Placing mother in nursing home - advice

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JDTHOOSIER
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Placing mother in nursing home - advice

Post by JDTHOOSIER » Sun Oct 14, 2018 3:29 pm

We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.

My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.

Any advise would be appreciated, on the best way to move forward.

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dm200
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Re: Placing mother in nursing home - advice

Post by dm200 » Sun Oct 14, 2018 3:42 pm

JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.
My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.
Any advise would be appreciated, on the best way to move forward.
Why is this, apparently, solely on your sister?

delamer
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Re: Placing mother in nursing home - advice

Post by delamer » Sun Oct 14, 2018 3:42 pm

The county government where your mother lives should have an Office for the Aging or something similarly titled.

That should be a good source of basic information on services and resources available to figure out options for your mother.

Best of luck.

remomnyc
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Re: Placing mother in nursing home - advice

Post by remomnyc » Sun Oct 14, 2018 3:45 pm

If you and your sister are going to be in the same city, that is the city your mom should be in, so look for a facility in your city. Speak to an elder care attorney, but I believe once she depletes her assets, she will be eligible for Medicaid, which does cover nursing homes. I would sell the house and use the proceeds for a nursing home in your city. When you are interviewing nursing homes, let them know approximately how much she has before she will have to apply for Medicaid and find a home that accepts both private pay and Medicaid patients, so she does not have to move. I am not an expert, so please consult with an elder care attorney.

P.S. Thank your sister for caring for your mother and congratulate her on being a grandmother.

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dm200
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Re: Placing mother in nursing home - advice

Post by dm200 » Sun Oct 14, 2018 3:52 pm

remomnyc wrote:
Sun Oct 14, 2018 3:45 pm
If you and your sister are going to be in the same city, that is the city your mom should be in, so look for a facility in your city. Speak to an elder care attorney, but I believe once she depletes her assets, she will be eligible for Medicaid, which does cover nursing homes. I would sell the house and use the proceeds for a nursing home in your city. When you are interviewing nursing homes, let them know approximately how much she has before she will have to apply for Medicaid and find a home that accepts both private pay and Medicaid patients, so she does not have to move. I am not an expert, so please consult with an elder care attorney.

P.S. Thank your sister for caring for your mother and congratulate her on being a grandmother.
Yes..

TN_Boy
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Re: Placing mother in nursing home - advice

Post by TN_Boy » Sun Oct 14, 2018 4:00 pm

JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.

My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.

Any advise would be appreciated, on the best way to move forward.
1) How much is the house worth? I cannot imagine why you wouldn't sell it. What shape is it in?
2) How much is combined SS + pension?
3) How much are nursing homes where you live (which is where your sister will move to, and as another poster says, where mom should almost certainly go).
4) Mother really has 0 savings?

I think your nursing home costs are going to be at least 70k to 80k a year. It's possible that you might be able to do something like put her in assisted living and also pay some home health to come in, but I doubt it (though it might be worth investigating in case the numbers are better). She will get better care if you and your sister visit a lot, no matter where she winds up living.

So, the likely path is move her as soon as possible, and sell the house so it can pay for as much of the care required as possible, until that money is gone. And then probably medicaid.

Your sister has certainly taken one for the family -- that level of caretaking is brutal.

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Stinky
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Re: Placing mother in nursing home - advice

Post by Stinky » Sun Oct 14, 2018 4:08 pm

remomnyc wrote:
Sun Oct 14, 2018 3:45 pm
If you and your sister are going to be in the same city, that is the city your mom should be in, so look for a facility in your city. Speak to an elder care attorney, but I believe once she depletes her assets, she will be eligible for Medicaid, which does cover nursing homes. I would sell the house and use the proceeds for a nursing home in your city. When you are interviewing nursing homes, let them know approximately how much she has before she will have to apply for Medicaid and find a home that accepts both private pay and Medicaid patients, so she does not have to move. I am not an expert, so please consult with an elder care attorney.

P.S. Thank your sister for caring for your mother and congratulate her on being a grandmother.
+1

Absolutely correct advice. Sell the house as soon as is reasonable, since it sounds like your mom can’t live there any more.

Sorry for what you’re going through.
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celia
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Re: Placing mother in nursing home - advice

Post by celia » Sun Oct 14, 2018 4:22 pm

Finding a local Assisted Living facility near you appears to be the way to go until she needs nursing care. Can the catheter be removed and use Adult diapers instead?

The best Assisted Livings, in my opinion, are the ones in a house in a neighborhood where they accept 6-8 patients and have 24 hour staff. In my area that might cost $3,000 a month. To find such a place, start with your state's licensing website and look for places between your place and the new dad's place. When you contact the owner, inquire about other places they also own nearby. My dad has such a facility next door to him but you would never know it except for the ramps next to the steps.

