What happens to an elderly person when they run put of money?

[Amethyst]

This is regarding someone I know peripherally; I’m not close to this person but someone I care about is (sort of) close to him. 
 

Elderly person had stroke about 6 months ago. He is divorced about 20 years. Has strained relationships with adult children. After stroke was in rehab facility, but elderly ex-wife can no longer keep checking in on him. Somehow or another they managed to sell his house (maybe his oldest has POA, dunno). But due to poor lifestyle and financial choices, whatever he got from the sale of the house is pretty much all he has. And I don’t expect it’s much. He was two weeks ago transferred to an assisted living facility. Wild guess: all his money (aside from pension and SS) will be used up in 6 months paying for this new facility   
 

What happens when his money runs out? (Assume his ex-wife, children, and siblings have no interest in paying now for his poor choices of the past 20+ years.) He doesn’t necessarily need a nursing home, but neither is he able after the stroke to adequately live on his own.

They won’t keep him at this private facility forever if he can’t pay. So what do they do with people who can’t pay?

[maize]

Medicaid will pay for some kind of facility if he needs it and has no assets.

[TechWife]

Disclaimer a I am Speaking very broadly, because things do vary among states and sometimes even within states.

Sadly, If this is the US, the private facility can evict him. He would then need to go to a family member or a shelter. Hopefully, before that happens he can get on a social workers’ radar and they can see if he qualifies for subsidized housing. He can ask his PCP for a referral to a social worker, or  perhaps assisted living can put him in touch. There is often a wait list, depending on the area where he lives. If & when he requires a nursing home, then Medicaid will step in and pay for it. His area probably has a counsel on aging or similar organization. They would be a good resource for him or a family member to contact now. There may also be elder abuse/abandonment laws that come into play with regards to his children making sure he has a safe place to live, I’m not sure. 

[Sneezyone]

He will die in a publicly funded care home and his remains may or may not be claimed by next of kin/family. No one is required to pay for/support their elderly/abusive relatives.

Edited December 12, 2023 by Sneezyone

[DeainUSA]

30 minutes ago, Sneezyone said:

He will die in a publicly funded care home and his remains may or may not be claimed by next of kin/family. No one is required to pay for/support their elderly/abusive relatives.

Does this include states with Filial Responsibility Laws?

Edited December 12, 2023 by DeainUSA

[Amethyst]

53 minutes ago, maize said:

Medicaid will pay for some kind of facility if he needs it and has no assets.

So, what kind of facilities would these be? Through the state?

[Pawz4me]

54 minutes ago, maize said:

Medicaid will pay for some kind of facility if he needs it and has no assets.

I believe Medicaid only pays for skilled nursing facilities. And a doctor (at least one, maybe two) has to say that a person needs that level of care.

Or at least that's my understanding of how Medicaid works in my state.

[Amethyst]

48 minutes ago, TechWife said:

 If & when he requires a nursing home, then Medicaid will step in and pay for it. 

So, am I understanding correctly that Medicaid will not pay for assisted living? Only nursing home?

[Sneezyone]

11 minutes ago, DeainUSA said:

Does this include states with Filial Responsibility Laws?

Unless both people live in the same state, yes. My mother lives in one of them. It’s her only hope. They will never get a dime from me. Also, if you can demonstrate abuse and neglect, courts will intervene. My non-contact relationship is well-established and long-standing.

Edited December 12, 2023 by Sneezyone

[SKL]

Presumably he gets social security income?

Some combination of medicare, medicaid, and social security should provide him subsistence, depending on his specific needs.

The quality of what's available will vary by location, just like it does for everyone who is low-income.

[Pawz4me]

29 minutes ago, Amethyst said:

So, am I understanding correctly that Medicaid will not pay for assisted living? Only nursing home?

Correct

[Grace Hopper]

1 hour ago, DeainUSA said:

Does this include states with Filial Responsibility Laws?

As I understand it, when I dealt with this a while back, they’re not typically enforced. Sneeze’s case in point. 

1 hour ago, Pawz4me said:

I believe Medicaid only pays for skilled nursing facilities. And a doctor (at least one, maybe two) has to say that a person needs that level of care.

Or at least that's my understanding of how Medicaid works in my state.

Some AL in some places do accept Medicaid but they are akin to unicorns, as I understand it. 
 

