I have been caring for mom for 14 years now, however, it is becoming dangerous for her and my family. She is denied Medicaid. Makes too much money. The immediate issue is that the hospital is releasing her and when I told them she cannot come back here, they said either I pick her up or they will deliver her by sheriff. Can they do that?
1) OP's mom has advanced dementia
2) mom's been in the hospital for psych eval
3) mom's income ($1400) > Medicaid limit
4) mom's income way < MC facility ($4000)
5) mom has no house, no assets of any kind - no spend down or home sale
6) mom is dangerous to have in home with minor children (and adults!)
7) there is no Miller trust in NC
8) OP has appt with EC next week
9) OP did NOT dump mom at the ER or hospital
10) OP WANTS appropriate placement for mom
I've probably missed a few points, but the above covers most.
Rehab won't be an option, she isn't "recovering" from a treatable medical condition. Medicare is cracking down on ALL rehab, but this wouldn't qualify.
Mom can't afford LTC. Her income exceeds Medicaid limit in NC.
This is a place TOO many people are in (kind of like the donut-hole for Medicare drug coverage.) Income too high for Medicaid, not nearly enough for ANY kind of LTC care. SS is NOT going to cover the cost of LTC - it was only intended as a buffer for those with little or no retirement income. Not everyone has a great job with great benefits and ability to save large amounts of money to cover this kind of care. It's only going to get worse as more pensions go the way of the dodo bird (not everyone had one to begin with!) Sure, investments are great at the moment, as they were before 2008. We all know what happened then, eh?
https://www.elderlawanswers.com/how-medicare-beneficiaries-can-fight-a-hospital-discharge-12218
Did you get any paperwork from the hospital when mom was admitted or prior to this "discharge" notification? There is more detail in the link above, but it mentions them being *required* to give you a notice within 2 days of admission (An Important Message from Medicare about Your Rights (IM)). It would explain discharge and appeal rights. It says it must be read, signed and dated. Did you get this paper and sign it? Hopefully as POA or rep, not as yourself or "responsible" party.
The link also says you should get another copy of this paperwork 2 days prior to discharge. It doesn't say anything about reading/signing the second copy, but do go to the link above. There is a place you can contact about appeal (indicates Medicare Quality Improvement Organization (QIO) and says the phone # should be on the IM.)
Read the rest of the link. If you didn't get the paperwork, I would contact Medicare ASAP and inquire about getting this appeal in the works! It might not buy a lot of time, but any time will give you more time to work out what needs to be done!
(I clicked on the QIO link in the web page above and selected NC - it shows these #s
North Carolina
KEPRO
888−317−0751 (toll-free);
813−280−8256 (local);
855−843−4776 (TTY);
833−868−4058 (toll-free fax)
www.keproqio.com
She is probably overwhelmed with all of this, as I am.
OP has responded to comments, but until something happens (hospital follows through with threat to transport mom back via sheriff or she can make them see the light) there isn't much OP can say right now.
My sister's current facility says if I don't like what they are doing care wise, I could take my sister to ER for "change in behavior". Sister behavior is fairly stable in spite of minimal care or concern at the facility-but still wanting to get her out due to loosing weight, injuries, being unclean. I have been digging for better placement for 4 months-several have refused her bad behavior, several wait list and several say no thank you for either behavior or because we don't have a bucket of money for self pay.
I did agree to hospital evaluation before as her behavior was out of control with agitation and elopement-resulted in nearly 3 weeks of being in restraints. Meds were changed and seem to be helpful-only because we knew she would not be able to return to assisted living-she was not doing well there-she needed more help than they were willing to provide at AL level. Only because we knew a change of care was imminent we started looking as soon as she was hospitalized-with only one option available as now sister has "agitation felony" on her records-not too many places are willing to take her on.
We were unsure as to how she might do in our home with my family members who sister does not know or recognize anymore would cause more problems for sister too. I have a couple more housing options to look at crossing my fingers again that one will work out for my sister.
I have had several communities ,including the current facility, recommend other communities for potential placement that have been cited for abuse-it is obvious to me that the staff who are making these recommendations are not doing any kind of vetting of care/quality before they pass along or set up a placement on your behalf.
All the resources available for finding senior housing are just going off a list too-they are not doing any research to narrow down best care choices either-they have no insight as to what the facility is really like-they have no power to move you to the first in line-even if they could do this -not always going to match up with when you need a bed.
Unfortunately, It is up to the family to do their own research and when it comes to hospital discharge the time can be very limited to figure out where to go in a short amount of time. As I have mentioned before the good places have few if any beds available when you might need one. I think there should be minimum standards of care required for a place to remain open-no community cited for abuse should even be out there waiting for the next emergency placement to come along. We are at the mercy of insurance, hospital discharges, available placements and quality of care.
Someone mentioned Memory Care. There are more & more Continuing Care facilities offering this service now, including the Senior Community where I live. That sounds like the right place for someone with dementia. The hospital should give you a list of Continuing Care facilities, as I obtained for my husband and successfully found him a good one not far away from me.
When my brother went to Continuing Care, he had to deplete whatever little savings he had; also, his social security check was sent directly to the care center. Anything extra was paid by Medicaid so it does not make sense what is happening in your Mom’s case. Unless rules have changed since then.
On the right of this page, there is a sidebar to contact Teresa Ann, Care Advisor. It might help to contact her to see if she could give you some guidance.
I only wish I could help you more. It’s hard going it alone. I know: I had to make the decisions for my father, my husband and my brother. They’re all gone now and I miss them terribly, but I know I did the best I could.