Nursing home trust fund account problems, has anyone had this problem?

I do not think you are understanding the implications of the funds in the PNA and the dental work account. It is very important if mom will continue to need Medicaid. Medicare will not pay for a nursing home.

Magnolia re-read this portion of igloo's post,

"Magnolia, if your mom is on Medicaid and has close to 2k in PNA / resident trust fund/ in-facility trust account AND has more $ in bank account for dental work, AND NH has her as delinquent in her bill, theres going to be an issue somewhere for her Medicaid eligibility."

Your mom, per Medicaid eligibility rules MUST not have more than 2K combined in her dental work account and her PNA. Having any more will cause problems with Medicaid eligibility. Meaning that, mom will be penalized and have to pay "out-of-pocket" for the nursing home fees. In that case her dental fund is gone to pay nursing home and PNA depleted too. Mom cannot be co-owner on any accounts with you, that will be determined to be mom's money unless you can show differently.

If this happens, you will have to reapply for Medicaid. You don't want that, I am sure.

Again, "if your mom is on Medicaid and has close to 2k in PNA / resident trust fund/ in-facility trust account AND has more $ in bank account for dental work, AND NH has her as delinquent in her bill, theres going to be an issue somewhere for her Medicaid eligibility."

Also I’d like to add that IF your mom is on Medicaid and has actually made the current NH her representative payee for her SS, that will be a not easily resolved hurdle to moving her. She would need to change the rep payee status with SSA. And you as a DPOA cannot do it for her. SSA does not recognize POAs. She needs to do it. If she is totally bedridden, it will be very challenging. If she has dementia atop this, she won’t be able to do what SSA requires. You would have to yourself file to become her representative payee. And this will take time. Meanwhile NH will fully expect to be paid the required copay.

if you move her & old NH still is her rep payee, they will continue to get SS$ till change is processed by SSA and mom gets refund from old NH. But new NH must be paid each month as per Medicaid rules, so you will likely have to basically personally do a bridge loan to the new NH and pay them moms copay; or you sign some sort of financial responsibility contract to be personally liable to pay. If there’s existing issues with payment at the old NH and the new NH becomes aware of this (likely as it’s probably in her Medicaid compliance notes), and there’s also rep payee status switching needed...... well you may find the new NH may not be quite so interested in having her as a resident.

NH encourage the rep. Payee stays as it’s a way to steamline billing, have the copay done in a timely manner & ensure they get paid. But mom or you as her dpoa do not have to do this. Mom can continue to have her SS$ and retirement income continue to go direct deposit into in her old in her SS# bank account that you are a signatory on. But NH must be paid the copay as per Medicaid rules.

Magnolia, if your mom is on Medicaid and has close to 2k in PNA / resident trust fund/ in-facility trust account AND has more $ in bank account for dental work, AND NH has her as delinquent in her bill, theres going to be an issue somewhere for her Medicaid eligibility.

setting aside the access issue of getting PNA $ for a bit..... your mom has to do copay of almost all her monthly income to NH as per Medicaid rules. If NH has her owing 3 months, then something not getting paid. They are - I bet - suspending access to her PNA till that gets straighted out. I’d suggest you really get on this ASAP & have all at zero balance for EOY. So mom starts 2020 freshy fresh for billing.

Medicaid for LTC has 2k as the max allowed for nonexempt assets. It sounds like between PNA & tooth fairy fund she’s way over that. Medicaid can do a recertification & will require maybe 3-6 mos. of all financials - like bank statements,PNA balance. It she’s over 2k she can be deemed ineligible for staying on Medicaid. It will be a nightmare to go thru & do new application. She needs to spend down her $ ASAP. Really calmly speak with billing to get her act zeroed and then see how much $ she has stashed overall. Personally id keep it at a max of $1500 total - whether it’s in a NH PNA or in her old checking account or a combo of both of them.

Been a couple of posts on this forum, where NH used PNA $ to buy resident durable $$$ equipment, like a wheelchair. Medicaid Resident was at or over 2k, so rather than have them get ineligible, NH did a spend down. I bet it’s allowed as per admissions contract.

On moving to a new NH. It can be done, I did it for my mom. But it will be quite the ballet to get accomplished. First you do want her totally current on old NH bill so compliant for Medicaid. So that month of move there is no hold on her account. I’d have her PNA at under $150 so whatever final charges (beauty shoppe, cable, phone) can be fully paid from PNA. New NH, should if their worth a fig, should send out a team to do a needs assessment on your mom, so that they can determine that the new place can meet her needs. For my mom, it was a duet of RN & SW; they called me from moms room to say all was good and put mom on the phone too. The assessment is usually good for 30 days, so you have to get her moved over by then. I timed it so that mom moved couple days after she got both her SS$ & her retirement $. Both old NH and new NH must get their respective copays for month of move. By doing it after all income in, mom could do a check to each to the penny for their exact # of days. I did notify old NH by fax day after assessment of move. If they are on Medicaid you can move them without having to do 30 day notice. Although old NH may tell you that isn’t the case......

new NH let me set up moms side of room the day before. So I basically stripped out old room and had all done & waiting for her. She had to be there by 10/10:30 AM as they wanted her there and in for lunch and off to afternoon activities.