What’s not been mentioned is that the elder must qualify for Medicaid for Long Term Care. There’s a look back period of 60 months to make sure there were no disqualifiying distributions of income (like if the kids were “gifted” any of the proceeds of the home sale, or if other assets were given away). Some facilities will intake a patient with a “Medicaid pending” status, but again, not all will. If taken in and Medicaid is not approved, they have 60 days to make other arrangements before being evicted (in my state, anyway). Typically when someone with zero assets enter a facility, they do have a spend down, using up any available funds before Medicaid kicks in. Social security payments are automatically paid to the facility. 
 

The patient also has to qualify based on physical abilities and level of care required. You can’t get into AL if you’re too incapacitated for it and need nursing care; you can’t get into a SNF if you’re deemed too capable. It’s a conundrum. 
 

But yes, sadly, people do end up streeted. Echoing the recommendations for contacting the local department of elder services for specific help. 

[Mrs Tiggywinkle Again]

If he can’t live alone he will probably qualify for a nursing home.  Medicaid will pay for it. It may not be the nicest nursing home but they’ll cover it.

[Ottakee]

Another option for some if they don’t qualify for a nursing home is an adult foster care home aka group home.   All depends on their care needs and mental status.

[Carol in Cal.]

1 hour ago, Amethyst said:

So, am I understanding correctly that Medicaid will not pay for assisted living? Only nursing home?

Usually.

[Bootsie]

3 hours ago, Amethyst said:

. Wild guess: all his money (aside from pension and SS) will be used up in 6 months paying for this new facility   

Does he receive Social Security retirement benefits and pension benefits?  Even if he does not have many additional assets, is the monthly income enought to cover his monthly expenses?  I know several elderly people who do not have a large amount of non-retirement related assets or savings but who have been able to cover monthly living expenses with their retirement income.  

[J-rap]

In our state, someone can enter a private assisted living/long-term care nursing home and private pay, but when their money runs dry, and if the facility also accepts state money, then Medicaid takes over.  But I'm not sure about assisted living vs. long term care.  I only have experience with long term care.  But, perhaps living in a nice long term care facility where they generally encourage any independence if possible, is better than an assisted living situation in a lesser quality facility.  

Upon research, there is something called an Elderly Waiver in our state which sounds like could potentially pay for all of assisted living, but again, I'm not sure if all facilities are included.   Probably every state handles it differently.  

[TechWife]

2 hours ago, Amethyst said:

So, am I understanding correctly that Medicaid will not pay for assisted living? Only nursing home?

That has been my experience, yes. It’s possible some states have made some state-specific provisions, IDK.

[J-rap]

7 minutes ago, Bootsie said:

Does he receive Social Security retirement benefits and pension benefits?  Even if he does not have many additional assets, is the monthly income enought to cover his monthly expenses?  I know several elderly people who do not have a large amount of non-retirement related assets or savings but who have been able to cover monthly living expenses with their retirement income.  

That's true.  I guess it depends on how much help is needed.  My dad is able to cover his entire rent in an independent apartment within a nice long-term care/assisted living community with his social security income.  State Medical Assistance might pay for part-time in-home aide if it comes to that.

[KidsHappen]

One of my brothers had a massive stroke two years ago. He was placed in a nursing home where they expect he will spend the rest of his life. He was already on disability and his care is now covered by Medicaid I believe (he is not even 55 yet). They didn't expect him to survive. I have no idea what would have happened if he wasn't put in a nursing home.

[Navymom]

10 hours ago, Pawz4me said:

I believe Medicaid only pays for skilled nursing facilities. And a doctor (at least one, maybe two) has to say that a person needs that level of care.

Or at least that's my understanding of how Medicaid works in my state.

Must depend on the state. In my state, there are a few select assisted living facilities that do accept Medicaid.

My parents chose their specific facility knowing that eventually they could run out of money.

[Pawz4me]

13 minutes ago, Navymom said:

Must depend on the state.

It does. Unlike Medicare, Medicaid coverage varies from state to state. I should have said “in my state” in my posts. 

[Faith-manor]

As to filial responsibility, the laws are rather vague. California says to the "best of the child's ability will support the parent". Nursing home care is around $100,000 a year in that state, and they are not allowed to bankrupt the child to pay for it. They also cannot make a working person quit their job to physically care for the elderly person in their home. These folks still end up on Medicaid in nursing homes that accept it. Usually " the best of their ability " amounts to providing personal care type items like new socks and specific brand of toothpaste the person wants.

