What am I supposed to do since my dad doesn't qualify for Medicaid and is getting kicked out of the nursing home?

This is from HHS.Texas.gov

'Nursing Home
If your doctor says you need full-time care from a nurse, a nursing home may be right for you. Nursing homes are the highest level of care most people will receive outside of a hospital. This type of care is sometimes called custodial care. In additional to a high level of medical care, residents get help getting into and out of bed and with feeding, bathing and dressing and other activities.'

Has his doc scripted NH care?

If your father is unable to transfer on his own from bed to chair, chair to bed, chair to toilet on his own, wouldn't he be an unsafe discharge if there isn't 24 hour care at his house?
You are not obligated to become a caregiver to your father, nor are you obligated to pay for his homecare.
BarbBrooklyn is right. Talk to his doctor.

Tell them it's THEIR job to come up with a plan.

You are NOT the plan.

If they say "oh, the state will take guardianship" say "that's just fine with me."

Two can play this game of hardball.

Jax, does dad have a regular doctor who can document his medical needs?

I am hoping that our pal Igloo, who knows Texas Medicaid, will chime in.

You need something more than a once over.

Why can he not qualify?
Is it because he has too much money saved or because he has too much income coming in.
Firstly tell them that your Father cannot return home.
If you do not wish to serve as POA know that you don't have to, but because you took the job on in the first place you will now have to attend an Elder Law Attorney to find out how to resign. It will include a letter to your Mom and Dad if they are competent, and it will include notification at the Nursing Home that you are no longer the POA as well as notification of any entity (bank, etc) that you are no longer POA. At that point it is up to the State to seek guardianship. Do know at that point you will have nothing to say about where placement occurs, finances or anything else. If there is a home that is an asset it will be sold, in all likelihood, to pay for care.
Speaking of that home, rather than Dad returning to it for care it is better it should be sold to pay for his care. If your POA is well written and your father and mother no longer competent, you can do the sale and use the proceeds. When those proceeds and any other assets are sold they will be ready for medicaid.
Do know that you can hire a Fiduciary (not one of the financial folks that call themselves a "fiduciary" but a real Licensed, trained Fiduciary) to manage all of this with Dad's assets. Will run about 90.00 an hour.
I am so sorry you are going through this. But step one is to keep Dad in care and tell them he is not a safe discharge to home and there is NO ONE THERE to care for him.
You should not be spending your own money on your parents care. Dad's money if he has too much of it for medicaid will pay for Attorney, Fiduciary and etc.
Is there anyone else in family willing to and capable of managing the difficult record keeping and care decisions of POA if your Dad is still competent to change his POA?
If not it is guardianship by the state as a last option and it IS a desperate last minute thing.
Meanwhile don't get anxious and pushed to act fast. If Dad is not qualifying for medicaid then there is money somewhere. USE IT to keep him in care. Spend it down with attorney and care. And do NOT accept him home nor even DISCUSS such an option or Dad will be there and you will have an awful mess.
Take it careful one day at a time and see an elder care attorney. Your POA allows that to be paid for out of Dad's funds.
Take all the information with you. All about applications, assets, reasons for refusals and everything.
Good luck.
Hope you'll update us.
Keep records and diaries and folders of EVERYTHING that is happening.

If your father has a home that he owns, he will need to sell it and use the proceeds to self-pay for a carer, assisted living, or nursing home (depending on the level of need). If it is not his home and he has no funds, there are options to help. However, if he has a home, even if the state takes guardianship, it will be sold (along with any assets liquidated).

If your father wants to stay there and be with your mother, I would discuss options with them (assuming he owns the house and does have funds). Most are willing to wait to get paid if there is a house sale involved. Also, if he is there for self-pay, it is likely he will be able to stay once he does run out of funds and needs Medicaid.

I was in a similar situation, a different state, and this is what I had to do. My mother had proceeds from a house and other assets which will be used for her care, but she will move to Medicaid once that is gone.

What do you think would happen if you weren’t there nor any other family was there? They wouldn’t throw him to the curb right? No, they would call the state and the state would have the court assign a guardian. It’s up to you but you do not have to be his caregiver if you are unable to. You need to strong and firm and tough. Call APS and report a vulnerable adult. I agree with what others have said, take our advice and don’t give in.

