UPDATED at end: Can someone point me in a direction Re: nursing home and Medicare?

[Ginevra]

I don’t know who I’m supposed to be calling and asking these things, so please speak to me like I’m ten years old. 
 

Mom is currently at the Rehab Nursing home she was released to from the hospital. At some point soon, they will be expecting to release her (unless she dies, obviously). My dad has come to terms with the fact that she needs to go to a care facility and he cannot care for her any further at home. 
 

I don’t know how I find out what places she could go that are covered through Medicare and I don’t understand how whatever tiny amount of $$ my dad does have (SS and a small pension) factors in. Do they say, “Well, you can pay $500/month, even though you are below poverty line”? Does needing Medicare coverage mean you have no choice at all? 
 

Also, last month they (finally) sold a small piece of property. This paid out around $18K, although I’m not sure if the deal is completed yet and cash is in hand. But my understanding is that Medicare would poach that tiny asset before covering mom’s stay, so if she lives for even a couple more months, it will be all expended. Am I right? 
 

Lastly, as usual, I have trouble finding the line between helping and taking on a burden that is not mine to figure out. 
 

Any help appreciated. 

Edited March 23, 2023 by Quill

[SKL]

Not an expert, but I wonder if you're talking about Medicaid vs. Medicare.  I think Medicare acts like health insurance regardless of your assets / income, but Medicaid is often needed to cover nursing home costs.  Medicaid will depend on assets / income.  Hopefully the nursing home staff would be able to advise you on the basics, and you might need to contact an expert if it gets dicey.

I'd probably start by asking the hospital for info on the contacts and process - they surely get this question all the time, and should know how to connect you to pertinent resources.

[prairiewindmomma]

Medicare.gov has a lot of helpful information, including a nursing home guide. 
 

There are layers of complication to this issue, including state look back issues re: funding and spend down guidelines.

But, I recommend starting with scouting around on Medicare.gov to get the basics and then I think you will have more specific questions. 

[Navymom]

Ask to speak with the Social Service Director at the facility she is currently residing. 

They handle things like this every day and should be able to point you in the right direction.

It sounds like you may need an elder attorney to help you sort things out. 

 

[skimomma]

Medicare does not cover assisted living or nursing home care.  It will cover some temporary at-home care in some cases as well as limited rehab facility time.  I think what you are asking is about Medicaid, which will require a spend down of some sort.  I would for sure find the social worker at the rehab place and start talking about options.  They will have to most information on what needs doing for your location and at this transition time.  They could get very pushy about insisting a family member take on full-time care at home, so come with your shield and armor.

[Grace Hopper]

1 minute ago, skimomma said:

Medicare does not cover assisted living or nursing home care.  It will cover some temporary at-home care in some cases as well as limited rehab facility time.  I think what you are asking is about Medicaid, which will require a spend down of some sort.  I would for sure find the social worker at the rehab place and start talking about options.  They will have to most information on what needs doing for your location and at this transition time.  They could get very pushy about insisting a family member take on full-time care at home, so come with your shield and armor.

Medicare is likely covering her current stay, but for a next residential facitilty, Medicaid for Long Term Care is what covers this IF she qualifies. I’ll repeat what’s been said upthread…

- the government websites have a lot of info, scour them first, keeping in mind that Medicaid is a federal program BUT is administered individually by state - so check the federal and state websites - these programs (particularly at state level) can also be reached by phone to answer questions 

- good social workers are gold - you may find one at her current rehab, or her  current Medicare insurance provider or primary care physician may have one on staff that can help you figure out next steps

- because her spouse is still living, you need to make sure that he is insulated from spend down requirements as best possible - this will mean a lawyer - if you can learn as much as possible yourself and gather up all documents required for the Medicaid for Long Term Care application, it will reduce the time and cost for the lawyer’s services 

If you can find a friend or family member who’s walked this path before, in your area, it is extremely helpful. I do hope you can find a social worker. 

[Spryte]

We have gotten three parents onto Medicaid to cover their long term care (nursing home) needs in the last two years. Medicare and Medicaid are not the same, and I think you are asking about Medicaid, which covers LTC.

We all likely have different experiences getting parents onto Medicaid, and it varies by state, so take all of this with a grain of salt. It’s my personal experience and may not match everyone else’s.

I have a lot of thoughts, but the most important is to make the nursing home SW and financial director into your new BFF. More so the financial director who handles Medicaid. My experience with the SW at our parents’ facility is lackluster, but the finance director has been golden.

Your mom can be on Medicaid while your dad is not, and your dad can retain more assets, which can vary by state, so you need state specific info. We did this with MIL and FIL, with the help of our new BFF, the facility’s finance person. We did not hire an attorney—there was not enough money to make it worthwhile—and I’m not advising you not to hire an attorney but it certainly can happen, with the right help. FIL retained most of the assets, until he, too, needed Medicaid and then we got him onto Medicaid, too. I think if there are a lot of assets to protect you will want an attorney, but in some cases it’s not necessary. We did meet with one, and have a consult, but in the end we proceeded without. Rather than using their limited funds for the attorney, we prepaid all their funeral expenses, which worked out to be about the same amount.

Does the rehab facility she’s in also do long term care? If you like that facility, my experience has been that it’s easiest to talk to them and shift your mom from rehab to LTC within the same facility. 

