Who pays for nursing home care?

[kpr1024]

I have a dear friend whose husband had an MI at age 40 and suffered hypoxic brain injury. He needs total care. She has been caring for him at home for over 2 years. She has a CNA during the day and she does the care nights and weekends. He is in diapers and has so much spasticity that even changing him is quite difficult. They have 2 small children and she is completely worn out from trying to do it all. She works full time as an RN.

She held out so much hope in the beginning that he would recover. Her children have been so patient but have recently been complaining that she doesn't spend enough time with them. She is contemplating nursing home care, even though this is not what she really wants. He will have medicare in August and is covered under her insurance from her job. They are buying their home and paying for a car, but have gone through their savings due to his medical needs. I would like to help her find information about this but don't know where to begin. We live in Texas. Any help is appreciated.

[catlady, BSN, RN]

Unfortunately for your friend, Medicare will not pay for her husband's nursing home care. It is only intended for short rehab stays, to a maximum of 100 days after a qualifying hospital stay. Doesn't sound like anything she can use, although if he does get in, he can receive some therapy under Part B.

The insurance benefit is likely similar, with an even shorter cap.

She should really consult her community social services and/or an attorney to review what her financial options should be. Depending on their finances, the best bet is probably to get him on Medicaid, which is accepted for long-term care. The social worker can help with determining what programs are available in your area and with completing the applications. The attorney can help protect what's left.

Wish I had a better answer for you.

[steelcityrn, RN]

This may sound harsh and extreme, but have seen couples divorce so that the spouse who is terminally ill and needs round the clock care can enter a nursing home and fall under medicaid, so the other does not lose everything they have worked so hard for together. This of course is a very, very difficult decision to make, some may say even moral. I have also known those who had very good insurance at work that is paying for round the clock care at home. But this also may not go on for the entire length of the patients life because, if there is any way that company can cut payment for round the clock or even partial care at home in the future, they will.

[tcoxrn]

That really stinks , But I do beleive that since they have children and only her income left that he may still qualify for medicaid without her having to divorce him or lose anything Sorry not real helpful , but I bet if she looked into a facility the marketing person could direct her to social work to help her with the paperwork and all the details.

[P_RN, ADN, RN]

In my state, and probably elsewhere too, Nursing Home Medicaid has different limits than "regular" medicaid. The problem we had with Mama was there was only ONE Medicaid social worker in the county, and only ONE Community long term care Nurse to validate she met the requirements.

Then (I was in the hospital at the time) my husband had to call around to every place within 30 miles to see if they had any medicaid beds. That still seems odd to me.

Fortunately on the third call he was told yes and he immediately told them he would take it. Then we had about 3 months of anxiety waiting for medicaid to kick in.

I hated to see Mama move there, but she is happier and more social than I have ever seen her. I wish your friend all the best. What she needs are good friends like you to assure her that what she contemplates is OK. The feeling of guilt associated with a decision like this is almost suffocating.

[Otessa, BSN, RN]

I only have experience with my grandmother. She is in an Alzheimer's Unit and all 7 of her children pay for her LTC. She literally had nothing much when grandpa died unexpectedly of a heart attack and she couldn't be cared for due to her declining mentation-none of her childre were of retirement age or needed to work.

[justpoorfect]

Does he already have his Social Security Disability Income in place?

[kpr1024]

Thank you all for your help. Yes, he has been receiving SS disability for 2 years next month. That is when his Medicare should begin. This is really a heartbreaking situation. Divorce would not be an option. Her current provider, who gives him excellent care, has said that if nothing is done by December, she is leaving. She has been through 4 or 5 providers in these past 2 years, one of which was verbally abusive.

[TheCommuter, BSN, RN]

I work in the long-term care wing at a nursing home in Texas. The majority of the patients are on Medicaid with a few private pays. If your friend and her husband have less than $50,000 in assets, they might be able to qualify for Texas Medicaid.

[IndyGal]

The only experience I have with this was with my grandfather, who had Alzheimer's and needed round-the-clock care. What we learned is that, as my grandparent's house was paid off, he could not qualify for Medicaid. If my grandmother sold the house (or mortgaged it to the hilt, I suppose) and put that money toward my grandfather's care first, then Medicaid would have kicked in once that money was gone. My grandmother didn't want to lose the house and no one in the family had the money for pay privately for LTC, so she made do with a CNA who came in once a day to help out and family driving in on weekends to assist. (Our family is spread across several states, no one was within daily driving range.) It was a difficult situation... makes me think about investing in LTC insurance now in case I'm ever in that position.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

My grandmother had to sell her house, car, husbands boat, and all of her furnature and belongings (after wiping out her bank account of course) to stay in the nursing home for 2 years. Sad, but none of her children were weathy enough to pay for her stay, and all had to work full time to pay their own bills, so no one was able to stay with her.

[KellieNurse06]

Can your friend get home nursing for her husband? My daughter gets 88 hours a week allotted for home care by nurses so she has nursing from 7am until 10pm everyday and Sundays are family days with no nursing. She is total care 100%. If your friends husband is totally 100% dependant on others for care than he can get SSI which will give him insurance which will cover home care nurses...sounds like they need home care nursing instead of cna's ( not to sound like cna's are bad, they do great work) but then the home care nurses can do everything from meds to feedings, which maybe a cna cannot do legally,then she can have some of the weight lifted off her without feeling horrible contemplating nursing home placement...gosh that's gotta be a hard thing to think about....and think of the poor husband if he is aware of everything but just can't verbalize....gosh my heart breaks for them... good luck & keep us posted on what happens...