Case Studies
Compassionate Home Care Services You Can Trust
Supporting a Family Through Missouri Medicaid Medical Eligibility
Background
A daughter contacted Callahan Care Solutions (CCS) regarding her 82-year-old mother, who was showing progressive cognitive decline and functional challenges. The family was considering long-term support options but was uncertain about Medicaid eligibility and how to best prepare their application.
Client Profile
Primary Diagnosis: Dementia
Secondary Conditions: Major Depression, Cataract
Functional Limitations: Required assistance with bathing, dressing, and walking. Dependent on a walker with frequent falls.
Cognitive Profile: Confusion, memory loss, impaired judgment, and safety risks.
Medication Management: Diazepam prescribed; unable to self-administer, with a history of missed doses and medication errors.
The Challenge
The family was overwhelmed by the complexity of Medicaid medical necessity criteria in Missouri. They feared denial due to incomplete documentation and were unsure whether her current diagnoses and functional limitations would meet the state’s threshold for skilled needs.
Our Approach
CCS completed a Level of Care (LOC) Report, tailored specifically to Missouri’s criteria. The report:
Documented all skilled needs related to mobility, cognitive safety risks, and medication oversight.
Highlighted how her dementia and vision impairments increased dependency in activities of daily living.
Positioned her deficits in alignment with the Missouri Department of Health & Senior Services (DHSS) criteria for medical necessity.
Recommended that the family explore additional clinical diagnoses with her physician to strengthen future applications if needed.
Outcome
The report provided the family with:
A clear, professional framework to present to Medicaid reviewers.
Confidence that their application would demonstrate the required level of medical necessity.
A foundation for care planning discussions, including assisted living, memory care, and in-home caregiver support options.
Impact
The daughter shared that the LOC report made her feel “relieved and equipped,” allowing her to approach the Medicaid application process with clarity instead of uncertainty. The structured documentation also gave her confidence in conversations with medical providers and facility administrators.
Clarity & Action Plan (CAP)
(De-Identified Client Profile)
Background
A 74-year-old female living in Texas was recently diagnosed with moderate dementia. She resides with her spouse, who has his own health limitations, and her adult children are worried about how to balance in-home support with long-term care planning. The family wanted clear direction on what options exist and what steps to take first, without committing to ongoing case management services.
Client Profile
Primary Diagnosis: Dementia (moderate stage)
Secondary Conditions: Hypertension, Cataracts
Cognitive Status: Increasing confusion, poor judgment, nighttime wandering
Mobility: Ambulates with a cane, unsteady gait, with 1 fall in the last 3 months
ADL Needs: Assistance with bathing, meal preparation, and medication oversight
Support System: Husband is the primary caregiver; daughter visits weekly
The Family’s Concerns
Immediate: Safety at home, fall risk, and medication adherence
Intermediate: Cost of hiring in-home help vs. moving to assisted living
Long-Term: Medicaid eligibility for memory care placement
Our Approach: The Clarity and Action Plan
CCS developed a targeted 12-page report that outlined:
1. Current Needs Assessment
Identified three urgent safety risks (wandering, fall risk, medication errors).
Outlined the caregiving limitations of the spouse and the impact on his own health.
2. Care Options & Costs
In-Home Care: Non-medical caregiver support (20 hrs/week) = ~$2,800/month.
Assisted Living with Memory Care: Average ~$5,000–$6,200/month in local area.
Hybrid Approach: Short-term in-home support while touring assisted living facilities.
3. Medicaid Insights
Reviewed Texas medical necessity criteria for memory care.
Explained the look-back period, income cap, and possibility of a Qualified Income Trust.
Recommended beginning a Medicaid readiness checklist to prevent delays if the transition becomes urgent.
4. Action Steps for Family
Within 30 Days: Hire part-time in-home aide, install home safety equipment, initiate medication management system.
Within 3–6 Months: Begin facility tours, consult an elder law attorney, and organize financial documents for Medicaid planning.
Ongoing: Monitor cognitive decline and reassess care needs quarterly.
Outcome & Impact
The family reported:
Immediate clarity on what they could afford now versus in the future.
Actionable next steps with timelines, reducing decision-making stress.
Confidence that they were preparing correctly for Medicaid eligibility while protecting assets.
The CAP gave the family a structured roadmap - not just options, but timelines and priorities - making it easier to navigate the present while planning responsibly for the future.
Life Care Plan
(De-Identified Client Profile)
Background
A 78-year-old male, widowed, living alone in Missouri, was referred to Callahan Care Solutions (CCS) by his daughter. He had recently been hospitalized for complications related to congestive heart failure (CHF) and was also living with early-stage dementia. His daughter was overwhelmed trying to coordinate his care, manage financial considerations, and plan for long-term support.
Client Profile
Primary Diagnoses: Congestive Heart Failure, Dementia (early stage)
Secondary Conditions: Type II Diabetes, Osteoarthritis
Cognitive Status: Short-term memory loss, difficulty with judgment and sequencing tasks, requires supervision for safety.
Mobility: Uses walker; frequent fatigue and dyspnea with exertion. Two falls in last six months.
Medication Needs: Eight daily prescriptions, requiring skilled oversight for administration and monitoring.
ADL Support Needs: Assistance required for bathing, dressing, meal preparation, and medication management.
Social Factors: Lives alone in a single-story home; limited local support; daughter lives 90 miles away.
The Challenge
The daughter was uncertain about Long-Term Care Costs and how to pay for assisted living, memory care, or in-home caregiver support. Medicaid Eligibility, whether her father would qualify, and what documentation was required. As well as Care Transitions. How to safely discharge him from the hospital and prevent re-admissions.
Our Approach
CCS developed a comprehensive Life Care Plan (LCP) that included:
Medical & Functional Analysis
Review of diagnoses, recent hospitalizations, and prognosis.
Detailed ADL/IADL assessment aligned with Missouri Medicaid medical necessity criteria.
Care Recommendations
Immediate need for home health nursing 3x/week for CHF monitoring.
Non-medical caregiver support of 6 hours daily for ADLs.
Long-term transition planning toward assisted living with memory care availability.
Financial & Benefits Planning
Cost breakdown of in-home support (~$6,000/month) versus assisted living (~$5,200/month).
Medicaid eligibility analysis, with recommendations for spend-down strategy and use of Miller Trust (Qualified Income Trust).
Coordination with Elder Law attorney for POA updates and financial protection.
Psychosocial Support
Counseling referral for the daughter as primary caregiver.
Encouragement of caregiver support group participation.
Emphasis on maintaining patient dignity, autonomy, and quality of life.
Outcome & Impact
Family Clarity: Daughter reported relief in “finally having a roadmap” instead of scattered information.
Strategic Direction: She understood short-term steps (caregiver hiring, home health orders) and long-term planning (transition to assisted living).
Medicaid Positioning: With the LCP and LOC documentation, the family entered the Medicaid process with confidence, avoiding common pitfalls that lead to denial or delay.
The Life Care Plan bridged the gap between medical needs, financial realities, and family goals, transforming uncertainty into a clear, actionable plan.
Serving Clients Across the U.S.
Whether you’re in Texas, California, New York, or anywhere else, Callahan Care crafts life care plans that adapt to your state’s landscape.
When you're ready, check our planning services in your city or get started now.