Q: My brother is 58 years old and just had a very severe stroke that affected his vision and left his right side completely disabled.
The doctors are telling me that his prognosis for a full recovery is very slim. He is in the hospital right now and it looks like he will probably go to nursing home for further rehab and probably long-term placement.
When I contacted a nursing home I was told that neither Medicare or nursing home Medicaid would pay for his stay because he is not 65 and is not enrolled in either program. He was working the day of the stroke, is widowed, has very little money, rents his apartment and has a 10-year-old car.
He has major medical insurance through a good insurance company, but I don't know what is available through it. The hospital says that they will be discharging him in about two weeks. Can you tell me where to start to get a payment source set up for him?
A: I am very sorry to hear about your brother's stroke. This will be a very trying time for both of you. You have a daunting task before you, so do not hesitate to ask your friends, family, pastor/priest or other people for help.
I will give you some general information to steer you in the right direction to get things started.
•The very first thing I would recommend that you do is to have your brother give you complete durable power of attorney (DPA) authority so that you can apply for and obtain the services for him that he will need. Without a power of attorney, you will not be able to do any of this. Once you have done this, obtain several certified copies of this document in case an agency needs a certified copy.
•The next thing I would recommend would be to contact the agent for your brother's medical insurance to see what the benefits will be for him under these circumstances. Most major medical insurance packages have some sort of nursing home benefit. You need to find out what this is so when the hospital is ready to discharge you have a payment method to fall back on while you are waiting for the other payment avenues to be approved.
•The next step would be to begin the process of getting your brother approved for Social Security Disability Insurance (SSDI) and possibly Supplemental Security Income (SSI). This process can take up to eight months for approval, so get started on it as quickly as you can. The case managers at the hospital are an excellent resource and may be able to help you get this started. Social Security will need a great deal of medical information for this, so having someone help you that has access to this would be a big help. You can also begin this application process online at www.ssa.gov/disability. The Web site also provides toll-free phone numbers and many other links to relevant information for this process. Going to the closest Social Security Administration Office and working with the case worker there is also an option. I would definitely try to have someone help you that you can meet face-to-face.
•Once your brother is approved for SSDI, you can then begin the application process for nursing home Medicaid (NHMa). One of the requirements to be eligible for NHMa is to be at least 65 years of age or to be approved for SSDI. The income requirements for SSI are very similar to NHMa income requirements, so he may be eligible for that benefit also. Once you have completed the SSDI process, completing the NHMa application will basically entail obtaining financial information for your brother and submitting it to the local Office of Public Assistance that you are working with.
•From your initial question it sounded like you have a good idea of which nursing home you are looking at having your brother go to for further rehab. It is important that you give the medical insurance information to the facility prior to admission. This gives the facility time to contact the insurance company and find out exactly what their procedures are.
Most of the time pre-authorization is required before admission can take place. There may also be co-payments and deductibles that need to be paid. You need to know what these are ahead of time so that there aren't any surprises later. The facility's social-services director will be a great help to you in coordinating all of the different things that will be coming your way. Do not hesitate to ask her/him for help.
I wish you the best in what you are facing. Thanks for your letter.
Brian Huso is the administrator of Eagle Cliff Manor and has been a long-term-care administrator for 22 years. Send questions for this column to email@example.com.