This is important, you MUST get all her medications from old NH. Their meds are done usually in 90 day blister packs. Medicaid & MediCARE will not pay for a 2nd set. So you or mom must get all meds. If NH uses a locked medication management system, you may need to actually schedule this in writing. If she is using NH equipment - walkers, wheelchair all that stuff stays - you need to have her able to get into your car on her own. Otherwise you’ll need to hire a ambulance service to transfer her - this is not paid by the M&Ms. My mom was totally ambulatory with her own footed cane, so not an issue.

There will be paperwork to request electronic transfer of her health chart too. You need to be on her HIPPA list at old NH to do this.
New NH will check Medicaid to make sure no eligibility or compliance issues too. So you do need that past due whatevers to be gone.

You have a separate account for dental work? Medicaid only allows $2,000.00 to be held for a recipient, when it becomes more, she is not eligible to continue receiving benefits. It doesn't matter where it is held. There is nearly $2,000.00 in her account at facility. You want to take it out. To put in dental work fund?

You froze Medicaid?

Get the dental work programmed and get it done. Then present bill to facility. The necessary dental may take some time.

Magnolia can you clarify this? “ I recieved a call from financial advisor she owed for 3 months when she first went in. “
Owed 3 months of what? Her monthly bill was in arrears 3 months? How is that possible? Do you get a statement or invoice of her monthly nursing home charges, not just the savings account?

Magnolia, I just read one of your responses stating that your mother owed 3 months when she moved in..if so, they can offset the "Trust". Start by reviewing what was signed when she moved in and go from there.

I think, and it seems as if most commenters think, you are getting scammed, Magnolia. Very sad. Ombudsmen aren't necessarily on the side of the SNF (in my area there is one paid head Ombudsman and all the others are volunteers) but they don't want to rock the boat. Contact your Dept. of Aging, either state or county. See if you can get a local journalist involved. Local or county or state representative often are helpful IF they aren't afraid to p*ss off a large industry. The last resort is a lawyer but this can be expensive. Do you have a chance to speak to other visiting family members to share experiences? Sounds like you are very involved with your mother's care, bless you.

Talk to a bank you trust to talk about transferring funds to them. Maybe they can help with the transfer of funds. If that doesn't work, get a lawyer.

An account facilities have for residents is technically called a Resident Trust Account. However, this is not the same as a legal trust set up where a trustee is appointed to manage the account. A legal trust is defined by Google dictionary as "an arrangement whereby a person (a trustee) holds property as its nominal owner for the good of one or more beneficiaries."

The Resident Trust Account is sort of like the facility acting as a bank holding the resident's money. Typically, a person who is on Medicaid has their social security come to the facility automatically. In this case, the facility has requested from the Social Security Administration to become the Representative Payee for the social security money. The funds get deposited into the resident trust account. The facility will deduct the liability to the nursing home (the part owed to the nursing home). The liability is the amount of income less what the state allows for a resident's personal needs allowance (PNA). In my state it is $52 each month. So, if grandma’s total monthly income is $1,052, the facility is to be paid $1,000 and the resident gets to keep $52. Again, this PNA varies from state to state.  

The important part is the PNA is the resident's money to do with what he/she wishes---give it away, spend it, save it or burn it. The facility is not entitled to the PNA. What does happen is that since the facility is the Representative Payee, they are responsible for reporting to the Social Security Administration as to where the funds went. A receipt the resident signs when they receive their PNA should be sufficient for the report, but some facilities take the reporting responsibility to the extreme. 

There is no requirement for the resident to use the Resident Trust Account at the facility. The alternative would be for the resident or their legal representative to receive the income into a personal bank account FOR THE RESIDENT, pay the facility the liability each month, manage the account and any reporting to social security.

Those who are private pay may also have their Resident Trust Account funded. This allows for the resident to have access to money when they wish. It is like having a bank within the facility.  The import take-away is it is the resident’s money! If a resident has trouble with this issue, they should contact their local Long-Term Care Ombudsman.

I think I am not understanding what you mean by a "Trust" that the facility is holding and using. I read responses below and realized my response was incorrect so deleted it.

In my experience "Trust" Account means there is a Trustee and while I'm not familiar with that kind of set up with a NH that doesn't mean they don't in places. I'm more familiar with a Personal or Personal Needs Account for NH residents where the NH basically acts as the bank. If this is indeed a "Trust" account I would think there should be something your mom or her POA signed to set it up when she entered the facility and if you don't have a copy of it they should be able to produce one easily (same goes for a Personal Needs Account). This would say who the trustee is and lead you in the right direction, I would think.

Is she on Medicaid and they are paying for her LTC or is she self pay where Medicare is maybe picking up some medical portion and you/she is paying the balance? The clarification is only important because it can affect the rules when it comes to these accounts. The $2000 max sounds high to me for a Medicaid patient and seems hard to attain with the small amounts they are typically allowed from their income but again, it may just be the state rules I'm somewhat familiar with being very different from yours.

