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Old 02-23-2013, 02:56 PM
 
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There are many other options now available for folks, who may need more assistance, but not necessarily a nursing home. Medical foster care seems to be a huge business now. I know of several folks, who could not manage in assisted living, and stepped to Medical Foster Care.

There are levels of assisted living, and sometimes, the money/cost of skilled care in assisted living is very costly. Medical Foster care will work with Medicare, Social Security, Veteran's benefits...and cheaper option for many than Assisted living.

Of course, most folks will just live with family, but...it seems like family now, in many cases, does not want to take care of elderly parents. Or, in my case, it just was too much for one person to do, taking care of a person who is incontinet, in a wheelchair, needs full transfers, and has dementia, is really a lot. And definitely, beyond the capabilities of someone who is also elderly.
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Old 02-23-2013, 04:38 PM
 
Location: Ponte Vedra Beach FL
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Originally Posted by catsy girl View Post
i worked in three different skilled care facilities from the late 80's through the late 90's. in the latter years i worked part-time but was at the facility 3 days a week. in the facilities i worked in- all in maryland but in very different locations- none had any more than two single rooms available. those rooms were in the rehab wing which usuaully takes patients who are coming from hospital with medicare as payor. if following rehab the patient stayed for a longer period and were private pay-usually spending down income- their room placement was whatever was available on the appropriate floor. i never saw private pay patients be given a private room over a medicaid patient if a private room was not available,i.e. kicking someone out of a room to clear private room for private pay. this was also the case in all of the facilities in which i worked. when my mother entered a nursing home as private pay many years ago for long term care, she was placed in a room with a roommate. her room placement stayed the same for all the time she was there, and at the last she was medicaid.

i don't know how other states work it, but in maryland, if there was any sign of discrimination because of funding source, a family could call the local ombudsman, complain, and they would be at the nursing facility on the next working day to investigate. this kind of practice might have and probably did happen at one time, but in the last 20+ years a facility would know that they could be cited and written up, for these practices.

so no, in my experience private pay did not mean preferential treatment. for those who may be thinking i wear rose colored glasses and was unaware of what went on, i will have to say i worked for social services in the inner city of baltimore investigating abuse and neglect for a number of years; following that i worked in adult protective service investigating senior abuse cases in baltimore county for several years as well. i don't think i ever found rosy glasses a comfortable fit, but if i had, my work experience would have ripped those glasses off very quickly.


catsy girl
There are many ways to skin a cat - catsy girl. When my late FIL first presented at his SNF - it was clear that if he ever became other than a rehab patient - he would be full private pay. He got a Medicare rehab bed in about 48 hours (perhaps it was luck of the draw - it's kind of first come - first served - but staying on the phone 24/7 doesn't hurt either). At his SNF (which I assume crosses all its t's and dots all its i's) - a patient in a Medicare rehab bed gets first dibs on a long term care bed - even if the Medicaid waiting list for long term care is 3 years long. IMO - people can ***** - moan - or complain to government agencies. But - in the long run - the people who are full pay will go to the front of the line. Because no SNF - except perhaps the worst of them - can afford to keep its doors open if > 50% of the residents are on Medicaid (because Medicaid doesn't pay what it costs to care for these residents - even on a breakeven basis). Robyn
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Old 02-23-2013, 04:52 PM
 
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Originally Posted by Robyn55 View Post
There are many ways to skin a cat - catsy girl. When my late FIL first presented at his SNF - it was clear that if he ever became other than a rehab patient - he would be full private pay. He got a Medicare rehab bed in about 48 hours (perhaps it was luck of the draw - it's kind of first come - first served - but staying on the phone 24/7 doesn't hurt either). At his SNF (which I assume crosses all its t's and dots all its i's) - a patient in a Medicare rehab bed gets first dibs on a long term care bed - even if the Medicaid waiting list for long term care is 3 years long. IMO - people can ***** - moan - or complain to government agencies. But - in the long run - the people who are full pay will go to the front of the line. Because no SNF - except perhaps the worst of them - can afford to keep its doors open if > 50% of the residents are on Medicaid (because Medicaid doesn't pay what it costs to care for these residents - even on a breakeven basis). Robyn
That is my sense also. I am hoping Catsy can clarify. There seems to be multiple ways to limit clientel if the facility wants. I think once in the care is suppose to be equal but the trick is getting in and some doors are more open than others. I may be wrong but from what I have gathered so far is that if you can pay cash for any up front fees and have significant enough fixed income cash flow to pay the cost each and every month you are golden. By fixed I mean pension and ss that they will get until you pass. I am becoming convinced that the economics of this are very regional and localized. If you are in a high income area with lots of pensions and ss income like the DC area you will find more goldent SNF passes. Or in another setting my FIL had a good pension from a big local employer along with GI bill benefits from WW2 and his assisted living was $3000 a month and now that he is sharing with his GF it is down to $1800 a month. This is small town but I have a hunch over the last 10-15 years or so they have had cost structure set up to meet the needs of folks like this. They also have on campus their own nursing home which you can as needed go back and forth. They have a waiting list and I am not sure everyone is treated equally getting in.
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Old 02-23-2013, 05:00 PM
 
Location: delaware
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Originally Posted by TuborgP View Post
I sent you a PM to get your insight on a couple of things.

i tried to dm you but didn't go through.
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Old 02-23-2013, 05:04 PM
 
