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Understand Your Loved One’s Terms Of Permanent Admission At A Nursing Home

During the week, I was presenting my “Senior Living Myths Unmasked – Separating Fact From Fiction,” to a group of business owners. As a senior living advisor, I told them that I always make certain that a skilled nursing community is certified for Medicare and Medicaid and to understand any stipulations relating to both. The response from several members of the audience was “Do you mean some aren’t?” Therefore, I would like to share an unusual incident that encourages exercising due diligence in understanding your loved one’s terms of permanent admission.

For the past several weeks, I have been assisting a woman whose husband was at home with a 24 hour caregiver. This arrangement had been in place for a number of years and the cost was becoming prohibitive. As much as she wanted to keep the current arrangement in place, she needed to move him in enough time to afford placing him in a top notch skilled nursing community. There were enough assets to pay privately for a number of years. But like many seniors, he would need to file a Medicaid application once his funds were depleted.

When I sat down with the wife, she gave me some location parameters. I immediately came up with a suggestion for a community that I felt would be perfect for him. My client was pleased because her husband’s primary care physician happened to be the community’s Medical Director. Although she was elated with my suggestion, she wanted to look at other communities for the purpose of comparison. I went home and chose 2 other communities to present to her.

I always inform my clients about how much money their loved ones will need to pay privately in order to stay at a community permanently. What I am seeing in the market currently is that the majority of nursing home communities are requiring at least one and sometimes two years of private pay before allowing a Medicaid application to be filed.

While the first community mentioned previously was very straight forward about what their dollar requirements were, the second two communities required the prospect’s application to be reviewed by a committee.

The second community that I approached was a smaller organization with an excellent reputation for good care. I was aware that in the past, an applicant was required to have at least five years of private pay before filing for Medicaid and being allowed to remain permanently. This was due to the lesser number of Medicaid beds available. While conducting my due diligence, I decided to call the Admissions Director and ask if the requirements had changed. I was told they were requiring 2 years of private pay before filing a Medicaid application and allowing the resident to stay. They had been hosting a number of residents from a neighboring community that was being renovated. Since the project was completed and the residents were moving back, they were experiencing some attrition. My client visited, took a tour, and was told to fill out an application for review.

I sat down with the Admissions Director to review the decision. I was told he had been accepted on the basis that once his assets ran out, the wife would have to spend down her assets in order for him to stay. When I reviewed the stipulations with my client, she was accepting of their terms and agreed to have their nurse come out and assess him.

When the tours were arranged with her children, the visit to the first community took place without a hitch. Upon arrival at the second community, it was discovered that the Admissions Director was gone for the day. One of the nursing home’s medical professionals took her place. When one of the daughters asked for clarification that her Father would be able to stay once both Dad and Mom’s assets were depleted, she immediately summoned the Executive Director. He informed them there were no Medicaid beds available because they were reserved for the retired members of the religious order from the community. Both my clients and I were livid.

When I called the Admissions Director and questioned the two year requirement for private pay that was given to me originally, she replied, “Oh, that’s just to get in,” in a very cavalier tone of voice. So I said, “So you were going to let my client spend his and wife’s assets down and then put his suitcase on the curb once he was out of money?” “No,” she replied, “we would just file the Medicaid application and seek other resources for him.”

Obviously our negotiations with them ended very quickly and he is moving to the other organization. Who knows why the story changed from the original offer. I am just grateful I clarified the gravely serious miscommunication before the move.