Don't forget that your mom is now a great-grandmother and will likely enjoy seeing the baby grow up.

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Re: Placing mother in nursing home - advice

Post by TN_Boy » Sun Oct 14, 2018 4:35 pm

celia wrote:
Sun Oct 14, 2018 4:22 pm
Finding a local Assisted Living facility near you appears to be the way to go until she needs nursing care. Can the catheter be removed and use Adult diapers instead?

The best Assisted Livings, in my opinion, are the ones in a house in a neighborhood where they accept 6-8 patients and have 24 hour staff. In my area that might cost $3,000 a month. To find such a place, start with your state's licensing website and look for places between your place and the new dad's place. When you contact the owner, inquire about other places they also own nearby. My dad has such a facility next door to him but you would never know it except for the ramps next to the steps.

Don't forget that your mom is now a great-grandmother and will likely enjoy seeing the baby grow up.
Best depends upon exact situation, but I think the suggestion to look into what I've heard called "group homes" is excellent. In my area though, the cost for a good one is quite a bit more than $3k a month -- more like double that.

To be clear, and I don't think I was in my original post, the need for a catheter probably means assisted living would not take her and she might need the much more expensive "nursing home." Even in assisted living, it sounds like she pretty much needs help doing everything, so you'd likely pay extra for more additional assistance. I mean, this does sound expensive.

JDTHOOSIER
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Re: Placing mother in nursing home - advice

Post by JDTHOOSIER » Sun Oct 14, 2018 5:24 pm

Thanks for all the advice. Just to be sure - it's not 100% on my sister. My wife and I go up on weekends to assist my sister, but my wife has her own health issues which I have to manage. I provide financial support and help my mom with managing bills, taxes, etc. I also moved from out of state to my current location to be closer to the situation. My sister has been doing this for a number of years, and we've looked together in trying to find some other arrangements to no avail.

So that was the general plan we are evolving - move my mom to a facility near by, and my sister sells her house and my mom's house and move here also. But it figuring out the finanical aspects that was the roadblock.

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Artful Dodger
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Re: Placing mother in nursing home - advice

Post by Artful Dodger » Sun Oct 14, 2018 5:25 pm

remomnyc wrote:
Sun Oct 14, 2018 3:45 pm
If you and your sister are going to be in the same city, that is the city your mom should be in, so look for a facility in your city. Speak to an elder care attorney, but I believe once she depletes her assets, she will be eligible for Medicaid, which does cover nursing homes. I would sell the house and use the proceeds for a nursing home in your city. When you are interviewing nursing homes, let them know approximately how much she has before she will have to apply for Medicaid and find a home that accepts both private pay and Medicaid patients, so she does not have to move. I am not an expert, so please consult with an elder care attorney.

P.S. Thank your sister for caring for your mother and congratulate her on being a grandmother.
This is the exact advice I would give. I would assume, unless you have a short stay or the house value is several times the annual NH cost, your mom's estate will be depleted, and she'll end up on Medicaid. I don't know how long your sister has been a full time caregiver, but if for very long, you might have her put together a daily log and other records to document her care giving, prepare an invoice for the amount owed, and pay her first thing from the proceeds of the house sale. Medicaid can come back on any recent transferred assets, but family members can still be paid for legitimate documented care.

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Mlm
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Re: Placing mother in nursing home - advice

Post by Mlm » Sun Oct 14, 2018 6:38 pm

Did your sister live in your mother's home as a caregiver? If she did for 2 years or more she may qualify for a caregiver-child exemption to the 5 year look back period. I would see an Eldercare Attorney regarding her options.

https://www.payingforseniorcare.com/med ... ption.html

JDTHOOSIER
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Re: Placing mother in nursing home - advice

Post by JDTHOOSIER » Sun Oct 14, 2018 8:09 pm

Mlm wrote:
Sun Oct 14, 2018 6:38 pm
Did your sister live in your mother's home as a caregiver? If she did for 2 years or more she may qualify for a caregiver-child exemption to the 5 year look back period. I would see an Eldercare Attorney regarding her options.

https://www.payingforseniorcare.com/med ... ption.html
No, but she lived nearby, near enough to be able to walk to my mom's. My mom's house is probably not valued at more than $75,000 in a lower income area, and she gets about $1500 month with social security/pension.

