What if a Parent Can’t Pay for Nursing Home Care?

The Caring Generation® – Episode 153 November 2, 2022. What if a parent can’t pay for nursing home care but can’t live alone? Caregiving expert Pamela D Wilson shares tips for family caregivers to be proactive when Medicare no longer pays for nursing home care. 

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What if a parent can’t pay for nursing home care? Some family caregivers worry about what might happen next when elderly parents need more and more help to live at home. Learn how the care needs of aging parents advance and the steps to obtain nursing home care for aging parents.

How to Avoid Paying for An Elderly Parent’s Nursing Home Bill

Watch More Videos About Caregiving and Aging on Pamela’s YouTube Channel

Caregivers can view increasing time commitments to care for parents as a progressive timeline. Being a caregiver has a beginning, a middle, and an end.

So if you think about life—birth and death—there’s a lot of time between when life happens. Health care concerns and caregiving have timelines. Like the time you realize that you are a caregiver to the day

you recognize caregiving responsibilities have ended. Somewhere in the middle, you might ask yourself, what if a parent can’t pay for nursing home care?

Stages of Caregiving

Let’s look at the caregiving timeline in stages. Beginning with health prevention, then managing chronic diseases like heart disease, diabetes, arthritis, and others, to the point where an elderly parent or spouse needs ongoing help from a caregiver.

As care needs increase, an unexpected health event might send a parent to the hospital and then to a nursing home. Or mom or dad has a sudden change in health, and you consider the reality that mom or dad may permanently need nursing home care.

Nursing homes are what I like to call the home of last resort. No one dreams of going to a nursing home to live there permanently.

But sometimes, health problems are severe, time-consuming, or medically complex. This high need for care means that living at home with caregivers or living in an assisted living community with care isn’t enough to provide the necessary round-the-clock care.

Proactive Health Begins With the Caregiver

What steps are you taking to remain healthy? If you or a loved one wants to stay out of a nursing home now or anytime in the future, being proactive with your health and lifestyle habits is the way to make this happen.

If you are in the early stages of caregiving and help an elderly parent who doesn’t yet need a lot, helping them be proactive with health care can delay or keep mom and dad living at home and out of a nursing home. When a parent is healthy, extensive and expensive care like having to live in a nursing home can be prevented or delayed.

So, taking a step back, proactive health care begins with the caregiver. Stress levels can take a toll mentally and physically. And if you are not feeling well, it will be difficult for you to continue to care for a parent.

Talking to a parent about proactive health and modeling behaviors by setting an example can be beneficial. This way your parent won’t feel like he or she is being asked to do something that you are unwilling to do.

Regular Medical Care

So go and get a check-up if you haven’t had one or if it’s been some time since your last annual physical. Health routines were interrupted by COVID. Not everyone is back on track with medical care.

If your parent is experiencing health issues schedule an appointment and attend with them.  A yearly visit to the doctor is the best way to identify if new or current health issues need attention.

Do you know your numbers? Blood sugar, cholesterol, triglycerides, or any other levels that might be high in your bloodwork. Do you exercise regularly? Are you at an appropriate weight for your age and height? If not, an opportunity exists to be proactive.

The Realities of Living in a Nursing Home

Because caregivers rarely have a free minute in the day, paying more attention to health, nutrition, and exercise may seem like a low priority or too much trouble. But if one is 90 and living in a nursing home, hindsight about health cannot change the present situation.

Unfortunately, gaining perspective on life doesn’t always happen until an irreversible situation exists. Then when making a before and after comparison, the before may look much better. But by then, it’s not always possible to turn back the clock.

Has your parent been in a nursing home for rehab recently? If not, your parent probably has an outdated vision of nursing home care and its appearance.

Nursing homes and rehab centers that may go by different names are night and day different than memories of 20, 40, or 60 years ago. This may be your parent’s memory if someone they knew was in a nursing home.

Residing in a nursing home is not like living in a hotel. It’s more of a cross between a hospital and a college dorm room. I compare a typical nursing home room to dorm rooms because nursing home rooms are small and usually shared.  There are many reasons why living in a nursing home might be unattractive.

