Do I Qualify For Medicaid?

'Poor-people' is what most think of when Medicaid is mentioned. A closer look at Medicaid reveals that the program does far more than assist the poor.  Medicaid is a State and Federal program that will pay most nursing home costs for two-thirds of all nursing home residents.    As I discussed in another post, the cost of nursing home care is daunting to say the least.  Medicaid was established to help a broad range of people deal with the financial pressures of long-term care.

Generally, in order to become eligible for Medicaid, personal assets be used first.  People who may never have considered themselves to be eligible for Medicare, may become eligible depending on; annual income, marital status and assets.  The ultimate determination of eligibility is determined by the individual State.

I came across this Wall Street Journal article explaining the complexities involved in the calculation of Medicaid eligibility.  Medicaid forms can be found here.



How Can I Learn More About Facilities?

"How do can I learn more about the facility for myself or for my loved one? 

In my line of work, I get asked this question every other day.  People have seen so many negative headlines in the news that they have a tendency to be scared of the word 'nursing home' itself.  Even though most facilities do not have problems and are staffed by caring medical professionals, there are some facilities who are 'frequent players' in nursing home abuse and neglect.

"How can I avoid the 'frequent player' offenders?"

The answer is easier than most people think.  There is no way to prevent future incidents of neglect or abuse.  However, there is a definite pattern of common problems that occur at a relatively small number of facilities on a regular basis.

While researching facilities for oneself or a loved one, I suggest 20 minutes of internet research.  Two places I suggest people look to are the Illinois Department of Public Health and Cook County Clerk of Court.  These are Chicago-related sites.  However most areas of the country have similar sites to review the facilities. 

Both of the links above allow you to search by facility name to determine if any violations or lawsuits have been brought against them.  If a facility has a violation or lawsuit brought against it, do not automatically discard this facility as being inadequate or unfit.  Rather, look and see if there is a pattern of problems or lawsuits brought against it.   While one or two people may have had bad experiences, a pattern problems or lawsuits is telling of substantial underlying problems and should be avoided.

Got Cash? You Better!

Failure to account for the cost of nursing facility care is the main cause of impoverishment among the elderly.  An American Health Care Association report recently reported that the average American man is expected to spend $56,895 in long-term care expenses.  The  average long term care cost for American women is $124,370.  Private health insurance generally does not cover extend stays at nursing facilities.  Therefore, even for people with means, an admission to a nursing home or skilled care facility means a rapid drain of personal funds.

Most residents at nursing homes are forced to rely on Medicaid because of a staggering drain on personal funds.  Unfortunately, people who rely exclusively on Medicaid have a limited number of facilities available to them.  Often, facilities which rely exclusively on Medicaid for funding are inferior to those who are predominately privately funded.

What is the consequence of all these financial problems with long term care for the elderly? I came across this article describing how the financial crisis trickles down to home how doctors and other medical professional make career choices.  Not surprisingly, the current  financial shortfalls involving nursing homes and long term care are discouraging many skilled medical professionals from treating the people who desperately need them.

Bedsores. Completely Preventable? Absolutely.

Today I met with a family who's mother recently died from sepsis after a month stay at a Chicago-area hospital.  The family hesitantly confided in me that their mother had a gaping hole on her buttocks at the time of her death.  While the family obviously was not responsible for their mother's care when she was in the hospital; they had a sense of responsibility because there is a stigma about bedsores.

Once you see how gruesome an advanced stage bedsore can be, you will never forget it.  Decubitus ulcers, commonly known as bed sores, may start in a small area and look similar to a bruise.  If left untreated or gone unnoticed, the bed sores may rapidly develop into literally deep holes in the body.  Bedsores are generally categorized I, II, III and IV.  A stage IV bedsore may involve dead skin, a putrid smell, and a tunneling which often times results in internal organs becoming visible.

Stages of pressure sores

To some, bedsores are associated with the poor and unwanted.  In reality, they are commonplace at many hospitals and skilled nursing facilities.  Wherever they develop it is unfortunate and completely preventable.  Upon admission, each facility should do an assessment to determine the potential for each resident / patient to develop bedsores.  The failure to do a five minute bedsore assessment at many facilities only leads to bigger problems developing more quickly.

I came across this New York Times article discussing the team-approach required to address the prevention of bedsores.  Clearly, every person responsible for a resident's care must keep in mind of the real possibility that bedsores may develop if one member of the team drops the ball.

Nursing Home Inspectors Miss Major Problems

 

Nursing Homes must meet certain Federal and State guidelines in order to receive money and keep their accreditation. Investigators periodically go to the facilities to ensure compliance. A recent New York Times article suggests that even these 'professional' nursing home investigators miss obvious safety violations.

According to the Mr. Morris, one of the studies sponsors, even some of the most obvious problems with nursing home residents went unnoticed.  "We’ve found patients with maggot infestations in wounds and dead flesh. We’ve found residents with broken bones that went unmended.”

This article raises the question: what can you do to assure your family member is in a satisfactory facility? Here are several basic things to look for when selecting a nursing home:

  • Make multiple unannounced visits at different times
  • Look at the residents, do they seem happy?
  • Ask friends about the facility
  • Does the staff know the residents by their names?

Medicare set forth a check-list for selection of a nursing home or long-term care facility.  You can view the Medicare suggested check list here.

 

 

About Jonathan Rosenfeld

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Jonathan Rosenfeld is a lawyer who represents people injured in nursing homes and long-term care facilities.   Jonathan has represented...

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Frequently asked questions on bed sore prevention, treatment and legal rights of those who have been neglected.

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