I recently had to high-tail it back to New York to help my mother with the Medicaid application for Dad's admittance into the nursing home we chose after his fall in August. Dad does not have full-blown Alzheimer's but he does suffer from some early-onset dementia. Meaning he's a bit loopy. And by loopy, I mean the conversation loops around and around and around. The subjects go in circles. He's also got COPD which is somewhere between having chronic asthma and having emphysema, roughly speaking. So he gets weaker, gets disoriented, he falls, breaks a hip. Falls again, this time, he heads into a nursing home because let's face it, Mom is 85 herself and cannot keep up with her own care, as lucid as she is, much less staying on top of his care, too. Add on top of that, 67 years of marriage and that also means that Dad doesn't listen to her anyway when she does try and help him. Or he's downright nasty in how he treats her. When he falls, she cannot pick him up. His 120lbs still outweigh her 95lbs.
So he goes from the hospital to the nursing home. Let's call it Babbling Brook Manor. It's conveniently located a few minutes way from where Mom and her closest friends live so they can take her to see my dad frequently. Nice staff attending to Dad, nice atmosphere...until we get to the money part.
Medicaid is Federal program administered on the state level. Each state has it's own perimeters and guidelines to accommodate cost of living and other criteria. Finding out simple info about a Medicaid application is not an easy thing, even in the age of The Google [tm] because each state offers up its own page about how to do it. There is no one address to send items to, no one person to speak to with questions. What New York State has is a list of facilitators, people trained to assist you in filling out your Medicaid application. Most nursing homes have a person who functions as a facilitator on staff and is usually the liaison between you, the applicant, and Medicaid. Their job, supposedly, is to let you know what information and proof Medicaid requires, and assist you with actually filling out the form. The problem is one of consistency. Lack of consistency creates opportunities for fraud, corruption and unscrupulous practices. Not all people on staff at a nursing home who help with the Medicaid application may have gone through what is referred to as a deputization process, meaning they have been officially briefed on the particulars, the rules, the ins-and-outs of the medicaid application. Technically, the facilitator doesn't review your application but instead, they help you gather the items needed and then they pass the whole she-bang on to the people at Social Services actually reviewing the application. In this case, the people reviewing the application work in the Nursing Home Unit of the Department of Social Services in Westchester County in the State of New York.
This maze of bureaucracy is intimidating and confusing on a good day. When it is exacerbated by unfortunate and emotionally-trying circumstances such as admitting an elderly parent or spouse into a nursing home after a medical emergency, it can be downright bewildering and overwhelming. Particularly if you are elderly yourself. Vultures prey on people in these situations and my mother almost got taken in by some in this instance.
The scam goes like this: An elderly person is moved from a hospital (after a fall, for instance) to a nursing home for short-term rehabilitation. People past the age of 65 usually are on Medicare at this point and Medicare takes care of short-term rehabilitation costs. The rehab is to assist a person to regain strength and mobility so they can return home. If, after this rehab period, a person is assessed to not be able to return home due to health, strength, mobility and other issues related to their ability to take care of themselves, they can be recommended for long-term care. At this point, Medicaid can assist with the cost of nursing home care, if one cannot afford nursing home care privately. You cannot apply for long-term nursing home care unless you are already in a facility. It's a bit of a Catch-22 and stupid beyond belief in my book but that's how we do it in this here US of A at the moment. What happens frequently, the person from the business office at the nursing home contacts the applicant or family member responsible for care, &c, as soon as the person is admitted into the nursing home to start the process of gathering the items needed for the application. The application should be submitted as soon as possible because once accepted, Medicaid pays for treatment three months prior to the filing of the application, so the sooner, the better.
