My mother had a severe stroke in December that has left her unable to communicate, swallow, move on her own, etc. She was in the hospital for about 3 weeks before being moved to a skilled nursing facility. Now I am being told that insurance will no longer pay for her care even though a doctor even stated she will need 24-hour care for the rest of her life (she is 68). We are working to get Medicaid but that seems like it will just be a bandaid for a short amount of time. How do I insure that she continues to get the care that she needs, and the rehab to one day hopefully have some quality of life?
If she has money, you'll need to use it for her 24 hour care if she's going home. Either way, you don't get Medicaid when you have money to pay.
If she's not on social security or Medicare right now, maybe you meant to say you were applying for Medicare. Different from Medicaid. And yes, Medicare has limited time they pay for rehab/NH care. So you would probably want to start the Medicaid application now, too. Just remember, all of her income and assets are considered for the Medicaid program.
The aide was awful (just his scenario). He recently moved himself and my mom into a nursing home that he pays for out of pocket. It costs less to live at the nursing home than to have the live in aide.
Before the move to the nursing home...
From the case worker at the hospital I was able to get palliative care for mom and dad. Palliative care (different than visiting nurses), pd for by Medicare as a medical charge will come once a month. A social worker and a nurse, one time each per month. They have great information, they were even able to call my mom's primary Dr to get a script for mom's pt. They also helped get my dad another stint down the road for more in facility rehab.
Talk to the case worker at the current rehab (if they won't help contact the hospital case worker) to set up pt, ot, a nurse (1x week), a shower aide once a week for showers (they can sometimes help with bedding changes and laundry into a washer) at home. This was pd by Medicare, but was temporary until they felt there was a plateau.
If your mom doesn't have a caretaker, make sure you tell the rehab case worker that they can't release her until this is set up. If you're not the caretaker, make sure you say that. They can't send a stroke survivor home that can't swallow or walk without a care plan. They harassed me to come in for family participation for my dad's pt...I refused. I wasn't going to be his caretaker.
Medicaid is for those with limited funds that meet a criteria. It shouldn't be a temporary bandaid unless your mother's financials improve above the medicaid criteria. Medicaid is different than Medicare.
Medicaid will cover for long term care when one's income and resorces are insufficient. What happens to Medicaid coverage when one is moved out of her residence but has to wait for the home to sell? I'm curious. Does the same Medicaid benefits stop but resume when the sold real estate proceeds finally run out with private pay? Or do you have to reapply after the estate is used up for care? Seek eldercare attorney assistance.
There is a MERP form (agree to let Medicaid recover what they pay out for you after death) that applies to leftovers at the time of death. Leftovers are usually what will be in the estate to split between heirs.
In Texas Medicaid looks back 5 years to see if you've given away money. Any gifted or given away creates penalty months where Medicaid won't pay for X number of months.
Im 2 years into my mom suffering a severe stroke at 75 and to be honest, over seen more recovery in the past 6 months than I've seen before. I brought my mom home after 6 months in facilities in 2021. I couldn't take the lack of care from a SNF any longer. It's a LOT of work but I'm thankful for my 2 siblings who are in this with me together. I also work from home and grateful my job allows me to do this.
I think it depends on your situation. If you have the expendable time, then think about bringing her home. There is also LTC now offered at home via MediCal/Medicaid. It's another waiver you fill out but it allows your LO to be home with you and have the same care as if she were in a snf.
My 85 year old Mom is just getting through with multiple hip surgeries with numerous infections. I know going forward she will need help at home and she has only Social Security to live on. I was also looking at the PACE program in Florida as another way to keep her in the home vs a nursing home. I expect she will need to get dual Medicare/Medicaid first.
Do you have experience with either of these programs?
I'm so sorry you are going through this. It is so hard to see someone you love go through this especially when they are younger. I wish you the best.
Medicare will only continue to pay as long as mom is improving.
There is not enough information here about mom's finances and assets to be able to provide a better answer. If mom has pension, Social Security, home and any other assets are all part of the equation.
In terms of further rehab, she may have progressed as far as she's capable of progressing after such a serious stroke. If so look into a hospice evaluation for her now so she can be kept comfortable and not forced to do pt she's no longer capable of doing.
I'm sorry you're both faced with such a situation. Sending you a hug and a prayer that you get all the facts laid out for you with moms prognosis so a good decision can be made.