Our Lives On Hold: Before She Comes Home
- Mark Fukae
- Jul 18
- 2 min read
What discharge preparation actually costs - and what happens when a family can't afford it.
By Mark Fukae - Director of Advocacy - Professionals Who Care
Rose is being discharged from Julia Temple skilled nursing facility on July 23. Before she arrives home, Mark Fukae and his wife Janet are spending this weekend building the infrastructure her return requires: a commode, a bathing bench, an entry ramp, a gait belt for two-person transfers while she remains zero weight bearing.
Kaiser's Tuck In home care assessment team noted the family is unusually prepared. Most families, at this stage of a discharge process, have not yet begun.
This week's Our Lives On Hold dispatch asks the question behind that observation: what does a family do when they cannot do this?
The capacity gap. The equipment list runs several hundred to over a thousand dollars before sensors or safety automations are added. The assumption that families can absorb discharge preparation - financially, physically, spatially - is a class assumption baked into every discharge plan. A family in a two-bedroom apartment cannot create a safe dementia discharge environment without restructuring their entire living space.
The Medicaid threshold. To qualify for Colorado Medicaid long-term care in 2026, an applicant must have $2,000 or less in countable assets and income under $2,982 per month, with a 60-month look-back on all asset transfers. A nursing home in Colorado costs an average of $10,200 per month without Medicaid. The community spouse may retain assets up to approximately $154,140. The family that paid into Medicare for decades discovers that the public safety net requires near-destitution - through a legally scrutinized process - before it will step in.
The data gap. The Caring Costs Survey v5.3, currently in active audit for v5.4, is the instrument designed to make this invisible labor visible. The July 7 stakeholder submission to the Colorado Commission on Medicaid - followed up July 9, unconfirmed as of publication - makes this case directly to the Commission ahead of the August 14 Medical Services Board vote and August 31 federal notification deadline.
Read the full dispatch: therevenueneutralcaregiver.substack.com
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