What should happen to old people w/o money?

[cronewitch]

If an old person who is in need of care doesn't have anyone to help them what should happen to them?

If they are in a nursing home and run out of money but haven't applied for or gotten Medicaid because their mind isn't working right or they don't qualify can they be evicted? What if the nursing home doesn't take Medicaid can they just be put in a cab and set to the streets?

YM is saying if your income is more than 2K a month you can't get Medicaid even if you are broke. So you have too much for Medicaid but not enough to pay for the nursing home.

If you don't have family or friends can they really put you on the streets when you aren't able to even feed yourself?

If they couldn't put people out nobody would pay and it isn't fair to a business to make them provide free care.

[swamp]

Hospitals and nursing homes have social workers who find placement and funding for these people.

[The J]

Soylent green?




(Sorry...somebody had to say it)

[Deleted]

Once they accept you, they are pretty much bound to continue you caring for you. At least that is the way i understand it for my mom' s assisted living. She pays until the money is all gone and then the state takes over and she stays put.

[Sum Dum Gai]

If an old person who is in need of care doesn't have anyone to help them what should happen to them?

The government should step in... and give them free one way plane tickets to Zimbabwe.

[busymom]

In our state, a social worker steps in & finds them a spot in a nursing home that accepts federal money.



We already pay for babies that no one made plans for. Why shouldn't we care for old people that no one planned properly for??

[shanendoah]

So the 2k/month limit is the limit in WA state. Medicaid varies per state, and it could be different elsewhere.
All the social workers/office personell we met with made it very clear that with insurance, we did not have to pay the monthly bill until after insurance had paid, but that if we didn't pay, or if insurance ran out and we didn't pay in full within X amount of days, they could and would put her out on the street. (Okay, more likely they would have called an ambulance and sent her to a hospital, given her particular state of health.)
Hospitals are required to care for you regardless of your ability to pay. Skilled Nursing Facilities are not.
I suppose it is possible to work with a place that has a contract that says they won't put people out on the street, but that's certainly not the law or even the standard in the Seattle area.
The facilities have social workers who work with families and patients to the best of their abilities to make sure this is all understood. Discharge planning is a complicated thing.
But most likely, people will end up in hospitals where their care can't be refused and because hospitals do have discharge rules, they can't be discharged because no other facility will take them.

[The Captain]

The way it worked in my Grandmother's case is the nursing home took her in and provided care until her assets were exhausted. Then the home provided assistance (they were great!) with getting her qualified for Medicare. Between my Grandfather's pension and SS Grandma was getting about 2k a month of which the home got all but $50. I don't know how much medicare covered after the 2k but all of the nursing homes in our area take Medicare. The trick for getting into one of the "nicer" ones it to be able to self-pay for awhile.

I'm not a lawyer but I believe they have to find a bed for you if care is required.

[The Captain]

May 11, 2012 13:05:46 GMT -5 busymom said:

In our state, a social worker steps in & finds them a spot in a nursing home that accepts federal money.



We already pay for babies that no one made plans for. Why shouldn't we care for old people that no one planned properly for??

The old people had over 40 years to prepare, the babies had no choice. Just saying...

[findingdeadbeats]

If they were living with you prior to hospital care, as in the case of my late DH with the hospital, they put him in a medical transport to home, had the local volunteer fire department dispatched to help place him in bed, and then it was my problem what we did from that point on. Him not being able to walk/think did not get me any choice in the matter. It was not considered to the doctor to be a reason to require admittance to the hospital therefore he was released. (And, I was reported for neglect/abuse for refusing to pick him up, hoping that would force them into finding a placement for him...)

If you are married, and your spouse ends up in this limbo place, you can expect them to be brought back to your house for care whether you can provide them the care they need or not. And, your spouse can refuse admittance to the hospital, regardless of their health situation or illness, and the same above will happen.

In the US, you have the legal right to refuse medical care and to live in your own home. No matter what the implications on the rest of your home or if there is anyone who can care for you. If you live with someone you are related to, they are required to care for you or be charged with abuse/neglect.

