I read an article on Care.com written in 2013 entitled "8 things to look for in a Nursing Home Agreement." The very first point in this article reads as follows: "Government-subsidized aid - Not all facilities accept Medicare or Medicaid, but the contract should explicitly state whether the facility takes either or both. It's illegal for a facility that participates in these programs to force your parent to pay privately for a period of time before accepting her as a Medicare or Medicaid resident.
So with that here's my question. My mom already qualifies for Medicaid and has been on Medicaid for over five years. She is currently living at home and I'm her primary caregiver. She has reached a point where I feel I may need to place her in a memory care unit. I've called several facilities that accept Medicaid in the Chicago suburban area and each told me the same thing and that is - "We can put your mom on a waiting list, but all of our medicaid beds go to patients who start off as private pay and then after 4 to 5 years in some cases; funds run out and we switch them to one of our medicaid beds. " In essence, I've been told it is virtually impossible to get my mom admitted to any of these facilities without first selling her home and paying privately, expending funds to at least cover 4 to 5 years. I've been told that the so called medicaid facility never takes a patient "from the outside" who is already medicaid eligible. Is that legal? Do I have any recourse? Have others encountered the same issue? The issue about requiring the sale of the home also seems illegal. In Illinois (perhaps elsewhere) if a child is required to move into the parents home and has lived there for at least two years to forestall the need to place the parent in a nursing home that home is exempt from medicaid estate recovery.
The policy you have described is common in many MC/AL. I would imagine the policy was created with fairness to others who are in the same situation and have priority because they had been self pay for so many years. .
It is to prevent discrimination against those patients. It wouldn’t be right for you to expect your mother to be placed at the top of their list over the others.
Many patients come to these facilities directly from hospitals, often for a period of rehab paid for by Medicare.
It is then determined that the patient can no longer live at home and said patient starts the spend down to Medicaid eligibility. When spend down is complete, they transition to Long Term Medicaid or a Medicaid waiver program.
For us, the key was working with the discharge planners at the hospital to get mom into the best Rehab/NH that would KEEP her as a Medicaid-pay resident after a period of private pay. I was a bit shocked when the Discharge department wanted to see a rough estimate of mom's assets before telling us which places to look at, but my SIL the MBA (who had been down this street with her own parents) understood completely and was able to supply the numbers.
This is why so many of us urge folks who have loved ones in the hospital to accept rehab, as it can be the easiest way to transition them into long term care.
Realize that a hospital stay and rehab could change the status. She is now in the facility for medical need and could transition to long term care.
Facilities only have a certain number of Medicaid beds and it is only fair that people that have lived and paid for years get to stay in their homes before a new person moves in.
It is difficult when you are first placing a loved one and the rules seem screwy, but you will appreciate it when she can't be displaced because of another person needing care.
Get on the lists and remember when she needs rehabilitation from a hospital stay to try and get her into the facility that you would like her in long term.
Hugs, it is challenging.
The home can become an exempt asset for a caregiver that has provided care for two years before the need for a nursing home. Medicaid would still place a lien on the home for repayment when sold. It may not be exempt from MERP.
So, see an attorney that can give you guidance.
Some very high-end NHs do want to see assets that cover a few years. I would look into a non-profit, faith-based facility that may be higher quality with more Medicaid beds. They didn't have a waiting list. That's where we transferred my MIL to and it's been fantastic. Good luck!