The financial director or whoever handles Medicaid can guide you through the process of applying. Medicaid back pays to the date of application, so don’t panic if it takes a while. And very likely they will reject her, and you will reapply. If that’s done within a certain time frame, they still backpay to the original date of application. My mom’s application was rejected twice and had to go to court — but the facility managed all of that, and I didn’t even need to go to the hearing (my mom’s case was unusual, highly unlikely that would happen with your mom!). Our finance person handled all the paperwork and it was time-consuming to gather the needed info, but otherwise pretty easy. Just a lot of stressful waiting and some flurries of deadline activity.

SWs can be great, but also be prepared to say, “No, I can’t care for her at home,” over and over. My mom’s SW really heaped on the guilt, but it was my third go-round and I knew from posts here to stay firm. The first two times I had said, “yes, of course I’ll take care of her till she’s back on her feet!” and ended up doing nursing care in my home for years. Seriously, if you aren’t set up for that: say no. I believe my mom has had better quality of life with 24/7 care than I could give her at home.

Good luck. It’s a hard road, and I hope it all falls into place easily for you.

[itsheresomewhere]

Might be worth a try- go into your local Facebook group for your area and see if there is a Medicare/Medicaid specialist in the area who can help you.  Our area has one who from what I am told is great, explains things well and makes suggestions.  

[Spryte]

2 hours ago, itsheresomewhere said:

Might be worth a try- go into your local Facebook group for your area and see if there is a Medicare/Medicaid specialist in the area who can help you.  Our area has one who from what I am told is great, explains things well and makes suggestions.  

Oh! Yes, and you might check to see if your area has an Agency on Aging or similar. They usually have a Medicaid person.

But do be careful — when I used ours and applied for community based Medicaid services while my mother lived with us, we were rejected before we even started because she was $80 over the income limit. I now know that I could have reapplied and it wouldn’t have been an issue, because her needs were higher than her income, but I felt discouraged and just kept paying OOP (my pocket, not hers). With your mom already in a facility, hopefully you can use their resources, and they will be very motivated to get her approved.

ETA, a repeat from my initial post: We all likely have different experiences getting parents onto Medicaid, and it varies by state, so take all of this with a grain of salt. It’s my personal experience and may not match everyone else’s.

Edited March 21, 2023 by Spryte

[Spryte]

I was thinking about this more, and not sure you need this info, but maybe it will help.

If in your shoes, I would ask for a care plan meeting, and make it abundantly clear to all of her team that the next step is moving toward LTC. At the same time, I would approach the SW, and let them know that you will need help with applying for Medicaid. That should get the ball rolling.

ETA: and yet again, quoting myself to say we all likely have different experiences getting parents onto Medicaid, and it varies by state, so take all of this with a grain of salt. It’s my personal experience and may not match everyone else’s.

Edited March 21, 2023 by Spryte

[lauraw4321]

You mean Medicaid, and you need to speak with the social worker in charge of your mom at the hospital. 

[Spryte]

4 hours ago, Quill said:

I don’t know who I’m supposed to be calling and asking these things, so please speak to me like I’m ten years old. 
 

Mom is currently at the Rehab Nursing home she was released to from the hospital. At some point soon, they will be expecting to release her (unless she dies, obviously). My dad has come to terms with the fact that she needs to go to a care facility and he cannot care for her any further at home. 
 

I don’t know how I find out what places she could go that are covered through Medicare and I don’t understand how whatever tiny amount of $$ my dad does have (SS and a small pension) factors in. Do they say, “Well, you can pay $500/month, even though you are below poverty line”? Does needing Medicare coverage mean you have no choice at all? 
 

Also, last month they (finally) sold a small piece of property. This paid out around $18K, although I’m not sure if the deal is completed yet and cash is in hand. But my understanding is that Medicare would poach that tiny asset before covering mom’s stay, so if she lives for even a couple more months, it will be all expended. Am I right? 
 

Lastly, as usual, I have trouble finding the line between helping and taking on a burden that is not mine to figure out. 
 

Any help appreciated. 

I am sorry that I keep posting! A few more thoughts, after re-reading your initial post.

My MIL had to go on Medicaid before FIL. Their assets were separated. So Medicaid looked at the SS benefits that MIL had, but did not touch FIL’s pension or SS. I can’t recall what happened with the joint assets, unfortunately. In our case, I know they had them separated already, and it worked out that most were in FIL’s name anyway. We used MIL’s limited  assets to pay for prepaid funeral expenses, which is acceptable to do during the spend down period. MIL had to spend enough so that her assets in the bank did not total more than $2000. I think any property could stay in FIL’s name, he would not have lost their home, etc.

As for the amount she will pay each month: Any income she has (her own SS or pension, etc) will go toward the nursing home bill, except for $40 per month. Medicaid will pay the rest. The remaining $40 is her spending money. They leave it for incidentals (hair cuts, etc). $40 doesn’t cover much, so we generally pay for cell phone plans, hair cuts, nails, clothes and gifts for the resident to give. We leave the $40 for her outings and extras.

Not sure that’s helpful, but those are the types of questions I had when we started this whole journey.

 

ETA: Again, we all likely have different experiences getting parents onto Medicaid, and it varies by state, so take all of this with a grain of salt. It’s my personal experience and may not match everyone else’s.