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willthrill81
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Re: Placing mother in nursing home - advice

Post by willthrill81 » Sun Oct 14, 2018 8:53 pm

Mlm wrote:
Sun Oct 14, 2018 6:38 pm
Did your sister live in your mother's home as a caregiver? If she did for 2 years or more she may qualify for a caregiver-child exemption to the 5 year look back period. I would see an Eldercare Attorney regarding her options.

https://www.payingforseniorcare.com/med ... ption.html
:beer Absolutely this should be done tomorrow morning.
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John88
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Re: Placing mother in nursing home - advice

Post by John88 » Mon Oct 15, 2018 10:43 am

Does your mother want to stay in her home or live with your Sister now and receive Care Giver Services?

If she receives $1,500 per month she is very close to qualifying for the no cost A&D Medicaid Program (Aged and Disabled Program) which does pay for In Home Support Services (IHSS). Does she pay for Part B or any other medical expenses? (dental or vision plans, incontinence supplies, etc.).

$1,012 (FPL for 1) + $250 (income disregard) + $134 (Part B) = $1,396 so about another $104 in medical expenses should get her passing for no cost Medicaid In Home Support Services (IHSS). A personal residence is exempt and the property limit for one person is $2,000 so this would be an issue if her residence is sold and the sale proceeds get converted to property. She would need to be in someone’s home for these services. She could even be in your sister’s home and your sister could be paid for providing IHSS.

For Long Term Care Medicaid pays for the stay in a Skilled Nursing Facility (SNF). The same property rules apply $2,000 and a personal residence is exempt. What commonly happens is the personal residence is sold to pay for the SNF and when the assets are depleted Medicaid kicks in. The SNF cost should be your mother’s entire $1,500 minus $35 which she is able to keep for herself.

Medicaid LTC program has a 30(could be 60 in other states) month look back on property transfers. So if her home is sold or transferred to someone within 30 months she will need to report that to the county and may disqualify her from LTC Medicaid. For IHSS there is no look back period. As with any advice these decisions may have tax and legal consequences please see the appropriate professionals for input.

At this link below are some good LTC resources targeted for CA residents but since the rules are based on federal regulations the same requirements should apply to other states.

http://canhr.org/factsheets/medi-cal_fs ... erview.htm
Last edited by John88 on Mon Oct 15, 2018 1:33 pm, edited 1 time in total.

fourkids
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Re: Placing mother in nursing home - advice

Post by fourkids » Mon Oct 15, 2018 10:54 am

can your mom move to your town and move in with you now? and you can hire some home health care, much cheaper than nursing home.

JDTHOOSIER
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Re: Placing mother in nursing home - advice

Post by JDTHOOSIER » Mon Oct 15, 2018 12:51 pm

fourkids wrote:
Mon Oct 15, 2018 10:54 am
can your mom move to your town and move in with you now? and you can hire some home health care, much cheaper than nursing home.
That's an idea that we considered, but we don't have a house to facilitate this, no bedroom/full bath on the ground floor, etc. I don't see any other alternatives to a nursing home, given my mom's limitations and needs.

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Re: Placing mother in nursing home - advice

Post by TN_Boy » Mon Oct 15, 2018 1:50 pm

fourkids wrote:
Mon Oct 15, 2018 10:54 am
can your mom move to your town and move in with you now? and you can hire some home health care, much cheaper than nursing home.
Up to a point it is cheaper. Probably over $20/hour, with a three hour minimum. If you start getting near 24x7 help, it starts to cost what a skilled nursing facility would cost. I also don't know whether standard home health would take his mom on -- that rate would not cover anything considered skilled nursing.

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Re: Placing mother in nursing home - advice

Post by White Coat Investor » Mon Oct 15, 2018 1:56 pm

JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.

My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.

Any advise would be appreciated, on the best way to move forward.
Sounds like the plan is sell the house, use the proceeds to pay for the nursing home until they're gone, then she goes on Medicaid. The only other thing to consider is to somehow hide the house and payments from the Medicaid folks so Medicaid starts paying sooner and the heirs get more left to them. This is called Medicaid planning and is legal although perhaps ethically questionable.

I agree to get a home in the new city.
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dm200
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Re: Placing mother in nursing home - advice

Post by dm200 » Mon Oct 15, 2018 2:40 pm

White Coat Investor wrote:
Mon Oct 15, 2018 1:56 pm
JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.
My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.
Any advise would be appreciated, on the best way to move forward.
Sounds like the plan is sell the house, use the proceeds to pay for the nursing home until they're gone, then she goes on Medicaid. The only other thing to consider is to somehow hide the house and payments from the Medicaid folks so Medicaid starts paying sooner and the heirs get more left to them. This is called Medicaid planning and is legal although perhaps ethically questionable.
I agree to get a home in the new city.
Seems to me that an important aspect of "Medicaid Planning" would be the best care over the long term (for her).

