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My mom is 92, currently in rehab at NH after an initial fall & then found she needed a pacemaker. She had a rough 12 days in hospital with lack of sleep & "sundowning" complete with hallucinations. She's been in rehab 25 days & she's doing very well with the physical therapy part but needs cues & help with daily living skills. She definitely is showing the dementia, often thinks she's at home & asks us to get things in kitchen,etc. We know she needs to be in long term but can only afford with Medicaid. I just turned in application 2 days ago, afraid they will want to discharge. She qualifies financially with SS of $1538. She owns a home, assessed at $184,000 but has had a reverse mortgage with line of credit & has used $131,000. I don't know how that will affect the Medicaid. I've looked at her files from NH as we were on our way to doctors. 2nd thing listed is Alzheimers/dementia so is this enough to keep her and move her to long-term? Thank you.

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Thank you! I just received a call from our local DHHR office & she was very encouraging about her being accepted for Medicaid. She had gone over the application & said because I had just about everything needed, she could possibly be approved by July 1. I was shocked! Now hoping the NH accepts & can transition her from rehab to long term. She is in the best home in our area & I would not want her anywhere else.
Yes, the cardiologist is aware of dementia. She has an appt with him on Thurs, hoping he can make recommendation. Last visit, I was told it would be dangerous for her to be home on blood thinner, although I realize she could fall in NH. The nurse practitioner said we as a family should decide blood thinner risks of falling & bleeding vs. no blood thinner & risk of stroke. That's not much of a choice.
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My daughter has worked at rehab/nursing facilities for 20 years and she says her patients are treated no differently when private pay then Medicaid. When it comes to generic vs name brand, the insurance companies usually only pay for generic unless there is no generic for the brand name. A doctor has to submit a request to the insurance company telling them why the patient has to have name brand. Now, my nephew was not on Medicaid for a nursing home but he was on for his Medications. They wanted to change him to another med for the same problem, but he only does well with the one he has. His doctor was able to explain this to the insurance company and he was allowed to continue with his med at a higher cost to him. Also, we found that by paying $5 extra a month (later went up to $16) he put him into a different terr and he was able to get the med with no problems.
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What state is she located? Has her doctor said that she needed nursing home care? I think that is required if she is seeking Medicaid to pay for it. I'd explore that. Also, you can explore a second option. If she doesn't need skilled nursing care, like in a nursing home, you can see if her state has benefits to cover Memory Care or regular assisted living. Some states provide that based on income, assets and NEED as prescribed by a doctor. usually people with dementia qualify since they cannot live alone unsupervised and are not able to take care of their daily needs. I don't think all states provide it, but, I'd explore. Often the terms are similar to Medicaid.

Are you planning for her to get a pacemaker?

I'd make it clear that you are not able to take her from the facility and provide her care. They'll need to figure out what level of care she needs, which facility would be best and how she'll pay for it, based on her ability.
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There does appear to be a plan in Maryland for Assisted Living for some seniors, but, it looks like there might be a waiting list. I'm going to send you a link by PM. We aren't supposed to post links on the thread. However, I would follow up with someone who is in charge of accepting applications for the commonwealth of MD, because there may be another option. Seniors, who have medical issues and dementia often go into a special category, because their needs are so great, though, they may not need skilled nursing care. I'd be careful about listening to info from a lay person.  

Still, I don't see how they can insist you provide her care.  It's based on her ability to pay and something will have to be done, based on her need and ability to pay. 

And if you are her Healthcare POA, do you have the option of finding a Geriatric Primary? They are more experienced in treating seniors and those with dementia. Did the doctors who suggested the pace maker know she had dementia?
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Sounds like you have gotten great advice here and are doing your utmost for your mom.

I'm in a different state where person permanently leaving their reverse-mortgaged home means that the bank requires the home to be sold. Any proceeds would then be available for NH care. That may "sweeten the pot" for the NH. But maybe MD is different. Just thought I would mention it.
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She will need to have a physicians orders that "skilled nursing care" is needed in order for her to meet the "at need" medical requirement for Medicaid.

If she was in rehab post hospitalization then she probably has the hefty medical chart that shows need, so orders can be written by the medical director of the NH where the rehab unit is. If not, then she may need tests done or other evaluations done to get the orders and the medical chart to show need. Like for me, my mom was in IL and did the hyperspace move from IL to a NH avoiding AL or a hospitalization/rehab situation, for mom it was more of a chart building process that took about 5 months. If yours is in rehab and not progressing, she can get orders done pretty easily I would think.