Edited March 21, 2023 by Spryte

[Grace Hopper]

29 minutes ago, Spryte said:

I am sorry that I keep posting! A few more thoughts, after re-reading your initial post.

My MIL had to go on Medicaid before FIL. Their assets were separated. So Medicaid looked at the SS benefits that MIL had, but did not touch FIL’s pension or SS. I can’t recall what happened with the joint assets, unfortunately. In our case, I know they had them separated already, and it worked out that most were in FIL’s name anyway. We used MIL’s limited  assets to pay for prepaid funeral expenses, which is acceptable to do during the spend down period. MIL had to spend enough so that her assets in the bank did not total more than $2000. I think any property could stay in FIL’s name, he would not have lost their home, etc.

As for the amount she will pay each month: Any income she has (her own SS or pension, etc) will go toward the nursing home bill, except for $40 per month. Medicaid will pay the rest. The remaining $40 is her spending money. They leave it for incidentals (hair cuts, etc). $40 doesn’t cover much, so we generally pay for cell phone plans, hair cuts, nails, clothes and gifts for the resident to give. We leave the $40 for her outings and extras.

Not sure that’s helpful, but those are the types of questions I had when we started this whole journey.

Just quoting to point out that these specific dollar amounts vary by state. I think my mom’s state recently went from $2K to $3K in retained assets and $60/month from SS income. This helps the patient/resident have more funds available for shoes, clothing replacement (things go missing in nursing homes), and treats like manicures, snacks, takeout from a favorite restaurant. She also had a monthly allowance for hair care (easy to use and the in-house salon). 

Edited March 21, 2023 by Grace Hopper

[Spryte]

12 minutes ago, Grace Hopper said:

Just quoting to point out that these specific dollar amounts vary by state. I think my mom’s state recently went from $2K to $3K in retained assets and $60/month from SS income. This helps the patient/resident have more funds available for shoes, clothing replacement (things go missing in nursing homes), and treats like manicures, snacks, takeout from a favorite restaurant. She also had a monthly allowance for hair care (easy to use and the in-house salon). 

Oh yes, like I said in my initial post, this is my personal experience and it varies by state.

ETA from my initial post (didn’t think to put it on each one, but will go back and do so, lest anyone think my experience applies everywhere. It does not.):

We all likely have different experiences getting parents onto Medicaid, and it varies by state, so take all of this with a grain of salt. It’s my personal experience and may not match everyone else’s.

Edited March 21, 2023 by Spryte

[sassenach]

My MIL hired an elder care lawyer who filed for institutional medicaid while FIL was in the facility for rehab. Once she filed, we were under strict instructions not to allow them to discharge him to us (long story, she doesn't live in our area- FIL lived near us even though they were still married). She had to pay out of pocket for about 6 weeks of care once the insurance stopped paying for rehab but he did get approved for medicaid and she was refunded back all of that money. From the end of rehab to his death was about 6 weeks. The out of pocket for his care was about 19k. Lawyer cost was 10k. So going the lawyer route saved her 9k.

I don't know how the calculation is made because MIL is still working and she makes more than 100k a year. I know most of her personal assets are in trust. FIL had very little income and only about 10k in his account when he went into the hospital. 

The paperwork was immense. I don't think we could have successfully navigated it all without the lawyer.

[sassenach]

If you haven't already, there's an elder care club on here. Look for my posts about FIL. Spryte wrote out some very helpful and detailed responses. 

 

 

[Guest]

3 hours ago, Spryte said:

I was thinking about this more, and not sure you need this info, but maybe it will help.

If in your shoes, I would ask for a care plan meeting, and make it abundantly clear to all of her team that the next step is moving toward LTC. At the same time, I would approach the SW, and let them know that you will need help with applying for Medicaid. That should get the ball rolling.

I really greatly appreciate any info you have, even though some of it is specific to your state and circumstances. I cannot think of a single person I know who was in *this* situation; all had parents who had money saved or good insurance or dividends or annuities to provide money and/or there was at least one adult kid who could bring the parent into their home. 

[Spryte]

Just now, Quill said:

I really greatly appreciate any info you have, even though some of it is specific to your state and circumstances. I cannot think of a single person I know who was in *this* situation; all had parents who had money saved or good insurance or dividends or annuities to provide money and/or there was at least one adult kid who could bring the parent into their home. 

It’s a crummy situation.

My mom was victim to a scammer when she was 74 (I probably posted about it). He took her for everything she had over several years. It’s endlessly frustrating to me. I feel like her entire 70s could be written up as a cautionary tale for daughters of single, elderly moms and what to watch for, to keep them safe. She lived with us for a while, but her care is too intensive for me, now.

And my ILs, heaven help them, have paid for assisted living or long term care OOP for almost 20 years. So expensive! It simply depleted all the funds they had saved. It makes me so sad. It made them sad, too. 
 

 

[skimomma]

16 hours ago, Spryte said:

It’s a crummy situation.

My mom was victim to a scammer when she was 74 (I probably posted about it). He took her for everything she had over several years. It’s endlessly frustrating to me. I feel like her entire 70s could be written up as a cautionary tale for daughters of single, elderly moms and what to watch for, to keep them safe. She lived with us for a while, but her care is too intensive for me, now.