JDTHOOSIER
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Re: Placing mother in nursing home - advice

Post by JDTHOOSIER » Mon Oct 15, 2018 4:17 pm

dm200 wrote:
Mon Oct 15, 2018 2:40 pm
White Coat Investor wrote:
Mon Oct 15, 2018 1:56 pm
JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.
My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.
Any advise would be appreciated, on the best way to move forward.
Sounds like the plan is sell the house, use the proceeds to pay for the nursing home until they're gone, then she goes on Medicaid. The only other thing to consider is to somehow hide the house and payments from the Medicaid folks so Medicaid starts paying sooner and the heirs get more left to them. This is called Medicaid planning and is legal although perhaps ethically questionable.
I agree to get a home in the new city.
Seems to me that an important aspect of "Medicaid Planning" would be the best care over the long term (for her).
The thing that frustrates me is that my Dad refused to divulge his insurance/planning/finances when I would ask about long-term plans or provisions for taking care of mom. I was shocked basically at the fact there was nothing there. They always "assumed" she would pass away first. So his passing away resulted in my sister having to take over the care. Like someone else said, it's brutal - and ruining her health, and she's hit her limits.

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dm200
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Re: Placing mother in nursing home - advice

Post by dm200 » Mon Oct 15, 2018 4:22 pm

JDTHOOSIER wrote:
Mon Oct 15, 2018 4:17 pm
dm200 wrote:
Mon Oct 15, 2018 2:40 pm
White Coat Investor wrote:
Mon Oct 15, 2018 1:56 pm
JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.
My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.
Any advise would be appreciated, on the best way to move forward.
Sounds like the plan is sell the house, use the proceeds to pay for the nursing home until they're gone, then she goes on Medicaid. The only other thing to consider is to somehow hide the house and payments from the Medicaid folks so Medicaid starts paying sooner and the heirs get more left to them. This is called Medicaid planning and is legal although perhaps ethically questionable.
I agree to get a home in the new city.
Seems to me that an important aspect of "Medicaid Planning" would be the best care over the long term (for her).
The thing that frustrates me is that my Dad refused to divulge his insurance/planning/finances when I would ask about long-term plans or provisions for taking care of mom. I was shocked basically at the fact there was nothing there. They always "assumed" she would pass away first. So his passing away resulted in my sister having to take over the care. Like someone else said, it's brutal - and ruining her health, and she's hit her limits.
Yes - such "assumptions" are often incorrect.

delamer
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Re: Placing mother in nursing home - advice

Post by delamer » Mon Oct 15, 2018 5:31 pm

JDTHOOSIER wrote:
Mon Oct 15, 2018 4:17 pm
dm200 wrote:
Mon Oct 15, 2018 2:40 pm
White Coat Investor wrote:
Mon Oct 15, 2018 1:56 pm
JDTHOOSIER wrote:
Sun Oct 14, 2018 3:29 pm
We have a situation where my sister has been a full-time caretaker for my mother, who is in her 80's, disabled and in a wheelchair, and needs catheterizing, help preparing meals, etc. My sister's son recently had a baby, and my sister is adamant about putting my mother in a nursing home, moving to the same city as her son (also where my wife and I live), so that she can assist the son with the baby.
My mom owns her house and it's paid off. She gets a small social security + dad's (deceased) pension payments each month - not enough to pay for nursing home care. No other assets. I'm at a loss on how to advise my sister on how to proceed. Obviously we need an elder care lawyer. Trying to navigate the legal maze and how to pay for care, and it's confusing at the start of the process.
Any advise would be appreciated, on the best way to move forward.
Sounds like the plan is sell the house, use the proceeds to pay for the nursing home until they're gone, then she goes on Medicaid. The only other thing to consider is to somehow hide the house and payments from the Medicaid folks so Medicaid starts paying sooner and the heirs get more left to them. This is called Medicaid planning and is legal although perhaps ethically questionable.
I agree to get a home in the new city.
Seems to me that an important aspect of "Medicaid Planning" would be the best care over the long term (for her).
The thing that frustrates me is that my Dad refused to divulge his insurance/planning/finances when I would ask about long-term plans or provisions for taking care of mom. I was shocked basically at the fact there was nothing there. They always "assumed" she would pass away first. So his passing away resulted in my sister having to take over the care. Like someone else said, it's brutal - and ruining her health, and she's hit her limits.
The fact that there was nothing there is undoubtedly a big part of the reason that he refused to discuss the subject.

