Elderly Mother in MI - Assisted Living transition

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NewVGI
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Elderly Mother in MI - Assisted Living transition

Post by NewVGI »

Our mom currently lives in Michigan, has approximately $140,000 in retirement accounts, owns a primary home and secondary property (a cottage) and has personal belongings and home furnishings. Her personal belongings include some items of value such as china, sterling silver, figurines, etc. She has no debt and both properties are paid off.

She is 86 years old covered by Medicare and ancillary medical coverage Blue Care Network Plus. Short-term care is covered, long term care is not. It is expected that in the next few years she will no longer be able to live without assistance and expect she may need to be placed in an assisted living arrangement. We understand that Medicaid does cover long-term care benefits, however for our mother to qualify for Medicaid she would need to burn down her assets (figuratively speaking of course).

We would like to understand the following:
1. Qualification Criteria for Medicaid
2. Options for asset protection both while mom is living and also after she has passed (otherwise called estate planning for Medicaid).
3. We have heard about the Lady Bird Deed legislation and the Enhanced Life Estate, we would like to learn more.
4. What other options are available and what types of assets can be protected.

We would really appreciate if anyone has any suggestions, experience or recommendations. Many thanks in advance.
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BL
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Re: Elderly Mother in MI - Assisted Living transition

Post by BL »

Be very sure that you (and she) would want her to be on Medicaid (if not necessary) before you deplete her assets! Some of those choices are not good, depending on state and communities. Personally I would choose to spend my assets to get the best choices possible.

You will have to see a lawyer to accomplish any of those choices.
Carefreeap
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Re: Elderly Mother in MI - Assisted Living transition

Post by Carefreeap »

Your best source of information is going to be an eldercare specialist in your state. Income and asset limitation vary from State to State and within Counties in a state depending on the COLA. Here is a website for CA. http://www.canhr.org/factsheets/medi-ca ... ry_FAQ.htm

I would try googling the same for your state. But you should get an idea of what exempt assets are.
Also you should find out if your State has a Medicaid recovery program. Also research what is your State's "Look back" period.

You may also be able to find free help with her local legal aid group. Google the county name and legal aid.
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stan1
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Re: Elderly Mother in MI - Assisted Living transition

Post by stan1 »

How much are the two properties worth if they were sold, or could they be rented out to generate income that together with her SS would pay for a lot of her care?
Warning: I am about 80% satisficer (accepting of good enough) and 20% maximizer
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jeffyscott
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Re: Elderly Mother in MI - Assisted Living transition

Post by jeffyscott »

Looks like this may be a place to get some info: http://www.payingforseniorcare.com/medi ... ogram.html

But, I would first spend your time finding an assisting living place that will work for her, rather than worrying about how much of her money you can protect for her heirs. She's got $140,000 and at least one extra house, she is a long way from getting on Medicaid. If she gives assets away now, there is at least a 5 year look back by Medicaid and she will lose benefits equal to the amount given away.

What if the assisted living place that she wants to go to keeps only private pay patients? This would eliminate any need to play games with her assets, as she would want to use them in order to continue living where she wants to.

My mom was in assisted living for the last 18 months of her life. We did not play games like pretending that she was going to return to her home. She sold the home and spent most of her meager assets (and all of her $1300 per month SS benefit) paying the ~$4000-4500 per month assisted living cost. Had she gone another 6-8 months, she'd have been nearly out of assets and have qualified for what they call "Family Care" in WI, this is a medicaid waiver program to cover assisted living cost.

The assisted living place she was in had policy that if you were private pay for at least 2 years, they guaranteed that they would keep you on Family Care (which pays much less than private) as long as they were able to meet the level of care needed.
BarbK
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Re: Elderly Mother in MI - Assisted Living transition

Post by BarbK »

For my mom, I didn't do the Medicaid route either; She lived in independent care and then assisted living for 6 years before she passed away. Everyone was private pay. Actually, I think all AL facilities in Florida are Private Pay and nursing homes are both private pay and Medicaid. She went to rehab twice during the 6 years; the rehab was 1/2 rehab(short term) and 1/2 nursing home and there is a HUGE difference between the nursing homes and Assisted living. When she was in the hospital, I visited the rehab facilities and choose the 'best' ones; she went to 2 different ones and I had the same non-favorable impression of the nursing home part for both.