The meeting next week on 7/3, is that a care plan meeting? if so you may want to write down any ?'s or concerns you have so you can bring them up at the meeting. You may want to have someone go with you to take notes. Once they are in a NH, the care plan meetings are every 3 months. They are really good as usually there is someone from each area there (nursing, dietary, activities, social work) but usually neither the MD/medical director nor the DON (director of nursing, she is the goddess & ruler at the NH btw) come to the meetings. So if your wondering what arts & crafts could happen, or outings, or what the medication schedule is, or how she deals with cardiology issues, this is the time to ask and get group input. The plan is written down and you will be asked to sign. SO if there's something you want done, you put it in in the tiny space above your signature. My concerns with my mom were dietary issues and they did get on it and change what her meals were like.

Good luck in all this. It sounds like you've got her in a well managed place. Try to develop good relationships with the staff and it will downstream into good will for them in dealing with your mom.
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Thank you so much for all the input. This is all new to me but I've learned a lot in the last 10 days about Medicaid. I've been very fortunate so far in getting the info I needed quickly and having positive experiences. My mom is really in an excellent home and the long term unit is on the same floor with familiar faces. Everyone there has been awesome & they all seem to really care for my mom. We will be meeting on July 3 for her review & hopefully have a plan. I'm a little nervous because one of the CNA's told me there are currently no beds in long term but 2 women are staying in rehab unit waiting. The rehab unit has 16 rooms & only 8 are occupied right now. The lady who reviewed her Medicaid app said she had some forms for me & forms to send to the nursing home. Tomorrow i will find out what these are about, wondering if a form is for NH doctor. He's really only seen mom once when she arrived. We accompany her to the cardiologist. So is the NH required to send a form to her primary doctor or do I get a form for him to fill out about her dementia & health concerns?
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Thank you for your suggestions, igloo572. Yes, the meeting on the 3rd is a care plan meeting. We met first on June 6, 1 week after she was in rehab. it says it's to develop a new plan or review the existing plan. My sister & I will attend & definitely have questions. When I saw her medical file, it had a list of 6 or 7 items, the first or second being Alzheimer's/Dementia. I really do like the staff & I've talked with everyone from PT,OT,nurses, CNA's, admissions director & the one who goes over the Medicaid. I always let them know how much we appreciate how kind and caring everyone is to mom. The CNA's and nurses all love my mom and a nurse just told me today that my mom is always nice and seems happy. I just pray this doesn't change when we tell her she needs to stay there. That is going to be so hard. Thank you.
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cindyann - In regards to the reverse mortgage, I came across an article the other day when my mom was considering one. I found it here on Aging Care. I read in another post that links can't be shared. So the content of that article is below. So make sure to look into the profit that she might receive. It could bounce her out of Medicaid, but she'd have to take that cash and pay the nursing home privately. Once she spends it down, she would be eligible for Medicaid again. This is all based on how a person is eligible in Georgia. But here's the article...

With a reverse mortgage, however, you receive a check each month from the bank or mortgage company, and you never have to pay them back as long as you live in the house. If the loan is made to a married couple, then no repayment need be made until neither spouse is living in the home.

At that time, the loan is repaid, plus interest. If the family members cannot pay the loan off, the house will be sold. Note, however, that if the amount of the loan exceeds the net proceeds from the sale of the house, the bank is simply out of luck—it cannot come after the family members for the shortfall.

Thus, a reverse mortgage may make sense for you if:

You find yourself short of cash each month;
You would like to make lifetime gifts to your children or grandchildren and don't have the cash to do so;
You would like to have medical treatment not covered by Medicare or your health plan;
You would love to go on an extended vacation;
Your spouse must move into assisted living; or
You like the idea of drawing down some of the equity in your house without having to repay the loan during your lifetime, so long as you are living in your house.
The amount you can borrow depends on your age, the value of your house, and the current interest rate. The older you are, the more you can borrow, since your life expectancy is shorter and the bank won't have to wait as long to get repaid. Also, as interest rates rise, the amount you can borrow decreases.

However, it rarely makes sense for a single person who may soon need nursing home care to obtain a reverse mortgage, because as soon as they move out of the house, the loan will have to be repaid. That will cause the house to be sold, exposing the cash that had been protected by the home exemption. Then you have to figure out what to do with that cash so that the person qualifies for Medicaid!
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Bellastar has a great point. On occasion, when the bank takes back the house, there is a positive cash addition to the elder's bank account. However, since your mom's house is in debt for more than half it's fmv, you won't have that problem.

A reminder: everyone, don't engage with people who argue. They don't need encouraging! Smile.
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