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Old 06-12-2013, 07:26 AM
 
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Default POA vs Responsible Party - Nursing Home

I have Durable Power of Attorney for my mom-in-law who is 103 with dementia. She cannot speak for herself. I am in the process of admitting her to a nursing home. She is on the Medicaid Waiver. All of the numerous admission pages I am required to initial and sign are as her 'Representative'. I am available and willing to participate in her care decisions and pay for incidentals, like getting her hair done. I am not willing or able to pay the per diem cost of the nursing home if there is any snafu with Medicaid. Advice or thoughts about how to sign these forms?
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Old 06-12-2013, 08:28 AM
 
Location: Covington, KY
1,187 posts, read 835,685 times
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Quote:
Originally Posted by julsmile View Post
I have Durable Power of Attorney for my mom-in-law who is 103 with dementia. She cannot speak for herself. I am in the process of admitting her to a nursing home. She is on the Medicaid Waiver. All of the numerous admission pages I am required to initial and sign are as her 'Representative'. I am available and willing to participate in her care decisions and pay for incidentals, like getting her hair done. I am not willing or able to pay the per diem cost of the nursing home if there is any snafu with Medicaid. Advice or thoughts about how to sign these forms?
I take it that one form or another says you agree to pay said costs under those circumstances. I would start by asking for clarification from the local government office, then verifying the information with a call to a hotline. Medicare has a website that might be helpful.

As I understand it (note that) Medicaid kicks in after Medicare benefits are exceeded, one angle being that under given circumstances the state pays Medicare premiums (at least Part B) out of Medicaid funds.
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Old 06-12-2013, 05:34 PM
 
Location: Mason, OH
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Medicare does not pay nursing home costs except in the circumstance of a short stay after a hospital stay for the purpose of rehabilitation therapy, and this is tightly controlled as to length of stay, the patient has to show progress, etc.

There is the ability for Medicaid to pay for nursing home costs for people without the necessary funds. Medicaid is state administered program funded by the federal government. Medicare is federal government only.

OP, has your mother-in-law been accepted by the Medicaid Program? I would do nothing further with the nursing home until I was confident she has been accepted by Medicaid, ID Card and Number, etc. Even then I would only sign papers you are admitting her to the nursing home under the POA with the understanding they will be billing Medicaid. In addition to the POA which covers legal and financial matters do you have a Medical Living Will for her stating she does not want any artificial means used to keep her alive?

Several years ago my mother who had been living alone began showing increasing signs of dimentia. My brother and I determined it was no longer safe for her to live alone and I brought her to live with me. Things were alright for about two years until she suffered a fall fracturing her shoulder and a severe blow to the head. While in the hospital for the shoulder to mend the doctors also told me she had fluid on the brain which had the potential to kill her but they could not operate due to her age and condition. She was about 94 then. With medication the fluid disipated. Upon release from the hospital she went to a nursing home under Medicare for rehabilition. But it was quickly obvious she was not progressing and the dementia was worsening. The nursing home people advised me they could no longer keep her under the rehabilitation program as she was incapable of making progress and would have to release her. They also advised we needed to put her into a full time nursing facility as we were not going to be capable of home care. I checked around and found a nursing home facility closer to where I live so frequent visits would be more practical. They fortunately had an opening and I was to take her from one facility to the other. Our circumstance was significantly different as she had the funds to pay. So we had very few forms to sign. I was concerned they had copies of the Living Will and agreed to abide by its terms. I kept her Medicare and Medicare Supplemental Insurance in effect. They would pay for strictly medical procedures performed by certified medical professionals while she was in the nursing home, but not for such items as room and board, personal care, etc. which was the bulk of the bill. The dimentia continued to worsen to the point I could tell she really did not know me when I went to visit. During a monthly status meeting the home personnel advised me she was refusing to eat despite all their efforts. They said she just doesn't realize she is hungry, at this rate she is going to starve to death. I said as unpleasant as that sounds, no I do not want her fed intravenously, what is the point of that, she is not going to get better. She was a strong old bird and hung on awhile longer before passing. She was in the last nursing home a total of 15 months to the tune of $180,000.
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Old 06-13-2013, 08:26 AM
 
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If you are signing as her representative (i.e. POA), you are authorizing them to bill her insurance (medicare, medicaid, Aenta, whatever..) on her behalf. You also could authorize them to bill her estate for anything that isn't covered (i.e. she would incur the bill personally).