And my ILs, heaven help them, have paid for assisted living or long term care OOP for almost 20 years. So expensive! It simply depleted all the funds they had saved. It makes me so sad. It made them sad, too. 
 

 

Scammers have hit my person as well.  But not before slow-moving dementia did.  The early stages of dementia, before a person asks for or appears to need help managing finances, can also be a huge financial loss.  My person theoretically had enough retirement savings to pay for LTC indefinitely but a long string of very poor and costly financial mistakes took out the bulk of that savings before I knew there was a problem.  This mostly involved unnecessary major home renovations that were not only very expensive but also in very poor taste (as in did not add value to the home and actually significantly decreased the value of the home) and then getting taken for a ride on one of those "senior community" condos where you somehow pay astronomical monthly rent on top of a "partially refundable" deposit to the tune of $200K.  We could only get the "partial refund" if they moved into that community's assisted living, which costs 3X what other local facilities cost.  All of this was clear at the time of the deal but my person did not have the capacity to see how bad of a deal it was.  And I did not even know the deal was being made until after it was final. Scammers may have been involved too.  And they certainly have been enjoying the opportunity to drain what little is left.  I never expected that Medicaid would be in our lives at any point but here we are.   It can happen to anyone.

[City Mouse]

First point of contact should be the sccial worker at current facility. Medicare will pay for some long term care under specific circumstances. It depends on how long her initial hospitalization was (Medicare could cover some LTC if hospitalization was at least 3 “midnights”) but even then there are limits, approvals and co-pays.  Last summer, my dad was hospitalized for heart issues. He went to in-patient rehab when he was first released but then he got Covid and the rehab unit shut down so he had to go to a skilled nursing facility. He was there about a month and Medicare did cover that stay. Last month the decision was made to move him to a skilled nursing for good. There was no hospitalization, so Medicare is not covering anything. Luckily, he is eligible for some veterans benefits which helps a lot with the expense.

If you want to know which places in your area take Medicaid patients, it is fine just to call and ask or stop in and visit. I would suggest someone go visits each facility in advance anyway if you have the opportunity. On the other hand some communities don’t have much options, so you take what you can get. 

[Grace Hopper]

13 minutes ago, City Mouse said:

First point of contact should be the sccial worker at current facility. Medicare will pay for some long term care under specific circumstances. It depends on how long her initial hospitalization was (Medicare could cover some LTC if hospitalization was at least 3 “midnights”) but even then there are limits, approvals and co-pays.  Last summer, my dad was hospitalized for heart issues. He went to in-patient rehab when he was first released but then he got Covid and the rehab unit shut down so he had to go to a skilled nursing facility. He was there about a month and Medicare did cover that stay. Last month the decision was made to move him to a skilled nursing for good. There was no hospitalization, so Medicare is not covering anything. Luckily, he is eligible for some veterans benefits which helps a lot with the expense.

If you want to know which places in your area take Medicaid patients, it is fine just to call and ask or stop in and visit. I would suggest someone go visits each facility in advance anyway if you have the opportunity. On the other hand some communities don’t have much options, so you take what you can get. 

A question to ask when you visit is if they will take a person “Medicaid pending.” That means you do not have to pay anything out of pocket, the facility will wait and collect back pay directly from Medicaid. They are willing to risk that a person will be denied Medicaid. If denied, you legally have (in my parent’s state) 60 days to make alternate arrangements and get the resident moved. 
 

The Medicaid website should list the SNFs in your area that accept Medicaid. 

[lauraw4321]

I see more and more cases of scamming with clients. There isn't a great solution to it because a power of attorney doesn't stop the person from spending their money. The only real choice is conservatorship, which is expensive, time-consuming and humiliating for the elder. I'm glad people like (weirdly enough) Mark Rober are drawing attention to this multi-million dollar industry that targets vulnerable people. 

[Grace Hopper]

2 minutes ago, lauraw4321 said:

I see more and more cases of scamming with clients. There isn't a great solution to it because a power of attorney doesn't stop the person from spending their money. The only real choice is conservatorship, which is expensive, time-consuming and humiliating for the elder. I'm glad people like (weirdly enough) Mark Rober are drawing attention to this multi-million dollar industry that targets vulnerable people. 

We had to move all my mother’s accounts, put them in joint ownership, and take over all access to them. She had sooooo many scammers latched on and even people having her leave cash “donations” under her front door mat!

We didn’t have to resort to legal conservatorship, but with the POA we could handle all her needs. What it did require was very close (live-in) assistance and the willingness to let her do some fun spending for like manicures, hair, clothing, restaurant) within her available funds. It was a full-time job and, for us, an unsustainable option for long term care.
 

Once in a SNF, the POA allowed us to handle finances. Upon death, the one remaining asset was checking account was joint owned, and there was no need to even open probate (though we did hold our breaths for a few months while Medicaid held a recovery case open - they can force probate to recover costs if there are enough remaining assets that were excluded from the original Medicaid qualification requirements, like a house or vehicle). 

[Carol in Cal.]

Be aware that if someone stays in the rehab place as a private paying patient, the rehab exercises can be stopped, and they can decondition.  This happened to a family member of mine, and it was very unfortunate but truly unavoidable in that case.