DC3509
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Re: Placing mother in nursing home - advice

Post by DC3509 » Mon Oct 15, 2018 10:01 pm

I am not so sure I would sell the house in this situation. The house is exempt from Medicaid. My guess is -- a $75,000 house in a low cost of living area occupied by a widower in fragile health probably has a lot of deferred maintenance and other issues. It might also be filled with clutter and junk. Getting it to a spot where it can realistically go to market and fetch anything close to the high end of the selling price is likely going to involve a lot of time, energy, and work. Are you or your sister up for that, with everything else going on? If the house is exempt from Medicaid anyway, and she has no other assets, she can probably qualify for Medicaid now. Why not just try to get into the best Medicaid facility you can right now and worry about the house later? If the costs of her Medicaid exceeds the value of the house then Medicaid will put a lien on it and get all of the money from the house -- but that's an issue that can be dealt with down the road. In fact, it would be all the more incentive not to fix up the house and just sell it for whatever as opposed to what you would likely do now.

You should absolutely be talking to a real elder law attorney though and not listening to people on a message board at 11pm on a Monday. This is a very dicey legal question and there are major differences state by state.

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Re: Placing mother in nursing home - advice

Post by willthrill81 » Mon Oct 15, 2018 10:40 pm

DC3509 wrote:
Mon Oct 15, 2018 10:01 pm
I am not so sure I would sell the house in this situation. The house is exempt from Medicaid. My guess is -- a $75,000 house in a low cost of living area occupied by a widower in fragile health probably has a lot of deferred maintenance and other issues. It might also be filled with clutter and junk. Getting it to a spot where it can realistically go to market and fetch anything close to the high end of the selling price is likely going to involve a lot of time, energy, and work. Are you or your sister up for that, with everything else going on? If the house is exempt from Medicaid anyway, and she has no other assets, she can probably qualify for Medicaid now. Why not just try to get into the best Medicaid facility you can right now and worry about the house later? If the costs of her Medicaid exceeds the value of the house then Medicaid will put a lien on it and get all of the money from the house -- but that's an issue that can be dealt with down the road. In fact, it would be all the more incentive not to fix up the house and just sell it for whatever as opposed to what you would likely do now.

You should absolutely be talking to a real elder law attorney though and not listening to people on a message board at 11pm on a Monday. This is a very dicey legal question and there are major differences state by state.
In my state, Washington, the first $572k of home equity is not counted for Medicaid eligibility. Around here, buying a home valued close to that limit could be an effective means of shielding a significant chunk of capital from Medicaid.
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Exit105
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Re: Placing mother in nursing home - advice

Post by Exit105 » Tue Oct 16, 2018 6:21 am

If either your mom or dad were Veterans, you could look into the Veterans Aid & Attendance Benefit for applicants requiring financial help.

quantAndHold
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Re: Placing mother in nursing home - advice

Post by quantAndHold » Tue Oct 16, 2018 7:13 am

So, there clearly aren’t a lot of options, but what does mom want to do that’s within the range of reality? Has anyone asked her?

TN_Boy
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Re: Placing mother in nursing home - advice

Post by TN_Boy » Tue Oct 16, 2018 7:43 am

DC3509 wrote:
Mon Oct 15, 2018 10:01 pm
I am not so sure I would sell the house in this situation. The house is exempt from Medicaid. My guess is -- a $75,000 house in a low cost of living area occupied by a widower in fragile health probably has a lot of deferred maintenance and other issues. It might also be filled with clutter and junk. Getting it to a spot where it can realistically go to market and fetch anything close to the high end of the selling price is likely going to involve a lot of time, energy, and work. Are you or your sister up for that, with everything else going on? If the house is exempt from Medicaid anyway, and she has no other assets, she can probably qualify for Medicaid now. Why not just try to get into the best Medicaid facility you can right now and worry about the house later? If the costs of her Medicaid exceeds the value of the house then Medicaid will put a lien on it and get all of the money from the house -- but that's an issue that can be dealt with down the road. In fact, it would be all the more incentive not to fix up the house and just sell it for whatever as opposed to what you would likely do now.

You should absolutely be talking to a real elder law attorney though and not listening to people on a message board at 11pm on a Monday. This is a very dicey legal question and there are major differences state by state.
That is an interesting point. I am wondering -- realizing it might vary by state -- how deferring the house sale might play out. The house isn't sold. So mom goes into a medicaid situation immediately. But what happens to the house? It's just a cost until it is sold (utilities, insurance -- which go up if the house is not occupied, etc). After it is sold, what happens? Wouldn't the proceeds still wind up with medicaid? (Please note I understand your other point, that you need an eldercare lawyer to ensure correct answers to those questions -- but wondered about the possibilities).

As far as getting rid of a house, I have seen people do auctions where everything in the house as well as the house itself is sold in one shot as-is. Or you can mix and match, an estate sale for the possessions, then place the house on the market as-is. Such strategies may not optimize the proceeds, but can greatly reduce the time required to manage everything. And if the value of the house and possessions is not high, time might be more important than money -- just make managing the house hassle go away.

