Paying For Assistant Living and Nursing Homes With No Money

OneEyedDiva

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Location
New Jersey
Many seniors will find themselves in need of assistant living or nursing home care. Not everyone can afford to pay for these things. I am not eligible for LTC insurance. Others may not have it because it was cost prohibitive. I was always leery about LTC insurance anyway...and find this tidbit disturbing, considering how much people pay for these policies and the peace of mind they are supposed to bring:
"Long-term care insurance will pay for assisted living, but you may have to jump through some hoops to receive your benefits. Many long-term care insurance companies automatically deny request for payment the first time. To get the insurance company to pay, you may need a doctor’s note describing your physical limitations that require help in at least two areas of activities of daily living. To speed along the process, ask a representative from the assisted living home to act as an advocate on your behalf."
This article lists methods to consider when needing to pay for entry into assisted living or nursing homes.
https://www.seniorliving.org/care/cost/no-money/
 

It's disturbing to read that a nursing home can just kick you out after you can no longer pay. If you have no family (or they can't pay for you, or are unwilling to take you in) what happens? They just set you out in a park somewhere? I'm serious! What do they do?
I've been personally acquainted with one person (a former brother-in-law) who through his own laziness did not get the Medic-Aid paperwork--proving that his mother was now officially out of money and now qualified for Medic-Aid--done for his elderly mother. BIL was warned and warned but didn't complete the paperwork in time and got a phone call from the head of the nursing home that his mother resided in that if they didn't get that proof of that paperwork by the end of the day, they were going to "strap your mother to her wheelchair and roll her out to the curb!" So his wife had to race down to the nearest Medic-aid office and managed to do it for him. So would they really have done that if they hadn't gotten proof of the paperwork?

I sometimes think so because 4 of my co-workers were in a kind of related situation with their mothers who resided in nursing homes:

1) mother was placed in a nursing home without the dementia-lockdown feature, daughter assured the facility that mother didn't have that wandering-off kind of dementia (she was in denial about it, I think), mother wandered off, staff brought her back & called daughter saying we think you should move mother to a lock-down facility, daughter said please let her stay because I'm sure she won't wander off again, facility says okay, mother wanders off again, facility after bringing her back calls daughter and says if mother wanders off one more time, we won't go after her but we'll just call the police & tell them to look for her and keep her there at the police station 'till you pick her up. So daughter had to go get the mother and keep her at her house 'till a spot opened up because she didn't want mom to be at the police station.

2) Another daughter gets a call from the facility that her mom resided in that mother was disruptive and upsetting the other residents and staff and you need to come pick her up and find another place for her immediately. Daughter says I was just leaving to go teach a class, let me just get my class started--the powers that be frowned on cancelling classes at the last minute--so I'll be there in about 30 min. Facility says no, if you're not here in 10 min. we're going to strap her to her wheelchair and roll her out to the curb! So she had to cancel class and go get the mother.

3) Another daughter's father-in-law also had the angry kind of dementia, beat up another elderly man who resided there putting other old man into the hospital and the facility called daughter saying come get him right now; daughter says I can't leave work right now, I'll be there when I get off this afternoon, no they say, the cops are here, other old man's family is saying they'll sue if your dad isn't taken out of here immediately, so she had to go get dad and take a leave of absence from work 'till the nearest facility that would take violent people had an opening.

4) Another daughter's mother came down with dementia, daughter tried hiring caregivers because daughter wasn't old enough yet for retirement so she could stay home with mother, mother was violent with caregivers so daughter had to take an unpaid leave of absence from work for 2 years and take care of mom 'till a spot opened up in the only facility here in town that would take violent residents on Medic-Aid. After mother was finally moved into the facility, daughter then had to work many years longer than she had planned and had taken such a financial hit during that 2-year period that she ended up losing her house & had to move into a tiny little apartment.