Are they saying that he's okay to live alone, without help?

If that's the case, yes, they can drop him off.

Be aware that DAD may be telling them that you will be there.

Please assure the NH that you will be out of town and if they "drop him off", the press and local elected representatives will be called.

Jaxsann,

Your father's nursing home, like every nursing home in the country is trying at intimidation tactics. They cannot put him in a van and drop him off at his house. He is a senior, unable to transfer on his own. He also has permanent income and owns property. All nursing homes are far too greedy to let that go.
Have they been putting pressure on you to list his house for sale and to give them access to his bank accounts? My guess is yes.
Don't give into their threats. Also, tell them that you moved and don't live at your parents' house anymore.

Just curious. If he has a house and they are both in care, why isn’t the house being sold?

That may be the solution to your problem.

Concentrate on an ongoing solution. Six months is getting to be too long to be called temporary.

Living in their house looks like you intend to default to taking on 24/7 responsibility while trying to patch in whatever programs are available. You need to figure out where you want to live and work towards that instead.

If their income can’t pay their bills, don’t use yours to cover the difference. Don’t assume you can “save” the home by living in it.

The POA lets you help them with decision making and implementation. It does not have to include hands on care.

What are you spending a lot of your own money on?

Your profile says you left Kansas to stay with your parents. You must not jeopardize your job.

Please heed the wonderful advice by the posters below. The NH is trying to guilt and shame you into taking responsibility for your father. Don't fall for it! YOU will be the default caregiver. And don't believe any promised "help" that they will provide if you agree to take him home. There won't be any.

Please keep us updated.

So , if the nursing home is to high of a level of care, would assisted living be appropriate? It’s sad your in this predicament.

Is your dad being denied because of ability to pay ?

I would call your county office for aged and disability, see if they can give you guidance.

See an Elder Law Attorney asap. They will devise a plan of action. Good luck & hugs 🤗

sounds like Dads health care chart does NOT show “at need” for skilled nursing care. And that is what a facility will need and in detail for him to ever be eligible for LTC Medicaid. I’m guessing that TX Medicaid sent out an assessment team to NH to go over his chart and do a bedside lookie-lou on him? Or maybe did a review on what his medical chart from NH show? Whatever the case, his chart was reviewed and is deficient for skilled nursing care needed.

Folks tend get all wadded on the financial aspect of LTC Medicaid, but LTC in a facility Medicaid is totally “at need” eligibility for BOTH medical and financial. I had to deal with a medical at need appeal for my mom….more on that below..

please realize that most go into a NH via a post hospitalization (MediCARE pays for hospitalization) discharge to a NH for rehab (again MediCARE pays); then they are determined to not need rehab anymore so segueway from MediCARE patient to a LTC custodial care resident at a NH. MediCARE and insurance does not pay for custodial room&board aspects of living at a NH. But Medicaid will. And the resident has a nice fat chart between hospital stay & rehab notes to show that they r now “at need”

Your mom shows at need.
So the issue then becomes, is there anything you can do in working with NH, dads old MDs to show in his health chart that he himself needs skilled care? If he has been living at home and not really seeing MD regularly and getting labs done often, perhaps his chart is thin so no documentation to show need. So could this be the case??
OR
is it flat that dad is not needing skilled care?
OR
that dad is saying that you & maybe others are there help him daily? That he is saying to them he wants to go home. And that you will arrange for home health for him?

what does the Nh say? Are they wanting him there? and will they work with you to beef up his chart or get labs run or get old info from his old MDs and hospital stays to use to show skilled nursing care needed?

