Getting indigent 94 yr old into nursing home +Medicaid - Illnois 2018
February 27, 2018 7:54 PM   Subscribe

We are at the point of setting our hair on fire in dealing with the state Medicaid bureaucracy. Our 94 year old sister (in law) - is very infirmed, legally blind, etc and extremely difficult to transport ($200.00 medicar every hospital visit!) We are trying to get her into the best (small private room) Medicaid Home we can find in Chicago but the medical tests and records collection have us at our wits end. Its been going on for months We have spent $1200.00 transporting her to hospitals just the last month in order to get the required medical tests in order to qualify for Medicaid and the nursing home but the two part TB testing is driving us up the wall.

It seems the State of Illinois now requires TWO two day TB tests in order to qualify for Medicaid. We just completed the "first" 2 day (48 hr apart) test and now we find they want ANOTHER two day (48 hr apart) test. That's another $500.00++ for the medicar and having her health aid prepare her dress her for traveling more $..

We are retired and don't have endless money for such expenses but we can no long transport her in our car due to her infirmities, need for wheelchair, etc.

Just getting her dressed and ready to be transported takes HOURS then the driver with the van and wheelchair ramp has to come and pick her up -take her down to the hospital and then come back in a few hours and transport us all (we go with her) back to her "independent" senior hotel.

Is there some way to simplify this procedure? Can we hire a visiting nurseto come to her room and do these tests? Is there an eldercare lawyer who can help us cut through this endless procedural red tape?

We are truly at our wits end. No light at the end of the tunnel.

Her senior independent living hotel wants her gone by 3/1 because she had not been living independently for 2 years and other residents are complaining about her habits (odor) and she falls at least once a week and they have to call the Chicago Fire Dept. to pick her up and everyone is complaining about her not being appropriate to be in independent living plus she can no longer afford the services of a "health aid" at $15.00 an hour.

Personality wise she is difficult and, while she doesn't have dementia she lives in a semi fantasy world wherein she is much more independent in her own mind than she is. Basically she listens to a loud tv all day and gets her meals delivered to her room.

Bottomline, Can anyone offer us any advice? We have our own health problems (mid 70's)and really dealing with her is making us both stressed out and ill. Frankly - we would like to run away!

We really never even knew her only as a distant older sibling, were never close with her, etc.

Thanks very much for any help!
posted by Tullyogallaghan to Health & Fitness (11 answers total) 4 users marked this as a favorite
You are under no obligation to ensure her care.

You can talk to a social worker associated with the institution where she currently resides, and inform them that you are abdicating all responsibility.

In order to take care of your own selves, you should do this.
posted by yesster at 8:36 PM on February 27, 2018 [2 favorites]

This from a therapist/friend of mine: there should be a social worker with the Medicaid Home who will be able to at least answer your questions and make referrals, though probably not available to take over any of your tasks.

(I am so sorry you're having to deal with this. The prospect of living to a ripe old age grows more frightening by the day.)
posted by she's not there at 8:54 PM on February 27, 2018 [1 favorite]

Good lord, don’t abandon her.

I’m a social worker at a facility that has long term care patients but I do not have any Medicaid beds so I can’t give you specific advice regarding the application itself. She’s not there is correct that the facility you choose should have a social worker on staff that can assist you in your application.

Are there any funds for a deposit at a facility while you are waiting for the public aid application to come through? That can often move someone higher on an admission list.

Can you tell me which part of Chicago she is in? I could get you some resources for care managers and attorneys but my facility is on the North Shore so they might not be applicable.
posted by We'll all float on okay at 9:31 PM on February 27, 2018 [8 favorites]

Medicaid does not have a TB test requirement. A specific nursing home might, but no medical or lack of medical condition is needed for Medicaid. You qualify for Medicaid though Department of Human Services based on income and assets. You can apply online , over the phone or in person. Some hospitals and nursing homes will also apply on behalf of the patient.

Does she Medicare? Medicare covers up too 100 days, which sometimes helps for people still in a pending sitiuation.

If she is Medicaid with no benefits or Medicare the likelyhood of a private room is really really low.

Medicaid covers transport, so if you solve the insurance issue then you solve the transport one as well.

I'm sending you a pm as well.
posted by AlexiaSky at 9:40 PM on February 27, 2018 [2 favorites]

To clarify re: Medicare. (I am not a Medicare expert but someone well versed.)

