My dad is in assisted living and mom is in memory care. Both of these are private pay. I have been trying to find out what happens when they run out of money, but haven't been able to get a straight answer from any one in the facility or where ever. All I have got from anyone is that they have a really good social worker or they change the subject. Obviously they can't just hand them their suitcase and send them to the curb - I hope. I have been told by friends that they have to find them a suitable place to go but if they have no money, what would this suitable place be since AL and MC are both private pay? And does the social worker find these alternate arrangements or is it my problem again? They have enough for a couple years providing nothing happens, so it's not a panic situation yet. I am in NY if that matters. I feel like I am constantly running in circles or up against brick walls with this caregiver role.
See an elder care attorney if you have questions or need help navigating the Medicaid application and 5 year look back. Don't rely on anyone but yourself to get your ducks lined up, and don't wait for the last minute either. Look over Medicaid nursing homes that you find nice and plan to place your parents there several months BEFORE their money runs out. That way, you can apply for Medicaid and have them situated by the time it kicks in.
Prepare for the worst & your experiences will be positive.
I would suggest you make an appt with the Administrator. Ask if the AL and MC will allow Medicaid. In NJ after paying privately for 2 yrs, the ALs will except Medicaid if they haven't met their quota. Also, in NJ you only have 90days after you apply for Medicaid to spend down monies, meet the criteria (5 yr look back and paperwork) and find a facility. I suggest if Mom and Dad have any money, you may want to start the process now and private pay for the NH a few months. Easier to get them in that way and will help with the spend down. Then start the Medicaid process.
The staff probably really does like you and your parents and they don't want to be the one who prematurely tells you something unpleasant - since you said you still have years of private pay funds at this point.
As for the people who may truly not know the answer to your questions, there are a lot of social workers and "Medicaid Liason" people who truly mean well, but they really don't know the nuances of their own job. I have observed high turnover, etc in these positions. If you end up getting help from one of these folks, you must watch them like a hawk to make sure your parents' file does not end up at the bottom of the pile and left for the last minute - meanwhile you think it's been getting worked on for months! The squeaky wheel gets the grease, but then that adds to the turnover/burnout problem....
If you want a real answer to your "what happens when the private pay money is gone" question, my advice will be to ask the business office. The people who cash your check every month will be able to tell you what happens when funds are gone.
In terms of finding a new place, first stop (since you're happy with the current care) would be to see if the current place has a sister facility which would take Medicaid.
I personally have chosen to only look at places with a 4-5 Medicare star rating. Sis has been living in a place that supposedly had reasonable reviews online, but are not a Medicaid facility. I personally think they would have been cited for abuse and neglect from what has happened to my sister-injuries, horrible food, not keeping my sister clean with regular showers-has been awful and why I would never go to a place rated any lower than 4. I even had a couple of facilities including current one recommend places that have been cited for abuse as possible placements. I was willing to drive a fair distance to find a good place-but this has not done me any good. I have been turned down 5-6 places for lack of self pay funds-gee folks this is why we need Medicaid....A few others told me sister's behaviors are disruptive because she cries from time to time-frustrated-told a staff member to shut up, lonely, bored-and therefore would not take her either. 5-6 more we are on a wait list some told me a few months wait, others are a minimum of a year or 2. One place recently passed us over when we had a few questions about the financial responsibility did not return calls for several days. When they finally did reply-guess what they had given the room to someone else. A couple more just said we can not take sister with no explanation as to whether a condition or financial issue. I have given up and we are going to a traditional community that seems to have a broad scale of allowed conditions etc. they will take in memory care-it is a fairly new community in my area which does not take Medicaid. More affordable than NH we are currently in and family will contribute to make ends meet beyond sister's retirement income. For a time I considered bringing my sister to live with us but I have a son in college, elderly parents driving me crazy, would take a lot to make my home safe (steps) and easy access for sis to even get in the front door, keep her safe in the shower. Do not rely on social worker to do your work for you-aka vetting a facility-social worker will just be looking for an available bed nothing else other than maybe distance you are willing to drive. If you have your top 5 list prepared ahead of time-to say only call these places....
One of the communities I looked at had several with same ownership in my area-some buildings were newer and had better ratings, the last one we toured was an older building with tiny shared rooms and if someone was in the wheelchair in the hallway it was difficult to get past-building code was different back in the day vs what is required/built now to be wheel chair accessible etc. Just because one company has several properties does not mean management/ or executive director, nursing at each facility is going to be exactly the same quality-i just have not seen this during my search.
Lets be real here-Medicaid beds are not profitable for a community-facility agrees to accept a lower payment for a bed that could be given to self pay instead. Although a community may say they have 20 medicaid beds there is no law that says they must be filled with the next person that comes along-we have also lost spots due to "internal" move from AL or what ever. I am not sure I believe them-just a reason that I have to accept but also don't believe they will be calling me anytime soon.
If you are placing someone without assets, you will be limited to facilities with open "Medicaid beds" and these can be an hour away from the family. You want to avoid that situation by trying to get into waiting pools now. If you have access to a social worker, I would use them.
As the social worker for the facility has a vested interest in keeping your family member as long as possible, I would find a social worker elsewhere. Try the Office of the Aging in the county where the. person lives. Or contract with a social worker yourself. You may find someone on aginglife.org
Good luck!
Talk to an Elder Care Attorney NOW and discuss the application process and what needs to be done.