[Miss Tick]

6 hours ago, Grace Hopper said:

Medicaid held a recovery case open - they can force probate to recover costs if there are enough remaining assets that were excluded from the original Medicaid qualification requirements, like a house or vehicle)

Can you elaborate on this a little more? I'm not sure exactly what it means. So things like a house, vehicle, jointly held assets could be excluded from the original qualification, but then Medicaid can potentially seize (?) those things after the person passes away? But in your case they decided not to?

[Mrs Tiggywinkle Again]

19 minutes ago, Miss Tick said:

Can you elaborate on this a little more? I'm not sure exactly what it means. So things like a house, vehicle, jointly held assets could be excluded from the original qualification, but then Medicaid can potentially seize (?) those things after the person passes away? But in your case they decided not to?

Yes—once someone passes away, medicaid can seek recovery payments from the assets of the estate if there are any that were previously excluded. Usually this happens if, say, a house is excluded because a spouse was living in it but that spouse is now deceased and the house is still in the estate when the Medicaid recipient passes.  They will not try for recovery payments if there is a surviving spouse, disabled/blind child or child under the age of 21.

https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html

[sassenach]

1 hour ago, Mrs Tiggywinkle Again said:

Yes—once someone passes away, medicaid can seek recovery payments from the assets of the estate if there are any that were previously excluded. Usually this happens if, say, a house is excluded because a spouse was living in it but that spouse is now deceased and the house is still in the estate when the Medicaid recipient passes.  They will not try for recovery payments if there is a surviving spouse, disabled/blind child or child under the age of 21.

https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html

I believe that putting property into trust will also protect it from recovery. 

[Grace Hopper]

4 hours ago, Miss Tick said:

Can you elaborate on this a little more? I'm not sure exactly what it means. So things like a house, vehicle, jointly held assets could be excluded from the original qualification, but then Medicaid can potentially seize (?) those things after the person passes away? But in your case they decided not to?

Yes, in certain circumstances they can come back for some previously excluded assets. It depends on how aggressive your (your elder’s) state is about Medicaid recovery. 
 

In our case, my parent had zero assets - no house, no car, nothing of value left over aside from about $1300 in a jointly held checking account. Recovery would happen (as it was described to me by my lawyer) if/when the estate went to probate; Medicaid would file a lien against any assets and take their rank in line of creditors. Because my mother had no estate to speak of, we did not open probate. Medicaid could have forced us to open probate, however, we did not expect that to happen, because there was nothing to collect and their legal fees would have never been recouped, much less anything to repay the cost of her care. 
 

I am answering this strictly based on my personal experience. I am not a lawyer; anyone who has an elder, who may be applying for Medicaid for long-term care, should ask a lot of questions about Medicaid in general, and Medicaid in specific regard to their own state’s practices, and how things might play out if there’s an attempt to preserve something like a house or land. 

[Grace Hopper]

12 hours ago, sassenach said:

I believe that putting property into trust will also protect it from recovery. 

Yes, but it has to be the right kind of trust and I believe (but don’t quote me) that it has to be done prior to the 60 month look back period. 
 

This is why estate planning attorneys earn their keep. 

Edited March 23, 2023 by Grace Hopper

[Guest]

Update: The Meeting happened yesterday. In attendance: myself, two sisters, mom on the bed, dad in the chair, lead social worker, PT provider, activities director. All standing around the bed in my mom’s half of the room. 😑

I am glad people here told me what to expect because that is exactly what happened. The pT person gushed about how she’s “Doing Great!” And then segued directly into, “So what arrangements are you making for home are providers to come and whose house is she going to?” So I told her we wanted to look into assisted living facilities and what could we expect and how do we work out the financial piece? 

So. My sisters and I are supposed to be contacting ALF right now. They plan to release her “next week” (Not sure if that means Monday morning or what.) SW indicated that Medicaid will not be a possibility. She said the waivers are on a five-year waitlist and she will not qualify because my parents own a home. 
 

I do not know what to do. I have begun contacting a couple places but it feels like a pipe dream, like that time my dd and I toured Harvard for kicks and giggles. They cannot afford these places, not any of them! My dad’s total income is around $5k a month. He has next to no cash assets, except the $18k-ish he just got from selling their Florida lot (it’s not in hand yet) And he has stock from Southwest airline, from when my (now-deceased) sister worked for the airline. He believes that is worth $2k, but also, I doubt he’s got his finger on the pulse of the market at all, much less that specific stock, which can’t be doing well at the moment given recent airline events. That’s about it. My sister tells me they have credit card debt of around $5-6k. 
 

Sorry this is so long. I will talk to the places again today and will give them this info and see if we can come up with anything. A friend mentioned a reverse mortgage, which could help (-ish) but that would surely be a band-aid and their house will not appraise well due to condition and hoard. It might appraise totally at $200k-ish. Mostly just because the location is good for people who want to poach a lot and tear down the house. My understanding is reverse mortgage will not be for the total asset anyway; maybe half. 
 

The other conundrum is that if mom moves out, then there is a new issue: dad is there alone. Dad likes the idea of them moving *together* into AL but if *one* cannot be afforded, how the eff do *two*?? And then we have to deal with that horrible house *with them alive* and all the emotional turmoil I fully expect that to bring. 
 

