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My mother has dementia and is not able to manage her personal & business affairs. I feel that my mother's rights are being violated when the facility frustrates my ability to have access to her Trust Fund as her legal POA, in order to use her funds as she would use them for purchasing items to meet her needs. If my mother was able to access her funds, she would not be required to purchase the item and then give them a receipt to be reimbursed. The LTC facilities process is in conflict with the Medicare regulations. The relevant POA language and Medicare rule are listed below. I feel the process they have in place is the cover whatever issues they have audits vs. meeting mom’s needs.


POA Language: Bank Accounts. “My agent is authorized to establish accounts of all kinds for me with financial institutions of any kind, including but not limited to, banks and brokerage firms; to make deposits to and to make withdrawals from all accounts in my name or with respect to which I am an authorized signatory; to execute and deliver any instruments or checks with respect to such accounts; and to contract for any services rendered by any bank or financial institution.“


42 CFR § 483.10 Resident rights. DEFINITIONS §483.10(b)(3)-(7)
Medicare Rule: (4) “The facility must treat the decisions of a resident’s representative as the decisions of the resident to the extent required by the court or delegated by the resident, in accordance with applicable law”

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Is your mother a private pay patient? Or is she on Medicaid?
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Is there actually a problem? You purchase items for your mother. You are reimbursed from her Trust Fund which for some reason is in the custody of the facility. So there is no difficulty either with shopping for your mother, or getting the money repaid to you?

If this is only about status, and the only problem is an additional layer of security and accountability, then irritating though it might be I should find something else to worry about. Goodness knows we all have plenty of worries to choose from at the moment!
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The relevant language is not Medicare regs, it is Medicaid regs, if that who is footing the bill.

If your mother is paying her own way, then indeed she would have no reason for a resident trust account.

But if Medicaid is involved, the facility is tasked with preventing the resident's funds from being gifted or used improperly.

If mom is private pay, she has need of a resident trust fund.
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This is how a Personal Needs Account works. There are people in LTC who are able to get money from their PNAs. They can buy food from vending machines. Order takeout. When they are not able to this, then a representative (POA) can be reimbursed for anything bought for the resident. This means showing a receipt to be reimbursed. Its Moms money and its their responsibility to maintain it correctly. They must be the payees to Moms SS. If you were were paying the SS amount of her bank acct every month you would need to keep a record of the $50 (or whatever ur state allows) and keep receipts for anything you spend on her.

Medicare has nothing to do with PNA. The PNA is taken from her Social Security check. When she passes, any money left goes to her estate.

Put "Personal Needs Account in (your state) into your search engine. You will see the rules for your state.
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Sounds like its Medicaid - not Medicare. Very different rules. With Medicaid, the state takes your income, but allows an "allowance" each month (in the state of Illinois, where I live, $90 month). If YOU have to purchase something for her, the state may require a receipt because they have to be accountable for every dollar. The medicaid recipient is also allowed to keep up to $2,000 in a "savings type account".
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My mother is Medicaid. To clarify for all who responded. My mother is 94 and she has dementia and not able to request funds to meet her needs. Receipts for reimbursement prior to COVID19 pandemic was not a problem. Now with facility on lockdown. I can’t visit mom & she is hard of hearing & can’t hear callers on the facilities phone. So I brought her a cell phone & Blue headset so she can hear phone calls & communicate with her children & grand children. This worked when I visited her prior to lockdown & called my sisters (in other States) to talk to her via phone.

I could not pay her 1st Phone bill & get reimbursed because her cell provider does not have paper bills. They bill via an app. The bill screen does not have her name on it. I had to go to several cell phone Co. franchises and someone was finally able to figure out how to even print a paper bill so the LTC facility could pay her bill.

I am 72 years old and cannot run around like this every month in the middle of this pandemic. Mom has sufficient money in her LTC Acct to take care of her needs. As her POA she has legally given me the right to make withdrawals from all accounts in her name.
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JoAnn29 May 2020
That makes things a little clearer, thank you. I guess you have called the phone company and requested a paper invoice to be sent? What a mess.
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Thank Your Lucky Stars she's got Medicaid! Private Pay is at least about five grand a month; my mother passed away from Alzheimer's complications nearly two years ago, and that was her private pay rate....two years ago.
I also had to deal with unfathomable inconveniences as her POA; it didn't ever seem to stop. On one hand, I can really sympathize and empathize with you on the headaches!! My Mom had a pension from the University of Guam (15 hours time difference), which is a Trust Territory of the United States, but they are stuck in like 1970 when it comes to modern technology. I had to have so much paperwork notarized and faxed and copied and faxed, then one page went missing and so the whole circus would start over. I thought I was going to lose my Freaking Mind so many times!! I was Mom's sole medical and financial POA . She wasn't married; I don't have any brothers or sisters. It was all on me.
I really hope your headaches are out of the way for the moment, but make sure to keep that P.O.A. paperwork handy at all times!! Just try to keep a folder with expenses for her all in one place (in your car if that's convenient for you). Sorry to forewarn you, but this stuff comes up about every few months, as a rough estimate from my experience. I kept a folder in my car with an original of my POA and Trust paperwork in my trunk...because that's how often I needed it. Almost weekly, sometimes more often.
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Barb, the Mom is on Medicaid. I can sympathize with the headaches, but it's FREE!! Gratitude seems to be lacking, yet I did put forth some empathetic words. Everyone that's a POA has to go through hoops, whether it's free, subsidized in some way, or private pay.
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Thanks all who responded. It is a nightmare with this pandemic. This phone business has really thrown me over the deep end. I am still trying to get a paper bill without success. I am new at being Mom’s POA (about 9 months). My sister who was her POA became ill. I do meticulously keep up with what I spend for mom separate from my accounts. I use a spread sheet & keep all receipts. If I ever get becoming her Medicare Representative straight (all Medicare offices closed with this pandemic) I may open a bank account for her instead of using the facility fund.
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