Long Term Care for MIL...

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zeldak
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Long Term Care for MIL...

Post by zeldak »

[Topic is now in Personal Finance (Not Investing) - mod mkc]

DW and I live in PA.
MIL is 80 years old and lives 90 miles (1.5 hours) away in MD.
MIL currently lives at her home and has a visiting aid approx. 3-4 times per week.

MIL needs assistance with most activities including getting in/out of bed, ambulating with walker, toileting, showering, dressing, meal prep.
MIL has memory/cognitive issues.

After her most recent ER visit, she was evaluated in her home by a nurse, occupational therapy, and physical therapy who all agreed that she is unsafe in her home.

MIL has $100,000 in savings.

DW has spoken with an elder care atty in MD who provided some information.

Yesterday for the first time DW and I visited a facility in MD that has a bed in a shared room in a small house. I was heartbroken. It was awful. The residents were 4 demented patients with 1 aid, not wheelchair friendly.

DW and I both work, have kids who need us, and are unable to spend multiple days needed to travel to MD and tour multiple facilities. MIL has no other family to rely on.

Questions....

1. Since MIL has been a Maryland resident for 40 years, must she stay in a Maryland facility? I'm thinking of future Medicaid assistance at the point when her $100,000 is depleted. DW and I could more easily visit and evaluate facilities closer to us in PA or DE.

2. Anything else we should be considering?

Thank you for helping!!
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Wiggums
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Re: Long Term Care for MIL...

Post by Wiggums »

A shared environment is cheaper than private care in her home. However, a shared house with ONE aid does not sound like a good fit. Your MIL needs access to medical staff too.

Your MIL does not need to stay in Maryland.

Being in close proximity to your loved one is important. Our mom rejected her primary care giver after showing signs of dementia and hallucinations. We moved her close to our home do we can visit her and bring her whatever she needs. It is hard to see people in various states of awareness on the dementia floor.

I’d look for something close to your home.

Good luck to you.
Last edited by Wiggums on Sun Jun 02, 2024 9:33 am, edited 1 time in total.
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delamer
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Re: Long Term Care for MIL...

Post by delamer »

It is a difficult situation. And it is good that you’ve been in touch with an attorney.

Remember that your MIL (presumably) has Social Security and/or pension income plus equity in her home. The home equity will be available if she sells the house or possibly through a reverse mortgage if she stays.

Try looking for a nicer facility where she can start as a private pay resident that will guarantee that she can stay (on Medicaid) if her savings and home equity run out. Usually she’ll need to be able to self-pay for 2 or 3 years to qualify.

Good luck to you all.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
InMyDreams
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Re: Long Term Care for MIL...

Post by InMyDreams »

Does the $100k include proceeds from the sale of her house?

IMO, 90 miles is too far away to be involved in managing her care. Is there another family member in her area?

People move to be near children all the time. Have you considered consulting an elder law attorney in your area?
Topic Author
zeldak
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Re: Long Term Care for MIL...

Post by zeldak »

MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
cs412a
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Re: Long Term Care for MIL...

Post by cs412a »

delamer wrote: Sun Jun 02, 2024 9:20 am It is a difficult situation. And it is good that you’ve been in touch with an attorney.

Remember that your MIL (presumably) has Social Security and/or pension income plus equity in her home. The home equity will be available if she sells the house or possibly through a reverse mortgage if she stays.

Try looking for a nicer facility where she can start as a private pay resident that will guarantee that she can stay (on Medicaid) if her savings and home equity run out. Usually she’ll need to be able to self-pay for 2 or 3 years to qualify.

Good luck to you all.
^^This.

It looks like it would be difficult for her to get access to any home equity, unless her sister could afford to buy her out. Ordinarily, if one person doesn't want to sell a jointly owned property, the nuclear option would be a partition suit - or negotiations with the possibility of a partition suit. However, in this case, that would be difficult, because if her sister could not afford to buy your MIL out, where is the sister going to live? So that doesn't look like an option.

Memory care in and of itself, and assisted living facilities will not qualify for Medicaid, so she will need to find a nursing home. The best bet is to look for a not-for-profit, nursing home with a religious affiliation close to you live, where your MIL could start as a private pay resident and transition to Medicaid once her savings run out. That might be difficult to find at such short notice.

I wish you all the best.
delamer
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Re: Long Term Care for MIL...

Post by delamer »

zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
That’s unfortunate about the home equity not being accessible.

If you could find a place for her that’s $6,000 month, then she could self-pay for about 2 years with $3,800/month needed out of savings. That might be enough to get her to having Medicaid accepted at some facilities. Obviously, I don’t know if $6,000 is realistic in her or your area.

Again, I hope it all works out for your family.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
delamer
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Re: Long Term Care for MIL...

Post by delamer »

cs412a wrote: Sun Jun 02, 2024 9:52 am
delamer wrote: Sun Jun 02, 2024 9:20 am It is a difficult situation. And it is good that you’ve been in touch with an attorney.

Remember that your MIL (presumably) has Social Security and/or pension income plus equity in her home. The home equity will be available if she sells the house or possibly through a reverse mortgage if she stays.

Try looking for a nicer facility where she can start as a private pay resident that will guarantee that she can stay (on Medicaid) if her savings and home equity run out. Usually she’ll need to be able to self-pay for 2 or 3 years to qualify.

Good luck to you all.
^^This.

It looks like it would be difficult for her to get access to any home equity, unless her sister could afford to buy her out. Ordinarily, if one person doesn't want to sell a jointly owned property, the nuclear option would be a partition suit - or negotiations with the possibility of a partition suit. However, in this case, that would be difficult, because if her sister could not afford to buy your MIL out, where is the sister going to live? So that doesn't look like an option.

Memory care in and of itself, and assisted living facilities will not qualify for Medicaid, so she will need to find a nursing home. The best bet is to look for a not-for-profit, nursing home with a religious affiliation close to you live, where your MIL could start as a private pay resident and transition to Medicaid once her savings run out. That might be difficult to find at such short notice.

I wish you all the best.
It isn’t universally true that Medicaid doesn’t cover memory care or assisted living. It varies by state.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
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zeldak
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Re: Long Term Care for MIL...

Post by zeldak »

delamer wrote: Sun Jun 02, 2024 12:10 pm
zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
That’s unfortunate about the home equity not being accessible.

If you could find a place for her that’s $6,000 month, then she could self-pay for about 2 years with $3,800/month needed out of savings. That might be enough to get her to having Medicaid accepted at some facilities. Obviously, I don’t know if $6,000 is realistic in her or your area.

