Adult blind and mentally disabled adult needs (Jacksonville: sale, insurance)

[laurir]

My sister has fallen through the cracks for services that she desperately needs. INFO: mother 90 in nursing home, sister is 58 and has no independant living skills and no where to live. Adult with Disabilities Agency in Jax. Hodges has her listed as not Medicaid Waiver applicable because of an old IQ test that I have not seen nor recieved a copy of the report. She is in a temp. shelter with senior citizens 3 counties away because they were for profit and we had to place her immediately when her mother fell and was moved to a nursing home. She will go through her mothers savings quickly if she has to pay $2,000.00 a MONTH to live like this. I was told her mother was uncooperative in getting her services. Well that may be but she desperately needs them now! Her social worker is in Duval county, her mother in Nassua co. and her family cannot take her in - they are unequipped with dealing with a challenging grown women who only had to nag and control her mother to get what she wanted and does not have any employable skills that I can see. Any advise will be greatly appreciated...

[dsb62574]

As a nurse and nursing home administrator, I can certainly understand your plight. I am going to assume this individual was never enrolled in the Title 19 program and does not have an IQ at or below 70. If this is the case, finding assistance will be difficult. She will need to designate you as her contact person. NOTE: This is not a power of attorney. Her permission will simply allow you to discuss her care with her health care providers not to make any health or monetary decisions!

A possible option is to continuing care at the nursing home. Medicaid is a financial and health based program. Individuals meeting the state mandated asset and income requirements and requiring a skilled level of care for health problems will qualify. She will have to "spend down" any cash or assets she owns until the state minimum asset dollar amount for Florida Medicaid ($2,000 in assets, and monthly income less than $2,022) is met. This means she will need to private pay for her care until her assets are less than these amounts. If she owns a house, she will be able to keep it, but no one can live there until her death. In other words, it may sit empty for a very long time. If it is sold, that sale money will need to go toward the bill for her care. Be aware, she will not be able to transfer assets or cash before applying. The program has a look back period of 60 months. Any assets transferred in this time frame will be counted--making her ineligible for the program. Of course, this is only for assets in her name. The social worker and business office should be easily able to qualify her for Medicaid once she meets the income requirements. Medicaid will cover all costs of a nursing home or participating assisted living and generally provides a personal needs allowance of $40 per month for the patient's discretionary spending. After assets are decreased, she can apply for SSI. This will allow for Medicare, and she will not have to wait until she reaches 65 years of age.

An outpatient program for the blind may increase her ability to stay at home independently. Here is a website for you access: Independent Living for Adult Blind (ILAB) - Florida State College - Acalog. You can call and inquire about this program to increase her ADL (activities of daily living) levels. It is likely this agency will assign a case worker, and the case worker will be able to perform assessments and make contacts for additional care options and services. You may have to provide transport because as a private pay resident, ambulance transportation will absolutely break the bank. Again, I would encourage you to speak with the social worker at her current facility (if available). They can provide some additional resources.

Finally, I notice you quote $2,000/month as the price she is currently paying. I assume this is not a nursing home. It may sound crazy, but that is VERY CHEAP for nursing home care. I think this might be an assisted living or some other type of housing. Nursing homes are generally in excess of $5,000/month. You will need to verify wherever she is admitted is eligible to participate in the Medicaid program--some are private pay only. As another helpful hint, make sure you tell the facility you will provide her medications (if needed) while she is private pay. The in-house pharmacy charges almost double a regular pharmacy, and this will save a lot of money. You can have the MD or DO order a 90 day supply and deliver them to the facility as needed.

Hopefully, this information has helped. It is stressful to worry about someone close to you who requires this level of assistance. I understand you may be very frustrated, and I am positive this is extremely difficult on your sister. I wish you the best of luck.

[fsu813]

Eldercare has a Help Hotline: Elder Care Management Services for Seniors - Eldercare Jax - Jacksonville, Florida

[laurir]

Thank you for all your information. It is quite frustrating and sad. No I guess it is not a real nursing home, a private home with 5 or 6 seniors living with a nurse. It may seem cheap compared to expensive nursing homes, but I cannot for the life of me understand why it takes that much she is not getting any services that justify that amount. When the trust savings is gone, there will be nothing left for the rest of her lifespan. So tell me this: Will she qualify for Medicaid if she has a special needs trust? I did check out Elderlaw and that is how I found my attorney.

[dsb62574]

Originally Posted by laurir

Thank you for all your information. It is quite frustrating and sad. No I guess it is not a real nursing home, a private home with 5 or 6 seniors living with a nurse. It may seem cheap compared to expensive nursing homes, but I cannot for the life of me understand why it takes that much she is not getting any services that justify that amount. When the trust savings is gone, there will be nothing left for the rest of her lifespan. So tell me this: Will she qualify for Medicaid if she has a special needs trust? I did check out Elderlaw and that is how I found my attorney.

Sorry, I completely overlooked this in my initial response. If your sister has a special needs trust, that amount will not count toward Medicaid assets in determining eligibility.

Facility charges are expensive. Most of the dollars charged in patient care are distributed to staffing, food, and malpractice insurance costs. Trust me, there is little profit margin in nursing home care, and the profession is heavily regulated (coming in second in regulation only to nuclear power plants). This is the reason most for-profit homes are operated by large chains. It takes the accumulated income of the homes to make the venture profitable. Non-profit facilities are often heavily funded by donations. An assisted living is a cheaper option; however, she must be able to perform certain activities for herself before qualifying. You may want to explore this option.

Whatever choice you make, be sure to take a tour of the facility at dinner time (usually 4:30-6:00pm) or during shift changes (3pm or 7pm). This will give you insight to staffing levels and the manner staff handle multiple demands on time commitments. If you have any additional questions, feel free to ask or private message me. I will try to be as helpful as possible.