• There’s not a lot of space.
• You have a neighbor or a roommate.
• You are not living in your home.
• There is very little privacy.
• Limited space exists for personal belongings.
• When they wash your clothes, they get lost or end up in someone else’s closet. As well as dentures, hearing aids, or eyeglasses disappearing.

If you have a loved one in a nursing home, you know that there are many things to monitor in addition to their health and medical care.

Chronic Disease Care for Aging Parents

If you care for a parent and take them to doctor appointments or help with any other type of medical care, you are probably in the chronic care stage. Let’s say mom or dad has high blood pressure, asthma, arthritis, or another condition that prevents them from doing everything they used to do.

Maybe parents are physically weak or become easily tired. They don’t do all of the things they used to do like play golf, garden, participate in social groups or attend events. Maybe they’ve stopped driving.

The point is life isn’t what it used to be. Mom or dad’s activities might be limited because of their health.

They are doing their best, but they rely on you or others for help with a lot of things. Managing chronic disease can involve taking prescription medications while still doing preventative activities like exercise, healthy eating, taking medications, and other actions.

There may be the sense that Mom or dad’s health probably isn’t going to get better. At best everything you and they do will help them maintain their current status which is a positive outcome.

When Health Declines

Even with preventative actions if a parent’s health is poor, it’s likely it will decline further. This is why if you haven’t discussed what if a mom or dad can’t pay for nursing home care yet, now is the time to initiate that conversation.

It’s a more extensive conversation if you haven’t talked about worsening health issues and all of the choices to make. This isn’t a topic that any of us look forward to discussing because there is so much uncertainty.

As a caregiver, you may not know how to begin the conversation or what it important to care for parents.

Risks of Delayed Action

In times of uncertainty, when you don’t know what to do about your health or a parent’s health or how to Investigate support and services, I encourage you to reach out for support and information. While searching for information can take time and effort, the alternative of not doing so can be more harmful in the long run.

Delaying healthcare by not seeing a doctor because you are too busy or have other life complications can happen to anyone. It’s essential to prioritize health and well-being when caregivers or parents have multiple health issues.

Being in poor health impacts motivation, mindset, and interactions with others. When elderly parents do less—because they don’t feel well or may be worried about going out in public and getting sick—they become more socially isolated.

Isolation Can Make Parents More Dependent on Caregivers

Becoming socially isolated is a factor that can worsen health problems. Decreased participation in activities outside of the home and interactions with others results in the world of elderly parents becoming smaller.

As a result, mom or dad might become more reliant on adult children to fill their time. Are your parents becoming more dependent on you?

Isolation and loneliness can increase levels of depression and anxiety. You may notice that your parent’s emotions are up and down. They may be more negative or critical.

The behaviors of persons who need care can be challenging and misunderstood. While you might think that mom or dad are being mean, they may not know how to express how feeling unwell affects their lives.

There may be a lack of knowledge about how health affects behaviors and thinking. All caregivers see is an elderly parent who is unappreciative of your efforts, angry, mean, critical, or negative all the time.

Chronic Disease Can Affect Multiple Body Systems

When a person has one chronic disease, it’s like a body system or a part of a car that doesn’t work right. For example, heart disease relates to the cardiovascular system. Dementia relates to the neurological system. Rheumatoid arthritis is an autoimmune disease that affects your immune system and attacks healthy tissues in your joints.

These chronic health conditions can cause medical problems with other body systems like musculoskeletal, digestive, endocrine, urinary, and others. So when you don’t pay attention to or treat an illness, a single condition can negatively affect other body systems and cause more diseases.

Understanding the effects of chronic disease can help reinforce the importance of preventative care. Health insurance exists so that you can get the care you need. So don’t be afraid to use this benefit to get the care you need and to prevent a small issue from becoming a really big issue.