Technically, the facilitator should simply give you a list of proof items needed for the application that you need to gather and they pass that, along with the actual application, filled-out and signed by the applicant onto DSS. Items include proof of birth, marriage, identity, citizenship, home ownership, assets, insurance and life insurance and most importantly, bank account information going back for 5 years prior to the date of admittance. The reason they do this is to make sure people aren't claiming to be needing financial assistance for nursing home care and asking taxpayers to foot their bill when a person can very well afford care for themselves. Sometimes unscrupulous, greedy people with plenty of money try to give away all their money and assets to family and friends and then claim they are poor and in need of Medicaid assistance as a purposeful way to avoid paying for their own care and get the taxpayer to do it for them. Now, there are two sides to every situation and many ways to protect assets that allow people to hang onto their money so that they may leave a legacy or inheritance to their family, friends, pet projects what have you. These are usually in the form of trusts. I could go on but peruse a search engine and you'll find oodles of information about this. Point is, check out this information from time to time and stay on top of your finances. Quite bluntly, poor people will qualify because they have no assets and the very wealthy will always be able to take care of themselves. It's the people in between that will find it worthwhile to look into this.
Medicaid is not totally heartless. They allow you to keep some of your money and assets depending on your situation. If you are single, you must spend your money on your care until you deplete your account to a balance of - in the case of NY State - $14,4000 and a monthly income of $1,500. If you have a community spouse, the amount is much higher because the assumptions is that the spouse not in a nursing home needs money to live on and plan for their elder care.
A nursing home makes more money if someone must pay privately as opposed to being reimbursed by the state Medicaid fund. If the cost of long-term care per month is billed at $9,000 per resident, it's more profitable to have private-pay residents than Medicaid-eligible residents, which may only reimburse the nursing home at a lower rate, say closer to $6-7,000 a month.
And so this is what happened to my mother and father. The facilitator at the nursing home never actually went through the deputization process. She was there for a short period of time. In fact, she was pregnant when I went back and due in several weeks so she would be gone, maybe by now, and her replacement was already being trained. Not by the DSS Nursing Home Unit, mind you, simply by the operators of the nursing home. So, she, and the operators who employed her can claim a certain degree of plausible deniability for any mistakes, mishaps and delays. And delay they did. About three weeks prior to the cut-off date for reimbursement, the woman at the nursing home, let's call her Janey, met with my mother in her office in the facility and explained that many items of proof - that we had already hand delivered to her 8 weeks earlier - were still needed. Gosh! Where did they go? She proceeded to try to scare my mother into believing that my father's application was in danger of being turned down. She then suggested that my mother hire a private service, a senior planning service, a service that handles money and estates and specializes in Medicaid applications, to help fill out and expedite Dad's application. She got my mother on a speakerphone conference call with this group. The woman from this group explained that for only $5,000, yes, that's right, $5,000, they would submit the application for my father and "cut through the red tape" and "smooth out the process" to guarantee that Dad's application would be accepted. Mom said she would think about it. She called my sister and myself and next thing I know, I'm headed back to New York to find out what the holy hell is going on. Janey even had a conversation with me the Monday prior to my drive to New York. She kept insisting that Dad's application had many "red flags" and she claimed he would be "turned down" and then "he'd be considered private-pay and then the lawyers would come after you." At which point I asked her if she was threatening me. Oh heavens, no, she insisted. I kept asking her what these people that she claimed to have worked with many times before, just what could they specifically do that we hadn't already been doing? What red tape exactly? Either Medicaid was going to evaluate and accept Dad's financials or they wouldn't and they would tell him how much he would have to pay and how much they would cover. Mom and Dad don't own their apartment. They own nothing but a car and Dad's been senile enough to bang that up so it's now thousands of dollars off it's value. The money they have in the bank was well below the Medicaid guideline. What was the problem? "Red flags! Red Flags!" But you're not an official from Medicaid, I insisted. Let them make the call because, frankly, it's out of our hands. "But I'm missing documentation!" But we gave that to you weeks ago, and besides, we're on a deadline. Medicaid recommends submitting the application even if you don't have all the paper proof so you file within the three-month reimbursement period. Why are you sitting on this application? "Senior Planning Services! Senior Planning Services!" Fine, send me their contact info.
