Where do we start with assisted living when on disability?

[athena1277]

I have an uncle who has been on full disability for a number of years.  He has had health issues his whole life with many surgeries and hospitalizations, so he has no savings.  He currently rents a tiny studio apartment.  He is to the point that he really needs to be in an assisted living place.  His daughter was starting to look at places for him, but had her own health problems that sidelined that.  My mom is willing to help him get in a place, but doesn’t know where to start.  The biggest question is how to find a place that isn’t really horrible (there are some in the area) when all you have is disability/Medicare?  He isn’t quite to 65yo yet.  Living with relatives is not an option.

[Mrs Tiggywinkle]

Medicare does not pay for assisted living.  Probably the easiest thing to do is to call places that are decent and ask to talk to their admissions staff or social worker.

Right now my mom is staying 24/7 with my grandmother, who needs assisted living but can’t afford it.  They could afford in home aides, but it’s impossible to find any in our area and the local home health agencies are so understaffed at the moment that they aren’t taking new clients.  It’s all very difficult.

[sassenach]

Medicare doesn't pay for AL but Medicaid might. I would start with his local disabilities office to find out what is available in his county.

[Ottakee]

Another place to check with is your local community mental health agency   they might have assisted living group home options.  Medicaid might be needed if he qualifies.

[Resilient]

There are a limited number of "beds" for pure-Medicaid pay.  Most places accept Medicaid after there has been a period of full-pay (18 months to 5 years in our experience). 

We have had to deal with this and in the end, the better option was getting dialed in to a LOT of home health care while the elder stayed in low-income housing.  That took a lot of effort, follow-up and involvement from us. The home health care people were absolutely wonderful.  And the elder was not distressed by ending up in "one of THOSE places."

In the greater metro area where we live, there were 5 (FIVE) places that accepted Medicaid-only from the start, and they had long waiting lists.

One thing you CAN do to get a jump on this is get an exam by an MD and have the MD recommend home health care or assisted living.  

IF you find an assisted living facility, THEY will have to do another assessment and then they can accept or reject.  The Medicaid rules and processes vary by State, so get dialed in to your state's resources.

 

 

[athena1277]

16 minutes ago, Resilient said:

There are a limited number of "beds" for pure-Medicaid pay.  Most places accept Medicaid after there has been a period of full-pay (18 months to 5 years in our experience). 

We have had to deal with this and in the end, the better option was getting dialed in to a LOT of home health care while the elder stayed in low-income housing.  That took a lot of effort, follow-up and involvement from us. The home health care people were absolutely wonderful.  And the elder was not distressed by ending up in "one of THOSE places."

In the greater metro area where we live, there were 5 (FIVE) places that accepted Medicaid-only from the start, and they had long waiting lists.

One thing you CAN do to get a jump on this is get an exam by an MD and have the MD recommend home health care or assisted living.  

IF you find an assisted living facility, THEY will have to do another assessment and then they can accept or reject.  The Medicaid rules and processes vary by State, so get dialed in to your state's resources.

 

 

I didn’t realize home health gave you a pathway into this.  We will definitely look into it.  
 

How do you get on Medicare from disability without a major health event?  Does that also vary by state?

[LucyStoner]

What level of assistance does he need?  If it’s just meal, cleaning and medication mgmt, you may find that a home visitor paid for by the state is the best option.  

Options vary a lot by area.  I would reach out and see if the medical center he has received most of his care from has a social worker.  another place to call is senior services. The social worker will likely have the most options for services (be it home health, a group home or nursing care facility) if it is made abundantly clear to him or her that there is no relative for him to live with or provide care for him.  Your mom should make it sound like she is less available/less involved than she actually is- IME, social workers who work with seniors tend to prioritize those who don’t have family available.  

Medicaid pays for long term care but there are strict eligibility guidelines to qualify as needing care- if he can get by with a home health visitor, they won’t want to move him into a care center.  Medicaid will take almost all of his disability check towards the room, board and care, leaving him with a small amount (less than $100/month last I checked) for incidental personal expenses.   

Quality of Medicaid options varies a a lot by location.  

[Spryte]

Echoing that our experience has been that Medicaid doesn’t cover AL, even if he gets on Medicaid. But … I would help him apply now, for home health options. They will cover many more services than Medicare.  Here, we can apply for LTC Medicaid coverage or community based care.  Apparently once they have community based care, the switch to LTC is easier.  LTC will kick in, theoretically, when he needs it, but then I’m not sure it’s an easy task to find a facility that will take a Medicaid patient from the start.  As someone else said, they generally reserve their Medicaid beds for patients who have been paying residents for a period of time.

If your health district has an agency on aging … that’s who you need to call.  They can give you ideas and guidance.

It took us almost nine months to get MIL onto Medicaid.  Next we need to do FIL, then another elder will need community based care.  It’s a slog, and sooo many hours seemingly wasted on doing things over and over, but if you start early at least you won’t have an emergency situation.