And…there’s that nagging old elephant in the room…my mom is terminally ill. Don’t know if that means she will be gone in a week or not for two years (sister meets with doctor today; hopefully some new info after that), but I fully expect medical emergencies will continue with accelerating frequency. She entered the hospital in excruciating pain. That seems to be mitigated at the moment but the cause still exists and is advancing so…? 
 

Also, if I’m honest (and why not be after all that crap I just revealed?) I feel resentment towards my dad and mom. At the moment, my dad especially. He is not a problem solver; he is a world-class avoider. In the meeting, he asked no questions. Not one! He isn’t trying to figure this out; he’s simply assuming his three bright daughters can figure it out. And he’s right!!! We *are*! He threw us the bone of verbally rehearsing their pension and ss income, their main expenses and the resources he has (stock worth pennies, house, Florida property money). So, for the past decades, they have avoided thinking/planning what would happen when this day comes and now it’s arrived and my dad’s like, “I can’t take care of her any more, she needs to go to AL…” but with no plan or resources as to how to make that happen. 
 

Im sorry this is so long and I’m not sure anybody has any ideas that can help. I’m just fighting to keep my mental health at a functional level and I’m meanwhile planning for MIL’s Celebration of Life, which is this Saturday. The contrast of everything from my in-law side of the family with my family makes me feel a bit hysterical. My parents-in-law were total problem-solvers and planners and were just extraordinary people. But my parents have been wing-and-a-prayer people for sixty years and the results are exactly what you might expect. 

[Storygirl]

I'm sorry, Quill. That's so stressful. Maybe try to get a second opinion on the Medicaid issue, because I think Medicaid lets the spouse keep the house. My dad was renting when my mom went on Medicaid, and he handled the paperwork, so I don't know. And it's a different state. But he did have to apply for Medicaid multiple times before they deemed Mom was able to receive it -- he had to spend down her retirement funds on the facility fees.

Another issue for you is that it's my understanding that Medicaid will not pay for assisted living; only skilled nursing. Someone can correct me, if I'm wrong.

[Storygirl]

I understand the frustration with a passive dad. My dad is like that. Although he handled the financial things (he's an accountant), in most other ways he was passive about stepping up for my mom during the decade-plus that she had Alzheimer's. It infuriated my brother (who also didn't step up in any way). My dad didn't do the caretaking of us when we were kids, and I came to the conclusion that he just didn't know how to be a caretaker (I suspect he's on the spectrum). I'm sorry this is landing on you and your sisters.

[Storygirl]

Oh, and seeing FIL care for MIL, who had dementia, in 2020, when he couldn't have a lot of help in their home -- that was a HUGE contrast to my dad. 😞

[saraha]

I’m so sorry. These years are so hard, sad, and frustrating. It’s not how you want this to go, I know.

[Beth S]

Agreeing that you all are in such a tough spot.  Usually Medicaid allows the spouse to keep the house, but honestly, SINCE they didn't plan, I think you should consider selling the house & put Dad in a small apartment near the nursing home (if possible). 

No 80yo wants to move.  No 80yo even has the capacity to plan things like this.  Yes, it's on you children to get them placed in something very modest. 
It's what children do at this point, for the parents.
Even if your Dad is pretty resistant.
Keep researching.
But for us, the solution was NOT to take them into our home.  Ever.

Keep bugging the social workers, researching, learning about Medicaid, etc. during this very intense time.

[scholastica]

I’m so sorry. We dealt with this with my parents as well. It was stressful and difficult and it shortened both their lives.  My in-laws are doing everything the best way possible. Moved into a small house in a 55+ community a few years ago, and now, when they need more help are moving into independent living that is attached to assisted living. The difference is night and day. 

[lauraw4321]

A few thoughts- is your mom on Hospice? She should definitely qualify and I would make sure she is before any other plans move forward. There may be inpatient hospice that she could eventually qualify for that would solve several problems. 
 

You and your sisters are the easiest solution for the hospital and the SW. They see that level of family support and figure someone will take them in and care for them so that’s an easy case for them. You need to disabuse them of that notion. 
 

In the background, without the hospital knowing, consider consulting with the best elder law attorney you can find. 
 

Finally, consider that your dad might not now and maybe never was able to plan and deal with these eventualities.

::hugs::  It’s so so hard. 

[lauraw4321]

Oh, and they won’t release her without there being a plan in place. The hospital wants her out ASAP and will pressure you to make plans by date X, but in reality they  can’t / won’t release her without a reasonable plan. I’ve seen folks end up in the hospital for MONTHS when no other plan is forthcoming. 
 

Final thought - are you close to another state? We often send people to another state because Medicaid laws are more favorable. 

[Grace Hopper]

55 minutes ago, Storygirl said:

I'm sorry, Quill. That's so stressful. Maybe try to get a second opinion on the Medicaid issue, because I think Medicaid lets the spouse keep the house. My dad was renting when my mom went on Medicaid, and he handled the paperwork, so I don't know. And it's a different state. But he did have to apply for Medicaid multiple times before they deemed Mom was able to receive it -- he had to spend down her retirement funds on the facility fees.

Another issue for you is that it's my understanding that Medicaid will not pay for assisted living; only skilled nursing. Someone can correct me, if I'm wrong.