You know, a few summers ago, Huzz and I were on vacation and at a restaurant in a resort town where the only people who can afford to live there are very wealthy, I mean we're talking if not in the 1 percent, close to it. Well, we overheard a conversation at the next table of a bunch of 60ish-looking women at the next table; from their conversation ["I wish my husband's patients or all his employees would realize he needs a vacation too, etc."], all of the women but one seemed to be very wealthy and the one seemed to be middle class. Well, the rich ladies were telling the middle-class gal that they wished she would retire and put her elderly mother into a facility since it was keeping her so busy that they never got to see her much anymore. Middle-class says she couldn't afford to retire and didn't want to put mother into a facility instead of taking care of her at home since the nearest decent facility that took Medic-Aid was 2 hours away. A moment of stunned silence and then "Dear, why can't you afford to retire?" Middle-class: when Dad died, he left Mom broke and me with having to pay his funeral expenses and having to take Mom into my home. Rich Lady: But dear, your Dad had a good job, didn't he? Middle-class: Yes, but he and Mom lived paycheck-to-paycheck. Rich lady: And dear, why in the world is your mother on...Medic-Aid?! Isn't it that...that WELFARE program?! [Said in a horrified tone.] Middle-class: Since Dad left her broke. And the rich ladies all had horrified/disgusted looks on their faces and literally kind of drew away from her. Huzz told me afterward that he couldn't believe that these rich women had never heard of Medic-Aid, that you would've thought that they had at least overheard their rich husbands griping about it with their tax attorneys for crying out loud. What gripes me is how some people are so spoiled and sheltered from the reality for too many others in this world, I am really sick and tired of it.
 
I know in NY state medicaid takes over once your money has run out. In nursing homes a person might start out in a private room but after their savings and money from the sale of their homes is exhausted then medicaid starts paying. Plus they move from their private room to a shared room.
Not sure being moved would be very pleasant, maybe be somewhat upsetting, I would hope the quality of care wouldn’t be affected.
 
It's disturbing to read that a nursing home can just kick you out after you can no longer pay. If you have no family (or they can't pay for you, or are unwilling to take you in) what happens? They just set you out in a park somewhere? I'm serious! What do they do?
Caroln, my mother had gotten over $26,000 from her brother's insurance policy shortly before she needed to be admitted to a nursing home. That only lasted a few months. During her admission process, the account manager sat with me and gave me some very helpful information and instructions. He said when her money was spent down to $2,000 (really he said try to get it down to $1,800), Medicaid would kick in. It was such a nice facility with a wonderful staff so blessedly, she was able to stay there. I don't think all nursing homes take Medicaid patients and some of the ones that do may not be desirable facilities.

The reason the account manager said to get it down to about $1,800 is because the home took all of her Social Security, except $35 a month. He said to make sure that accumulation of those funds never added up to more than $2,000. I was able to get money from her nursing home account to buy necessities...clothing, personal care items, etc. When I presented the receipts to accounting, the money was taken out of her account to reimburse me.
 
Caroln, my mother had gotten over $26,000 from her brother's insurance policy shortly before she needed to be admitted to a nursing home. That only lasted a few months. During her admission process, the account manager sat with me and gave me some very helpful information and instructions. He said when her money was spent down to $2,000 (really he said try to get it down to $1,800), Medicaid would kick in. It was such a nice facility with a wonderful staff so blessedly, she was able to stay there. I don't think all nursing homes take Medicaid patients and some of the ones that do may not be desirable facilities.

The reason the account manager said to get it down to about $1,800 is because the home took all of her Social Security, except $35 a month. He said to make sure that accumulation of those funds never added up to more than $2,000. I was able to get money from her nursing home account to buy necessities...clothing, personal care items, etc. When I presented the receipts to accounting, the money was taken out of her account to reimburse me.
That is the secret to hopefully having a nice nursing home experience I learned recently with my God daughter and her mom (my old best friend) in Ohio. Her mom needed to go into long term care for possibly the rest of her life (they didn't know) and she got a lawyer. She learned to find the nicest place for her mom, put her in there and have the funds to pay for a few months, if necessary, there. Then, she could qualify in the meantime for medicare and she could stay without having to move to another facility.

She didn't have to stay longer than 3 months, but she has been back in the same nursing home a couple of times since. She is set up for medicaid to pay for her now and is always accepted back in. Now that's what I call long term care insurance.
 
