Question: When my mother-in-law was admitted to a nursing home three years ago, we were told that she could not apply for Medicaid until she only had $2,000 left and that her funds would have to be paid toward her care. Now, after nearly three years as a private pay patient ($3,500 monthly), only $2,500 remains from the inheritance she received when my father-in-law died. Since Medicaid qualification is imminent, we want to go ahead and pay for her funeral now – about $10,000, but don’t have the money. Our question: When she qualifies, will Medicaid pay all of her expenses so we can use her income to begin saving for her funeral?

Answer: No. Because you received bad, self-serving advice from the facility, the funds that could have been used to prepay your mother-in-law’s funeral expenses were instead used to purchase three additional months of private pay care.

After qualifying for Medicaid, unmarried persons like your mother-in-law must pay the vast majority of their recurring monthly income to the nursing home and are allowed to keep only what is known as a "Personal Needs Allowance." The amount of the monthly PNA varies from state to state, but is generally in the $30 per month range. After all other income is applied to the monthly nursing home charges and certain medical bills, the remaining charges are paid by the State Medicaid program.

Had you received proper advice, your mother-in-law’s funds could have been used to purchase an irrevocable prepaid funeral contract and a number of other non-countable resources years ago. Since you can’t get the money back from the nursing home, we suggest that the family begin making plans to pay for the funeral.

Question: My father, a stroke victim, was transferred from the hospital to a nursing home for skilled care and rehabilitation that was paid for by Medicare. After a time, the facility told us that since Dad had reached maximum improvement, Medicare would no longer pay for his care. Because he has limited assets, we applied for Medicaid, but the nursing home has not continued his rehabilitation despite our requests. Does the nursing home have to help him try to improve?

Answer: According to the Nursing Home Reform Act, a federal law that governs all nursing homes which accept money from the Medicare or Medicaid programs, your father’s facility is required to "provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident." In other words, the nursing home should not allow your father’s state of health to worsen unless his condition is such that a decline is inevitable. The facility should assist your father in remaining as independent as possible in his activities of daily living such as bathing, eating, dressing, and toileting. If, for example, your father can use the bathroom with assistance, the facility must provide that assistance even if it would be less expensive to use a catheter or diapers.

We suggest that you schedule a meeting with the facility administrator to voice your concerns. You may wish to contact your father’s doctor to make sure appropriate orders are left with the facility. And it might be a good idea to hire a geriatric care manager to monitor your father’s care plan. If you still get no results, contact an elder law attorney to assist you.

Question: I was appointed the health care agent for my aunt who, after receiving extended care at home, has been admitted to a nursing facility. I am getting conflicting reports of how my aunt is to be cared for from the each shift of employees. On weekends, it seems that the facility is especially short-staffed and care is almost non-existent. What can I do to make sure she is properly cared for?

Answer: The federal Nursing Home Reform Act requires that the care of each resident be provided according to a written plan of care. After admission, each nursing home that accepts Medicare or Medicaid dollars should establish a care plan meeting at which time your aunt (or you on her behalf) should be given the opportunity to have input into the plan of care.

Despite this mandate, many nursing facilities erroneously give the impression that doctors and nurses control what goes into care plans. In truth, physicians and nurses provide advice, but the ultimate decisions rest with either the resident or the authorized member of the family.

Being short-staffed does not excuse the facility from its obligation under quality of care laws. The solution is to hire a sufficient number of new employees so that each resident receives the type of care the law requires.

Again, we suggest that you meet with the facility administrator, contact a geriatric care manager to monitor your father’s care plan, and, if necessary, contact an elder law attorney to make help you make sure your aunt receives the care she needs.