Long Term Care Co, now paying her, wants to 'reassess' my Mom in Assisted Living

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RandomName

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My Mom has been in assisted living since August of 2023. My sister got her approved for payments from her LTC co, and Mom has received eight monthly payouts so far.

For the initial approval, a nurse from the LTC came to the AL apartment and talked to Mom and my sister. Mom was on 'level 1' level of care with the AL place at that time.

Out of the blue, a nurse called my sister and said the LTC co was sending her out to the assisted living facility to do a 'reassessment' of Mom. My sister asked why it was being done, and the nurse was vague. Sounds like they want to assess Mom as not needing the benefit any more.

Mom is about the same as she was when she got approved, except her memory is worse, and she is anemic now due to bleeding from inoperable tumors in her bladder, and therefore sleeps more.

Why are they 'reassessing' Mom? Routine practice? Nothing to get upset about?

Any comments welcome !
 

It is routine practice. Reassessment is usually done annually. They basically verify her eligibility for the benefits she's getting and see if she's eligible for additional benefits.

One caution; they sometimes say the person needs "more appropriate placement" and then try to get them into a cheaper place. Avoid that by making sure they see that all your mom's needs are being met with no difficulties or challenges whatsoever.
 
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Murrmurr said:
It is routine practice. Reassessment is usually done annually. They basically verify her eligibility for the benefits she's getting and see if she's eligible for additional benefits.

One caution; they sometimes say the person needs "more appropriate placement" and then try to get them into a cheaper place. Avoid that by making sure they see that all your mom's needs are being met with no difficulties or challenges whatsoever.
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Thanks for the information. Here's an update. I'm getting worried, but maybe (hopefully) needlessly.

My sister is talking to the LTC co about why they need to do a reassessment. LTC co said it was to determine continued eligibility for benefits. The LTC company says they sent a 'functional cognitive screening' form to Mom's assisted living facility, and that the form was never returned, and that is why they want an on site visit from a nurse to do a 'reassessment'.

Coincidentally, just before this 'reassessment' stuff started, Mom received a memory assessment in Skilled Nursing at the same organization that owns her AL place. She did pretty well on it, I think. Doing well is bad, I assume, for getting benefits. Wondering if this test is part of why the AL staff never returned the form. She was in skilled nursing for 10 days, following a hospitalization.

The AL place never said anything about the form to me or my sister.

The AL staff was helpful in getting Mom approved for the claim when she moved in back in Aug, 2023, and it would be convenient for them to be 'on board' with us, and help us with this form, but they never mentioned any form.

LTC co implies that the chance to fill out and return that form is over, and that the next step, a visit from a nurse, is mandatory in order to keep the claim open. They are asking us to schedule a date for a nurse to visit. I or my sister can be there with Mom and the nurse for the reassessment.

My sister was there for the initial assessment by a nurse. It was a friendly interview. Mom was approved for benefits. But I never could figure out why. Did she need to do poorly, or do well, on the cognitive ability test?

As far as ADL's (activities of daily living) , she gets help with showers, and I think that is it. She walks with a walker usually, sometimes uses a wheel chair, by herself, and feeds herself.

Frankly, I am surprised they approved her claim back in Aug, 2023. My sister was the person coordinating all of this. She now wants me to step in and take over, which I do not want to do, but may have to.

She wants me to be there when the nurse does the reassessment. I live only 90 miles away, but she would have to fly up. I want to know what to expect at the nurse interview.

I'm waiting for my sister to get some answers from Mom's AL staff about this form they refused to fill out.

Hopefully it is just standard procedure, nothing to get all paranoid about, but my sister thinks the LTC co is trying to get out of continuing to pay.

Advice welcome.
 
RandomName said:
... I want to know what to expect at the nurse interview.

I'm waiting for my sister to get some answers from Mom's AL staff about this form they refused to fill out.

Hopefully it is just standard procedure, nothing to get all paranoid about, but my sister thinks the LTC co is trying to get out of continuing to pay.

Advice welcome.
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They usually ask how much physical assistance Mom needs with hygiene, dressing, meal prep..."tasks of daily living" is what they call it.

They also usually ask if Mom needs prompts and reminders because she is forgetful and if you sometimes fear for her safety when she is unsupervised....like does she sometimes leave the oven or stove on, have falls, is careless with electrical stuff, etc.

Be honest, but keep in mind: if she needs minimal assistance, it could mean minimal benefits, and if she needs a LOT of assistance, they may find "more appropriate placement", and you probly don't want that.
 
New development.

My sister found out from the LTC co that the assisted living place ignored email requests for a 'benefit eligibility review' from the LTC ins co back in Feb, 2024, and the 'maximum number of followup requests has been reached'.

My sister has asked the assisted living place about it, and they responded that they never got any such requests. My sister then asked the LTC co for screenshots of their email requests.

We might still be stuck with the nurse review, unless the LTC co will allow a review by the assisted living place this late in the game. wow.
 
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What state are you in?

I am not familiar with any of this stuff, but if you mention your state maybe we could help you find some Senior Advocacy agencies or groups there who can help you understand the process and make sure they are not screwing your mom over?
 


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