In November 2019, my 92-year-old widowed mother took an uncontrolled ride down the indoor wooden stairs and took a helicopter ride to the trauma center in the area.
Before she fell, we had a simple but semi-functional care system in place. But the chaotic aftermath pushed us into unknown territory and robbed us of a great deal of time, money and other resources from her caregivers. We spent months grappling with a new set of rules and referees, it couldn’t be more complicated.
A few short weeks after her accident, her maternal rehabilitation allowance was nearly exhausted and we were briefly informed of the upcoming discharge date on December 21st. partly cognitive and motor but obviously unable to manage daily needs at home.
A moment of choice has arrived. Medicaid The rules require her to enter a long-term care facility (LTC) directly from inpatient rehabilitation. If we take her home, even for one day, she will have to go through another health crisis and be inpatient before she becomes eligible again for LTC benefits. We – her children – agree that it’s time for the LTC.
You need to be perfectly normal to get help from Medicaid, at least in Maryland. My mother was receiving a small railroad subsidy, which covered about 85% of her living expenses before she got into her accident. The rest revolve around kids and grandchildren, who have for years kept her afloat with careful attention to her needs and expenses. But that pension – and even her small cash-value life insurance policy – became the target when we applied for Medicaid benefits.
The speed of the Medicaid system is so slow that it is confusing. While Mother’s state benefits were registered and under review, she accumulated cost about $ 400 a day in professional care and housing. Several of her children have scrambled to cover these costs, along with expenses related to applying for state benefits using the required 17 page application. The three filing options, listed in order of increase in cost and probability of success, are:
Do it yourself
Hire a Medicaid registrar
Hire an attorney
Due to our pressing situation, we have opted for the third option, with the engagement agreement on 9 December 2019. The hat has been adopted within the family and who can contribute to the effort. are both generous.
Medicaid applicants are required to submit an unusual amount of data. Thankfully, my mother’s financial life is very simple and I have carefully submitted the related papers for many years. However, the collection of required items takes dozens of hours over a weekly period. Finally, the application was submitted on January 8, 2020.
While waiting for Medicaid’s approval, Mother’s medical expenses continue to accumulate. For us, there is a term called PEME, which stands for pre-eligibility medical expenses, that covers costs incurred after the date of application but before the date of approval. To be eligible, these expenses must be owed at the time of approval, meaning many of them will be past due before Medicaid coverage. As payment requests became more urgent and threatening, I resisted the urge to simply pay them to try to reduce the noise in my head. This turned out to be the right financial decision.
On January 10, I received a “Request for information to verify eligibility” message from my Medicaid case manager. Requirements for Forms DHMH 257or “Long Term Care Activity Report” from Mother’s LTC facility. Essentially, this is a detailed summary of the services she receives on a daily basis, identifying her condition and the need for professional care. Care facilities must provide this form directly to Medicaid case manager.
We forwarded the message to many of the site administrators, first by email and then in person. None of our email or phone messages received a response for the next six weeks. Clearly there was no incentive for the facility to produce the form, as the people there were happy to continue charging patients for the services provided. We received a notice of ineligibility from Medicaid on February 25, 2020, as the requested information has not been provided. Mother’s attorney intervened with a number of very specific requests and threats, and in the end the appropriate form was released. This is possibly the most valuable service the attorney has provided.
The eligibility notice was finally received on March 13, more than 60 days after the application was submitted. I finally slept through the night for the first time in weeks.
The LTC institution is not perfect. This is a very generous statement. Facility staff are mostly courteous and competent, but serious medical errors have occurred and the need for care is not always provided in a timely manner. My daughter, Leah, who worked at a respected LTC facility for many years, helped the family turn her expectations into reality. We learn that even better facilities lack staff, plus staff are often underpaid. Fortunately, mom has family members visiting every day. We were able to fill gaps in service and advocate for Mom while care was slow. This is not the case for all residents, some of whom have not been visited for days or weeks in a row.
COVID-19 then hit the target. Mother’s daily clients go early and often go to zero. In four short months, she had gone from ruling the universe from a chair in her home to a helpless dependence on overworked strangers. She was not satisfied with this arrangement and was opposed to anyone who would listen. This increased feelings for her already suffering family. Her 93rd birthday was celebrated on May 5, with her masked family facing the outside window.
While our family struggled to understand and adapt to the chaos that engulfed us, our mother’s hardworking nephew, Brooks discovered a recent, little-known change in the Medicaid options. This change provides the opportunity to transfer part of her benefits to home care while maintaining eligibility. This has obvious advantages for Mom and for the state, but means that much of her daily care will depend on the family. Brooks has carefully navigated another complex application process. Several kind volunteers explained in detail and mom returned home on July 31st. Home care is now available 24/7, mainly due to unpaid family members. Professional care is available for several hours a week to help you lift heavy loads. Mom was very happy to go home and the government costs were much lower.
It pays to make friends before you need them. Care for our elderly mother, in her old home, has fallen disproportionately for a small part of her large family. It is not clear how long we can continue to provide needed care or how those needs will change, or when this part of the story will end. Could it be that my parents predicted and prepared for this situation? I do not know. But my humble suggestion is: Strengthen yourself and your family – human capital – to prepare for challenges you can’t imagine.
This column initially appeared above Humble dollar. It has been republished with permission.