I've been personally acquainted with one person (a former brother-in-law) who through his own laziness did not get the Medic-Aid paperwork--proving that his mother was now officially out of money and now qualified for Medic-Aid--done for his elderly mother. BIL was warned and warned but didn't complete the paperwork in time and got a phone call from the head of the nursing home that his mother resided in that if they didn't get that proof of that paperwork by the end of the day, they were going to "strap your mother to her wheelchair and roll her out to the curb!" So his wife had to race down to the nearest Medic-aid office and managed to do it for him. So would they really have done that if they hadn't gotten proof of the paperwork?

I sometimes think so because 4 of my co-workers were in a kind of related situation with their mothers who resided in nursing homes:

1) mother was placed in a nursing home without the dementia-lockdown feature, daughter assured the facility that mother didn't have that wandering-off kind of dementia (she was in denial about it, I think), mother wandered off, staff brought her back & called daughter saying we think you should move mother to a lock-down facility, daughter said please let her stay because I'm sure she won't wander off again, facility says okay, mother wanders off again, facility after bringing her back calls daughter and says if mother wanders off one more time, we won't go after her but we'll just call the police & tell them to look for her and keep her there at the police station 'till you pick her up. So daughter had to go get the mother and keep her at her house 'till a spot opened up because she didn't want mom to be at the police station.

2) Another daughter gets a call from the facility that her mom resided in that mother was disruptive and upsetting the other residents and staff and you need to come pick her up and find another place for her immediately. Daughter says I was just leaving to go teach a class, let me just get my class started--the powers that be frowned on cancelling classes at the last minute--so I'll be there in about 30 min. Facility says no, if you're not here in 10 min. we're going to strap her to her wheelchair and roll her out to the curb! So she had to cancel class and go get the mother.

3) Another daughter's father-in-law also had the angry kind of dementia, beat up another elderly man who resided there putting other old man into the hospital and the facility called daughter saying come get him right now; daughter says I can't leave work right now, I'll be there when I get off this afternoon, no they say, the cops are here, other old man's family is saying they'll sue if your dad isn't taken out of here immediately, so she had to go get dad and take a leave of absence from work 'till the nearest facility that would take violent people had an opening.

4) Another daughter's mother came down with dementia, daughter tried hiring caregivers because daughter wasn't old enough yet for retirement so she could stay home with mother, mother was violent with caregivers so daughter had to take an unpaid leave of absence from work for 2 years and take care of mom 'till a spot opened up in the only facility here in town that would take violent residents on Medic-Aid. After mother was finally moved into the facility, daughter then had to work many years longer than she had planned and had taken such a financial hit during that 2-year period that she ended up losing her house & had to move into a tiny little apartment.
That's exactly the kind of disturbing things I was referring to. How can these places be so callous? I see nursing home and assisted living websites spouting about their loving and tender care, then read about this sort of stuff going on. These places are nice and caring until the money runs out. I guess it's the corporations that own these places, though, not the staff that makes the rules.

My own father was ejected from a nursing home because he was disruptive. He was blind and mostly deaf and when he needed something he yelled for assistance, which bothered the other "inmates". I had one afternoon to find another place for him. They didn't even help me pack up his stuff and get it, or him, out to the car. Just...get out. And they were s-o-o-o nice when he was accepted into the facility. A bunch of double-dealing hypocrites.

How is this allowed to happen??? What would they have done if I couldn't find another place in a matter of a couple hours? Curbside service for him too?

And in relation to the question of standard of care for those self paying patients versus Medicaid paying patients, I had to find a temporary nursing home for my mom after her operation. I looked at 3. One I remember in particular. The self paying patients rooms were fine, but when I passed by the Medicaid rooms, they were messy, stuff strewn everywhere, and the whole wing smelled bad. (Yes, the Medicaid patients are separated from the self paying.) Obviously the Medicaid patients did not received the same care. My mom's nursing home experience is another whole story, too long for this post.
 