[shanendoah]

Medicare does NOT pay for nursing home/custodial care. They only pay for skilled care, up to 120 days in a calendar year. What that means is that the person has to be actively doing rehab with a plan for them to leave care. This is what MIL started with. Total knee replacement surgery, then in a skilled facility to do PT. Medicare would only pay while she was in need of the skilled (ie rehab) care.
On some level, we were lucky enough that when she went downhill, she went fast, and before Medicare could issue a Notice of Medicare Non-Coverage, she passed.
If a person is not getting active rehab, Medicare is NOT footing the bill. Medicaid is- and those are state funds, not federal funds (without getting into the issues of the fact that the federal gov't subsidizes medicaid for the states).

SNFs do NOT have to find a bed for you. Hospitals do, but nursing facilities do not

[busymom]

Crone, if you know someone in that situation, I'd be speaking with both a social worker AND an attorney. Sometimes, the squeaky wheel gets the grease!


Oh, and I should have said government money, not federal money. Rehab is covered by federal money. It gets a little more complicated once an elderly family member is out of rehab, and you're trying to figure out the next logical placement for them.

[The Captain]

Oops, my bad. I said medicare and meant medicaid for grandma's care.

[Deleted]

apparently they should just wither and die so they stop sucking all us taxpayers dry.

[cronewitch]

I don't know anyone now but I don't have a spouse or children so if I was to run out of money at say 95 with no siblings or anyone I wouldn't want put on the street.

Grandma was in assisted living at 98 she only had enough money for about 2 more years but her assisted living said they would keep her if she ran out of money. She had two daughters who would have helped her apply for Medicaid if she needed it but many people have nobody left.

We might have 40 years to save for old age but it is expensive once you are in nursing homes or assisted living. Mom said a couple of years ago she could only afford 12 years. She has income of about 35K a year but if assisted living is 80K you could run out of money even if you were a pretty good saver. She is 85 and in good health and has kids to help her so can probably live at home until she is over 95 like her mom did.

I am asking about people without family so a situation like Shasta's husband couldn't happen if they have nobody to you on.

[findingdeadbeats]

If you have no one, then you become a "permanent patient"

www.ncpa.org/sub/dpd/index.php?Article_ID=21464

[Deleted]

May 11, 2012 13:12:13 GMT -5 shanendoah said:

Medicare does NOT pay for nursing home/custodial care. They only pay for skilled care, up to 120 days in a calendar year. What that means is that the person has to be actively doing rehab with a plan for them to leave care. This is what MIL started with. Total knee replacement surgery, then in a skilled facility to do PT. Medicare would only pay while she was in need of the skilled (ie rehab) care.
On some level, we were lucky enough that when she went downhill, she went fast, and before Medicare could issue a Notice of Medicare Non-Coverage, she passed.
If a person is not getting active rehab, Medicare is NOT footing the bill. Medicaid is- and those are state funds, not federal funds (without getting into the issues of the fact that the federal gov't subsidizes medicaid for the states).

SNFs do NOT have to find a bed for you. Hospitals do, but nursing facilities do not

A nursing home is skilled care (hence, the nursing).
If you need unskilled care from a home worker or an assisted living/personal care community, you are screwed though. Neither Medicaid nor Medicare will pay for that.

[findingdeadbeats]

MediCARE = Health insurance for older/disabled people. Pays for limited rehabilitation care but not long tern nursing home care.

MediCAID = Health coverage for the poor which will pay for nursing home care for someone with no assets and low income, and sometimes in home support for people who are not deemed sick enough to require a nursing home/SNF. MediCAID doesn't pay for "assisted living" or other rental type places because they are considered residences and not medical facilities.

MediCARE = Federal program with same rules everywhere. Part A pays for most hospital stuff, Part B you pay for each month out of your SS checks and covers most clinical type appts. Part D is drug coverage and that is something you also pay for each month and it helps pay your RX costs until you get to the dreaded "donuts hole" where it pays nothing until you pay a couple thousand dollars out of pocket.

MediCAID = State run programs which vary depending on where you live. Some states pay more to support many illegals and their health care needs and that limits the coverage for everyone.

[Deleted]

Thanks, Shasta. It drives me crazy when people confuse the two, because you end up with plenty of people who think that "Medicare" provides a type of LTC coverage, when only Medicaid does, and that's available only to people with low income and no assets.

[973beachbum]

May 11, 2012 15:07:08 GMT -5 @athena53 said:

Thanks, Shasta. It drives me crazy when people confuse the two, because you end up with plenty of people who think that "Medicare" provides a type of LTC coverage, when only Medicaid does, and that's available only to people with low income and no assets.