The related question -- and I have no idea what the answer is -- whether or not that by selling the house and having the money to pay at least part of the initial year's cost in a facility, you have the option of getting mom into a "better" place as opposed to starting with a medicaid payment.

NotWhoYouThink
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Re: Placing mother in nursing home - advice

Post by NotWhoYouThink » Tue Oct 16, 2018 8:00 am

The related question -- and I have no idea what the answer is -- whether or not that by selling the house and having the money to pay at least part of the initial year's cost in a facility, you have the option of getting mom into a "better" place as opposed to starting with a medicaid payment.
You should be able to pay for at least a year with the house sale and your mother's SS and pension. That might open up options considerably. But you have a lot of work in front of you finding a place in your area where you would be comfortable having her live. There is no clear path forward, because every community has different options. From what I've read, the closer to your house the better - like 10 minutes is worlds better than 25 minutes away. In my area the places that will take patients who will be on Medicaid from day 1 are not places I would want to even visit.

InMyDreams
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Re: Placing mother in nursing home - advice

Post by InMyDreams » Tue Oct 16, 2018 9:35 am

Yes, while locating an attorney, start locating a facility. There will probably be a waiting list. And I think most facilities have someone who also works on figuring out how to finance a stay.

There have been other threads about the problems with an unoccupied house. You not only have to provide upkeep, but your insurance company may drop coverage if the home is unoccupied.

I did know someone who, after his uncle went into a care facility, rented the uncle's home and used the income to fund the uncle's stay. When the uncle died, the house was sold. Do you want to be a long distance landlord?

Kudos to you and your sister for looking out for your mom.

TN_Boy
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Re: Placing mother in nursing home - advice

Post by TN_Boy » Tue Oct 16, 2018 11:11 am

InMyDreams wrote:
Tue Oct 16, 2018 9:35 am
Yes, while locating an attorney, start locating a facility. There will probably be a waiting list. And I think most facilities have someone who also works on figuring out how to finance a stay.

There have been other threads about the problems with an unoccupied house. You not only have to provide upkeep, but your insurance company may drop coverage if the home is unoccupied.

I did know someone who, after his uncle went into a care facility, rented the uncle's home and used the income to fund the uncle's stay. When the uncle died, the house was sold. Do you want to be a long distance landlord?

Kudos to you and your sister for looking out for your mom.
Given the stated value of mom's home (75k), I'd think the after-expenses return on the rent would be a trivial percentage of her nursing home costs. I doubt that is a viable option

DC3509
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Re: Placing mother in nursing home - advice

Post by DC3509 » Tue Oct 16, 2018 12:07 pm

TN_Boy wrote:
Tue Oct 16, 2018 7:43 am
DC3509 wrote:
Mon Oct 15, 2018 10:01 pm
I am not so sure I would sell the house in this situation. The house is exempt from Medicaid. My guess is -- a $75,000 house in a low cost of living area occupied by a widower in fragile health probably has a lot of deferred maintenance and other issues. It might also be filled with clutter and junk. Getting it to a spot where it can realistically go to market and fetch anything close to the high end of the selling price is likely going to involve a lot of time, energy, and work. Are you or your sister up for that, with everything else going on? If the house is exempt from Medicaid anyway, and she has no other assets, she can probably qualify for Medicaid now. Why not just try to get into the best Medicaid facility you can right now and worry about the house later? If the costs of her Medicaid exceeds the value of the house then Medicaid will put a lien on it and get all of the money from the house -- but that's an issue that can be dealt with down the road. In fact, it would be all the more incentive not to fix up the house and just sell it for whatever as opposed to what you would likely do now.

You should absolutely be talking to a real elder law attorney though and not listening to people on a message board at 11pm on a Monday. This is a very dicey legal question and there are major differences state by state.
That is an interesting point. I am wondering -- realizing it might vary by state -- how deferring the house sale might play out. The house isn't sold. So mom goes into a medicaid situation immediately. But what happens to the house? It's just a cost until it is sold (utilities, insurance -- which go up if the house is not occupied, etc). After it is sold, what happens? Wouldn't the proceeds still wind up with medicaid? (Please note I understand your other point, that you need an eldercare lawyer to ensure correct answers to those questions -- but wondered about the possibilities).

As far as getting rid of a house, I have seen people do auctions where everything in the house as well as the house itself is sold in one shot as-is. Or you can mix and match, an estate sale for the possessions, then place the house on the market as-is. Such strategies may not optimize the proceeds, but can greatly reduce the time required to manage everything. And if the value of the house and possessions is not high, time might be more important than money -- just make managing the house hassle go away.