To qualify for a bank of 100 days paid for by Medicare A in a skilled nursing level facility, a person must have a three midnight inpatient stay in the hospital. Then this person can go to a SNF for rehab BUT to continue to have Medicare coverage the person must make progress in physical and occupational therapy or have a skilled medical need like a g tube or daily IV antibiotics. It is not common for someone to use all 100 days of Medicare coverage. Also, if there is no supplemental insurance, after 20 a day stay there is a daily copay of about $167.

I explain this just to say that counting on Medicare to buy you some time would not necessarily work. However, if she does have a qualifying hospital stay, then it can be an easier transition to staying long term than just coming in public aid pending.
posted by We'll all float on okay at 10:12 PM on February 27, 2018

In terms of the TB is there a reason they aren't accepting the quantiferon blood test instead? With the out of pocket costs of transportation it may be easier/cheaper to have the blood test instead than the ppd skin test.
posted by AlexiaSky at 12:30 AM on February 28, 2018

She definitely needs to leave the independent living facility, regardless of whether they want her gone or not. She far beyond independent living.

How is she currently affording the rent there, though? It seems to be a huge leap from her being able to pay for the independent living place and jumping straight to a Medicaid-paid facility. I'm sure Medicaid will ask about this, too. She will be required to demonstrate need, which will entail providing financial information (tax returns, bank statements, an accounting of assets, etc.) from the past few years.

Generally speaking, if the individual has any sort of income, they will be required to spend a set portion of that on her housing before Medicaid kicks in. Any manager or social worker at a facility that accepts Medicaid will be able to explain the ins-n-outs of how it works.

Some places will accept new occupants on a "Medicaid pending" basis, during which she will be required to pay what she can. (see also: Medicaid spend-down) Once Medicaid approval comes through, the facility will then bill Medicaid retroactively for the balance. Medicaid approval will take several months. She will probably be denied at first. You will appeal. A few months will pass, then, hopefully, she will be approved. Again, any good social worker at a home will know how all this works. They deal with it on a daily basis.

We are trying to get her into the best (small private room) Medicaid Home we can find

Generally speaking again, Medicaid will not pay for a private room. Conversely, places that offer private rooms generally don't accept Medicaid for those rooms. Those places might have private rooms, but they are going to be private-pay. They might have a small number of dedicated "Medicaid beds" that will be dual-occupancy rooms. They will also almost always be on a waiting list.

You will find that most places that accept Medicaid will not be the nicest. They will be more like what we think of as the stereotypical "nursing home." There definitely are exceptions. When my mother needed to be moved to an Alzheimer's facility, we were lucky to find a place that actually had private rooms. But that was only in the lock-down Alzheimer's area. The rest of the nursing home was semi-private (i.e. two to a room.)

I'm sorry you have to deal with this. It's a hair-pulling exercise even in the best of situations.
posted by Thorzdad at 4:07 AM on February 28, 2018 [2 favorites]

Get an extremely accurate list of her assets, as something can come out of the blue, like a life insurance policy with a cash value, which can make her ineligible for medical assistance until it is divested. We learned that the hard way with my dad, who had lived one his pension for decades. We had to get him spent down to under $2000 each month, so his emergency savings also went toward medical expenses.
posted by childofTethys at 4:46 AM on February 28, 2018 [3 favorites]

fwiw, two TB tests before initial admittance to a care facility is relatively standard. A single case of TB in a facility full of people with weaker immune systems living in close quarters would be a moral and legal disaster. You should, however, be able to hire a visiting nurse to administer and read the tests, though I don't know if it would necessarily be cheaper.
posted by Lutoslawski at 6:53 AM on February 28, 2018

Every community has an agency whose job is to advocate for seniors. My local one is So. Maine Agency on Aging. In Illinois, Illinois Area Agencies on Aging. Locate the agency in her part of the state and get in touch; they should have useful information. She's lucky to have you but you are over-extended. If there's help, they'll know about it.
posted by theora55 at 6:59 AM on February 28, 2018 [5 favorites]

I'm sorry you're going through this. The Area Agency on Aging could help, as mentioned above, and I would also suggest contacting Illinois Citizens for Better Care, which helps people who are in/are looking for long term care. The link I shared is to their "help" page, which has their information and referral line as well as the ombudsman and some other local resources. They can help you find places that take Medicaid, and whether they have openings or have a waiting list. When there's a waiting list, it can sometimes be circumvented by having the person pay privately for a couple of months while "waiting" and then converting to a Medicaid bed.
posted by assenav at 10:11 AM on February 28, 2018

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