Pennsylvania is the tough state. They have had judges force kids to pay their parents rehab bills, nursing care bill, etc. In one case, they made a woman who was raised in foster care because her parents were so abusive, financially support her biological father. It was disgusting. By in large filial laws in other states are not enforced because the lower court judges really question the constitutionality of them. Of course the reality is that unless one is independently wealthy, paying for our elders care will only lead to another generation in the same boat. Aging. Out of money. Can't pay their own bills. Makes for a vicious cycle, and especially to my generation who was the one steamrolled with the insane cost of college and trade schools at the same time aging parents expected handouts in order to "age in place". 

I really think this person, unless it is Pennsylvania, is likely to end up in a shelter while social workers look for a placement in a Medicaid accepting nursing home. If he truly has little money, and used the proceeds of the sale of his home to take care of himself, the 6 year look back should be no worry allowing him to qualify.

[Navymom]

28 minutes ago, Faith-manor said:

Pennsylvania is the tough state. They have had judges force kids to pay their parents rehab bills, nursing care bill, etc.

That is frightening! My 85 year old dad only was laid off in his 40's and only worked a few very part time jobs after that. My mom did work until 60ish, but at a fairly low paying job.

The thought of ME being responsible for any of their bills now (over $15,000 per month-assisted living apartment/him & nursing home care/her) when he was able to work MANY more years and chose not to is scary. 

They are close to running out of money and I have been telling them for years that they need to do some sort of financial planning to prepare.

 

[Pam in CT]

I'm only familiar with NY, CT and MA; but in all of those states, Medicaid covers nursing homes but not assisted living.  (MediCARE covered certain specific services, like PT/ OT/ Speech and I think weekly nurse visits, along with physical equipment like bedlift/ wheelchair/ sitting shower etc, when my father was in a MA-based assisted living situation. But not the basic weekly cost of living there.)

[Grace Hopper]

Medicaid is a federal program that is administered by each state, that’s why things vary. 
 

Something to keep in mind is that if a person qualifies for hospice care (terminal diagnosis, trajectory of decline), that brings additional services that are covered by Medicare, not Medicaid. It brings a whole jump in level of care that is typically fully funded, that’s why I always encourage people to seek hospice services well before the last few days of life if one qualifies. 
 

It’s really sad that those who most need care are the ones least likely to be able to figure out the business of getting that needed care. Plan ahead, folks! Too many people just wind up in their later years with what my attorney calls the Drop-Dead Plan, not acknowledging they may face an extended period of limited capabilities before departing. 

[Amethyst]

21 hours ago, Bootsie said:

Does he receive Social Security retirement benefits and pension benefits?  Even if he does not have many additional assets, is the monthly income enought to cover his monthly expenses?  

I found out today that he probably has enough with his small pension and his SS benefits to pay for his monthly AL place. So, that’s good news. It’s not the swankiest of places but it’s not bad either. 

[Amethyst]

10 hours ago, Faith-manor said:

As to filial responsibility, the laws are rather vague. California says to the "best of the child's ability will support the parent". Nursing home care is around $100,000 a year in that state, and they are not allowed to bankrupt the child to pay for it. They also cannot make a working person quit their job to physically care for the elderly person in their home. These folks still end up on Medicaid in nursing homes that accept it. Usually " the best of their ability " amounts to providing personal care type items like new socks and specific brand of toothpaste the person wants.

Pennsylvania is the tough state. They have had judges force kids to pay their parents rehab bills, nursing care bill, etc. In one case, they made a woman who was raised in foster care because her parents were so abusive, financially support her biological father. It was disgusting. By in large filial laws in other states are not enforced because the lower court judges really question the constitutionality of them. Of course the reality is that unless one is independently wealthy, paying for our elders care will only lead to another generation in the same boat. Aging. Out of money. Can't pay their own bills. Makes for a vicious cycle, and especially to my generation who was the one steamrolled with the insane cost of college and trade schools at the same time aging parents expected handouts in order to "age in place". 

I really think this person, unless it is Pennsylvania, is likely to end up in a shelter while social workers look for a placement in a Medicaid accepting nursing home. If he truly has little money, and used the proceeds of the sale of his home to take care of himself, the 6 year look back should be no worry allowing him to qualify.