Again, I hope it all works out for your family.
Thank you so much for this helpful information. We really appreciate it.
RetiredAL
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Re: Long Term Care for MIL...

Post by RetiredAL »

zeldak wrote: Sun Jun 02, 2024 12:27 pm
delamer wrote: Sun Jun 02, 2024 12:10 pm
zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
That’s unfortunate about the home equity not being accessible.

If you could find a place for her that’s $6,000 month, then she could self-pay for about 2 years with $3,800/month needed out of savings. That might be enough to get her to having Medicaid accepted at some facilities. Obviously, I don’t know if $6,000 is realistic in her or your area.

Again, I hope it all works out for your family.
Thank you so much for this helpful information. We really appreciate it.
In 2019, I had to place my Dad in Assisted Living for medical reasons. Cognitively, he was fine, just feeble. He passed in 2022 at 97. He lived 90 miles away but want to stay local to him so that his friends could visit. I was already retired so weekly trips were mainly inconvenient, but I suspect distance/time would be a disaster to your family. I was fortunate in that money was not an issue.

As said by others, look towards a non-profit Assisted near you. In 2019, Dad's base (single room @ non-profit) was $4500/month and when he passed in fall 2022 he was at max care level at $7200/month. This was in a MCOL area of Calif.

The cruel fact is that when a person having significant medical issues goes to Assisted, the average stay is something around 2 years. Where this drags on is for a healthy person who mainly needs memory care.
InMyDreams
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Re: Long Term Care for MIL...

Post by InMyDreams »

It isn’t universally true that Medicaid doesn’t cover memory care or assisted living. It varies by state.
This, which would also make looking closely at which state would provide the best assistance important.
IME, friends visit less and less over time - they too have lives, and they too have aging abilities, and they too reach their, hmm, final destination. OTH, will a group home or an ALF or memory care really assist with doctor visits, etc?
bogart
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Re: Long Term Care for MIL...

Post by bogart »

I'm so sorry you and your MIL are having to deal with this.

I don't have tons to add to what others have said, but it occurs to me it might be worth checking with an attorney or elder-care resource (e.g. state office) with information about Medicaid and other relevant details in your state, or any state you/your MIL are considering as an alternative to MD -- the details of what's allowed definitely vary state-by-state so this could be relevant to choosing a location if as your post suggests you have a choice between DE and PA.

My dad had dementia and relied on care in a skilled nursing facility for maybe the last 4 years of his life, almost all of that covered by Medicaid (he had also broken a hip and not regained the ability to stand or walk following that break and the surgery, so the care he needed was extensive though, despite his dementia, he was coherent and understood in a short-term sense what was going on, as well as remembering who people were. He wasn't mentally gone, just not fully capable, and definitely became less capable as time went by).

At least in our state, Medicaid patients can own/have basically nothing (he was allowed to have no more than $2K in savings when his care started and to get $20/month out of his SS to pay for "personal expenses," including things like clothes and haircuts. Your state(s) may be different, but don't expect your MIL to have anything, including a surplus to pay for basic non-medical needs, if she is relying on Medicaid for care.

Also, based on what I observed about my dad, change is really, really hard for people declining into dementia. That sounds obvious once someone says it, but the point is, I'd recommend trying to find your MIL a place that can serve her needs throughout the rest of her life (not something that's "good for now"). My dad had to move nursing homes once (the one he was in closed down), and it was really, really hard for him.

And try to find somewhere close to you, because the more present/frequent/engaged family can be, the better the care will be -- the staff know who gets visited and who doesn't (of course), and they are overworked, underpaid, and underappreciated. Be kind to the staff (and appreciative of the really hard work they do), but also be sure to speak up (not adversarially, unless you see something extreme) to be sure your MIL is getting the care she needs.
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arcticpineapplecorp.
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Re: Long Term Care for MIL...

Post by arcticpineapplecorp. »

zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
I'm in PA and medicaid nursing facilities do cover memory care to my knowledge. And yes, you can move her from MD to PA if it would be better for her. There may be a cost for that transportation obviously.

May I ask questions about the house, namely was it purchased by the two of them together or was sister added to deed at some point, and if the latter was it within the past 5 years or longer than that?

trying to establish if there might be an issue with the house from a medicaid perspective (if half the house equity was gifted to sister within lookback period. If so, and sister didn't give your MIL fair consideration, i.e., payment for half of equity gifted, then that would cause a period of ineligibility for medicaid, if done within 5 years from application for medicaid). Now with $100,000 and income, you might not need to apply for medicaid for another year, but you can see timeframes (especially with regards to gifting) can matter.

other things to consider? well, if you're going to apply for medicaid, make sure to start gathering documents now and over the next year as you anticipate applying for medicaid. You'll need lots of pieces of info in no order and not comprehensive: proof of death of spouse or proof of divorce, i.d. or birth certificate, tax returns for last 5 years if filed, statements for last 5 years for any financial accounts along with proof of closure of any resources in the past 5 years and where proceeds were deposited, proof of any gifting over $500 in any month in past 5 years, deed to home, life insurance face and current cash value if any, or proof term/group and no cash value, prepaid burial and proof if irrevocable.
Last edited by arcticpineapplecorp. on Sun Jun 02, 2024 8:49 pm, edited 1 time in total.
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Topic Author
zeldak
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Re: Long Term Care for MIL...

Post by zeldak »

The house was purchased by both sisters together more than 10 years ago.

We recommended that they speak to an attorney prior to home purchase so as to avoid this situation, but they would not listen to us.

Once again, we are so thankful for all of the above recommendations and comments. We learned an awful lot this weekend and feel like we are gaining an understanding of what needs to be done regarding MIL.
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TexasPE
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Re: Long Term Care for MIL...

Post by TexasPE »

bogart wrote: Sun Jun 02, 2024 4:27 pm checking with an attorney or elder-care resource (e.g. state office) with information about Medicaid and other relevant details in your state, or any state you/your MIL are considering as an alternative to MD -- the details of what's allowed definitely vary state-by-state so this could be relevant to choosing a location if as your post suggests you have a choice between DE and PA.
+1 on engaging a competent Elder Care attorney in the state you plan to relocate your MIL to (https://www.naela.org/). A family attorney can make mistakes - you need a specialist. In my mother's case (TX), an Elder Care attorney helped us in several ways - a spend down plan to qualify for Medicaid, prepaying for her funeral out of her funds, retaining her auto and home, setting up a 'gifting' program that allowed her to set aside money for personal needs (clothing, hair care, toiletries, personal items, etc) within the Medicaid universe.

A friend used their family attorney to get her aunt on Medicaid, and he missed all these allowable actions.