How is this allowed to happen???
As you said, it's because of the corporations that own these places. My niece-in-law has worked at more than a few of these corporation-owned places and she'd come up with ideas to make things easier/more pleasant for residents (and staff) and even after offering to pay out of her own pocket the paltry amount that it'd cost, was told no, nope, forget it, not what's in our corporate by-laws, brochure, etc., nope.
 
I've been personally acquainted with one person (a former brother-in-law) who through his own laziness did not get the Medic-Aid paperwork--proving that his mother was now officially out of money and now qualified for Medic-Aid--done for his elderly mother. BIL was warned and warned but didn't complete the paperwork in time and got a phone call from the head of the nursing home that his mother resided in that if they didn't get that proof of that paperwork by the end of the day, they were going to "strap your mother to her wheelchair and roll her out to the curb!" So his wife had to race down to the nearest Medic-aid office and managed to do it for him. So would they really have done that if they hadn't gotten proof of the paperwork?

I sometimes think so because 4 of my co-workers were in a kind of related situation with their mothers who resided in nursing homes:

1) mother was placed in a nursing home without the dementia-lockdown feature, daughter assured the facility that mother didn't have that wandering-off kind of dementia (she was in denial about it, I think), mother wandered off, staff brought her back & called daughter saying we think you should move mother to a lock-down facility, daughter said please let her stay because I'm sure she won't wander off again, facility says okay, mother wanders off again, facility after bringing her back calls daughter and says if mother wanders off one more time, we won't go after her but we'll just call the police & tell them to look for her and keep her there at the police station 'till you pick her up. So daughter had to go get the mother and keep her at her house 'till a spot opened up because she didn't want mom to be at the police station.

2) Another daughter gets a call from the facility that her mom resided in that mother was disruptive and upsetting the other residents and staff and you need to come pick her up and find another place for her immediately. Daughter says I was just leaving to go teach a class, let me just get my class started--the powers that be frowned on cancelling classes at the last minute--so I'll be there in about 30 min. Facility says no, if you're not here in 10 min. we're going to strap her to her wheelchair and roll her out to the curb! So she had to cancel class and go get the mother.

3) Another daughter's father-in-law also had the angry kind of dementia, beat up another elderly man who resided there putting other old man into the hospital and the facility called daughter saying come get him right now; daughter says I can't leave work right now, I'll be there when I get off this afternoon, no they say, the cops are here, other old man's family is saying they'll sue if your dad isn't taken out of here immediately, so she had to go get dad and take a leave of absence from work 'till the nearest facility that would take violent people had an opening.

4) Another daughter's mother came down with dementia, daughter tried hiring caregivers because daughter wasn't old enough yet for retirement so she could stay home with mother, mother was violent with caregivers so daughter had to take an unpaid leave of absence from work for 2 years and take care of mom 'till a spot opened up in the only facility here in town that would take violent residents on Medic-Aid. After mother was finally moved into the facility, daughter then had to work many years longer than she had planned and had taken such a financial hit during that 2-year period that she ended up losing her house & had to move into a tiny little apartment.

You know, a few summers ago, Huzz and I were on vacation and at a restaurant in a resort town where the only people who can afford to live there are very wealthy, I mean we're talking if not in the 1 percent, close to it. Well, we overheard a conversation at the next table of a bunch of 60ish-looking women at the next table; from their conversation ["I wish my husband's patients or all his employees would realize he needs a vacation too, etc."], all of the women but one seemed to be very wealthy and the one seemed to be middle class. Well, the rich ladies were telling the middle-class gal that they wished she would retire and put her elderly mother into a facility since it was keeping her so busy that they never got to see her much anymore. Middle-class says she couldn't afford to retire and didn't want to put mother into a facility instead of taking care of her at home since the nearest decent facility that took Medic-Aid was 2 hours away. A moment of stunned silence and then "Dear, why can't you afford to retire?" Middle-class: when Dad died, he left Mom broke and me with having to pay his funeral expenses and having to take Mom into my home. Rich Lady: But dear, your Dad had a good job, didn't he? Middle-class: Yes, but he and Mom lived paycheck-to-paycheck. Rich lady: And dear, why in the world is your mother on...Medic-Aid?! Isn't it that...that WELFARE program?! [Said in a horrified tone.] Middle-class: Since Dad left her broke. And the rich ladies all had horrified/disgusted looks on their faces and literally kind of drew away from her. Huzz told me afterward that he couldn't believe that these rich women had never heard of Medic-Aid, that you would've thought that they had at least overheard their rich husbands griping about it with their tax attorneys for crying out loud. What gripes me is how some people are so spoiled and sheltered from the reality for too many others in this world, I am really sick and tired of it.
Re: Your last paragraph. I'm surprised they let her into their inner circle in the first place unless she pretended to be wealthy like them. We should realize how detached from reality the rich are when we read about some of the policies they come up with that affect the poor and the shrinking middle class.
 