The related question -- and I have no idea what the answer is -- whether or not that by selling the house and having the money to pay at least part of the initial year's cost in a facility, you have the option of getting mom into a "better" place as opposed to starting with a medicaid payment.
Yes, the house sits there and you would have to pay taxes and insurance presumably. When you apply for Medicaid, you have to disclose the house. This will not prevent her from getting Medicaid immediately. Medicaid then keeps track of how much money it is spending. If they know there is a leftover house out there, they will put a lien on the house to be first in line for the proceeds.

You may decide that you want to sell the house sooner -- that's fine ofcourse. But that does not prevent her from qualifying for Medicaid NOW. Most of the other comments were basically stating that you needed a two-step process -- first sell house, and use that money for a nursing home; then go on Medicaid. That's simply not necessary.

On whether you have more options if you have money to private pay -- this varies dramatically state by state and area by area. In most lower cost of living areas, nursing homes are almost entirely paid for by Medicaid. Having some private pay source is not necessary and will not incrementally help that much with where she ends up. If you are in a higher cost of living area with wealthier people -- yes, being able to private pay can make a big difference. A good elder law attorney in the specific town where you are looking can help you navigate all of this. They know which nursing homes are good, bad, or intolerable. They know exactly what you need in terms of private pay versus Medicaid, etc. I understand the desire to post here and obviously I am responding because I feel for you in this situation and I am trying to be helpful but whatever myself or others can offer pales in comparison to what a good elder law attorney can tell you.

Best of luck.

TN_Boy
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Re: Placing mother in nursing home - advice

Post by TN_Boy » Tue Oct 16, 2018 12:33 pm

DC3509 wrote:
Tue Oct 16, 2018 12:07 pm
TN_Boy wrote:
Tue Oct 16, 2018 7:43 am
DC3509 wrote:
Mon Oct 15, 2018 10:01 pm
I am not so sure I would sell the house in this situation. The house is exempt from Medicaid. My guess is -- a $75,000 house in a low cost of living area occupied by a widower in fragile health probably has a lot of deferred maintenance and other issues. It might also be filled with clutter and junk. Getting it to a spot where it can realistically go to market and fetch anything close to the high end of the selling price is likely going to involve a lot of time, energy, and work. Are you or your sister up for that, with everything else going on? If the house is exempt from Medicaid anyway, and she has no other assets, she can probably qualify for Medicaid now. Why not just try to get into the best Medicaid facility you can right now and worry about the house later? If the costs of her Medicaid exceeds the value of the house then Medicaid will put a lien on it and get all of the money from the house -- but that's an issue that can be dealt with down the road. In fact, it would be all the more incentive not to fix up the house and just sell it for whatever as opposed to what you would likely do now.

You should absolutely be talking to a real elder law attorney though and not listening to people on a message board at 11pm on a Monday. This is a very dicey legal question and there are major differences state by state.
That is an interesting point. I am wondering -- realizing it might vary by state -- how deferring the house sale might play out. The house isn't sold. So mom goes into a medicaid situation immediately. But what happens to the house? It's just a cost until it is sold (utilities, insurance -- which go up if the house is not occupied, etc). After it is sold, what happens? Wouldn't the proceeds still wind up with medicaid? (Please note I understand your other point, that you need an eldercare lawyer to ensure correct answers to those questions -- but wondered about the possibilities).

As far as getting rid of a house, I have seen people do auctions where everything in the house as well as the house itself is sold in one shot as-is. Or you can mix and match, an estate sale for the possessions, then place the house on the market as-is. Such strategies may not optimize the proceeds, but can greatly reduce the time required to manage everything. And if the value of the house and possessions is not high, time might be more important than money -- just make managing the house hassle go away.

The related question -- and I have no idea what the answer is -- whether or not that by selling the house and having the money to pay at least part of the initial year's cost in a facility, you have the option of getting mom into a "better" place as opposed to starting with a medicaid payment.
Yes, the house sits there and you would have to pay taxes and insurance presumably. When you apply for Medicaid, you have to disclose the house. This will not prevent her from getting Medicaid immediately. Medicaid then keeps track of how much money it is spending. If they know there is a leftover house out there, they will put a lien on the house to be first in line for the proceeds.

You may decide that you want to sell the house sooner -- that's fine ofcourse. But that does not prevent her from qualifying for Medicaid NOW. Most of the other comments were basically stating that you needed a two-step process -- first sell house, and use that money for a nursing home; then go on Medicaid. That's simply not necessary.

On whether you have more options if you have money to private pay -- this varies dramatically state by state and area by area. In most lower cost of living areas, nursing homes are almost entirely paid for by Medicaid. Having some private pay source is not necessary and will not incrementally help that much with where she ends up. If you are in a higher cost of living area with wealthier people -- yes, being able to private pay can make a big difference. A good elder law attorney in the specific town where you are looking can help you navigate all of this. They know which nursing homes are good, bad, or intolerable. They know exactly what you need in terms of private pay versus Medicaid, etc. I understand the desire to post here and obviously I am responding because I feel for you in this situation and I am trying to be helpful but whatever myself or others can offer pales in comparison to what a good elder law attorney can tell you.