Again, Medicaid is a state-administered program so you will need an elder care attorney qualified in the proper state.
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techbud
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Re: Long Term Care for MIL...

Post by techbud »

Is MIL a veteran or widow of a veteran who served in wartime? She might qualify for a VA Assistance pension.
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arcticpineapplecorp.
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Re: Long Term Care for MIL...

Post by arcticpineapplecorp. »

techbud wrote: Sun Jun 02, 2024 8:46 pm Is MIL a veteran or widow of a veteran who served in wartime? She might qualify for a VA Assistance pension.
yes, but if you're talking about aid and attendance, once in a facility and on medicaid that pension will be reduced to $90. Don't forget to report that info (when on medicaid and in skilled nursing facility) to VA otherwise an overpayment can result.
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celia
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Re: Long Term Care for MIL...

Post by celia »

zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.
Does this aunt have children who would help her if she ends up in something like MIL's situation? Would you be responsible for her care too? (...possibly not legally, but because that's what relatives might do)

I would think ahead and consider that they may both need care at the same time or that the aunt might need similar care after MIL is gone.

I'm sorry that this doesn't address the current situation but should be considered. (My family had a case like this and we continued to look after our father's last wife (he had been widowed two times previously) until she died a year after him, because that's what he would have wanted.
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Re: Long Term Care for MIL...

Post by techbud »

arcticpineapplecorp. wrote: Sun Jun 02, 2024 8:48 pm
techbud wrote: Sun Jun 02, 2024 8:46 pm Is MIL a veteran or widow of a veteran who served in wartime? She might qualify for a VA Assistance pension.
yes, but if you're talking about aid and attendance, once in a facility and on medicaid that pension will be reduced to $90. Don't forget to report that info (when on medicaid and in skilled nursing facility) to VA otherwise an overpayment can result.
No, I was referring to the VA survivors pension. https://www.va.gov/pension/survivors-pension/
I am far, far from an expert on this, but as I understand it, this pension and Medicaid can both be received without a reduction in either.
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Re: Long Term Care for MIL...

Post by Gearheaddd »

You visited one facility and are basing your decision on that? You need to do further research and get some recommendations. I have multiple friends who took the shared house route with their elderly parents and had very good experiences. It seems the common thread for the good ones are owners that have a passion for the mission of helping the elderly and not just turning a profit. Admittedly harder to find these type places but they do exist. Good luck to you and your family.
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AllMostThere
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Re: Long Term Care for MIL...

Post by AllMostThere »

The private house assisted living setup for my DM was a game changer for our family. Well ran and had 3rd party contract regular visits of a doctor and nurse which was paid for by Medicare. The house was not cheap, but that was mostly a cause of my DM being very demanding of care and attention. While the house was not cheap, it was worth every penny and only 15 minutes from our house thus allowing visits 3-5 times a week. She required dialysis ~ 3 times per week which required 3rd party wheelchair transport that was ~ $75 one-way. Ultimately, what I'm trying to say is that local private house assisted living is not cheap, but IMHO your DM will receive more attention and you will be able to be more involved in her care decisions, if local. This is NOT something that can be managed long distance. Continue looking in your area and most definitely investigate reputable local elder attorney.
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Artsdoctor
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Re: Long Term Care for MIL...

Post by Artsdoctor »

I've been through variations on this theme with friends' relatives and have navigated Assisted Living (AL), Skilled Nursing (SNF), and Memory Care (MC) with my own family.

1. The assessment which you outlined now suggests that she's already at a Skilled Nursing Facility level because she needs help with all or nearly all of her ADLs, and there's also cognitive impairment. Even if she managed to make it in AL, she'd be transferred to SNF in a very short period of time. You should strongly consider finding a place at the SNF level (you don't want to move her to AL at one place only to transfer to another after 6-9 months). Some SNF facilities do better with MC than others. You should be realistic about how advanced any cognitive decline is (is it mild, moderate, severe? how long as this been going on? has she been properly evaluated for this?).

2. She has limited resources and she'll ultimately need to go on Medicaid. The details vary by state. If you can, an elder care attorney can help you plan although this should have been done a very long time ago. The SNF you look for will need to be Medicaid-eligible; her assets will be exhausted relatively quickly so this is why the elder care attorney can be helpful, making sure that mistakes are not made which will complicate her Medicaid application.

3. What's going on with all of her legal documents? Is there a power of attorney (medical, financial)? Given her level of care and cognitive decline at this point, if these documents weren't taken of, you're going to have trouble just drafting up the powers of attorney now.

4. Her house is an asset and she should be able to tap it. How much is the house worth? Can she and her sister get a reverse mortgage? Again, an elder care attorney can help with this since any income from the house will most likely affect the Medicaid numbers.

5. Don't forget to watch your emotions here. It sounds as if your MIL made very bad decisions despite being advised to the contrary and her sister was relatively negligent with basic assessments. It would very easy to get angry at both of them but try to let that go. This is going to be a very hard road and you'll need to keep a sense of calm as best as you can.
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cheese_breath
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Re: Long Term Care for MIL...

Post by cheese_breath »

RetiredAL wrote: Sun Jun 02, 2024 1:13 pm
zeldak wrote: Sun Jun 02, 2024 12:27 pm
delamer wrote: Sun Jun 02, 2024 12:10 pm
zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.

MIL has $100,000 in savings, and her SS is $2200/mo.
No other source of income.
That’s unfortunate about the home equity not being accessible.

If you could find a place for her that’s $6,000 month, then she could self-pay for about 2 years with $3,800/month needed out of savings. That might be enough to get her to having Medicaid accepted at some facilities. Obviously, I don’t know if $6,000 is realistic in her or your area.

Again, I hope it all works out for your family.
Thank you so much for this helpful information. We really appreciate it.
In 2019, I had to place my Dad in Assisted Living for medical reasons. Cognitively, he was fine, just feeble. He passed in 2022 at 97. He lived 90 miles away but want to stay local to him so that his friends could visit. I was already retired so weekly trips were mainly inconvenient, but I suspect distance/time would be a disaster to your family. I was fortunate in that money was not an issue.

As said by others, look towards a non-profit Assisted near you. In 2019, Dad's base (single room @ non-profit) was $4500/month and when he passed in fall 2022 he was at max care level at $7200/month. This was in a MCOL area of Calif.

The cruel fact is that when a person having significant medical issues goes to Assisted, the average stay is something around 2 years. Where this drags on is for a healthy person who mainly needs memory care.
AFAIK assisting living doesn't accept people in the condition OP describes. As soon as they see 'help with toileting' that would probably rule her out.
The surest way to know the future is when it becomes the past.
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cheese_breath
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Re: Long Term Care for MIL...