If you are signing as the RESPONSIBLE party -- that is different, as you are saying that you will be responsible for her costs.

I would not do that.

If it is the matter of small incidentals that medicaid does not cover (tv, hair salon appts, etc..) -- you can usually deposit a small amount with such places monthly in her name, for her use. That way it doesn't count against medicaid as income, and allows her to have a little dignity.

But don't sign that you are "responsible" for her bills, or you might find yourself paying for a lot more than a shampoo and set!

As mom's POA, the few times she went into a SNF, I was asked "and are you the responsible party", to which I would always reply pleasantly, "No, My mother is responsible for herself, but I can sign as her POA if you need a signature".
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Old 06-13-2013, 09:35 AM
 
Location: Cartersville, GA
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Laws regarding Medicaid and payment for long-term care vary from State to State. I would therefore strongly suggest that you consult with an attorney. Medicare laws are generally the same in every state, sine Medicare is a federally funded and administered/regulated program. However, Medicare rarely pays for Nursing Home care, unless the patient is there for short term care (usually rehabilitation.)

I have heard of Nursing Homes attempting to force children and other relatives to pay for expenses. An attorney could tell you how to avoid this.

If you only have a POA for your mother-in-law, you might want to also talk to an attorney about getting guardianship. This may give you more rights to manage her care, depending on your State's laws.
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Old 06-13-2013, 12:06 PM
 
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You basically have taken over her responsibility .No different than when she would sign but you taken over that. you also will do same for medical care in place of her when admitted to hospital. You need attorney advise on responsibilities.
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Old 06-14-2013, 08:36 AM
 
2,434 posts, read 5,485,591 times
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Quote:
Originally Posted by julsmile View Post
I have Durable Power of Attorney for my mom-in-law who is 103 with dementia. She cannot speak for herself. I am in the process of admitting her to a nursing home. She is on the Medicaid Waiver. All of the numerous admission pages I am required to initial and sign are as her 'Representative'. I am available and willing to participate in her care decisions and pay for incidentals, like getting her hair done. I am not willing or able to pay the per diem cost of the nursing home if there is any snafu with Medicaid. Advice or thoughts about how to sign these forms?



I didn't even see your actual question --

You sign as: JULSMILE, dpoa for MIL


Which shows that while you are signing, you are doing it ON BEHALF of your MIL, which leaves her/her insurance/her estate liable for any charges.

Which does mean that they can come after her estate for anything not covered by insurance, which might mean any inheritance (if there were to be) would be reduced -- but it does not hold you PERSONALLY liable.


A few states with medicaid have tried to go after relatives to claw back some fees for patients care, but I don't think they've been successful as, at this moment, there are few places with laws saying you have to assume finanical responsibilty for an impoverished relative.

And once your MIL passes, collections companies will come out of the woodwork if her estate is unable to pay -- and they will use tactics like "Wouldn't your MIL have wanted you to settle her account?" -- to try to get you to take *personal* responsibility. Hang up or say "no".

If there is money in the estate - they are entitled to it and it is theirs. If there is no money in the estate, they are not entitled to your personal assets -- unless of course you were foolish enough to accept financial responsibilty for her care. (Which signing as her DPOA does not do).

best of luck!
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Old 06-14-2013, 09:15 AM
 
Location: TOVCCA
3,476 posts, read 2,480,030 times
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Quote:
Originally Posted by Briolat21 View Post
[/u][/b]A few states with medicaid have tried to go after relatives to claw back some fees for patients care, but I don't think they've been successful as, at this moment, there are few places with laws saying you have to assume finanical responsibilty for an impoverished relative.
So far, SD & PA have been successful at getting money from relatives, but maybe more to come?

Are You Responsible for Mom's Nursing Home Bill? | Fox Business
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Old 06-14-2013, 09:37 AM
 
Location: Cartersville, GA
1,067 posts, read 1,149,704 times
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Quote:
Originally Posted by nightlysparrow View Post
So far, SD & PA have been successful at getting money from relatives, but maybe more to come?

Are You Responsible for Mom's Nursing Home Bill? | Fox Business
So, some this can happen in some states, and not in others. As I said before, you need to consult an attorney who knows the laws in your specific state.
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Old 06-14-2013, 10:22 AM
 
Location: in the miseries
2,196 posts, read 1,081,037 times
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After she is on medicaid, an amount of money is put into her 'personal' account for incidentals ie hair dos,
clothes, etc.
She must, of course have no assets.
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