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Originally Posted by catsy girl View Post
i tried to dm you but didn't go through.
My question is for you and you would know. In Maryland are there differences in being able to get into facilitities ranging from continuing care up to nursing home based on wealth and income? Does everyone take or have to take Medicaid patients?
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Old 02-23-2013, 05:09 PM
 
Location: Near a river
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Originally Posted by TuborgP View Post
Or in another setting my FIL had a good pension from a big local employer along with GI bill benefits from WW2 and his assisted living was $3000 a month and now that he is sharing with his GF it is down to $1800 a month.
That is interesting. Will they reduce the cost further for 3 or more in a room?
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Old 02-23-2013, 05:12 PM
 
Location: southern california
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u could be right but i read the obituaries daily. that everybody lives to 85 is a fantasy.
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Old 02-23-2013, 05:13 PM
 
Location: delaware
688 posts, read 864,694 times
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Quote:
Originally Posted by TuborgP View Post
That is my sense also. I am hoping Catsy can clarify. There seems to be multiple ways to limit clientel if the facility wants. I think once in the care is suppose to be equal but the trick is getting in and some doors are more open than others. I may be wrong but from what I have gathered so far is that if you can pay cash for any up front fees and have significant enough fixed income cash flow to pay the cost each and every month you are golden. By fixed I mean pension and ss that they will get until you pass. I am becoming convinced that the economics of this are very regional and localized. If you are in a high income area with lots of pensions and ss income like the DC area you will find more goldent SNF passes. Or in another setting my FIL had a good pension from a big local employer along with GI bill benefits from WW2 and his assisted living was $3000 a month and now that he is sharing with his GF it is down to $1800 a month. This is small town but I have a hunch over the last 10-15 years or so they have had cost structure set up to meet the needs of folks like this. They also have on campus their own nursing home which you can as needed go back and forth. They have a waiting list and I am not sure everyone is treated equally getting in.


i have had, on a personal level, three relatives admitted to nursing facilities in balto. area over a period of the last 25 years. all came in with medicare and in two cases became long term with enough private pay to last 6 months-after that, medicaid. in my mother's case, she paid privately for a number of years and rec'd medicaid for last six months. my mil, who never has a nickel, entered a nursing home in virginia on medicaid.

some facilities which claim to take medicaid, and do, will find a reason to accept private pay and /or medicare, and than 6 or 7 months down the road when these funds are exhausted, will accept medicaid from these patients. but- the patient has to have the funds to pay up front.

assisted living facilities take only private pay or insurance and do not operate on the same basis as snf.


catsy girl
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Old 02-23-2013, 05:16 PM
 
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Originally Posted by newenglandgirl View Post
That is interesting. Will they reduce the cost further for 3 or more in a room?
As you have mentioned elsewhere who knows how things will evolve down the road to contain cost and provide services to and for multiple generations of families. I assume he is paying as much as he is because he had a larger room from when his wife was still alive. Not sure why it is cheaper.
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Old 02-23-2013, 05:25 PM
 
Location: Ponte Vedra Beach FL
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Originally Posted by Upstate Nancy View Post
It's not a large percentage, something like 5% and another 5% that will use one temporarily. Most people don't end up in NH's, thank God.
And you base this conclusion on what?

I hate conclusions by anecdote - but here's my family (in my parents' generation).

Of my parents and in-laws - late FIL spent 2 1/2 years in SNF. Late MIL was in and out of SNFs both in rehab and long term care beds for about 3 years. Note that although they were both smokers - they died in their 80's (seems like even unhealthy people are living pretty long these days). Late mother died at home because she had 24/7 home health care (more expensive than SNF). Father (at 94) is still alive and not in SNF (living in independent senior living facility).

Mother's brother spent about 4-5 years in what California calls an "Alzheimer's facility" (we don't have those here in Florida). It was not a SNF. I visited him in one of them once - and think most people put their dogs in better kennels. It wasn't particularly cheap either. One of my father's sisters spent about 2 years in a SNF - and died there in her late 80's. Another died of a massive stroke at home when she was 90. My father and a sister and brother are all 90+ and still alive and ok (his family has exceptional longevity).

IOW - out of the 6 close relatives in my parents' generation who are dead - 3 spent time in a SNF. One had SNF care at home. And one lived his last days in something that resembled a dog kennel. Only one person - my late Aunt M. - died suddenly at home in her recliner watching TV (and lest you think she was a saint - she was an alcoholic - albeit a happy one ).

Going back a generation - when it came to my father's father and his mother - my late aunt (the one who died in the SNF) - took care of them hand and foot until she went into a SNF (I frankly think her elder care did her in) - and then the State of New York provided a full time live in aide for my paternal grandmother until she died (does New York still do that? - I've never heard of anything like that in any other state). My late maternal grandmother spent about the last 4 years of her life in a SNF - and her husband - my grandfather - has a massive heart and died when he was < 60. So even in the 1950's and 1960's - you're talking about most older people needing elder care 24/7 at some point in their lives.

And now we get to today. My father and his brother and one remaining sister are all > 90. My late mother's SIL is over 90 too. I can tell you they are not doing ok. And are very close to needing more supportive living environments than they have now. I suspect my Aunt Y. will do whatever she has to do to make herself comfortable (which doesn't involve having her children being her caretakers). As for my father and his brother - who knows. About the only things I do know is I'm not going to become a caretaker. No way. And that all of these people have wound up with a reasonable amount of money - for a variety of reasons. My late mother's SIL is really nice - but doesn't have hardly money. And her children seem more anxious to take what little she has for themselves when she's dead than to help her in her old age. Robyn
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