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My mother is now on private pay after a stint in the hospital and the 21 days Medicare payed for upon release to rehab in the nursing home she will spend the rest of her life in if we can afford it still after a few years. She has exhausted her LTC policy after 7 years in AL facilities


She is 90, immobile and on oxygen. Her secondary insurance said they would pay for the balance of days to arrive at 100 days in a Medicare facility which she is in. However the NH is categorizing her care as custodial which seems to be exempt for payment.


We don't understand how this is strictly custodial. She must be lifted from the bed to a lounge or wheelchair. She is on oxygen which obviously has to be administored to her at varying levels due to present need which changes. She is completely assisted with bathing and toileting.. She is receiving PT in her room in her bed or wheelchair. Medicare is presently covering that. When we asked what would categorize skilled nursing we were told something of a surgical nature. I am fairly certain surgical procedures are not conducted within the NH.


We feel that it might be easier for the NH to categorize it this way in order to receive payment. We have a meeting with them next week. Other than this question are there others I should be asking of them. Their cost is $295.00 per day which seems on the high side for the area we are in. The costs of oxygen seem to be additional. I know they will not accept Medicaid for the future if she is still alive after the spend downs.

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Riverdale, my mom went to a NH rehab after hip surgery. She had CHF. Not sure what qualified her for "skilled nursing".

We were told that after 2 years of private pay, if she needed to tranfer to Medicaid, there would be no change in her shared room or her services.

In other words, once you get her in to a place like that, there is no need to move her again.

When we looked for rehabs after the hip surgery, we ONLY looked at places that would accept Medicaid after private pay, which was explained to us by the great discharge planning folks at the hospital.
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Riverdale Feb 2021
Thanks. She has had the virus vaccines but we have not. My husband will within a month but I may have to wait until the summer. Perhaps in a few months I can visit other facilities. I did do that prior to her entering the AL one here after we all moved. I imagine it will be hard to do that right now. I am only allowed to see her since she still seems to be in the palliative care category. The AL facility she was in next door is still very restrictive regarding visits. I am fairly certain others will be too.
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Everything I know about American nursing homes and medicare and medicaid I've learned from reading on the forum, I'm just brainstorming with you and am not an expert by any stretch of the imagination.
My understanding is that she is in this facility for rehab after her hospital stay, is that right? Of course hospital to rehab and then another move is going to be confusing, but unless she is imminently nearing the end of her life she needs to find a permanent placement somewhere. No doubt her previous home would be best, but would her AL even accept her back with her current needs? If she outlives her money you will be forced to move her anyway, and the choice of places will be more limited.
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Riverdale Feb 2021
No chance to move to previous home before the 7 years in 2 AL facilities. No chance to return to AL facility. She requires too much help. She cannot even stand unassisted. First admitted to rehab combo palliative care. Now is on a long term wing of NH. Yes I am worried about the future. She has many medical issues. I appreciate your brainstorming.
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She’s receiving custodial care by Medicare standards. Everything she’s receiving at the facility, including the oxygen, can be “reasonablY and safely done at home by non-licensed caregivers”. She’s really not receiving any skilled care. The only exception here is the PT but she’s not in the facility for rehab anymore and her PT can be done at home.
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Riverdale Feb 2021
Thanks. No one yesterday explained it in that manner at all.
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If this facility doesn't accept medicaid then they have no incentive to try to assist people who will need it, I would begin by finding a place that does accept medicaid and enlist their help in getting your mother qualified and moved. It is my understanding if she has $$ left for a period of private pay your options may include some better places.
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Riverdale Feb 2021
She has also had more cognitive decline. Moving her now would feel traumatic and I don't know how long she has. The hospital told me they doubted she would recover from the septic infection in her system but she did although further compromised physically and mentally


Do you mean if I found a place that would eventually accept Medicaid should she be approved that the whole facility would be a better experience pre and post Medicaid eligibility?
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