Life Can Get in the Way of Focusing on Health

Maintaining a positive attitude and an outlook can take a lot of work or effort if you don’t feel well. Even for people who feel well, if you have a lot of other life issues like trying to hold down a job, caring for children, transportation issues, you don’t live in a safe neighborhood, and you’re worried about going out – all of these stressors take an emotional toll.

Family caregivers struggle with the same emotional challenges that elderly loved ones experience but for different reasons. Chronic disease—health problems result from stresses in other parts of life.

So trying to keep it all together and live a good life is complicated when health worsens and one doesn’t feel good all the time. It’s like operating on a low battery or with a low tank of gas.

Eventually, you run out of physical and emotional energy and become drained. So, where do you find support to manage chronic disease?

The first place is your doctor’s office. Time for medical appointments is limited. Fifteen minutes at best.  So to make the time effective, you want to be well organized.

Looking for more information about how to prepare for a doctor’s appointment? Check out my online caregiver program and the segment about managing medical care. 

Care Coordination

What if a parent can’t pay for nursing home care? What other steps can you take to be proactive in this area?

Coordinating the care of elderly parents can help them maintain their health conditions. Care coordination means working with a primary care physician and any other doctors or providers a parent sees to share information.

To avoid feeling rushed at medical appointments you must pre-plan. This means you may need to schedule one visit to discuss one condition and another appointment to discuss another condition.

It can take several meetings with a doctor to establish a trusting relationship. And beyond the relationship with your doctor, it can be beneficial to establish a relationship with a nurse, nurse practitioner, or medical assistant in the doctor’s office to support the coordination of a parent’s care.

Disease Specific Organizations

Beyond establishing regular medical care and trusting relationships with healthcare providers, the next step is to contact disease-specific organizations to obtain access to more information. When you start searching, you will find organizations specializing in heart disease, multiple sclerosis, Parkinson’s, Alzheimer’s, arthritis, cancer, and more.

All of these organizations have extensive websites with information. Caregivers tell me there is a gap between finding generic information that may not be helpful and needing or wanting more specific information that applies to your health or care situation.

But, from personal experience when helping family members and persons needing care, I can say that there are navigational, social, problem-solving, collaboration, and teamwork skills that caregivers can learn.

These social and transactional skills come in handy when you need to make decisions and are fretting about what if a parent can’t pay for nursing home care. Another essential skill is continual curiosity, wanting to learn, and asking questions.

The Value of Asking Questions

Becoming a great question-asker is a skill that everyone can learn. Asking questions will help you in the role of a caregiver and in other parts of your life.

Another vital skill that relates to what if a parent can’t pay for nursing home care is the idea of presence. Being present and attentive can be difficult for caregivers who juggle multiple projects at the same time.

You have so much going on that you may not be alert to small details. Things like misplacing your keys, forgetting to take your lunch to work, going to the grocery store, and leaving without that one item that was the reason you went to the store in the first place. We’ve all done these things.

Present and Attentive

Forgetting things and missing essential details are some of the perils of distraction or inattentiveness. You may forget to give mom or dad medications or miss a doctor’s appointment because it was listed on your calendar on a wrong day.

Being present allows you to notice small changes in a parent’s health or activity level that might indicate that something is changing. For example, when I managed the care of clients, I would walk into a person’s home. Immediately I could sense or see that my client wasn’t feeling well, was emotionally upset, or recognized that something else was happening that I needed to investigate.

Noticing the little things is essential when managing chronic disease and healthcare. For example, something as simple as a change in medication—whether adding or deleting—can result in side effects.

Likewise, a change in mental confusion can mean that a parent has a urinary tract infection and should see a doctor. It’s kind of like being familiar with the car that you drive. When you hear a new noise or a strange sound, you know it’s time to get it checked out before the issue turns into an expensive repair.

What If a Parent Can’t Pay for Nursing Home Care?

Worrying about an aging parent who needs more care than you can provide care can be scary especially if there are serious health problems.

Let’s review a scenario of a parent admitted to the hospital for a severe illness or accident as an example of steps to move toward getting paid nursing home care.

This begins with mom or dad being in the hospital for a few days. As a result, they are physically weak.