Do you know these people actually called little ol' me while I was still on my way home from doing errands not 15 minutes later?? And, get this, an attorney for Babbling Brook Manor also called me and left a voice mail wanting to speak with me about Dad's Medicaid application and eligibility! Unsolicited! Not only that, after emailing the Senior Planning Services people with a list of questions, they were kind enough to ignore replying to me in writing in lieu of a phone call/voice mail, because they "really like to have a conversation first." After I insisted in writing that they get back to me via email, they finally did. And provided no references and yes, it's costs $5,000 because they fill out the application "CORRECTLY and in the manner Medicaid prefers." All for $5,000. We turned their services down and informed Babbling Brook we would not be using their "Senior Planning Service" buddies.
I also received an additional email from the attorney for the nursing home reiterating that he tried to "reach out" to me via phone and would like me to contact him about Dad's application. How about that? Twice! Unsolicited contact from an attorney — twice! Without a lawsuit pending or anything! And I didn't even have to pay him anything. When have you ever known that to happen? I ask you.
My sister and I sat down at my kitchen table with 5 years of bank accounts and, after consulting with a close friend who recently had to admit her father in to a nursing home, split the statements up and began flagging transactions over a designated amount. This is the big pain-in-the-ass of a Medicaid Nursing Home application, explaining five years of transactions. But we did. We downloaded the entire actual NYS Medicaid Application [Access NY Health Care]. We scratch filled-out the application. And it wasn't worth $5,000 of anyone's money.
I made Mom get wi-fi for the apartment. I drove to NY. We purchased an iPad and a color Printer. I spoke with the wonderfully helpful people at the DSS Nursing Home Division in Yonkers who advised me that we actually didn't need to have the nursing home do the application for us. That Babbling Brook Manor was notorious for errors and delays. That in no way on earth, should my mother and father pay anyone $5,000 to fill out an application. We recreated the entire application and made new copies of all the proof that was needed. That included original documents that the nursing home business office had in their possession and insisted they did not, such as the Social Security annual awards letters for both my parents. That meant we had to take a trip to the Westchester Social Security office and spend about an hour in the culturally diverse waiting room, waiting to request duplicates (a shout-out to Ms. Bellini, a wonderfully helpful US Government worker who could not have been more on top of things and more helpful to us). We had Dad sign forms for the IRS, his WWII records, you name it. We made triplicates of everything. We bought three plastic folding files and labeled everything within an inch of its life, a copy for mom, a copy for me and the copy we were turing in. While I was working during the week in New York of gathering all this information, the business office at the nursing home was still trying to insist that items were missing. I didn't even bother telling poor Janey that we were by-passing her "help." Mom and I went in to visit Dad one afternoon and had him sign. As we were leaving, Janey actually ran out the door after us, 8-months pregnant, trying to get us to sign her form that she wanted to submit. I called back, "It's okay. We've got it taken care of. I'll email you." Thanks for nothing.
Mom and I hand-delivered the application to Ms. Jackson of DSS, who signed off on receiving it, in Yonkers on Friday morning, November 22. Unreal.
Don't get scammed. It sticks in my craw that there are people who get taken in by this kind of tactic. You know Babbling Brook has done this before and you know they'll try it with the next applicant. This whole set-up was done with enough plausible deniability that you can't prove intent to de-fraud but the whole procedure smells to high heaven. Janey routinely blamed my mother for making mistakes and not providing her with correct documentation (essentially calling my mother incompetent and a liar), even though Janey was in no capacity to determine whether the paperwork provided was correct because she was not the Medicaid authority. People like this depend on the applicant's (or the people assisting them such as my mother and myself) ignorance of the rules and regulations, emotional distress to muddle clear-thinking and prompt poor decision-making, and intimidation by authority figures such as lawyers, administrators, supervisors, government workers and the like. Don't be taken in. Ask questions. Be skeptical. Insist on things in writing. Make triplicates. Use copies only. Be pro-active about your situation. And never, ever pay anyone, least of all a "Senior Planning Service" $5,000 to fill-out an application. Shame on them. All of them.
(Additional kudos go out to the bank people who were enormously helpful in assisting us in tracking down all the transaction information. We couldn't have done it without them.)
