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I wonder if anyone can weigh in on this one. We are planning to put my mom in the same nursing home as my dad. She is on hospice because her palliative care team recommended it. She is not dying imminently but it was recommended because she gets a caregiver for 3 hours a day, oxygen, adult disposables, and her prescriptions at no charge which is a huge savings for her.



Our attorney said the best way to make this happen is through the ER with the three day hospital stay in order to be placed in the facility where my dad is. We did exactly the same thing for my dad back in January and it worked out fine in his case. Our plan is to get her in there and apply for Medicaid pending. She will have a lien on her house that will have to be paid when the house is sold. C'est la vie.



Hospice has their processes. They are supposed to be informed of any ER visits. Unfortunately the hospice social worker has not returned my sister's calls . So I am throwing this out to the gods here on this site. Has anyone had to do something similar?



So many moving parts and you just never know how one thing impacts another. Many thanks.

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@igloo572...One of the forms that is in the Hospice Admission paperwork is a form that will indicate if the person is living home alone. If at anytime Hospice staff feels that the patient is not safe home alone then they will discuss options. Some of the options are:
*The patient is placed in a facility that will accommodate the level of care that is needed.
*The Patient appoints a caregiver that will be there as much as needed.
*Hospice elects to discontinue service if it is deemed to be unsafe. (I am sure if this is the case they then report the situation)
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igloo572 Jun 2023
Really? Hmmm I’m wondering if maybe this is something hospice can use to shed clients they don’t want? That as the hospice group does the evaluation and if there is not a “24/7 primary person”, they determine is needed, hospice can resign. A household without a spouse or family living there is likely to be more akimbo, so more work for hospice.

Anecdotally, I’ve noticed a real shift in hospice landscape. There’s private equity/venture capital $ owing hospice groups. It’s perfect opportunity for bad biz model as Medicare pays really well - about $6Ka mo / $200 a day - and the workforce can be and is as low wage as possible, like state minimum wage aide types (my state min wage is $7.25 hr) plus can use hospice “free” volunteers. RNs & SW tend to do the on-boarding & oversight of cases. RN do hands in if it’s a complex cancer and tend to come by just for whatever procedure needed for that cancer. But to make the hospice profitable, you have to have the most # of patients who are easy care and fit the 3-4 hr window visits multiple times a week to do the health & hygiene checks that Medicare pays for and for as long as possible. (Like my mom who was on hospice for 18 months). That’s what a VC group needs to be done for Medicare hospice benefit to pay them the max. So they can sell the hospice company in 5-8 years as that’s how VC makes their serious $. So to make this work, enter the on site primary caregiver to make sure the patient is clean, fed, groceries bought, laundry done, diapers changes regularly, meds taken on schedule, house/apr fairly straighten up etc.
I can see a cancer patient w/good outside support system and great cancer team and meds, living solo on hospice being OK.
But a dementia patient, not so much. Hospice gonna want an on site primary caregiver.
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I would talk to the Hospice Social Worker or the Nurse and see if Hospice can get her admitted. Might even want to ask if she can be admitted to that particular facility as a Respite Stay that she / you are entitled to now that she is on Hospice.

If you go the ER route you have to notify Hospice PRIOR to the 911 call. Hospice determines if 911 and the ER are necessary.
If you go the ER route she will be dropped from Hospice and she will have to be "readmitted" to Hospice (that would probably happen in the Hospital)

No one wants to to the Hospital so I would see if that can be avoided if the Hospice Social Worker can get her into the facility without "jumping through hoops"
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It’s mainly Goddesses, just sayin’. I personally prefer my Goddess outfits in silk organza & illusion with a sash or two.

I’d be kinda worried about the Financial considerations, which aren’t mentioned other than mom to go Medicaid Pending. So is your dad already in a NH on LTC Medicaid? I’m guessing he is, if so, the house he & your mom were living in b4 he went into the NH, is already subject to a required attempt of Estate Recovery. Dad has created his own tally of every day he has been in that NH since January which is its own potential lein. What may happen now is IF your mom got any type of waiver of his monthly income (instead of it going to the NH as a copay or SOC/share of cost is going to her), that will stop. The waiver to her will stop. She too will have to have her mo. income go as her own SOC to the NH. So neither of them will have any of their own $ to pay any property costs as basically almost all their $ is a required copay to the NH.

For a couple, once both on LTC Medicaid for most States their combined nonexempt assets max is $3,000. Again couples combined nonexempt 3K for most States. So if your mom has had her own assets because she was a community spouse, once she stops being that, it will effect BOTH his current eligibility AND her new application as her community spouse segregated assets cease to exist. They will need to do a spend down to get jointly to 3K.

I would suggest that you asap find out clearly what her filing Medicaid Pending will mean for her existing segregated as a community spouse assets and his eligibility. And do this BEFORE she files the application.

LTC Medicaid allows them to continue to own their homestead as an exempt asset. But basically due to the SOC, the folks have a zero-nada-no $ to pay any property costs. So it’s on you and your family to do so. When are y’all planning on selling the house? Like ASAP or after they both die? You & your siblings OK on paying the whatevers on that house without reimbursement if that’s what ends up happening? Is the house absolutely sellable at FMV with no work / no upgrades needed? Medicaid is going to want it sold at FMV on a Realtor MLS type of listing & tend to allow a 6 month grace period for Medicaid eligibility which proposed on the market. Realtors will need insurance in force, utilities on and yard maintained. Medicaid does not like FSBO nonsense.

The medical placement aspect is going to be interdependent on who has an open bed at the time mom actually gets discharged from the hospital (MediCARE) and what type of discharge orders she’s under. Normally they leave with rehab orders (MediCARE) & the NHs vary as to what staffing and equipment they have. So that will be a factor. I’m sure they will try to have her go to the same facility as your dad if there is an open bed. If not, you can move her after the Medicare paid rehab period ends and she files for LTC Medicaid custodial care application in the NH your dad is at.
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I myself think that hospice care today, as a hedgefund honey, is trying only to go after the buck, and I am highly suspicious of hospice that doesn't own up front that you are in END OF LIFE CARE in which there is likely never to be treatment or ER visits nor many tests ever again. In trade for this you get a couple of bed baths a week, a social worker who calls and a clergy who calls and an RN who makes weekly or biweekly visit. How our Medicare is paying the ENORMOUS amounts for this currently very spotty care I can't imagine.

It is now so bad as far as hospice goes that I hesitate to weigh in on what's happening in your area. Just please don't come back wailing that someone gave a whole lot of MS and you didn't know it was end of life care, as we are starting to see that as docs become more and more willing to sell this as "more care".

My humble opinion as an old nurse who once saw Hospice as a miraculous godsend.
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Hothouseflower Jun 2023
Thanks for responding. I can say that this hospice is a non profit one. It actually has been a great help having the extra services which my mom could not have gotten otherwise. So far we have no complaints with the services.

But we are getting pressure from hospice to have someone in her home 24/7. My mom cannot afford it and for various good reasons her daughters are unable to do more than they are now. I guess when we’re ready we will need to cancel
hospice and do what we need to do.
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