When someone goes into a nursing home does their Medicare cover the entire cost or will there be out of pocket expense also?

Mom has been Medicaid eligible for the past three years. She has been in Physical Therapy/NH two different times tlll she could go back to her apartment. She lives in Senior Apartment and until the past month has managed most of the time with assistance from me doing her shopping, taking her to Dr app'ts, etc. As I mentioned earlier her health was slowly worsening due to anemia from Leukemia. Since her last 2 transfusion last week she is showing improvements. She is eating better and getting some energy back. She has had her little Chihauhua with her till now. I had to take the dog to my house since she cannot manage taking it out during the day. This mad Mom MAD and hurt that I took her 'Chi-Chi' away. It makes me feel awful doing this but I know I can't keep staying with Mom to make sure the dog can go outside when needed. I can only hope Mom will be get over the dog not being with her. I guess my question about a NH is answered knowing if she goes there and needs future transfusions they wouldn't be able to do it there, she would still be going to her Oncologist as long as she is able. Your reply is very helpful. Then on the matter of Hospice. I wonder if Oncologist would recommend Hospice in NH right now since Mom is not bedfast? I will ask Dr. for hospice evaluation as you mentioned to see what happens. Thank you so much.

Karen - in theory once they go into a NH, they are in skilled nursing care and under the care of the medical director (a MD) of the NH. Mom should not be needing to schedule visits with her old docs. Now if they have a specific need or a specific relationship with maybe like their ENT or endocrhrinologist, then you can take them for those medical appointments. But this gets sticky for dealing with their care plan as all medications and orders are guided by whatever is in their chart at the NH. So the outside MD will have to consult with the NH MD to get this done.......understand? Usually NH residents stop all outside MDs as it just causes conflicts.

About M &Ms, Medicaid will pay for NH if mom meets the "at need" requirement to be medically at need for skilled nursing care & at need financially which means impoverished. Now they can have their home and a car as an exempt asset under Medicaid. BUT due to the required co-pay or SOC, she will have no -nada - zero of her $ to pay on anything " house" anymore. The way your post reads it sounds like you are going and spending the night at moms house, is that right? If so, you need to think hard about what to do with the house. Most of the time, the house gets sold and so mom has assets to pay for NH so won't qualify or requalify for medicaid till she spends the funds down to be impoverished again.

Medicare only pays for medical costs like MD, hospitalization, health care providers like PT or OT. Medicare pays for hospice. Medicare pays for RXs depending on their Medicare drug plan. Medicare does NOT pay for long term care or it's room & board costs in a NH but Medicaid will pay if they qualify both financially & medically to be "at need" for a NH.

Pam's idea of getting her evaluated for hospice is spot on. She could likely qualify and you coukd have at home hospice coming in a few hours every week while you & mom work out the many details On getting her qualified for Medicaid, dealing with her home; finding a NH suited for her needs; spending down $, etc before ever doing the Medicaid applications.

Hospice as its a Medicare benefit is self directed so mom or you as her DPOA can select the vendor. Not all hospice are alike. There are bigger nationwide companies like Vitas & Compassus and then small local ones. The bigger ones usually have the staffing ability to get equipment ordered and installed ASAP (like speciality beds). Some are nonprofit, some for profit. Some have a special bent like oncology care. You can shop around for hospice & then change providers if thet are not a good fit. I changed my moms hospice company within her first 90 day first eligibility period.

They can be on hospice and be in a NH on Medicaid at the same time as well. It's been my experience that a NH really loves, loves, loves this as hospice provides for extra hands to help in caregiving (especially the bathing & sanitary supplies & obtaining higher end nutitionals aspects) without being a cost to the NH.

Ask her MD to write orders for hospice evaluation to start the process on this.

what about her on-going medical expenses, prescriptions, doctor, hospital? Is this all part of nursing home care?

Medicare will not, but Medicaid will cover care only if she agrees to a "share of cost", meaning she signs over her SS and pension. She can only have less than $2000 in cash available.
If she is not eating, ask your MD if it is time for Hospice services. You can also call Hospice yourself and they will come to the home for an evaluation of need.