Best of luck.
To clear, TN_Boy is not the OP. To clarify slightly your answer, it doesn't sound like there is any advantage to delaying the house sale if they do that. I understand your point that it may not be necessary.

LilyFleur
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Re: Placing mother in nursing home - advice

Post by LilyFleur » Tue Oct 16, 2018 12:53 pm

From my recent personal experience, the contents of a senior citizen's house will not be worth very much money, and it is a huge amount of work to clean out a house that someone has lived in for decades and decades.

Also from my recent personal experience, elder care attorneys can drain assets quickly.

A good, private-pay case manager (i.e., a social worker who specializes in senior care) could probably give you a lot of valuable advice in terms of what facilities are decent and how to transition your mother at a much lower hourly rate than an attorney. If you can maneuver the system, you might even be able to get the help of a social worker paid for by Medicaid.

I think it would be very appropriate for your sister to receive something from the proceeds of the sale of your mother's house (whether payment for her services, or a gift from the estate). Her hands-on caregiving has saved your family a great deal of money. I would research this very carefully, though.

Does your mother have a will? Minimally, you will want to avoid probate, whether you are left with bills or a small inheritance.

TN_Boy
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Re: Placing mother in nursing home - advice

Post by TN_Boy » Tue Oct 16, 2018 1:06 pm

LilyFleur wrote:
Tue Oct 16, 2018 12:53 pm
From my recent personal experience, the contents of a senior citizen's house will not be worth very much money, and it is a huge amount of work to clean out a house that someone has lived in for decades and decades.

Stuff deleted
Which is why I suggest looking into an estate sale. At least in my experience, they will come in, sell the property and get rid of the stuff that doesn't sell for you. As you say, the OP's family probably won't get a lot of out of the sale, but if they do can an estate sale, it can save huge amounts of time. The family picks what they want, takes it away, and then the rest is handled. It is possible that for a small home with modest possessions, it might be difficult to get a company to run an estate sale (not enough profit), but I'd investigate it.

Another note on handling house contents, if there is a lot of stuff you want shredded (medical paperwork, bank accounts, etc), you can usually find businesses that will securely shred by the pound, rather than you spending hours feeding a personal shredder.

amazonchic
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Re: Placing mother in nursing home - advice

Post by amazonchic » Tue Oct 16, 2018 2:40 pm

Contact an Eldercare attorney. Going on Medicaid is not as simple and straightforward as just depleting assets. Medicaid looks back at the sale of any house and other assets for a period of years prior to approving one for financial assistance. While they take their time reviewing your mother's situation, she doesn't get a free ride. There are misconceptions about just going on Medicaid that an Eldercare attorney can help clear up.

DC3509
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Re: Placing mother in nursing home - advice

Post by DC3509 » Tue Oct 16, 2018 2:52 pm

amazonchic wrote:
Tue Oct 16, 2018 2:40 pm
Contact an Eldercare attorney. Going on Medicaid is not as simple and straightforward as just depleting assets. Medicaid looks back at the sale of any house and other assets for a period of years prior to approving one for financial assistance. While they take their time reviewing your mother's situation, she doesn't get a free ride. There are misconceptions about just going on Medicaid that an Eldercare attorney can help clear up.
I agree that the OP should contact an elder law attorney but the house is irrelevant to qualifying for Medicaid right now -- primary residences are almost always exempt from the countable assets.

carolinaman
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Re: Placing mother in nursing home - advice

Post by carolinaman » Tue Oct 16, 2018 3:34 pm

delamer wrote:
Sun Oct 14, 2018 3:42 pm
The county government where your mother lives should have an Office for the Aging or something similarly titled.

That should be a good source of basic information on services and resources available to figure out options for your mother.

Best of luck.
+1. This agency for seniors should be your first contact to find out what the family's options are. This is something that you should help your sister with if she is willing to do so.

Our mother got to the point she needed to go to a nursing home a few years ago. She only had enough money to pay for a few months of care as private pay. Once that was gone, Medicaid kicked in. She owned her home but no one else was living there so Medicaid required us to sell the home to help pay the nursing home cost.

The senior agency should be able to explain qualifications for Medicaid and your best course of action. The process for qualifying for Medicaid is well defined but varies from state to state. An elder law attorney may be an unnecessary expense but you should have a better feel once you have researched this.

This is a difficult process and decision and it really helps to have everyone on the same page. Best wishes to you and your family in sorting this out.

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