My 76-year-old aunt had a stroke and is currently in a SNF for rehab, but they are telling us that she has "plateaued" after 6 weeks and is a candidate for memory care. There is no way that my aunt can afford memory care. She owns no assets except an old car, has $3000 in the bank and only gets social security and a small pension.
I would take her into my home except that my mother (her sister, 78) who lives with me is showing signs of dementia and has never gotten along with her. Our house also only has one ground floor bedroom and my mother is using it. Also, my mother refuses to sell the house (she has life estate although it is co owned by her and me) so we can't even sell the house and find something more appropriate for two elders and a live-in caregiver. I'd even convert my living room into a bedroom for my aunt and "seniorize" the tiny downstairs bathroom, and I'd even consider quitting my job to look after them both, but the last time my aunt stayed with us my mom was so awful that she started trying to climb stairs to get away from her, arguments all the time, not a good environment for either one of them. (My mom is also a serious fall risk and her trying to climb stairs is a broken hip waiting to happen.)
I would move into an apartment with my aunt if I could, but then my mom would have no one to help her and she doesn't have very much money either except the house which she WILL NOT SELL (and the house isn't even worth that much to begin with - she's likely going to need to sell it to pay for her OWN care some day). My mom is extremely possessive and territorial about the entire house and has made it clear she won't tolerate my aunt being present and taking up "her" space.
I'm terrified that my aunt won't qualify for care at an SNF soon and although she is Medicaid pending, I don't even know what Medicaid will pay for. No one at the SNF has been very helpful or communicative with me and I haven't been able to find a lawyer who will help because whenever they find out how little money my aunt has, they don't seem interested in helping.
What can I expect to happen next if she doesn't qualify for SNF and they are saying she needs memory care?
The problem will be her 3k. Most states only allow 2k. So u will need to spenddown 1k probably within 90days of applying for Medicaid. You can allow the facility to help you in applying but keep on top of things because in my state u only have 90 days to apply, spend down, get Medicaid info needed and get her into a facility. I went directly to Medicaid and a caseworker helped me. Since ur Aunt has no assets, it should be an easy application.
If she is 24/7 care, the facility cannot release her. Its called an unsafe discharge. If no one has POA, you may want to consider allowing the State to take over her care. The only thing with that is, they are in charge. She will get placed easier though. A guardian will be chosen to oversee her care. Even if a POA is in place, the state could take over.
To spenddown, you can take her 3k and prepay a funeral. 3k would cover a cremation.
While I was writing so were you. If u don't like the facility, then u will need to find another one who will except Aunt with Medicaid pending. DO NOT allow the SW to talk u into caring for Aunt. And they will try. You are under no obligation to care for her.
We were not able to get POA for my aunt before she got taken into the SNF and COVID access restrictions and also her aphasic condition have caused difficulties in getting a POA notarized. We don't think a notary will agree to witness for her even if we can bring one in, and we aren't allowed to take her out of the facility even for a hour. We will have to do adult guardianship, but again we're having difficulty arranging for two medical exams attesting to her incapacity (one lawyer won't take on the guardianship until we have those done, and another lawyer doesn't seem interested in taking it on), and we don't even know how she could appear in court under COVID restrictions. She is in legal limbo until we get this worked out. I cannot request documents on her behalf or arrange for any private pay anything. I can't sign her checks for her. I can't access her bank account. Nothing. We're dead in the water because no POA and no guardianship. I can't get free legal help on her behalf because I'm not her and she can't request it herself. I would hire a lawyer with my own money, but no one seems interested in helping us so far.
I am meeting with her SNF social worker tomorrow and I will lay out again that there are no family resources for memory care. Her admission to the SNF was highly chaotic due to the COVID vaccine mandate causing staffing issues, and they never even sent any paperwork to us until 9 days after she was taken in, so her Medicaid application only just got started last week after a delay of nearly a month. (We were not sure of her level of cognition and needed to request another assessment appropriate for an aphasic person, but now we understand that she is likely incapacitated so I was able to get the Medicaid application started even though I don't have POA for her.)
We do not like the SNF she is in, it's under investigation by the state. We would like to move her to a different facility; but for now, they have her, she is getting rehabilitation and interaction, and she is holding her own. We don't want to move her around if it causes undue stress for her, and I desperately want to keep her close to home if possible. I just don't know how much "choice" we have in the matter because she is so bereft of resources and wholly dependent on Medicaid and a very small family with few resources.
Please don't feel guilty that you won't be providing her care -- honestly if she requires that much help and you were attempting it by yourself, 2 things would likely happen: you will burn-out in no time; and, you will discover that even hiring privately paid in-home help will be just as expensive (because you'll discover you won't be able to do it all yourself without serious consequences).
It is very possible your aunt will do well in a good facility that has events and activities and a caring admin and medical staff. One strategy is that you research good, reputable places that accept Medicaid, and have your aunt enter on private pay and then she applies for Medicaid. This way she avoids waiting lists. No facility can kick her out if they accept Medicaid, she gets priority. A Medicaid room means she will have a roommate (no private rooms in most cases). FYI if your mom ever becomes more than you can handle, please consider a place where the both of them can be residents (but not roomies!), if you are managing their care and affairs this would make life a little easier for you. And you should think about your mom being able to qualify for Medicaid, since this is a very important resource to preserve, as many people eventually require it since the cost of care is very high. Wishing you much clarity, wisdom and peace in your heart as you help your Auntie, and bless you for being there for her!