State Data & Information - NursingHome411
Here is a link to some interesting general information, by state.
I had to deal with a few nursing homes for family members. Some took medicaid, some did not. One (very nice one) accepted Medicaid only after the resident was self pay for 2 years prior.
Thank you for posting the link. You reminded me about this site that gives comparative information about nursing home vs at home care costs.
Although it is showing cost of care in N.J., scroll down to the Cost of Care Calculator and choose your state and type of care from the drop down menus. https://www.payingforseniorcare.com/new-jersey
 
Although it is showing cost of care in N.J., scroll down to the Cost of Care Calculator and choose your state and type of care from the drop down menus. https://www.payingforseniorcare.com/new-jersey
Thank you for this. My experience with self pay x 2 yrs was actually in Bergen County.
Most times the need for nursing home care is last minute and unexpected.
A sudden illness, hospitalization, then the need for short term rehab. Depending on the patient's age, cognition, and ability to have assistance at home a switch from rehab to nursing home is sometimes necessary.
It leads to much confusion and uncertainty. The more everyone knows, the more prepared we can be.
 
Thank you for this. My experience with self pay x 2 yrs was actually in Bergen County.
Most times the need for nursing home care is last minute and unexpected.
A sudden illness, hospitalization, then the need for short term rehab. Depending on the patient's age, cognition, and ability to have assistance at home a switch from rehab to nursing home is sometimes necessary.
It leads to much confusion and uncertainty. The more everyone knows, the more prepared we can be.
Aaaah...the infamously expensive Bergen County!
 
It's disturbing to read that a nursing home can just kick you out after you can no longer pay. If you have no family (or they can't pay for you, or are unwilling to take you in) what happens? They just set you out in a park somewhere? I'm serious! What do they do?
They move you to a home that accepts Medicare. These are state-run facilities, not pleasant places to live out your final days. The up-side is, your final days are greatly reduced in state-run nursing homes.
 
They move you to a home that accepts Medicare. These are state-run facilities, not pleasant places to live out your final days. The up-side is, your final days are greatly reduced in state-run nursing homes.
Or as in the case of the co-worker's father-in-law I mentioned earlier, she was told that if he had had no family to take him in and there were no facilities within that county that took violent dementia cases (or, not him but others on Medic-Aid), that he would have been put in the nearest jail 'till one of the violent care facilities opened up. That was in Oregon; not sure about this or other states.
 
That is the secret to hopefully having a nice nursing home experience I learned recently with my God daughter and her mom (my old best friend) in Ohio. Her mom needed to go into long term care for possibly the rest of her life (they didn't know) and she got a lawyer. She learned to find the nicest place for her mom, put her in there and have the funds to pay for a few months, if necessary, there. Then, she could qualify in the meantime for medicare and she could stay without having to move to another facility.

She didn't have to stay longer than 3 months, but she has been back in the same nursing home a couple of times since. She is set up for medicaid to pay for her now and is always accepted back in. Now that's what I call long term care insurance.

They move you to a home that accepts Medicare. These are state-run facilities, not pleasant places to live out your final days. The up-side is, your final days are greatly reduced in state-run nursing homes.
There is some confusion here about the two programs MEDICARE and MEDICAID. They are not the same, and it is very important people use the terms correctly. You do not want to be making these kinds of mistakes when 'push comes to shove' and you are talking to eldercare facilities and attorneys.