For my mom, she moved from IL to a NH totally bypassing AL stay or a hospitalization when she entered the NH. At the time it did not ever occur to me that getting this done was unusual. Mom went regularly to her gerontologist and got labs runs, her health chart showed her decline and how they had increased. MD wrote script for LTC needed and mom moved out of her IL and into a NH. I assumed all good but there was a glitch…. NH intake RN left off basically all my moms RXs and her prior 3 or so of lab reports and physician notes. She was ineligible due to not needing skilled. NH called me like week after she entered. I - as her POA - had to file the Medicaid medical appeal BUT the facility had to get / gather the old documentation to add into her chart to fattened it out to show need and submit it to the State. And they got on it as it was their clusterF for leaving stuff out. I was pretty definite with them as to it was their lack of due diligence as to what we were all stuck in appeal process with. Hearing was set like 5 months out but all documentation got done in abt 3 weeks and submitted by the NH to Medicaid and mom got cleared around 8 weeks after the denial and way way ahead of the hearing. So I sent a certified letter with clearance notice to the hearing officer to cancel the appeal as no longer needed. She entered as Medicaid Pending, she paid from day 1 her mo income less the TX $60 a mo personal needs allowance and finally was completely eligible at 5.5 mos.

Are both of your folks paying thier mo income to the NH less $60 ea?
if not, the NH may not exactly be happy with them or you….

fwiw please realize that should they both be in a NH w/Medicaid involved, they have no-nada-zero $ to pay anything on home of theirs that you r now living in. Can u afford all house costs till whenever? Will u likely have exemptions or exclusions to MERP? U have $ for atty now & later to deal w probate? Have u thought all the$e a$pect$ out?

Update as of today is that I am working on appealing the denial of my dad's Medicaid application due to it was determined that he did not meet medical necessity requiring a licensed nurse daily. Again he can't transfer on his own to a chair and remains in bed all the time unless someone assists him. He's in adult diapers and hardly ever gets taken to the bathroom even when he asks. They say it's not safe and not enough staff I believe to do a 2 person assist all the time. That's one of many frustrations. Then to be told he doesn't meet MN seems so unfair. My main focus is stopping the involuntary discharge because he can't obviously take care of himself and I am not available. Thank you everyone for chiming in. This has broken me down almost to giving in and bringing him home. I just know I can't do it plus keep my job and any life. I kept trying to imagine how my parents could live at home again since they want to come back so bad. I had hoped my dad would get strong enough to take care of himself. I held onto the house this long because the hope for that future. It's a hard reality to face. I really appreciate the people who encourage me to not give in to the full time caregiving responsibility. I love my parents and would almost do anything to make them happy but I can't do it all with limited support from other family.

You are living in their house? Sell it to pay for dad's nursing home. I assume you are paying for all household expenses? Are you paying a market rate rent to the folks?

There may be more to dad's being kicked out then meets the eye.

jax, my moms NH became proactive in large part because I push them… like via certified letter to the DON aja the Director of Nursing which is imo the rules and goddes of the NH. The letter clearly outline how they had been lax ad I knew mom prescriptions and how some required being compounded (if dad needs a med to me compounded in some way this is specialized level of medication management). Her MD had really tight every 4-6 week visits on her a year plus lots of lab work done too….. so the documents existed but not in in the new health chart the NH had for the State assessment team to review.

often it’s small things like if they have significant weight loss in x # of days that’s serious and can add into why skilled nursing care needed. My moms UTHeatlh system based gerontology group had some of their MD ps also a medical directors of NH do they know what’s needed to show documentation of skilled nursing care.

If this NH is like the only player in your area of Tx and they are kinda fully occupied already, they have no incentive to be proactive. Yeah it sucks, if that what’s happening. You have to push & get records from his other docs and hopefully there are hospitalization revirds & how he was discharged somewhere in the house.

i don’t know if the NH has leeway on allowing his stay for billing to be Medicaid Pending while the appeal is on going. I got it done but it was known the whole issue was thier fault as the doctors offices had records of sending it to NH. You don’t have that…. It’s more there r no records ever submitted as neither you or dad requested them to go to the NH. That part is on you or Him to do. Not the NH. It’d different when they come in via post hospitalization & discharged to rehab as they have a huge fat file that’s updated daily while in rehab….and so imo they really don’t have to work it… .I’d suggest that you make sure the NH is getting to the penny whatever dad supposedly Medicaid copay would be if he was approved for Medicaid. Both dad & mom need to have that copay done. If not, they r considered out of compliance for LTC Medicaid system and the NH can do a 30 Day Notice. You don’t want yo have it ever go there, Comprende?

out of curiosity, did mom clear LTC Medicaid way before dad ever entered the NH himself? & if so how many months btw the 2 events? The $ allowed to be kept in on old still open checking account once it’s 2 in a NH changes dramatically.

