3. When a Nursing Home is Necessary: How Not to Break the Bank Paying for It

Lesson

Situations that appear to be very challenging MAY require more intensive intervention, including finding a facility for the person in need.  To avoid undue pain and suffering for all parties, as well as crippling financial options, don’t wait for the situation to become unbearable.  Getting reliable and practical advice in a timely manner can make a tremendous difference in the outcome.

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Background

This situation involved a young couple who called me as a referral by a nurse colleague, who knew me from a previous client.  I met with them in their home and the woman said, “We’re taking care of my father.”   They struck me as being kind of young; in their late 30s.  We met in their house and the father lives downstairs, and they have a 7-year old son and in addition she was about 6 months pregnant at the time. She has since had the baby and everything is fine.

Current Situation

They called me thinking that they really didn’t need too much, and since they’re personal friends with this nurse, she told them to speak with me.  They just wanted to hear what I had to say and if I had any ideas that could help their situation.  I spoke with them first and then I met the father.  My immediate reaction was how can they possibly do this with so little help.  They have one child; are about to have another, and they’re running up and down the stairs all day long taking care of the father.  He’s got dementia, is defecating on the floor, and he’s got no understanding of what his limitations are, so at any moment he can jump up and fall down.    He’s very nasty and he’s not receptive to having any caregivers, paid or unpaid.   I’m struck by how little help they have and how they can possibly do this.  I tell them I really think this is heading towards a crisis, if it isn’t one already, since she’s about to have a baby.  From my perspective it doesn’t quite make sense, “You could have round the clock care almost immediately.”

I then talked about Medicaid planning and they thought, “That’s interesting.  We want just 8 hours.”  They started with that and it eventually increased to full-time care.  We ended up talking for about 3 hours, and it comes out that they’ve been taking care of this guy for three years.  They rescued him from the other daughter who was about to abandon him, and then bought a house that could also accommodate him, and they’ve done this for this for three years.   Then it comes out that what they really wanted, but were feeling helpless about because they had tried and didn’t get anywhere, was to place him in a nursing home because, in fact, they couldn’t care for him.  It was a tremendous drain on them, emotionally, and in every kind of way; it was just too much.

From their initial presentation of “we’re doing fine, we don’t need that much help,” progressed to, in fact, “that we need more help than we think is available, and it’s kind of hopeless and we’re just stuck here.  We’re just going to plug away and do the best we can."

The first scenario was if we can get all this home care, let’s do that.  And then, a couple of months went by, she had the baby, a new crisis developed.  He went into the hospital, and they thought, we can place him in a nursing home right from the hospital.  And they thought it was all set because the doctor assured them he would get him into the nursing home where he, the doctor, worked.   But the Medicaid situation fell through because they didn’t present the facts to the nursing home Medicaid worker the right way.

Steve’s Role

I reviewed the Medicaid situation in terms of the nursing home perspective, and I saw that he was eligible, but I could see where it needed to be presented differently. It was somewhat complicated, and needed to be presented by a lawyer, not just a social worker, because they wouldn’t buy it from me.   I said, I know this great lawyer, and he will present the facts in such a way that the nursing home will agree that there is no risk that Medicaid will be denied, and they’ll probably admit him before the Medicaid is approved, on a Medicaid pending basis.

Sure enough, we met with the elder law attorney, and I presented the facts to him.  It was crucial for me to be there to present the facts in a way that was relevant for what he needed to know, so that he could say that this was a sound way to proceed. He reviewed the facts of the case while we’re all sitting there, and he said, “This is fine, and I’ll take care of it.”  And, sure enough, within a couple of weeks, it was all done, he was placed in the nursing home and they did not have to lay out any money, because of the Medicaid pending status.


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