Post by cheese_breath »

TexasPE wrote: Sun Jun 02, 2024 8:18 pm
+1 on engaging a competent Elder Care attorney in the state you plan to relocate your MIL to (https://www.naela.org/). A family attorney can make mistakes - you need a specialist. In my mother's case (TX), an Elder Care attorney helped us in several ways - a spend down plan to qualify for Medicaid, prepaying for her funeral out of her funds, retaining her auto and home, setting up a 'gifting' program that allowed her to set aside money for personal needs (clothing, hair care, toiletries, personal items, etc) within the Medicaid universe.
In MI in 2017 (don't know if it's still that way) the spouse was allowed to retain the home and one vehicle.
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w5000
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Re: Long Term Care for MIL...

Post by w5000 »

I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
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zeldak
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Re: Long Term Care for MIL...

Post by zeldak »

Gearheaddd wrote: Tue Jun 04, 2024 8:59 am You visited one facility and are basing your decision on that? You need to do further research and get some recommendations. I have multiple friends who took the shared house route with their elderly parents and had very good experiences. It seems the common thread for the good ones are owners that have a passion for the mission of helping the elderly and not just turning a profit. Admittedly harder to find these type places but they do exist. Good luck to you and your family.
We are newbees at this. Never done it before. This was our first visit to a facility. It was awful. In every way.
We have since seen two other places and are trying to learn as fast as possible,
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zeldak
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Re: Long Term Care for MIL...

Post by zeldak »

AllMostThere wrote: Tue Jun 04, 2024 4:48 pm The private house assisted living setup for my DM was a game changer for our family. Well ran and had 3rd party contract regular visits of a doctor and nurse which was paid for by Medicare. The house was not cheap, but that was mostly a cause of my DM being very demanding of care and attention. While the house was not cheap, it was worth every penny and only 15 minutes from our house thus allowing visits 3-5 times a week. She required dialysis ~ 3 times per week which required 3rd party wheelchair transport that was ~ $75 one-way. Ultimately, what I'm trying to say is that local private house assisted living is not cheap, but IMHO your DM will receive more attention and you will be able to be more involved in her care decisions, if local. This is NOT something that can be managed long distance. Continue looking in your area and most definitely investigate reputable local elder attorney.
MIL is in MD
We live in PA
Near the DE line

We are trying to learn as much as possible. We need to figure out WHICH STATE to move her to, considering the money will run out soon.
MIL has $100K and $2200/mo SS
We are doing our best but the process of learning is time consuming, frustrating and potentially expensive.

All advice is most welcome!!
Most local elder attorneys want to be paid first before they will answer any simple orienting questions.
TheGiantess
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Re: Long Term Care for MIL...

Post by TheGiantess »

Another person you might contact is a geriatric care manager or geriatric social worker. They charge a fee but they know the ropes. My aunt used one to help find a placement and her kids who lived out of town found it helpful.
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arcticpineapplecorp.
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Re: Long Term Care for MIL...

Post by arcticpineapplecorp. »

techbud wrote: Sun Jun 02, 2024 9:38 pm
arcticpineapplecorp. wrote: Sun Jun 02, 2024 8:48 pm
techbud wrote: Sun Jun 02, 2024 8:46 pm Is MIL a veteran or widow of a veteran who served in wartime? She might qualify for a VA Assistance pension.
yes, but if you're talking about aid and attendance, once in a facility and on medicaid that pension will be reduced to $90. Don't forget to report that info (when on medicaid and in skilled nursing facility) to VA otherwise an overpayment can result.
No, I was referring to the VA survivors pension. https://www.va.gov/pension/survivors-pension/
I am far, far from an expert on this, but as I understand it, this pension and Medicaid can both be received without a reduction in either.
think it depends. I see a VA widowers benefit in 2024 of $1478 with Aid and attendance of $553. The aid and attendance portion is excluded from the $1478, so countable income (for cost of care purposes) would be $1478-$553=$925 countable income (along with SS and any other income like pension, RMD, etc). But VA would need to be notified the client is on skilled care and on medicaid and the pension should reduce to just the $90/month, which would be excluded.

say "it depends" because a person could get a widower's benefit WITHOUT Aid and attendance. In that case, there should be no reduction in benefits as you say.
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TTBG
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Re: Long Term Care for MIL...

Post by TTBG »

I don't see that it's been mentioned already, but check your local county to see if it provides any information/support for senior citizens. It might be called "council on aging" or "support for seniors" or something like that. Also, when you're visiting facilities, you can ask them about the transition from self-pay to medicaid and how it would be done (will they help? when and how do you start it? etc)

I guess it's very state/location dependent, but in my experience, we paid a reasonable amount to consult with a lawyer and get updated POAs. For the Medicaid application, we didn't use the lawyer; instead we got a lot of (free!) help from the county's office on aging, and also from the social worker at the facility that my Mom was in. But her financial situation was very simple, just social security and a small retirement account that she used to self-pay until it ran out. Your situation might be more complicated due to the joint ownership with her sister so that might be something you want to bring up early in any conversation.

It's a stressful thing to go through, I hope you find a workable solution soon!
RationalWalk
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Re: Long Term Care for MIL...

Post by RationalWalk »

I know a little bit about Medicaid eligibility, having dealt with this for my mother in KC area, which splits between Kansas and Missouri. There are many LTC facilities in KC metro, some on the Missouri side and some on the Kansas side. My mother was a Missouri resident. Since this was the case, we learned that she would not qualify immediately for Medicaid in a KC facility that was located on the Kansas side.

Medicaid is a state-based program and recipients must be residents of the state where they are seeking Medicaid assistance. If you want to move your MIL to a different state than her current residency, you should become familiar with the requirements for her to become a resident of that new state and become eligible for Medicaid. States don't like it when people move there and want to start collecting Medicaid right away. So there is usually a time period they are required to reside in that state in order to qualify for residency-based Medicaid assistance.

I believe that in my mother's case, she would have needed to reside in a Kansas facility for a year before becoming eligible for Medicaid. We figured that wasn't going to work for us, so we limited our search for a LTC facility to ones located on the Missouri side. Not optimal, because most of the better ones were actually on the Kansas side of KC.
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maroon
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Re: Long Term Care for MIL...

Post by maroon »

Hi OP, I have recent experience with this, so a few notes:

1) Before moving your MIL to a new state, check out the state's requirements for Medicaid eligiblity. In my state, a person needs state residency to qualify for Medicaid. And it takes living in the state for a year to get residency.

