Nursing Home Care; When it is Appropriate?

The Case of “Flora”

I recently had a case. This was a huge case,and is still ongoing, where State and local legislators were asked to get involved. This case kept me up asking things like did they know, or not know she couldn’t afford a facility?

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The consumer: a little “blissfully happy” old lady who was brought to the US from Peru. We will call the little old lady “Flora”. Flora was brought here to the States by her son and daughter-in-Law from Peru for reasons that I am still unsure of. I have a ton of speculations, but will leave my speculations aside for fear of muddling this story for our readers.

Flora ended up having a fall accident last month and was hospitalized. Flora is 79, has Alzheimer’s, and is otherwise healthy and mobile. She stayed in the hospital under private insurance where administrators labeled her as “blissfully unaware”. The doctors at the hospital wrote for Flora papers to receive rehab in a long-term facility after her hospital discharge. So she went. 

What’s the big deal…?

The big deal came a month later, on August 1st, when there was no more insurance to pay Flora’s skilled nursing facility bill. The bills can run upwards of $225 (USD) a day. Yes, the care for an elderly (or anyone for that matter who needs skilled nursing) adult, in a facility, can cost double a middle class mortgage on a monthly basis. Let’s not even start the discussion on how an individual can contract some of the most deadly staff (MRSA), diarrhea diseases (ever hear of C-Dif), and urinary tract infections known to public health officials. I thought: hey, she will totally would qualify for Medicaid.

Nope! Flora’s been here a year. She would have needed to be in the States under sponsorship for five years to qualify for Medicaid.  

Naturally, the family became desperate when the nursing facility began contacting them for payment every day. They didn’t want to take her home, and yet they couldn’t afford to keep her in that facility. The daughter in-law said she would not take Flora because she (and Flora’s son) could not care for her. To make a very long story much shorter, the facility wanted to just open the doors and release Flora. This is what is called an unsafe release, and actually happens all the time. Facilities can be sued up the wazoo if caught releasing patients under unsafe circumstances. This actually happens a lot. So legislators, the Office of the Ombudsman, and local advocates got involved. The State Department of Health and Human services told the nursing home no way, you can’t release her until she’s safe. This bought some time. 

We were prepared to set up in-home help for the daughter-in-law, but she wouldn’t accept it. She was only interested in keeping Flora in an institute. I still don’t understand why. 

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As mentioned above, Flora did not qualify for Medicaid because she was not in the States long enough. I’m not even going to get into the web of Medicaid policy and legislation, but the family thought she would qualify, but she didn’t. I keep asking myself if they did research on how Flora would be able to age here successfully AND safely. There are so many circumstances families encounter. Unfortunately, it’s all too often that desperation causes families to make some pretty bad unfortunate on behalf of an aging loved one.  

Placing a family member into a facility is a very hard decision. When is it the time to get a skilled nursing facility involved for an aging loved one? 

The answer isn’t easy, and a caregiver shouldn’t make promises. The abilities of the individual should be reflected, AS WELL as the abilities of the family caregiving team. If a person is bed bound 24 hours a day, and requires constant assistance, a skilled nursing facility may be the way to go. Just make sure the financials and details are in-line with the State of residence. Otherwise, the family may end up with a case similar to Flora’s. On the other hand, if the person has an organic brain disease or Alzheimers , but seems to be orientated, needs minimal queuing, or is blissfully unaware, then a facility may not be the best choice for that person. 

If a person has worked in the States, and receives a pension or social security, odds are the facility will gladly take those dollars in exchange for a bed. Many times social security or a pension only covers a portion of a bed and facility costs. A lot of times Medicare will make up the difference; for a little while anyway. It’s so important to know the costs before placing a loved on in the facility. Label the responsible party and whatever you do, DON’T SIGN ANYTHING holding you accountable financially. Also, know if the flow of money runs out, the facility may try to collect payment with next of kin. 

Now, if a loved one immigrated to the US, and develops health issues, the family must understand the Federal and State criteria the individual must meet in order to receive aid and social services. Otherwise the family will be on the hook to foot the bill.

Plan, plan, plan.




2 thoughts on “Nursing Home Care; When it is Appropriate?

  • August 23, 2018 at 3:46 pm

    I am curious why you see it as Flora’s daughter in law’s obligation to care for Flora? The burden is on the son.
    When you talk about the cost of a nursing home being more than a middle class mortgage you are comparing apples and oranges.
    MRSA can be acquired from a stay in the hospital. C Diff can be the result of misuse of drugs like proton pump inhibitors or antibiotics….thus a prescribing issue.
    No one is owed to be cared for in their children’s home which is sort of what you seem to imply. The ability, needs and health of the caregiver matter as well.

  • August 23, 2018 at 4:47 pm

    Hi Kate! Thanks for your comment! I’ll try to hit all of your points.

    Every instance where someone chooses to take care of (or not take care of) their aging loved one will vary greatly. We believe this is why discussions should take place early on as every family situation will vary as well. This was just one rare example of how tricky elder placement can be. Many people believe they can easily place an aging parent in a nursing home. Unfortunately, it’s not that easy.

    According to the social security calculator at, a person making $60K retiring at age 68 and 7 months in January 2019, will bring home approx $1,836 in monthly income. Someone who needs nursing home care would not be able to cover monthly costs with SS alone., as stated at the end of the article. Medicaid is an option if the individual meets all of the spend down requirements, but the facility will have no problem taking that $1,836 check.

    Please see the following link for total facility cost.

    The example used is pretty rare, but not uncommon. Flora was sponsored by her son to migrate to the States two years ago from South America. But, she wasn’t a resident long enough to qualify for State Medicaid. The son became quite ill himself shortly after Flora’s arrival, and could no longer care for his mother due to his illness. I’m sure Flora’s son had the best intentions for his mother. The story creates a conversation, rather than implication, of establishing care responsibility.

    Yes, MRSA and C-Dif have higher prevalence in facilities and nursing homes.

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