Plus the cost of AL is much lower than Nursing homes. A lot of the AL places are also converting some of their space to memory care facilities.

You might want to look at independent living facilities first - it would make the transition easier for her. The apartments are larger, have a kitchen, they do your linens, clean the apartment, provide all meals, transporation, etc. I didn't find the cost much more than the cost of running a house; plus her quality of life was much better having people to eat with, tons of activities, exercise classes, etc.
Gnirk
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Re: Elderly Mother in MI - Assisted Living transition

Post by Gnirk »

For what it's worth:
In our area, there can be a great difference in the quality of personal care between most private pay homes and Medicaid homes. We are spending her money on the best care we can find. We sold her home, and the proceeds plus her savings, will pay for another 7 years of care in an Adult Family Home that specializes in Alzheimer's, where she receives almost one on one care.
stan1
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Re: Elderly Mother in MI - Assisted Living transition

Post by stan1 »

When it comes time to look at an independent living, assisted living, or nursing home facility my recommendation is to look for a well maintained older facility (built 20+ years ago) that also maintains a high quality of care. We found such a place for my mom which costs almost half as much as a new facility nearby. New facilities all seem to have more luxurious accommodations than my mom needs and that comes with a high price tag. You can also get better value in private home care situations as well.

Michigan may already be relatively low cost so might be in a good situation geographhically. I'm convinced you can get better care at half the cost in LCOL areas.
Warning: I am about 80% satisficer (accepting of good enough) and 20% maximizer
Independent
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Re: Elderly Mother in MI - Assisted Living transition

Post by Independent »

In Michigan, assisted living facilities might cost $4,000 per month or $48,000 per year. It looks like her assets would cover 5-10 years of private pay.
(I'm assuming that her only income is Social Security, and it would cover medical care, clothing, and incidentals.)

Given that, you're a long way from Medicaid. I think that talking to an attorney who specializes in those issues is a fine idea. You'll get some ideas, probably get rid of some myths, and will get MI specific details.

But, the real issue is finding the best quality that she can afford. My mom was in a sprawling building that had Independent living, Assisted care, and Skilled nursing all under one roof. The quality seemed reasonably consistent in the three areas. After she lived in the Independent living wing for a while, she knew people who had started there and moved to the other wings. That made the whole transition concept more acceptable.
stan1
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Re: Elderly Mother in MI - Assisted Living transition

Post by stan1 »

Independent wrote: But, the real issue is finding the best quality that she can afford. My mom was in a sprawling building that had Independent living, Assisted care, and Skilled nursing all under one roof. The quality seemed reasonably consistent in the three areas. After she lived in the Independent living wing for a while, she knew people who had started there and moved to the other wings. That made the whole transition concept more acceptable.
At my mom's elder care facility the independent living people call the assisted living building "the big house" (it's a large building with interior hallways whereas the independent living units are more spread out with patios and balconies). There's a lot of gossip among the residents over who "got sent to the big house". I've told my mom that she needs to go to exercise classes and maintain her mobility otherwise she'll "get sent to the big house". She thought about that for a bit, and has started going more regularly to her exercise classes so maybe it sank in.
Warning: I am about 80% satisficer (accepting of good enough) and 20% maximizer
Beth*
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Re: Elderly Mother in MI - Assisted Living transition

Post by Beth* »

Does Medicaid even pay for assisted living in Michigan? My understanding is that Medicaid covers nursing homes in all states for people who qualify medically and financially. However, states have an option regarding whether or not to use Medicaid funds to cover assisted living. When my mother-in-law was in assisted living Medicaid did not provide any coverage even though she had no assets other than her social security and pension (which together did not fully cover the cost of assisted living). She needed help with bathing and dressing, she used a walker, she was incontinent, and she had serious memory issues, but she was not able to qualify for admission to a nursing home under Medicaid rules, so her family was responsible for all costs.

People don't always realize that there is a gap between a person being able to live on his or her own and a person qualifying for admission to a nursing home that is covered by Medicaid and that no government assistance may be available when the person is in that gap. I think this is state specific so you need to look up Michigan's policy.
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