Medicare is funded by premiums paid by workers. It is a basic hospitalization/prescriptions insurance, meant for illnesses and injuries to those over 65. It is overseen by the Social Security Administration.

Medicaid is 50% funded by Feds and 50% funded by the state you live in. Control of Medicaid funds is COMPLETELY under state government control, as long as they follow certain minimum federal requirements. This includes the state 100% matching the federal funds grant. Thus, for example, during the COVID temporary expansion of Medicaid benefits, some states DID NOT accept those temporary funds because they did not wish to match those extra federal funds, seeing no need to increase spending on COVID prevention.

Medicare pays for convalescent care, i.e., recovering from illness/injury, as defined by its disability standard of 2 ADLs. It will pay as long as you show improvement; however, funding is otherwise limited to 90 days. You MUST go into a care facility directly from the hospital, upon doctor recommendation. As the saying goes, "do not pass 'Go'"; IOW, do not go home for a day or even half a day, in-between.

Medicaid reimburses for Skilled Care Nursing but at a lower rate than market. Because the US does not have universal healthcare, it is completely up to a facility to decide whether to take Medicaid patients or not. It is up to the facility to decide whether to help patients (and their families) once their money runs out, with the Medicaid paperwork. Since they lose money on Medicaid patients, they generally prefer not to bother, in the case of for-profit chains. Nonprofits tend to be more generous about assisting residents/families.

So yes, when it comes to Medicaid, a facility reserves the right to enforce its own policies. Anyone who enters an eldercare facility should pay attention to the type it is, the financial strength of the facility, and its policy on transfers.

It should be noted that many facilities have stringent rules on dementia patients; often there are personality changes and workers have been injured. If you are looking for eventual Memory Care, be aware your choices of facilities will be far more limited.

Too many people fall for the "pretty reception area" sales pitch and fail to do sufficient research into what their options are when things start to go badly. And you do not have the right to sue; virtually all facilities use and enforce an arbitration clause wherein if you become a resident, you have accepted an arbiter's judgment.
 
I don't know how things are these days.. and hope I don't need to find out.. but when my parents owned and operated a Home they accepted both self-pay and medicaid. There were no differences in the way the elderly folks were treated, although private individuals could have their own rooms but most preferred to share rooms anyway.
Nobody was kicked out over a change in income (or source), that's for sure.
 
Medicare pays for convalescent care, i.e., recovering from illness/injury, as defined by its disability standard of 2 ADLs. It will pay aes long as you show improvement; however, funding is otherwise limited to 90 days. You MUST go into a care facility directly from the hospital, upon doctor recommendation. As the saying goes, "do not pass 'Go'"; IOW, do not go home for a day or even half a day, in-between.
May I add that "convalescent care" is commonly known as "short term rehab." To be eligible, all of the items @Lethe200 stated, PLUS a mandatory hospital stay of at least 3 midnights.
 
May I add that "convalescent care" is commonly known as "short term rehab." To be eligible, all of the items @Lethe200 stated, PLUS a mandatory hospital stay of at least 3 midnights.
Thank you Kika, a very important point. Be aware that many hospitals try to "fudge" the definition of "admittance" by claiming they are keeping patients for several days for "observation". To Medicare, those two terms are NOT the same; Medicare does not pay for hospital stays of 'observation', no matter how short or long they may be!
 
It's disturbing to read that a nursing home can just kick you out after you can no longer pay. If you have no family (or they can't pay for you, or are unwilling to take you in) what happens? They just set you out in a park somewhere? I'm serious! What do they do?
I guess you wish you lived in the Amish community.
 
Doesn't medicaid kick in?
Absolutely. If you are deemed qualified to need long term care. They will of coarse take your money first. What can you have? Is it about $2,000 left? I'm not sure. They will take your income whatever it is, leaving you with the 40 or so dollars a month.

However, if you are in a long term facility and they decide you don't need it anymore and you have no place to go. They will discharge you to a homeless shelter. Think I'm making this up. I'm not. It's not an everyday occurrence but it can happen.
 


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