Definitely get a second opinion. A spouse is allowed to remain in the house! And a vehicle. This is why you need a lawyer.

See an attorney before you look at a reverse mortgage - it can be a big disqualifier for both Medicaid approval and acceptance into a nursing home. If you sell the house and attempt to move dad into an apartment- which seems like a good idea - you may be expected to pay in all sale proceeds before she would be eligible for Medicaid approval.

I don’t know what they were referring to about a “waiver,” but it is true there are often waiting lists for SNFs. The best shot at admission is directly from another care facility (hospital, rehab). Try your best to not let them discharge her to home in the interim. A hospice designation would definitely help. 

It is a hard hard season to walk through, Quill. I’m glad you have sisters to stand together with. 

[Grace Hopper]

7 minutes ago, lauraw4321 said:

Oh, and they won’t release her without there being a plan in place. The hospital wants her out ASAP and will pressure you to make plans by date X, but in reality they  can’t / won’t release her without a reasonable plan. I’ve seen folks end up in the hospital for MONTHS when no other plan is forthcoming. 
 

Final thought - are you close to another state? We often send people to another state because Medicaid laws are more favorable. 

IME the patient must be a legal resident of the state in which you apply for Medicaid (ime, relocating an elder state to state). We went through that and it was a bear - had to change Medicare, SS, etc, before applying for Medicaid. Have you seen this done successfully and easily without establishing residency first? Would the person just go into a SNF full pay first and use that as a residence? 
 

eta this is probably one of those “every state is different” sort of things

Edited March 23, 2023 by Grace Hopper

[lauraw4321]

4 minutes ago, Grace Hopper said:

IME the patient must be a legal resident of the state in which you apply for Medicaid (ime, relocating an elder state to state). We went through that and it was a bear - had to change Medicare, SS, etc, before applying for Medicaid. Have you seen this done successfully and easily without establishing residency first? Would the person just go into a SNF full pay first and use that as a residence? 
 

eta this is probably one of those “every state is different” sort of things

Yes we have. The neighboring state requires one year of residency. Assets are used to pay for that year and then Medicaid takes over. 

[lauraw4321]

Final thought (sorry!) Many ALFs have double occupancy rooms, so you could get them both in for about the same price. 
 

I think I’m your shoes, I’d move them both in, sell house as is, use their income and house proceeds to pay for ALF.  With his income, in my state, he’d never qualify for Medicaid. So there’s obviously a future shortfall coming, but it’s hard for places to just kick people out for failure to pay once they are in. 

[Mrs Tiggywinkle Again]

Medicaid does not generally pay for assisted living; it may pay for some services provided there but not room and board.
 

To be frank; people with plenty of money saved spend it all on assisted living and elder care.  People who were poor and/or don’t have hundreds of thousands in assets for ALF wind up in a Medicaid nursing home bed in a double or triple room—or pass away before that point, because poverty and low income is a huge factor in poor health.

I would also be asking if your mom would even be accepted into assisted living.  You have to be very independent for my local ALFs, you must be able to ambulate or transfer yourself into a wheelchair and not need incontinence care.  Or you have the money to pay both for assisted living and an aide to help you 1:1. If your mom needs a lot of medical care with the cancer, she may not even be eligible. I’d find that out first before investing too much energy into figuring out how to pay for an ALF.  

[ScoutTN]

I am sorry this is so hard, @Quill

Edited March 23, 2023 by ScoutTN

[ScoutTN]

4 minutes ago, Mrs Tiggywinkle Again said:

Medicaid does not generally pay for assisted living; it may pay for some services provided there but not room and board.
 

To be frank; people with plenty of money saved spend it all on assisted living and elder care.  People who were poor and/or don’t have hundreds of thousands in assets for ALF wind up in a Medicaid nursing home bed in a double or triple room—or pass away before that point, because poverty and low income is a huge factor in poor health.

I would also be asking if your mom would even be accepted into assisted living.  You have to be very independent for my local ALFs, you must be able to ambulate or transfer yourself into a wheelchair and not need incontinence care.  Or you have the money to pay both for assisted living and an aide to help you 1:1. If your mom needs a lot of medical care with the cancer, she may not even be eligible. I’d find that out first before investing too much energy into figuring out how to pay for an ALF.  

Seconding this. Though my mom’s AL place does not have a restriction on incontinence. 

[skimomma]

I'm so sorry.  I completely understand what you are feeling....a mix of helplessness, being overwhelmed, anger, concern, etc....

First, don't take the "won't qualify" advice as gospel yet.  Contact your (or her) local Agency for Aging and try to get some basic information.  If you have the resources, an elder attorney will be very helpful.

Second, do NOT take her home or allow her husband to take her home.  They cannot release her with no plan.  Once they figure out that you are firm on this, the story probably will change.

