Why am I still having trouble getting dad into a nursing home?

Where is he now? I never heard of a NH not taking someone because they weren't in the hospital first? Odd.

I agree - get him in somewhere and then transfer if/when possible.

Good luck.

Answry, if dad gets admitted to a NH that accepts Medicaid as a REHAB patient, paid for by Medicare they MIGHT accept him as a LTC resident afterwards.

When my mom broke her hip and was hospitalized, we were advised by the discharge folks to ONLY look at places that would accept Medicaid as payment after a period of either Medicare or private pay, as shechad limited funds.

Answry, dad needs to be AT NEED both medically and financially for LTC.

Find out on which end he is not meeting criteria. Always easier to get a direct admit from another facility, ie, hospital, not home.

Keep applying and get him into any LTC facility that accepts him. You can always move him to another one once he is already in a place.

Part of the trouble may also be places having openings. It there are not a lot of openings, the LTCs may be prioritizing those coming from a hospital. Just remember that staffing in all medical settings is a current issue - clinics, hospitals, and LTCs - all need more staff.

Regarding “Help Wanted” at a NH, right now all health care facilities are short staffed. Most of it imo is interrelated to Covid…. Like staff got it back in early ‘20 or summers Delta surge and decided just too much to work & deal w Omicron so quit; decision made to take early retirement; bigger health care institutions paying bonus to new hires, so leaving a NH to work at a hospital with bigger benefit package makes sense; CNA might can make more $ working at a restaurant nowadays.

On the NH snafu…..Does he really truly need skilled nursing care?
So hospital has found no reasons at all to admit him?
Has he had a needs assessment done?
Most entries (like 70%) come into a NH via a hospitalization (MediCARE benefit) discharge to a NH for rehab (MediCARE benefit) and then they end up staying there and go from rehab patient (MediCARE) to long term care resident (private pay, LTC insurance or Medicaid). NHs are happy about this route as MediCARE rehab pays like double or triple what Medicaid ever would and rehab pretty much is a guaranteed given to run the full first 20/21 days at 100% Medicare paid. Then if they still need to continue rehab, MediCARE will pay 50% up to a max of 100 days & most of the time the patients secondary health insurance covers the other 50%. AND he will have a huge medical charts between his hospital stay and his rehab should he stay after rehab and become a LTC resident and apply to Medicaid. It’s a smoother transition.

This is mucho importante cause if he should need to apply to LTC Medicaid to pay for stay in a NH, Medicaid will review his charts &/or do an in-person needs assessment on him at the NH. If his chart does not clearly & in detail show him to be “at need” for skilled, then Medicaid will not pay. Medicaid will find him ineligible for medical requirements. Could this be part of the problem you are encountering?

A NH will take in a private pay resident (under a contract with guarantees) who is not quite needing skilled care if they are on the cusp between AL & NH or have Co-morbidities & up in age. But I’ve found most of these are facilities are totally & only private pay…. places that do not ever take Medicaid. They take Medicare but not ever Medicaid. So elder has lots of assets &/or thier kids/ POA does and everyone signs off on legally binding contract to pay for their stay. Often there is a substantial “buy in” or deposit required at a private pay facility.

But a NH that takes MediCARE & Medicaid doesn’t have this and really doesn’t want to take the risk of having a resident move in obstensibly “ok” for Medicaid and then find out 3-6 months later their application is denied…. that they are not “at need”… so not eligible and the resident has no $. The NH will have only gotten paid the residents SS mo income leaving a bill of thousands of $ a mo unpaid.

If he is going to need Medicaid to pay, he’s got to be “at need” both medically and financially for Medicaids requirements to be eligible. Most states LTC Medicaid programs are only for NH/skilled nursing care. If he doesn’t have a needs assessment done, I’d suggest that he has one done so you have a realistic idea of what placement is best or what needs to happen to have his chart be more accurate to his health status. Good luck.

answry: You state that you've "been trying the hospital route, last time November." Am I to assume that your father was hospitalized last November? If that was the case, what should have happened is that the social worker at the hospital should be aware of an unsafe discharge to home AND that a Medicare bed is available at the NH for rehab. My late mother, who resided in her own home many states away from me until I had to move in temporarily, was hospitalized and then sent to an NH in a rehab unit of said facility. Ideally, we wished (and wrongly surmised) that she would be then transferred to the long term care unit of same NH since she could no longer reside ALONE without me or her other adult kid present. We were very wrong. Long story short was that the NH said "Ma'am, you're too well to stay here (even in the rehab unit)." Less than 48 hours after they made that statement, my mother suffered a fatal ischemic stroke.

Answry, I think perhaps you need to get you dad into ANY NH and then transfer hin.

"Admit staff person also mentioned getting him pre-approved for long-term care Medicaid. I told the lady his Medicaid worker threw out his application saying that long-term care could not be applied for until dad is in a nursing home. The Medicaid worker said a nursing home can be billing for services doing it that way and never accept the patient."

When I applied for Mom, I had 90 days to get her spent down, all info need to the caseworker and find a place. I was under the impression the day Medicaid took effect was the day I could move Mom in. What Mom did was pay 2 months privately and medicaid started the 3rd month.

I also have never heard that you need a 3 day stay in a hospital to get into a LTC facility. Rehab yes. I can see trying to get in Medicaid pending because there is no guarantee that Medicaid will except the person and then the facility is owed a big bill.

You may need an elder lawyer to help with getting Dad into a place. Next hospital stay pray he is in the 3 days. Have him transferred to a rehab that is attached to a LTC you like. Have him evaluated for 24/7 care and tell them he needs to be placed in LTC because there is no one to care for him. They cannot release him unsafely. Then you start the Medicaid application with the help of the SW but keep on top of things because Medicaid has a limit on how long you need to meet criteria.

People here are making a good point that your issue might be that you are trying to get Medicaid to pay and that will require meeting specific need levels. If you pay full price out-of-pocket, many Nursing Homes would be glad for the money. There may also be a shortage of spaces available right now b/c of staffing shortages.
Does "dealing with your siblings" mean you will all have to share care taking duties and/or costs until you can get your dad placed? Yes, you might have to do that. You are fortunate if they will be of some help, even if they have to be pressured.

Thanks so much, everyone, for the replies. It has been a busy last few days and I didn't know there were more responses. I wasn't going to update until Monday after more phone calls but I see there were some responses so here is an update.

On Friday, I notified the doctor of what the nursing home I desired for dad said (required 3-day hospital stay). So then the primary called and said the previous nursing home and doctor (same clinic) is willing to accept him. And lordy mercy it has been a cry-baby sleepless weekend for me. This facility was so so and the doctor that is over that facility is the one that helped my sister over-medicate. So I'm not trusting. I know others on here say transfers can be done but I'm reading where some people on here are having trouble with getting transfers done.

But my hands may be tied to that facility for now. I'll know more tomorrow. The one I wanted still has not called me back since the previous statement.

Another thought I wondered about was whether getting him put under hospice would help with getting him better placement or at least a second set of eyes if I sent him back to the previous nursing home.

Where can I get a needs assessment done?