2) I got an extended relative on Medicaid without using a lawyer, but it was a long, involved, time consuming process. I contacted multiple non-profit agencies and also the local area center for aging, and not one organization was able to help; either they didn't have the resources or they had a multi-month waiting list for services. I suggest getting a lawyer to facilitate if funds are available.

3) Medicaid does cover assisted living facilities (in my state, anyway). When my extended relative qualified for Medicaid, I was given a list of approved assisted living facilities. I called upward of 30 facilities and visited several before choosing the facility my relative now lives in. Note: Medicaid only pays for shared rooms.

4) Once my relative got on Medicaid, I learned that NONE of my relative's previous doctors accept Medicaid patients. I had to find all new doctors/specialists.

5) You mentioned you're 90 minutes away, be prepared for many trips or find someone in your MIL's immediate area who can monitor her care. In my experience, the assisted living facility provides required services/support, but that's it.
johnz1001
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Re: Long Term Care for MIL...

Post by johnz1001 »

This may have been already addressed, or you already know it. The quote relates to married couples but joint ownership is joint ownership, and it may hold in the case of the sister being the joint owner of the MIL's home.

"Medicaid will take a jointly owned home as part of its calculation of an individual’s assets, but it will not take a jointly owned home if the other owner occupies it and is not on Medicaid. Medicaid rules provide that for jointly owned real estate, such as a home or farm land, the entire value of the property can, in certain circumstances, be disregarded as a non-countable resource, meaning it will not count against the applicant. All property assets of married couples are considered to be joint assets by Medicaid even if only one name is on the deed. If the Medicaid applicant/recipient is married and will move out of the home, but their spouse will remain living in the home, the home will be exempt and not counted against the asset limit for Medicaid eligibility."

https://elrodfirm.com/ask-the-pros/medi ... 0applicant.
RationalWalk
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Re: Long Term Care for MIL...

Post by RationalWalk »

Regarding the cost of consulting an attorney for assistance in planning MIL's care and handling Medicaid, etc. In particular, an attorney can do the Medicaid application process and work with the facility in doing that, which will save you a lot of work. You may not be aware that the funds can come from your MIL's accounts, assuming you have POA or that she can make payment. For a long time, I paid those costs for my mother until l wised up. Don't know if it has already been advised, but if you don't have POA you should get it ASAP to deal with all the stuff that will be coming as you care for her.
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Re: Long Term Care for MIL...

Post by 123 »

Artsdoctor wrote: Tue Jun 04, 2024 6:56 pm ...1. The assessment which you outlined now suggests that she's already at a Skilled Nursing Facility level because she needs help with all or nearly all of her ADLs, and there's also cognitive impairment. Even if she managed to make it in AL, she'd be transferred to SNF in a very short period of time. You should strongly consider finding a place at the SNF level (you don't want to move her to AL at one place only to transfer to another after 6-9 months)...
+1 Different states have different rules about the kinds of residents an assisted living facility can have, in some states the mobility of residents is a factor in the facility licensing. It can be a safety concern, in the event of a fire can the residents evacuate themselves? In a SNF there is often a requirement that there be at least one RN on duty at all times and other staff 24/7 are usually required. In an assisted living facility there may be only one staff member on duty overnight.

Don't succumb to an inappropriate assisted living placement because the facility says they can "stretch" to accommodate her. The AL administrator may only be stretching in their own self-interest to meet an occupancy or financial goal. Assisted living facilities can be indirect about later transferring her to an SNF. They may call 911 about an issue and then, while she is at the hospital, decide that they can no longer accommodate her and then you will be under significant time pressure to locate a SNF for her.
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Re: Long Term Care for MIL...

Post by TexasPE »

RationalWalk wrote: Wed Jun 05, 2024 10:57 am ... the funds can come from your MIL's accounts, assuming you have POA or that she can make payment. For a long time, I paid those costs for my mother until l wised up. Don't know if it has already been advised, but if you don't have POA you should get it ASAP to deal with all the stuff that will be coming as you care for her.
+1 you will be spending down your MIL's assets in any case, so use her funds. Also consider a prepaid funeral (funded by MIL) if the Eldercare Attorney agrees.
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vested1
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Re: Long Term Care for MIL...

Post by vested1 »

w5000 wrote: Tue Jun 04, 2024 7:33 pm I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
I did my MIL's Medicaid application and it wasn't that difficult. I certainly wouldn't pay a lawyer 10 to 20k to do it.

To the OP. Finding a caring attorney who specializes in elder issues is vital, and stress to the attorney that they represent your Mil, and not the family. Visit every facility in the area to see how they compare for quality, staffing, and cleanliness. My Mil had about 145k in savings when she entered her skilled nursing facility, which charged $8,500 a month for a small shared room (2010). She ran out of her own money after less than 1.5 years and transitioned to Medicaid. She lived for another 4 years on Medicaid until she died at age 94.

If you are the one doing the application be aware that social service agents greatly appreciate honesty, and will reward you for it. Disclose everything and you'll be fine. Your MIL will be able to keep a small amount of income, about $25 a month if I remember correctly, with a bank balance of less than $2,000 (California). The rules may vary on the amounts allowed depending on the state she is in.

If I had any further advice it would be to document every source of income and all agencies or businesses that your MIL is connected to for future reference when she passes. Go through all of her records and ask her about any discrepancies you find, but do it with compassion. Make sure to file her taxes every year, even if she doesn't owe anything.

Good luck.
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cheese_breath
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Re: Long Term Care for MIL...

Post by cheese_breath »

RationalWalk wrote: Wed Jun 05, 2024 10:57 am Regarding the cost of consulting an attorney for assistance in planning MIL's care and handling Medicaid, etc. In particular, an attorney can do the Medicaid application process and work with the facility in doing that, which will save you a lot of work. You may not be aware that the funds can come from your MIL's accounts, assuming you have POA or that she can make payment. For a long time, I paid those costs for my mother until l wised up. Don't know if it has already been advised, but if you don't have POA you should get it ASAP to deal with all the stuff that will be coming as you care for her.
Also get Medical POA and HIPAA authorization while she is still competent to grant them.
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RationalWalk
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Re: Long Term Care for MIL...

Post by RationalWalk »

vested1 wrote: Wed Jun 05, 2024 3:07 pm
w5000 wrote: Tue Jun 04, 2024 7:33 pm I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
I did my MIL's Medicaid application and it wasn't that difficult. I certainly wouldn't pay a lawyer 10 to 20k to do it.