It sounds to me however that this money/account isn't your only complaint and might not be your biggest concern. If she isn't getting the care you feel she should be that's a whole other ball game and should be addressed sooner than later and separately as well as combined with the financial concerns. IMHO.

Get in touch with the long-term care ombudsman in your area for better clarification and you also might want to invest with an certified elder law attorney.

I am not sure what you mean by residents trust fund. In skilled nursing home's resident's have a personal needs account, some may call this the residents fund. If the resident receives Medicaid a portion of their social security check is placed into that account each month. The amount depends varies State to State, here in Missouri the amount is $50 per month. When a resident moves into a skilled it is their choice to set up this personal needs account, some families don't, instead they subtract the money for the amount they send to the home each month.

If the resident is private pay they can put as much money into the account as they choose.

This personal needs account is just that the resident has total control over how the money is spent in the account, the home cannot use this money for any reason unless the resident gives them permission. Under Federal law the resident has access to this account when ever they choose to take out the money. In most cases if the resident want to take out a large amount they need to give the home some notice so they can have the funds available, if it is under $50 they should have no problems getting the money on short notice.

If the resident is on Medicaid the home must notify the resident/responsible party when the personal needs account/resident funds reach $800, This is so they can spend the money down before it affects their Medicaid Status.

Again, the home has NO control over how the resident spends this money. Many residents use this money to pay for beauty shop appointments, snacks or for spending money on out trips.

If you are having problems with the home trying to control the residents personal needs account/resident fund call your local Long-term Care Ombudsman Program. The Ombudsman are the Federally mandated advocates for residents in long-term care communities/nursing homes, they are experts and know the State and Federal laws that govern nursing homes. This is a free service and they will be able to investigate what is going on and correct the situation for you and your loved one.

I hope this helps, good luck and have a good holiday!

How much are you talking about per month?

Perhaps it was Set up like this to Take her Money, Honey, Monthly to Pay her way. Apparently, She is No eligible for Medicaid, And this Trust Helps Pay her Way. Talk to the Social Worker over there, maybe something else can be Arranged with the Financial Advisor. Need Funds to pay her way.

Is this a for-profit privately owned home? Because they might be counting on families forgetting about those funds after the person dies. I would get that money away from the nursing home and keep it in an account of your mother's, with you as PoA. Do not give in to the administrator.

Thank you JoAnn29, my mother is bedridden. Past statements show misuse of funds. My mother and I were denied taking any money out. I buy what she needs and even if the lost money was accounted for, there's still were money taken out that was a waste. I wish I had known I didn't need a resident trust fund. I would never reccomend having one.
I'm sending a certified letter return receipt to the administrator on this, lack of bathing etc...
If you can get home help for your love one please do. I've seen my mother and other patients go downhill after a year in a nursing home.

Sorry people but that money is the person's whose name is on it. It does not go back to the NH or Medicaid. When my Mom passed, I presented the short certificate showing I was Executor. The info was sent to the billing office. Within a few weeks, I had all the money in Moms acct. It was included in her estate.

If Mom is still in the NH, don't think you can freeze it. If its approaching the 2k that she is allowed, u need to spend it. Get her teeth. Get her some clothes. I would question any deductions made without her authority or yours if ur POA. This money cannot be used by the NH for any of her care.

Look up Personal needs acct on the Medicaid site for your state. It should have an explanation on how it can and can't be used. I would contact Moms Medicaid caseworker and tell them ur having a problem. Maybe u can set up an acct that the NH can deposit that PNA. There have been members who continue to pay SS to NH being allowed to take out the PN monies.

Is your mom leaving the nursing home?

the thing with Medicaid is, if they are giving her the $30 a month then there may be Medicaid rules about what can be done with the fund. It’s not meant to accumalate & become an inheritance or a nest egg (not saying that’s what you are trying to do). It’s supoosed to be spend on her personal needs-clothing, tooth brushes, shampoo, lotions, hair cuts, shoes, etc. You should call the ombudsman and find out if you are allowed to withdraw all that money. Only reason I think you wouldn’t be able to is again, if it all came from Medicaid. It’s still your moms funds but Medicaid has their rules.

No my mother is bed ridden. I've also been told that the P.O.A, recieves any money left over after death. A lawyer I talked too told me to try and talk once more with them.

Worredincali, how does Medicare figure in? I've always been told that's the residents fund to draw out. I've also been told her or I could get these funds.
In this site is a article on not starting a resident trust fund.

After my Mom passed away, I was told the same thing by the finance dept. It was only about $40 and I was going to give it to their activity dept, but they said they keep it. Has your Mom passed away, or is she moving to another facility? If moving, I would think that money should move with her.

Yes shes on Medicaid and I froze her account due to discrepancies of about 400 dollars. Shes very close to the 2000 dollar limit. Plus I have another account for her to get her teeth redone.

Its 30 dollars after the nursing home is paid.

How is the trust fund funded? I mean, is the account compromised of money you have deposited yourself? Is she on Medicaid?