Third, as others have said, assisted living is not covered by Medicaid (or Medicare).  Only skilled nursing (AKA nursing home) is, once they qualify.  It sounds like there are enough assets to pay for a nursing home for at least a few months.  I would first just get her into one, even if that means self-paying at first.  Use those self-paying months to get the finances and legal sorted out.  That facility will likely be a key help in applying for Medicaid since it is in their best interests once the money runs out.  Her husband should be able to keep the house, but if he does not even want to stay, it might be easier on everyone to dispose of that property now.  That is probably not the best "financial advice" but there are other factors to consider, like dealing with this all again in a few years, that might make the financial hit worth it.  It does not sound like your dad wants or cares much about retaining assets.  See about low income senior housing close to whatever nursing home is found.  I investigated this heavily at one point and found that semi-independent (meaning perhaps there are some services like limited meals and activities), low income housing was available both in my person's location (HCOL, urban area) and my own (LCOL, rural) that could be attained within SSA income.  There were waiting lists and I was told they were years long, but I did put my person on them and we got called up on most of those lists within a year, so it was not nearly as bleak as they led us to believe.  Unfortunately, in our case, my person was not independent enough to be able to live in those anyway....which is probably why the lists move faster than they said.

[Pawz4me]

I think you need to talk to a knowledgeable attorney ASAP. As others have said, Medicaid varies a lot from state to state. I'm certainly no expert, but I'm pretty sure in our state a $5k/month income puts someone far away from Medicaid eligibility. I don't know how marital income is considered, though. But I think even half of that is well above the Medicaid insurance cutoff here for one person.

Meanwhile, I'd practice saying "I [we] do not feel safe taking her home." I don't personally know for sure that's the magic sentence to keep her from being discharged, but I've heard multiple knowledgeable people say it is.

Hugs to you, Quill. Elder care or any end-of-life care is hard. Being in a financial gray space makes it a lot harder.

Edited March 23, 2023 by Pawz4me

[Mrs Tiggywinkle Again]

Some states have a Medicaid nursing home waiver where a spouse’s income is not considered.  If I had to guess, that was what the SW was talking about as your dad’s income is well above Medicaid limits for two people.

[Spryte]

3 minutes ago, Mrs Tiggywinkle Again said:

Medicaid does not generally pay for assisted living; it may pay for some services provided there but not room and board.
 

To be frank; people with plenty of money saved spend it all on assisted living and elder care.  People who were poor and/or don’t have hundreds of thousands in assets for ALF wind up in a Medicaid nursing home bed in a double or triple room—or pass away before that point, because poverty and low income is a huge factor in poor health.

I would also be asking if your mom would even be accepted into assisted living.  You have to be very independent for my local ALFs, you must be able to ambulate or transfer yourself into a wheelchair and not need incontinence care.  Or you have the money to pay both for assisted living and an aide to help you 1:1. If your mom needs a lot of medical care with the cancer, she may not even be eligible. I’d find that out first before investing too much energy into figuring out how to pay for an ALF.  

This is my experience, especially the bolded.

In my state, and in my ILs’ former state, Medicaid does not pay for assisted living. My ILs’ had saved and planned, but 15 years for both in AL, paying OOP, then 2 years for both paying OOP for LTC in a nursing home ate it all. My mother did not have her savings any longer, so my family had to provide the AL portion in our home until she qualified for LTC and Medicaid.

Quill, a question you might ask is would your mother qualify for long term care? Can she do the activities of daily living? Can she walk up stairs if there are stairs at home? Toilet? Get dressed? Prepare food? 

I would follow @skimomma’s advice and be firm about not taking her home, that you don’t have a plan. You will feel uncomfortable, and they will push, but stay firm. 

My experience again, not a universal statement that this works for everyone, but if your elderly parent (general you) is going to be released to rehab from a hospital stay — fight to get them released to a facility that does both rehab and LTC. Those facilities generally know how to move a patient over to the LTC side and will work with you in Medicaid. My ILs landed in such a facility, and I fought hard to get my mom sent to the same one for rehab (the third time. Our first two experiences sounded just like yours, Quill). My guess is that your mom’s current rehab facility doesn’t also do LTC? If so, I would not hang my hat on anything they tell you about qualifying for LTC Medicaid in a facility, it’s probably not their area of expertise.

And to speak to the pension worry: we are intertwined with what I think is your state, and through a roundabout journey, my ILs were qualified for Medicaid (according to a Medicaid specialist in your state) if they want to move “home” from ours. FIL’s pension and other monthly income, even with all the savings gone, is just barely under what he owes each month for his care (around $9K), but since his pension isn’t quite high enough to cover his care needs — and he has under the asset limit left — he does indeed qualify for Medicaid. They pay the difference in his LTC bill, and he has a small amount left in his account for incidentals. But again, not for assisted living, only for skilled nursing LTC in a facility. If I had to guess, the people who said your dad makes too much were likely thinking of something like community based services, which in our state is what someone living at home might have — if your mom qualified for that, she’d get a lot more in-home services and your dad would have a lot of support to care for her at home. I never managed to get my mother qualified for that, as they are stricter on income limits in my state, and her monthly income was too high.

You really need to speak to someone knowledgeable, I think. 

 

[mlktwins]

Quill, I don't have any experience with the Medicaid/financial and assisted living/nursing home piece of it so am no help there.

I do get the resentment and anger though. 4.5 years with my dad (I'll be surprised if he is here another 6 months) and my in-laws both went quickly in 2021. DH is still cleaning out their house, but everything else with the estate has been completed. It is a lot! 

Just hang on for the ride. While you could just not get involved, I know that isn't really possible. I hear so many of us going through this elder care thing and it just makes me so sad. Big hugs!!!