with her clothes off, trying to "leave" to go "home," etc. Those are the things that qualified her because they had a doctor take another look at those things, not because she ticked the normal boxes.
Fast forward to today, she's in a memory care facility and doing REALLY well. Like she's the most "with it" person in the facility. She has a review tomorrow and I just found out that they can kick her out of the program for no longer qualifying medically.
She CANNOT come back to my house. I almost didn't survive the first round of her living her. She has no other options of places to go. She can't afford self-pay at the facility. What do I do to prepare for this so I'm not caught with my pants down??
Legally, they cannot discharge her from memory care unless there is an alternative careplan in place. If someone is willing to take responsibility for her, once she's out the door they are no longer obligated to take care of her. So they're pulling out all the stops because they want you to take her. Don't do it.
Let me ask you. Who told you memory care can kick her out? Did Medicaid (the state) tell you this? Or was it some social worker, case worker, or administrator from the facility your mother is in? Speak directly to Medicaid. You should also speak to your state's Ombudsman about this.
Whenever you have to meet with anyone from a LTC facility, ALWAYS take a witness with you. Or tell the people you're meeting with that every word said is going to be recorded by you. They don't like this in a LTC facility because they're trained to intimidate residents' family members, distort facts, falsify financial information, and to downright lie. They will say and do anything to maximize profits for the facility. That's why you don't even say hello to someone who works in the administration of a LTC facility without a witness or a recording turned on.
They will not kick your mother out until there's somewhere to kick her to. Stay strong and don't let them talk you into taking her in. They will figure it out. Good luck.
It helps to separate two different programs people often mix together:
1) Medicare (or Medicare Advantage) skilled nursing: coverage is for short-term skilled care after a qualifying hospital stay (or per plan rules for Advantage). It ends when skilled need ends — it was never designed as indefinite custodial nursing-home payment.
2) Medicaid long-term care (or a state LTC waiver): this is the program that can pay custodial nursing-home or certain home/community services, but only while the person meets both financial and medical/functional (level-of-care) rules. If she no longer meets the medical/functional criteria, the state can end that LTC benefit even if finances still look the same.
Practical steps families often take when a medical denial/termination letter arrives: (a) read the notice for appeal deadlines and request a fair hearing/appeal if you disagree; (b) ask the assessing nurse/plan what ADLs or skilled needs they say are missing and whether a new assessment can be requested if her condition worsens again; (c) ask the facility/social worker what the private-pay rate would be and whether any short-term discharge planning or alternative level of care is available while you appeal.
I'm not a lawyer or licensed agent — just outlining how Medicare skilled coverage and Medicaid LTC medical eligibility usually differ so you know which notice you're dealing with.
They are suppose to have care meetings every 90 days where I live. You should be able to sit in as Moms POA or contact since she would not understand what is going on.
Is your mother taking any medications that were added or increased from last year? That may be the reason for her more calm nature. My uncle can also be the most "with it" person in the facility on the surface but show timing is not fooling anyone that is with him more than an hour. Even the most "with it person" is there for a reason and the met the qualifications.
I would go into the meeting with a calmness and take notes. Don't become upset quite yet or feel you have to pro-actively figure out a plan when you don't know any details. Stop and take a deep breath. Even if they feel she doesn't belong at that type of facility they can't evict her immediately. You will have time to find another facility.
I can't even remember now where I read about this, but it was saying that's what this quarterly review is all about, to see if she still scores enough to remain under this ALTCS umbrella.
I know dementia doesn't get better, but there must have been other factors going on last year that she's recovered from because she *has* improved. :(
Are you planning to be present for this review meeting?
How and why is your mother doing so much better? That doesn't sound like the normal progression for dementia.
Did she have a medical condition, such as UTI, which was successfully treated and resolved her dementia symptoms?
Is your mother able to live independently, that is, could she live in an apartment on her own? You could help her to find a HUD subsidized, low-cost senior apartment. If she is NOT able to live on her own, then she can not be "kicked out for not qualifying medically". If she needs community supports and services to help her with daily activities, then talk to the Medicaid worker about a HCBS waiver. That is Home and Community Based Services for people who qualify.
It could be this particular Memory Care facility can not keep her, but there must be other options - talk with the Medicaid Social Worker and find a solution.
Please let us know how things are going and what decisions have been made. Maybe I didn't understand your post. Are we talking about Memory Care or Long Term Care?
I believe there was something else going on last year when she originally qualified that may have resolved itself. She still has dementia, but I'm wondering now if she had some sort of cardiological issue that's resolved now.
If you feel strongly about not being able to giver her the right care, then ask them for other options...
If so, THIS MAY HELP YOU BUY TIME ...