To the OP. Finding a caring attorney who specializes in elder issues is vital, and stress to the attorney that they represent your Mil, and not the family. Visit every facility in the area to see how they compare for quality, staffing, and cleanliness. My Mil had about 145k in savings when she entered her skilled nursing facility, which charged $8,500 a month for a small shared room (2010). She ran out of her own money after less than 1.5 years and transitioned to Medicaid. She lived for another 4 years on Medicaid until she died at age 94.

If you are the one doing the application be aware that social service agents greatly appreciate honesty, and will reward you for it. Disclose everything and you'll be fine. Your MIL will be able to keep a small amount of income, about $25 a month if I remember correctly, with a bank balance of less than $2,000 (California). The rules may vary on the amounts allowed depending on the state she is in.

If I had any further advice it would be to document every source of income and all agencies or businesses that your MIL is connected to for future reference when she passes. Go through all of her records and ask her about any discrepancies you find, but do it with compassion. Make sure to file her taxes every year, even if she doesn't owe anything.

Good luck.
An elder law attorney did my mother's Medicaid application for far less than $10-20K. More like $1500 as I recall. Yep, I could have done it myself but it was one less thing off my plate and helps avoid the little glitches with the gummit people that can delay things by weeks with the back and forth. You don't want to test the LTC facility's patience while they are waiting for Medicaid payments to kick in. Even with the attorney, I had to spar with them because of the amount of time it took for Medicaid to be approved. They're understaffed you know. And, as I mentioned, the funds came from my mother's account which helped facilitate the spend down necessary for her to become eligible for Medicaid. You can't even send in the application until the applicant is dead broke or they'll just send it back to you.
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Re: Long Term Care for MIL...

Post by maroon »

RationalWalk wrote: Thu Jun 06, 2024 12:07 am An elder law attorney did my mother's Medicaid application for far less than $10-20K. More like $1500 as I recall. Yep, I could have done it myself but it was one less thing off my plate and helps avoid the little glitches with the gummit people that can delay things by weeks with the back and forth. You don't want to test the LTC facility's patience while they are waiting for Medicaid payments to kick in. Even with the attorney, I had to spar with them because of the amount of time it took for Medicaid to be approved. They're understaffed you know. And, as I mentioned, the funds came from my mother's account which helped facilitate the spend down necessary for her to become eligible for Medicaid. You can't even send in the application until the applicant is dead broke or they'll just send it back to you.
This is true. Not sure about the attorney part - as I didn't use one - but the part about waiting to submit the application until the applicant is broke. I had to provide financial records detailing < $2K in assets.

Regarding Medicaid approval timeframe, I believe it took me about 3 months. I was told it usually takes longer; supposedly during/after COVID the processing times increased. I was able to speed things up by collecting the medical records myself and being immediately available for any meetings/phone calls with Medicaid case workers. (I gave permission for a case worker to obtain medical records, but as I recall she had about a 400-applicant caseload so I went ahead and got them myself.)

I think $1,500 is a deal for an attorney to handle the Medicaid application. I would have paid that for sure. I posted upthread I contacted multiple non-profits for help and not one had the resources or time to assist.
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Re: Long Term Care for MIL...

Post by RationalWalk »

maroon wrote: Thu Jun 06, 2024 9:20 am
RationalWalk wrote: Thu Jun 06, 2024 12:07 am An elder law attorney did my mother's Medicaid application for far less than $10-20K. More like $1500 as I recall. Yep, I could have done it myself but it was one less thing off my plate and helps avoid the little glitches with the gummit people that can delay things by weeks with the back and forth. You don't want to test the LTC facility's patience while they are waiting for Medicaid payments to kick in. Even with the attorney, I had to spar with them because of the amount of time it took for Medicaid to be approved. They're understaffed you know. And, as I mentioned, the funds came from my mother's account which helped facilitate the spend down necessary for her to become eligible for Medicaid. You can't even send in the application until the applicant is dead broke or they'll just send it back to you.
This is true. Not sure about the attorney part - as I didn't use one - but the part about waiting to submit the application until the applicant is broke. I had to provide financial records detailing < $2K in assets.

Regarding Medicaid approval timeframe, I believe it took me about 3 months. I was told it usually takes longer; supposedly during/after COVID the processing times increased. I was able to speed things up by collecting the medical records myself and being immediately available for any meetings/phone calls with Medicaid case workers. (I gave permission for a case worker to obtain medical records, but as I recall she had about a 400-applicant caseload so I went ahead and got them myself.)

I think $1,500 is a deal for an attorney to handle the Medicaid application. I would have paid that for sure. I posted upthread I contacted multiple non-profits for help and not one had the resources or time to assist.
There is a gap between the time the applicant becomes destitute and Medicaid is approved, called the "Medicaid pending" period. The facility is not being paid until Medicaid starts and fills in the gap with back payments. There is always the chance that Medicaid won't be approved, in which case the applicant would be discharged and the "responsible parties" will be billed. We encountered one facility that told us that they actually discharge the resident during the Medicaid pending period and then re-admit them once Medicaid is approved. This was in Kansas, whose Medicaid system was apparently broken at the time. I can't imagine dealing with that, so it's worth finding out how the Medicaid Pending period is being handled at prospective facilities before admitting your loved one.

Having an elder law attorney to manage the Medicaid process can help. They usually know the ropes and are familiar with various facilities. They know who to contact at the facility and at the Medicaid office to smooth out the process if necessary, and they should know how to prepare the Medicaid application so that the i's and t's are correct. For example, I purchased my mother's condo because it had to be sold for the spend-down. Since this was a family transaction, it had to be done properly for Medicaid down the road. The el attorney advised me correctly how to handle this.
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Re: Long Term Care for MIL...

Post by AnnetteLouisan »

vested1 wrote: Wed Jun 05, 2024 3:07 pm
w5000 wrote: Tue Jun 04, 2024 7:33 pm I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
I did my MIL's Medicaid application and it wasn't that difficult. I certainly wouldn't pay a lawyer 10 to 20k to do it.

To the OP. Finding a caring attorney who specializes in elder issues is vital, and stress to the attorney that they represent your Mil, and not the family. Visit every facility in the area to see how they compare for quality, staffing, and cleanliness. My Mil had about 145k in savings when she entered her skilled nursing facility, which charged $8,500 a month for a small shared room (2010). She ran out of her own money after less than 1.5 years and transitioned to Medicaid. She lived for another 4 years on Medicaid until she died at age 94.

If you are the one doing the application be aware that social service agents greatly appreciate honesty, and will reward you for it. Disclose everything and you'll be fine. Your MIL will be able to keep a small amount of income, about $25 a month if I remember correctly, with a bank balance of less than $2,000 (California). The rules may vary on the amounts allowed depending on the state she is in.