It IS Pennsylvania. Although his estranged children are not in PA

[Amethyst]

10 hours ago, Faith-manor said:

 

I really think this person, unless it is Pennsylvania, is likely to end up in a shelter while social workers look for a placement in a Medicaid accepting nursing home. If he truly has little money, and used the proceeds of the sale of his home to take care of himself, the 6 year look back should be no worry allowing him to qualify.

So, it’s hard for me to get the full story about this person who is not my relative, and I’m hearing things second and thirdhand. I’m more optimistic today that he might have enough money. But the person where I got the information from is not always the most reliable source. So, this is all good information.

[Bambam]

One of our independent/assisted/memory care/long term care facilities here is a faith based non-profit. As long as you are a paying customer for 3 years previously, they let you stay in the facility until death. At least that is what they say. I don't know anyone who has done that. 

Are there facilities like that other places? 

[freesia]

44 minutes ago, Bambam said:

One of our independent/assisted/memory care/long term care facilities here is a faith based non-profit. As long as you are a paying customer for 3 years previously, they let you stay in the facility until death. At least that is what they say. I don't know anyone who has done that. 

Are there facilities like that other places? 

My mother is in one. She had to prove a certain amount of savings before she could enter. 

[Grace Hopper]

2 hours ago, Bambam said:

One of our independent/assisted/memory care/long term care facilities here is a faith based non-profit. As long as you are a paying customer for 3 years previously, they let you stay in the facility until death. At least that is what they say. I don't know anyone who has done that. 

Are there facilities like that other places? 

The average life span after entering a SNF is under 3 years; I imagine after 3 years mantua would also qualify for Medicare funded hospice care. Of course there are outliers, and I’m sure many here could comment about loved ones living beyond that. I just mention it because a well run facility could afford to make such an offer based on statistics; it is a lovely policy.  
 

Memory care is another matter. One of my elders was in managed care over a decade before Alzheimer’s incapacitated her physically, while mentally she was unable to live in AL or independently or even with loving family members. 

[livetoread]

2 hours ago, Bambam said:

One of our independent/assisted/memory care/long term care facilities here is a faith based non-profit. As long as you are a paying customer for 3 years previously, they let you stay in the facility until death. At least that is what they say. I don't know anyone who has done that. 

Are there facilities like that other places? 

My parents are in one. If they deplete their savings, the facility will still keep them. My folks wanted a faith based non-profit because they didn't want to go into a good place only to have it sold to some other worse entity. Those places can turn over quickly, and quality can suffer. The well established faith based non profits are less likely to sell. Luckily the best facility around here also happens to be faith based, non profit, so it worked out well. The facility has been around for decades. However, my folks had to show substantial resources before getting admitted and pay a big amount just to get in. They are in independent living now but all the options are there for more advanced care.

[Ting Tang]

The government pays I believe.  My father battled for his health for several years.  He did leave some money and had a premium. Haven't quite figured it all out yet, but he didn't leave much.  He and my mother were long divorced.  My mother will be in this scenario--worse off than my father because she doesn't really have relationships with us.  I have never heard of responsibility laws.  I need to research this---we are estranged.  I sometimes wonder if she dies how that will be handled; I am not going to spend thousands of dollars on a simple cremation.  My brother talks to her more, and I know he and his wife have very tight finances.  Ugh.  

[Pawz4me]

7 hours ago, Grace Hopper said:

The average life span after entering a SNF is under 3 years; I imagine after 3 years mantua would also qualify for Medicare funded hospice care.

I believe Medicare pays for hospice services that are provided in the patient's home. Or if the patient lives in an assisted living or skilled nursing home then hospice provides the services there. The equivalent to assisted living or a skilled nursing facility is a live-in hospice facility, which Medicare does cover. But beds in those in most areas are very limited and hard to get. The patient has to be in a situation that absolutely requires it, like needing almost continuous IV pain medication or something like that. We recently had a (too young 😞 ) neighbor who spent her last month or so in an in-patient hospice facility, but it was only because her pain couldn't be controlled at home. OTOH, a friend's elderly father with lung cancer and COPD spent his last weeks at a skilled nursing facility, which he paid for OOP, while receiving hospice services. His needs could be met there, he didn't qualify for inpatient hospice services.