From what I have heard in NJ it is normally only easy for people who truly are destitute. When the person is young, has family living with them, has some income beyond SS etc.

We did have a few cases of LTC facilities literally packing up their residents belongings and calling them a cab and wheeling them to the street. They had been self pay but by the time they had used up all their asets the facility had as many medicaid patients as they said they could have. It was a big stink. Just the picture in the paper of an elderly person in a wheelchair with no "home" was pretty disturbing to most!

The NH's point of view was that although they had promised to let these residents stay after they had used up all their assets they should not be legally bound by that. The NH said that if they had more than a certain percent of patients on medicaid they wouldn't be able to run the business the way they wanted.

Either way it is a real tough place for those people to be in.

ETA This is a link that explains the incidents I was refferring to.
www.nj.gov/ooie/pdf/ALCPressRelease.pdf

[cronewitch]

I think I will go live on a Cruise ship, cheaper than assisted living and they clean your room and feed you.

[Works4me]

Medical Social Worker since 1987 - $2K income is BS for Nursing Home Medicaid and I hate it when people are misled! Will write it out tonight ass there are a ton of details. Can also explain some of the ins and outs of the system.

ETA - what Shanendoah was told about putting someone out when funds run out is illegal by Federal Law! They also cannot be sent to an acute care hopital unless there is an acute care need. However if the facility can get you to agree to it they are sitting pretty because once you exit as a patient they do not have to take you back.

Shasta - wish I had known you then as what they did actually is illegal aside from being immoral and unethical. However, that is what facilities will do with difficult cases and it is hard as hell to effectively fight it.

At some point I have wanted to start a non-profit to inform and educate people as to the laws and facts because most nursing homes and hospitals and assisted living exploit people and the system so badly. Also LOVE helping people "stick-it" to certain types of facilities.

[TD2K]

www.prokerala.com/news/articles/a285611.html


Need to think outside the box


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The Fokkens shot to fame overnight when a documentary featuring their lives premiered at a Dutch film festival last November, Xinhua reported.

[qofcc]

YM is saying if your income is more than 2K a month you can't get Medicaid even if you are broke. So you have too much for Medicaid but not enough to pay for the nursing home.

In NY, if you need nursing home care you can get Medicaid after your assets are spent regardless of your income. Medicaid takes your income (ss check or whatever), lets you keep the first $50 or so and pays the nursing home bill.

[midjd]

Euthanasia?

[findingdeadbeats]

If I am ever in this situation where I need 24/7 care, I hope that physician assisted suicide is legal, if not, I am sure to find a way.

[Deleted]

May 11, 2012 16:10:30 GMT -5 @tbird said:

I shall geteth myself to the nunnery!

I think nunneries are wise to that- they have a maximum entry age! The church is struggling to take care of its ageing nuns, though- my mother's cousin was actually sent to teach in the public schools for 10 years even though she was a nun (I assume she wore regular clothes) so she could get in her "40 quarters" for Medicare and SS, then went back with her order again. They've also set up charities to support retired nuns.

But to get back to the OP's questions- as a compassionate society we have to provide the bare, humane basics. Sorry, no Wi-Fi, no field trips, no woodworking shop, no swimming pool. The more we go beyond the bare basics for those who can't pay, the less incentive for anyone to take care of their ageing family members as long as they can, and the less incentive for people to save or otherwise provide for their own retirement.

[Works4me]

Rule #1 - what is in your best interest in not always in the best interest of the facility. Social Workers and/or Discharge Planners are in a Catch 22 situation. Their job is to look out for patient rights and make sure that they are sent to the best, safest situation possible. It is a position that mandated by federal law but funded by the facility. Yes, I was fired by the administrator of an acute care hospital for refusing to lie to a patient about federal medicare law.

[Works4me]

Euthenasia/physician assisted suicide is legal in Oregon, among other states. There also was an excellent book written on it many years ago, what I have always thought of as the ultimate do it yourself manual. Sorry, very dark sense of humor - occupational hazard. Plus, remember Dr. Kevorickian - sp?

[midjd]

Oh I so hope it's legal in my state when I'm old enough/incapacitated enough to need it. I have no moral compunctions about suicide whatsoever (and I wouldn't want to be a burden on anyone) but I don't want to die in pain. Or leave a mess, I'm kind of a neat freak.