If I had any further advice it would be to document every source of income and all agencies or businesses that your MIL is connected to for future reference when she passes. Go through all of her records and ask her about any discrepancies you find, but do it with compassion. Make sure to file her taxes every year, even if she doesn't owe anything.

Good luck.
When I started dealing with this it was recommended that I hire an elder attorney and I passed.

I knew some lawyers with experience in this area so I sought their counsel. They had very important insights - one of which made all the difference for my relative. So in hindsight a non lawyer might consider getting one because at various turns people may try to overstep - whether it’s a rehab center that did not confirm their preliminary diagnosis with a specialist and made and treated the wrong diagnosis, to an assisted living facility that denied a patient on the basis of an inadequate assessment, to overcharging, overmedicating, failure to utilize a patient’s cardiac monitoring device or even negligently failed to inform their staff of an implanted defibrillator, insurance company recalcitrance, negligent aide agencies, inadequate record keeping, negligent rehab centers, contract review, or trying to get another family member to accept personal liability for expenses (hint: don’t do that), the list goes on.

It is vital to have the POAs for medical and financial matters and living will, as well as signatory authority on at least one bank account so you can arrange for needed services.

Good luck!!
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Re: Long Term Care for MIL...

Post by vested1 »

AnnetteLouisan wrote: Thu Jun 06, 2024 2:20 pm
vested1 wrote: Wed Jun 05, 2024 3:07 pm
w5000 wrote: Tue Jun 04, 2024 7:33 pm I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
I did my MIL's Medicaid application and it wasn't that difficult. I certainly wouldn't pay a lawyer 10 to 20k to do it.

To the OP. Finding a caring attorney who specializes in elder issues is vital, and stress to the attorney that they represent your Mil, and not the family. Visit every facility in the area to see how they compare for quality, staffing, and cleanliness. My Mil had about 145k in savings when she entered her skilled nursing facility, which charged $8,500 a month for a small shared room (2010). She ran out of her own money after less than 1.5 years and transitioned to Medicaid. She lived for another 4 years on Medicaid until she died at age 94.

If you are the one doing the application be aware that social service agents greatly appreciate honesty, and will reward you for it. Disclose everything and you'll be fine. Your MIL will be able to keep a small amount of income, about $25 a month if I remember correctly, with a bank balance of less than $2,000 (California). The rules may vary on the amounts allowed depending on the state she is in.

If I had any further advice it would be to document every source of income and all agencies or businesses that your MIL is connected to for future reference when she passes. Go through all of her records and ask her about any discrepancies you find, but do it with compassion. Make sure to file her taxes every year, even if she doesn't owe anything.

Good luck.
When I started dealing with this it was recommended that I hire an elder attorney and I passed.

I knew some lawyers with experience in this area so I sought their counsel. They had very important insights - one of which made all the difference for my relative. So in hindsight a non lawyer might consider getting one because at various turns people may try to overstep - whether it’s a rehab center that did not confirm their preliminary diagnosis with a specialist and made and treated the wrong diagnosis, to an assisted living facility that denied a patient on the basis of an inadequate assessment, to overcharging, overmedicating, failure to utilize a patient’s cardiac monitoring device or even negligently failed to inform their staff of an implanted defibrillator, insurance company recalcitrance, negligent aide agencies, inadequate record keeping, negligent rehab centers, contract review, or trying to get another family member to accept personal liability for expenses (hint: don’t do that), the list goes on.

It is vital to have the POAs for medical and financial matters and living will, as well as signatory authority on at least one bank account so you can arrange for needed services.

Good luck!!
Good points. Depending on the family support situation it would also be a good idea to have multiple family members having the POA's for medical and financial issues, especially savings and checking accounts at a bank. When my mil went into managed care she was blind, incontinent, unable to walk, and at 80 pounds soaking wet with osteoarthritis, extremely brittle. All adult family members worked full time. My brother in law was the signatory for my mil's bank and the only one other than my wife who was still local, so we figured that was covered, but it all became too much for him and he moved far away to a different state during her last several years in the care facility.

She had a checking account at a local B of A where all her income (SS, pension, annuity) were direct deposited, and they insisted that to get my wife (her daughter) on the account that my mil had visit the bank in person, and they were intractable in that regard. I told them that my mil would need to be transported by ambulance to visit the bank and they just shrugged. Every time we needed something done that required an in person visit we had to contact my brother in law so that he could complete the transaction at his local B of A in the other state. We even had my mil's elder lawyer contact them but they wouldn't budge. Luckily my mil had given us her pin number so we could use an atm when she needed something. He had signed a number of blank checks so we could pay her bills, including her portion of the care facility monthly cost. Her fixed income was about 3k a month.

My bil and I visited every facility in the area before we found one that was acceptable and that would transition to Medicaid once my mil ran out of her own money. Of the 15 or so we visited, only one fit the bill. I handled all of her other financial matters before and after her death. The process of settling all her various accounts after she died was an ordeal, with varying amounts of cooperation from every entity. I finally gave up on one account after many months of trying, which was her deceased husband's state pension, because of the repeated roadblocks they placed in my path at every turn. There were 4 siblings living in four different states that had to sign every document in several instances.

It helps to be a bulldog. It also helps to have a competent and caring elder attorney. The one we hired was a jewel.
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Re: Long Term Care for MIL...

Post by cheese_breath »

One thing that hasn't been mentioned yet... While MIL is still 'competent' one of you might approach her about becoming her Social Security Representative Payee. Social Security does not accept POAs, only representative payees.
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Re: Long Term Care for MIL...

Post by increment »

cheese_breath wrote: Fri Jun 07, 2024 8:37 am While MIL is still 'competent' one of you might approach her about becoming her Social Security Representative Payee. Social Security does not accept POAs, only representative payees.
The program "provides benefit payment management for our beneficiaries who are incapable of managing their Social Security or Supplemental Security Income (SSI) payments." Does the SSA ever appoint representative payees for those who are still capable of handling their own money?
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Re: Long Term Care for MIL...

Post by cheese_breath »

increment wrote: Fri Jun 07, 2024 8:55 am
cheese_breath wrote: Fri Jun 07, 2024 8:37 am While MIL is still 'competent' one of you might approach her about becoming her Social Security Representative Payee. Social Security does not accept POAs, only representative payees.
The program "provides benefit payment management for our beneficiaries who are incapable of managing their Social Security or Supplemental Security Income (SSI) payments." Does the SSA ever appoint representative payees for those who are still capable of handling their own money?
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The Social Security Administration (SSA) may appoint a representative payee for a legally competent beneficiary if it determines that representative payment is in the beneficiary's interest.
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Re: Long Term Care for MIL...