Jax, it's not making sense to me, your father from how you've described his condition absolutely needs a SNF. Is he able to live on his own? Is he able to do ADL's by himself? Is able to survive with no one to assist him or without 24/7 supervision? If not, he requires a NH or 24/7 caregivers at home. What do you think they would do if no family was around? Do you think they would drop him off at his house alone? Wouldn't that be like killing him? You definitely should appeal, but you need to understand it totally up to you whether you will be his caregiver or not. If you are unable to because of your own job responsibilities you need to let APS in the state know, as well as the NH SW and ombudsman that you are not an option, that you are unable to do enough that is required to keep him safe at home. You also should not be spending your own money If you want to spend your own money and are not strong enough to fight this, hire a lawyer to fight for you and your dad, but you don't need to do that, you need to be firm, insistent, persistent and adamant that you will not be his 24/7 caregiver. Unless you want to be. Its up to you.

It is interesting how some of the requirements seem to contradict each other. I’m caring for my husband 24/7 and hope to never need a facility but try to be prepared for the whatever.

He has a Feeding tube that I use for meds plus 1-2 meals and the rest by mouth. Because of this, only a nurse is allowed to use the tube (using care through an agency) so this limits my leaving while he is cared for at home. I can hire someone privately, with no caregiving experience, teach them to use it and that is fine. He can’t go to AL because there is no full-time nurse. Even though only a nurse can use the feeding tube, he still does not qualify for SNF. He is a fall risk, has Parkinson’s, and a lot of cognitive issues so definitely can not stay by himself. I haven’t asked if ever needed… and we win the lottery… can he go into a SNF on private pay whether he qualifies or not. So, bottom line is I’m saving as much as I can hoping it will give me choices if I’m unable to continue 24/7 care. I am blessed for now to qualify for 14 hours a week through VA for someone to help shave, shower, etc.

In NJ your Dad would meet the custodial care requirements for NH. Is he a veteran? If so get in touch with the local VA administration.
Is he the owner of the home in which he lives and does anyone else reside there or is anyone else on the title? If he is the only owner and he is not living in the house, Medicaid may need to have the house put up for sale. If he qualifies for NH level of care you can put the house up for sale while applying for Medicaid. The sale of the house will give him money to private pay for his nursing home care while his Medicaid application is pending approval by the state. Be aware that you have a better choice of nursing homes while you have funds to private pay. Also when you become a Medicaid recipient chances are that you will be in "shared" quarters (private pays can often be in single rooms).

Regardless of what happens, do stop using your own private funds to pay for Dad's care and supplies. If you are buying anything for him do it out of his SS or pension funds and for heaven's sake make notations of what you purchased and keep receipts and most state's Medicaid take a five year look over the shoulder to make sure that Dad didn't "gift" anyone amounts of money to qualify for Medicaid.
Good luck to you in looking after your Dad and please keep us updated.

Big UPDATE:
It's been a little over a month since I posted my question in my desperate hour of need. I took a lot of good advice and the strength from the support I received here as well as other resources. I contacted an elder law attorney for a consultation, but I handled the appeal processes for both the involuntary discharge from the nursing home for non-payment as well as the Medicaid denial based on lack of medical necessity. I am so happy today the denial was overturned and medical necessity has been determined. It didn't look promising at all but my persistence and advocacy for my dad's case really won over. I knew he met the requirements for nursing home level of care but the NH where he is at really didn't help with the documentation. My dad is a special case in that he maintains a high level of cognition and that kind of throws things off when trying to prove medical necessity. However the main point proven today is that his medical needs specifically medication management with his blood pressure issues is vitally important for a licensed nurse to oversee. I am so relieved and thankful for the words of encouragement I received.

Jaxann, that is awesome news!!

Thanks so much for the update.