Do you know these people actually called little ol' me while I was still on my way home from doing errands not 15 minutes later?? And, get this, an attorney for Babbling Brook Manor also called me and left a voice mail wanting to speak with me about Dad's Medicaid application and eligibility! Unsolicited! Not only that, after emailing the Senior Planning Services people with a list of questions, they were kind enough to ignore replying to me in writing in lieu of a phone call/voice mail, because they "really like to have a conversation first." After I insisted in writing that they get back to me via email, they finally did. And provided no references and yes, it's costs $5,000 because they fill out the application "CORRECTLY and in the manner Medicaid prefers." All for $5,000. We turned their services down and informed Babbling Brook we would not be using their "Senior Planning Service" buddies.
I also received an additional email from the attorney for the nursing home reiterating that he tried to "reach out" to me via phone and would like me to contact him about Dad's application. How about that? Twice! Unsolicited contact from an attorney — twice! Without a lawsuit pending or anything! And I didn't even have to pay him anything. When have you ever known that to happen? I ask you.
My sister and I sat down at my kitchen table with 5 years of bank accounts and, after consulting with a close friend who recently had to admit her father in to a nursing home, split the statements up and began flagging transactions over a designated amount. This is the big pain-in-the-ass of a Medicaid Nursing Home application, explaining five years of transactions. But we did. We downloaded the entire actual NYS Medicaid Application [Access NY Health Care]. We scratch filled-out the application. And it wasn't worth $5,000 of anyone's money.
I made Mom get wi-fi for the apartment. I drove to NY. We purchased an iPad and a color Printer. I spoke with the wonderfully helpful people at the DSS Nursing Home Division in Yonkers who advised me that we actually didn't need to have the nursing home do the application for us. That Babbling Brook Manor was notorious for errors and delays. That in no way on earth, should my mother and father pay anyone $5,000 to fill out an application. We recreated the entire application and made new copies of all the proof that was needed. That included original documents that the nursing home business office had in their possession and insisted they did not, such as the Social Security annual awards letters for both my parents. That meant we had to take a trip to the Westchester Social Security office and spend about an hour in the culturally diverse waiting room, waiting to request duplicates (a shout-out to Ms. Bellini, a wonderfully helpful US Government worker who could not have been more on top of things and more helpful to us). We had Dad sign forms for the IRS, his WWII records, you name it. We made triplicates of everything. We bought three plastic folding files and labeled everything within an inch of its life, a copy for mom, a copy for me and the copy we were turing in. While I was working during the week in New York of gathering all this information, the business office at the nursing home was still trying to insist that items were missing. I didn't even bother telling poor Janey that we were by-passing her "help." Mom and I went in to visit Dad one afternoon and had him sign. As we were leaving, Janey actually ran out the door after us, 8-months pregnant, trying to get us to sign her form that she wanted to submit. I called back, "It's okay. We've got it taken care of. I'll email you." Thanks for nothing.
Mom and I hand-delivered the application to Ms. Jackson of DSS, who signed off on receiving it, in Yonkers on Friday morning, November 22. Unreal.
Don't get scammed. It sticks in my craw that there are people who get taken in by this kind of tactic. You know Babbling Brook has done this before and you know they'll try it with the next applicant. This whole set-up was done with enough plausible deniability that you can't prove intent to de-fraud but the whole procedure smells to high heaven. Janey routinely blamed my mother for making mistakes and not providing her with correct documentation (essentially calling my mother incompetent and a liar), even though Janey was in no capacity to determine whether the paperwork provided was correct because she was not the Medicaid authority. People like this depend on the applicant's (or the people assisting them such as my mother and myself) ignorance of the rules and regulations, emotional distress to muddle clear-thinking and prompt poor decision-making, and intimidation by authority figures such as lawyers, administrators, supervisors, government workers and the like. Don't be taken in. Ask questions. Be skeptical. Insist on things in writing. Make triplicates. Use copies only. Be pro-active about your situation. And never, ever pay anyone, least of all a "Senior Planning Service" $5,000 to fill-out an application. Shame on them. All of them.
(Additional kudos go out to the bank people who were enormously helpful in assisting us in tracking down all the transaction information. We couldn't have done it without them.)
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