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I am currently caring for my mother in her home but I know that at some point I may no longer be able to do so. I'm getting conflicting opinions about how to fund her care if she has to go into a nursing home. Is it possible to get compassionate, professional nursing home memory care funded by Medicaid? I'm very concerned about how to get the best care for my Mom knowing that we're not in a position to fund private pay for a sustained length of time. Any suggestions regarding what kind of research I should be doing now in order to prepare in case her needs become more than I am capable of meeting?

I'm going to tell you plainly. You're not getting top-shelf nursing home/memory care when you're on Medicaid. That's not happening.

What you can do is liquidate all of your mother's assets (real estate, vehicles, bank accounts, insurance policies, etc...) into cash and place her in an excellent memory care facility now. There are ones who accept Medicaid if a resident has paid a certain amount of time on cash-pay. Most placed I've heard of want at least a year or more of cash-pay. Then the person goes on Medicaid when their assets have been spent down, and some facilities allow them to stay.

This could be an option for your mother. Let me tell you something. I've been in the care business for a long time. Anyone in a memory care or nursing home needs a good advocate on the outside who keeps on these people to make sure their LO is getting good care. Even if they're in a high-end place everyone still needs this.
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Reply to BurntCaregiver
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Persisting Dec 18, 2024
Thanks very much, BurntCaregiver. I'm postponing making the move because my Mom is doing well at home and I was able to retire to care for her full-time. There are challenges but on the whole things are good right now. I know they will not stay that way when her dementia progresses. I appreciate your reminder that I will need to remain an advocate for her.
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You say you are caring for her in her home.
Is her home paid for and in a place to get some cash if sold?
Because sale of home may provide some time in private pay, which is more likely to give on average better care.
You will get a variety of opinion here.
Cover will tell you that there IS no good care for ANYONE in placement.
I will tell you that care is what the particular facility demands it to be and that starts with the top and who is running it, who is hiring and who is firing as well as the availability of good staff to run it.
There are those who will have hard stories to hear.
There are those who will have good ones; my brother's ALF was EXCELLENT.

This is all something you will research in your area on your own, looking at the facilities themselves.
And do know that aging in America is not a pretty picture and has little of perfection in it.
It all comes down to the best that can be done with a bad set of choices.
I am so sorry.
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Reply to AlvaDeer
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Persisting Dec 18, 2024
Thanks very much AlvaDeer. Yes, my Mom owns her home so it is a resource if we need it. I think one of the worse parts of navigating aging is the uncertainty and lack of predictability that makes it so hard to know how to plan. Thank you very much for your post.
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Getting “compassionate, professional nursing home memory care”, however it is funded, means different things to different people. For many (most?) people, care at home means lots of love, immediate attention to wet diapers, and time spent sitting and talking or reading to the person in bed. That’s not what ‘professional’ means. What ‘compassionate’ means is even less clear. What do the terms mean to you?

Medicaid funding may mean that you only have access to a less attractive facility. However - particularly if there is a time first on private pay, and then a transfer to Medicaid - it may be exactly the same care in the same facility. Perhaps a double room, not a single room, but even that varies. Care staff often know nothing about how the care is funded.

It probably makes sense to do the sums about what you can afford, and do the grind of going around and looking at facilities. Opinions can help, but often they don’t.
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Reply to MargaretMcKen
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Persisting Dec 18, 2024
Thank you very much, MargaretMcKen. Compassionate to me means staff who see my Mom as a person no matter how difficult she might become to care for. I'm hopeful after reading your post and BurntCaregiver's post that going private pay first might be able to get her into a more attractive facility.
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I sure hope so. My mother will run out of money for her MC in a year. I'm going to have to find a Medicaid placement for her.

Can't have her in my home. Been there, done that.

Looking forward to hearing what others say:

Lea, where were you going to place your mother, had she not passed away? I remember that she was running out of $ as well.
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Reply to cxmoody
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Persisting Dec 18, 2024
Thanks very much, cxmoody. I hope things work out for your Mom.
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Research faith-based facilities in your area. My MIL is in a wonderful place (since 2019) as part of Presbyterian Homes, which is in many states, is non-profit, affordable, well-run and sees the care as a mission. Much of the way they keep prices down is through fundraising efforts (not through the facility, though). She's on a large suburban lake, they have activities, special events, a boat that takes out LTC residents like my MIL, raised garden beds for the residents).

She went into their AL on an Elder Waiver and then when in LTC went on to Medicaid. She receives the same level of care as all other residents not on Medicaid.

Just saying that these "unicorn" places do exist, you need to look for them.
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Reply to Geaton777
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Persisting Dec 18, 2024
Thank you very much, Geaton777. There is a Presbyterian Homes facility in our town. I will reach out to them for more information.
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Aging is not about perfection.
There isn't any. Not in help, not in hope, not in care.
And that's true whether the care is funded by assets saved over a lifetime or by the state.

So the search for perfection needs to stop where it starts. It starts with knowing that no one, not you alone and not a full coterie of caregivers (no matter who pays their salaries) can make aging anything but very sad and difficult. It is a time of loss upon loss upon loss ending with the loss of the mind and all that made us who we were.

You must now do what you CAN, not what you WISH YOU COULD.
The search begins with a collection of assets available for care, and with visits to Nursing Home Facilities in your area.
Questions:
1. If my mother enters as a private pay client, when her assets are gone can she stay here with Medicaid funds?
2. What are your costs of care and what levels of care do you provide (usually I-IV). What constitutes what category and level my Mom is on.
3. What activities do you provide.
4. May I attend a lunch and eat a meal here?
and so on.
While visiting you will examine for safety, cleanliness, and etc and more questions will come to you as you go. Their policy of how much they are willing to show you will tell it all.
Good luck. But PLEASE, relieve yourself of expectations of perfection. That isn't going NEARLY to be possible.
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Reply to AlvaDeer
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Persisting Dec 18, 2024
Thanks for the list of questions, AlvaDeer! My Mom was in rehab for three weeks a couple of years ago and I quickly discovered that although it was a nice facility, she wasn't going to receive the level of care that I wanted for her. I was able to win my battle to stay with her while she was there but I doubt that this will be possible if she has to go into long term care (plus, I barely made it through 3 weeks - don't know if I still have it in me). My only consolation is the hope that if that time comes, my mother won't be aware of her surroundings.
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Medicaid is a federal program that is run by each state in their own ways. In most states Medicaid will only cover LTC, the medical portion of care in combination with one's SS income, which covers the custodial (room & board) portion. Therefore, one needs to qualify both medically and financially through Medicaid.

Most states' Medicaid does not cover AL or MC, although there are Elder Waiver programs that each state and county may have, which provides *some* assistance for keeping an elder "in the community" (meaning in their home). This also requires application, which can be researched on your Mom's county Dept of Health website (and social services). But in the vast majority of cases, it eventually is not enough once the elder's daily needs increase.

I recommend you have a discussion with a certified elder law attorney for your home state, or an estate planner or a Medicaid Planner for your state. This is a global forum of plain ol' caregivers and care receivers so we aren't professionals and cannot be relied upon to give you the most appropriate advice on which to make your future decisions. Just pointing you in a hopefully helpful direction.

I wish you all the best as you plan.
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Reply to Geaton777
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Persisting Dec 18, 2024
Thanks for the additional info, Geaton777. It's so helpful to have input for others going through a similar situation. I knew Medicaid would pay for nursing home care but clearly I need to better understand the different types of long term care related to memory care. This is very helpful - thanks!
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