[Grace Hopper]

3 hours ago, Pawz4me said:

I believe Medicare pays for hospice services that are provided in the patient's home. Or if the patient lives in an assisted living or skilled nursing home then hospice provides the services there. The equivalent to assisted living or a skilled nursing facility is a live-in hospice facility, which Medicare does cover. But beds in those in most areas are very limited and hard to get. The patient has to be in a situation that absolutely requires it, like needing almost continuous IV pain medication or something like that. We recently had a (too young 😞 ) neighbor who spent her last month or so in an in-patient hospice facility, but it was only because her pain couldn't be controlled at home. OTOH, a friend's elderly father with lung cancer and COPD spent his last weeks at a skilled nursing facility, which he paid for OOP, while receiving hospice services. His needs could be met there, he didn't qualify for inpatient hospice services.

Hospice services can be provided anywhere - home, in a facility, or in a hospice house. The patient just needs to meet the criteria to qualify. 

[Pawz4me]

1 hour ago, Grace Hopper said:

Hospice services can be provided anywhere - home, in a facility, or in a hospice house. The patient just needs to meet the criteria to qualify. 

Yes, but qualifying for hospice services does NOT mean that one qualifies for inpatient services in a dedicated hospice facility. That's often a surprise to people, and a big smack-upside-the-head-come-to-reality moment. Those inpatient beds are very strictly triaged according to need.

[Grace Hopper]

1 hour ago, Pawz4me said:

Yes, but qualifying for hospice services does NOT mean that one qualifies for inpatient services in a dedicated hospice facility. That's often a surprise to people, and a big smack-upside-the-head-come-to-reality moment. Those inpatient beds are very strictly triaged according to need.

Right. But people can still receive hospice services, even if they don’t go into a hospice house for them. 
 

I guess the question would be what the living arrangements are previous to m (by qualification) hospice intake. The reason I even mentioned it in the context of the OP is that by the time a person has been in skilled nursing for 3 years, they may be at the point of qualifying for hospice. Those Medicare provided services likely reduce the cost of care to the facility (at the very least frees up regular staff for bathing, etc), thus helping them to be able to generously allow residents to live “rent free” at that point. 
 

Usual elder care caveat: every state, every person, can have a different story. 

[TexasProud]

1 hour ago, Grace Hopper said:

Right. But people can still receive hospice services, even if they don’t go into a hospice house for them. 
 

I guess the question would be what the living arrangements are previous to m (by qualification) hospice intake. The reason I even mentioned it in the context of the OP is that by the time a person has been in skilled nursing for 3 years, they may be at the point of qualifying for hospice. Those Medicare provided services likely reduce the cost of care to the facility (at the very least frees up regular staff for bathing, etc), thus helping them to be able to generously allow residents to live “rent free” at that point. 
 

Usual elder care caveat: every state, every person, can have a different story. 

Hospice does not mean what people may think it means.  I still get angry when I think about our hospice experience.  Hospice does NOT mean that someone will be there 24/7.  For my mom, who was terminally ill, they had someone come at first they thought it would be a couple of times a week, though it ended up being every day.  The hospice worker only stayed maybe 30 minutes.  We were expected to do everything: give the morphine many times a day, guessing at what dose would be enough, etc.  It was horrible. If this person has no family to do that, it won't really help.  That said, Medicaid will pay for some kind of facility, though it may not be nice.  But hospice care...nope.  I mean yes, like my mom, medicare paid for all of the hospice equipment and hospice care. But we had to hire other caregivers because I couldn't handle staying awake 24/7 so she didn't get out of bed, pick her up off the floor when she fell, etc. 

[Grace Hopper]

6 minutes ago, TexasProud said:

Hospice does not mean what people may think it means.  I still get angry when I think about our hospice experience.  Hospice does NOT mean that someone will be there 24/7.  For my mom, who was terminally ill, they had someone come at first they thought it would be a couple of times a week, though it ended up being every day.  The hospice worker only stayed maybe 30 minutes.  We were expected to do everything: give the morphine many times a day, guessing at what dose would be enough, etc.  It was horrible. If this person has no family to do that, it won't really help.  That said, Medicaid will pay for some kind of facility, though it may not be nice.  But hospice care...nope.  I mean yes, like my mom, medicare paid for all of the hospice equipment and hospice care. But we had to hire other caregivers because I couldn't handle staying awake 24/7 so she didn't get out of bed, pick her up off the floor when she fell, etc. 

I understand what hospice means. Been through it several times in different settings (hospice house, home, SNF). I’m sorry your experience was bad; mine were all wonderful blessings to the families. People seeking that level of care definitely do need to learn and understand exactly what services would be provided in their own specific case.