This is to be expected. Older adults usually don’t leave the hospital physically stronger than before they arrived. So,  if you’re following my recommendation to be curious, you might wonder why.

The Journey to a Nursing Home Can Begin with a Hospital Stay

A hospital is a place where people with severe conditions who need urgent medical care go to get better. But what’s a hospital stay really like?

How many of you have been in the hospital? Do you think a hospital stay is restful or, is one sleep-deprived because nurses come in every four hours around the clock to check and record vital signs like blood pressure, temperature, and oxygen levels? The correct answer is the latter.

While you have access to time-sensitive necessary medical care, being in the hospital can be exhausting. And if you had multiple health conditions before you arrived and were not physically active, what do you think happens?

A patient quickly becomes physically weaker because—unless you insist on making an effort to get up and walk around, which is difficult because you are connected to an IV machine—you will lie in bed for days.

So for a 70, 80, or 90-year-old person with many health problems, the hospital is a great place to receive critical medical care but a horrible place for anyone who is not in tip-top physical condition. The body becomes deconditioned due to physical inactivity.

It’s likely that if the person you care for has cancer, heart problems, physical injuries, or other health issues, their body became weak before the hospital stay.

Physical Activity, Health, and Independence

So returning to solutions for what if a parent can’t pay for nursing home care? The preventative measure of participating in physical activity is one of the best things caregivers can encourage. In this case, the no pain – no gain theory applies.

After receiving approval from a doctor for physical activity, create a schedule and commit. Participate in a physical therapy regimen, find a physical trainer, go to the gym for exercise, walk inside or outdoors,  ride a bicycle or find something to get you moving that you enjoy.

Buy small weights or rubberbands to build strength. Use cans of food if you don’t have an equipment budget. Watch YouTube exercise videos and follow along.

The elderly who permanently reside in nursing homes have multiple health diagnoses. Most are physically weak.

Is your elderly parent physically weak? If so they may be a fall risk. Or have they fallen?

Falls are a significant indicator of a future inability to remain safe and independent at home. So the correct question may not be, what if a parent can’t pay for nursing home care, but what if a parent—or anyone— refuses or fails to participate in preventative healthcare and won’t exercise?

Asking the right question is something to think about. Learning the importance of the asking question skill will improve results in all areas of life. It’s the questions you don’t think to ask that cause the most trouble.

Rehabilitation Stays After a Hospitalization

Let’s take one step back. What if a parent who is in the hospital needs more care, isn’t physically fit to return home, and can’t pay for nursing home care?

There’s some good news. In many, but not all, cases—there are no 100% guarantees for anything—your parent’s health insurance will pay for a rehabilitation stay in a nursing home, also called a rehab center.

So as the caregiver, here are the next steps. This is a time-sensitive activity, so don’t delay.

Ask to speak to the case manager or the hospital discharge planner. Go to this person and make it clear that your parent has health issues, is physically weak and it’s not safe for them to return home.

Do not let the case manager talk you into having a parent move in with you or recommend that you move in with them temporarily. Temporary is never temporary in these situations.

You have a job and a life. Your mom or dad’s health insurance will pay for rehab. Also, make it clear to mom and dad that going to rehab isn’t an option because you can’t provide the level of help they need.

Nursing Home Care

After the hospital, the next step to recovery is to transfer to a nursing home for physical rehab. This means receiving help with daily exercises to regain physical strength and stability to live independently and avoid falls.

Once your parent is in the nursing home, there is another immediate action. Investigate the state program of Medicaid (not Medicare). Medicaid is known by different names depending on the state where you live.

Schedule a care conference as soon as possible so you can meet the staff caring for your parent and share an understanding of the goal. A goal in rehab is something like being able to walk 500 feet independently, return home and live independently. This goal depends on what a parent did before going into the hospital.

You can usually schedule this meeting within the first three days of a parent’s admission. However, if there is a delay in scheduling this meeting and your parent has no money to pay for ongoing nursing home care or even home care, then it’s time to start asking about support through the Medicaid program.

It’s question time. Time to ask questions like, how does one financially and physically qualify for Medicaid?

What if my parent needs to stay here in the nursing home and insurance payments end? What options can provide care for parents when I can’t?

The most important question to ask after you know that a parent meets Medicaid qualifications financially and physically is—will you help me apply for Medicaid?

Applying for Medicaid (or Whatever It’s Called In Your State)

Here comes the next hurdle. You have to decide which type of Medicaid is the most practical and beneficial.

Medicaid, sometimes called HCBS or LTSS or another name, provides caregivers in the home for a set amount of time each week. Then there is Medicaid long-term care. This type of Medicaid pays for care in some, and I emphasize the word some assisted living communities and nursing homes that have available Medicaid beds.

So the decision you have to make for what if a parent can’t pay for care in a nursing home is where will mom and dad live and receive care.

• If at home, then you want to apply for the home-based program.
• If not at home, you want to apply for long-term care.

Either way, the billing or financial person at a nursing home may be the person to help begin the application process. The benefit of applying while a parent is in a nursing home is that the application process can move more quickly, especially if your parent will be in the nursing home for a few weeks.

In Colorado, there is a screening form called Colorado ULTC 100.2.

If you look at the form, you’ll see the two sections. One is for Potential Community Based Long Term Care Program that would be the in-home care option. Then  Residential Alternatives like alternative care facilities, Developmentally Disabled residential programs, nursing facilities, or ICF/IID an intermediate care or intellectual disability care facility.

For all of these options, the payor is Medicaid. So once the nursing home submits the ULTC100.2 in Colorado (your state may have a different form name and number), the timeline for review and approval begins.

Medicaid Applications: Details Matter

If the nursing homes completed the ULTC100.s make sure you request a copy of the form for your records. Applications get lost all the time.

It is a must to be extremely present and attentive to this application process. You have a limited amount of time to provide the financial background. Make sure the billing person at the nursing home or someone in the Medicaid office gives you a list of what you must gather and submit.

Any delays on your part or providing incomplete or inaccurate information will slow down the process. And depending on where you live, it can take weeks or months for an application to be approved.

So time is of the essence. This process to apply for Medicaid that I am describing is the answer to what if a parent can’t pay for nursing home care.

How to Apply for Medicaid if a Parent Isn’t in a Nursing Home

Now you might be wondering, well what if my parent doesn’t go to the hospital or a nursing home. Great question.

The process is similar, although you have a little more work to do. First, contact your county social services office and ask who administers the Medicaid community-based or long-term care program. Next, contact the agency and request a Medicaid application. Again know whether you are applying for in-home care or nursing home care.

Third, gather all of the financial information you need. Fourth, on the medical side, you will want to request your doctor’s most recent medical visit notes and something called an H&P. An H&P means history and physical.

If you can request a letter from your doctor about your parent needing long-term care services, all the better, but sometimes due to the doctor’s schedule, you can’t get a letter. The reason you have to go through this extra effort is that when a parent is in the hospital or nursing home they have all of this medical information in their records.

So you don’t have to gather it. Be extremely detailed in all of this. Be present. Because any information left out or completed incorrectly can delay the application approval timing.

Once you’ve submitted the application call on a regular basis to request status updates. Document every phone call. Make a copy of the entire application for your records before you submit it.

Best Case Scenarios

The best possible scenario for what if a parent can’t pay for nursing home care is that the family and the caregiver discuss options and plans early. The decision may be made that an elderly parent live with children for a period of time or rotate being with children for set periods of time.

While this is happening, investigate how to apply for Medicaid and begin gathering the background information.

Advance planning helps families avoid the opposite scenario where a parent’s health declines, the caregiver is burned out, a parent goes to the hospital and then you realize they can’t come home and don’t have money to pay for nursing home care.

Avoid placing yourself or an elderly parent in the situation of being rushed to make a decision about Medicaid or the next steps of a care situation.

Looking For Help Caring for Elderly Parents? Find the Information Including Step-by-Step Processes in Pamela’s Online Program

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