Post by RationalWalk »

vested1 wrote: Fri Jun 07, 2024 8:15 am
AnnetteLouisan wrote: Thu Jun 06, 2024 2:20 pm
vested1 wrote: Wed Jun 05, 2024 3:07 pm
w5000 wrote: Tue Jun 04, 2024 7:33 pm I don't have much more to add than what's already been posted, except that you're probably going to need to consult with an eldercare attorney soon. A net worth of $100K doesn't last very long when a nursing facility costs $10K a month or more (YMMV). And keep in mind that you will probably pay an eldercare attorney $10-20K to do a Medicaid application. (And by "you", I mean your MIL -- she should pay for it, not you. Because you can always spend money on her later, but her liquid assets are going to be depleted anyway if she lives long enough, so she might as well be paying for the eldercare attorney.)
I did my MIL's Medicaid application and it wasn't that difficult. I certainly wouldn't pay a lawyer 10 to 20k to do it.

To the OP. Finding a caring attorney who specializes in elder issues is vital, and stress to the attorney that they represent your Mil, and not the family. Visit every facility in the area to see how they compare for quality, staffing, and cleanliness. My Mil had about 145k in savings when she entered her skilled nursing facility, which charged $8,500 a month for a small shared room (2010). She ran out of her own money after less than 1.5 years and transitioned to Medicaid. She lived for another 4 years on Medicaid until she died at age 94.

If you are the one doing the application be aware that social service agents greatly appreciate honesty, and will reward you for it. Disclose everything and you'll be fine. Your MIL will be able to keep a small amount of income, about $25 a month if I remember correctly, with a bank balance of less than $2,000 (California). The rules may vary on the amounts allowed depending on the state she is in.

If I had any further advice it would be to document every source of income and all agencies or businesses that your MIL is connected to for future reference when she passes. Go through all of her records and ask her about any discrepancies you find, but do it with compassion. Make sure to file her taxes every year, even if she doesn't owe anything.

Good luck.
When I started dealing with this it was recommended that I hire an elder attorney and I passed.

I knew some lawyers with experience in this area so I sought their counsel. They had very important insights - one of which made all the difference for my relative. So in hindsight a non lawyer might consider getting one because at various turns people may try to overstep - whether it’s a rehab center that did not confirm their preliminary diagnosis with a specialist and made and treated the wrong diagnosis, to an assisted living facility that denied a patient on the basis of an inadequate assessment, to overcharging, overmedicating, failure to utilize a patient’s cardiac monitoring device or even negligently failed to inform their staff of an implanted defibrillator, insurance company recalcitrance, negligent aide agencies, inadequate record keeping, negligent rehab centers, contract review, or trying to get another family member to accept personal liability for expenses (hint: don’t do that), the list goes on.

It is vital to have the POAs for medical and financial matters and living will, as well as signatory authority on at least one bank account so you can arrange for needed services.

Good luck!!
Good points. Depending on the family support situation it would also be a good idea to have multiple family members having the POA's for medical and financial issues, especially savings and checking accounts at a bank. When my mil went into managed care she was blind, incontinent, unable to walk, and at 80 pounds soaking wet with osteoarthritis, extremely brittle. All adult family members worked full time. My brother in law was the signatory for my mil's bank and the only one other than my wife who was still local, so we figured that was covered, but it all became too much for him and he moved far away to a different state during her last several years in the care facility.

She had a checking account at a local B of A where all her income (SS, pension, annuity) were direct deposited, and they insisted that to get my wife (her daughter) on the account that my mil had visit the bank in person, and they were intractable in that regard. I told them that my mil would need to be transported by ambulance to visit the bank and they just shrugged. Every time we needed something done that required an in person visit we had to contact my brother in law so that he could complete the transaction at his local B of A in the other state. We even had my mil's elder lawyer contact them but they wouldn't budge. Luckily my mil had given us her pin number so we could use an atm when she needed something. He had signed a number of blank checks so we could pay her bills, including her portion of the care facility monthly cost. Her fixed income was about 3k a month.

My bil and I visited every facility in the area before we found one that was acceptable and that would transition to Medicaid once my mil ran out of her own money. Of the 15 or so we visited, only one fit the bill. I handled all of her other financial matters before and after her death. The process of settling all her various accounts after she died was an ordeal, with varying amounts of cooperation from every entity. I finally gave up on one account after many months of trying, which was her deceased husband's state pension, because of the repeated roadblocks they placed in my path at every turn. There were 4 siblings living in four different states that had to sign every document in several instances.

It helps to be a bulldog. It also helps to have a competent and caring elder attorney. The one we hired was a jewel.
+1 You should always have more than one DPOA if possible. If something happens to DPOA #1 you are pickled.
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Topic Author
zeldak
Posts: 173
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

celia wrote: Sun Jun 02, 2024 9:25 pm
zeldak wrote: Sun Jun 02, 2024 9:38 am MIL lives in a house with her (unhelpful/younger/healthier) sister.
The house is joint ownership with rite of survivorship.
Does this aunt have children who would help her if she ends up in something like MIL's situation? Would you be responsible for her care too? (...possibly not legally, but because that's what relatives might do)

I would think ahead and consider that they may both need care at the same time or that the aunt might need similar care after MIL is gone.

I'm sorry that this doesn't address the current situation but should be considered. (My family had a case like this and we continued to look after our father's last wife (he had been widowed two times previously) until she died a year after him, because that's what he would have wanted.
The aunt does not have children.
MIL and aunt are both stubborn, immature, financially illiterate. And they barely tolerate each other.
DW and I have tried over the past 10 years to help both of them to understand that they BOTH will end up in a bad situation unless plans are made to circumvent disaster.
They are angry at us for being nosey. They ignored our requests that they speak with an eldercare attorney. Multiple times over 10+ years.

Now here they (we) are.
Topic Author
zeldak
Posts: 173
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

RationalWalk wrote: Wed Jun 05, 2024 12:03 am I know a little bit about Medicaid eligibility, having dealt with this for my mother in KC area, which splits between Kansas and Missouri. There are many LTC facilities in KC metro, some on the Missouri side and some on the Kansas side. My mother was a Missouri resident. Since this was the case, we learned that she would not qualify immediately for Medicaid in a KC facility that was located on the Kansas side.

Medicaid is a state-based program and recipients must be residents of the state where they are seeking Medicaid assistance. If you want to move your MIL to a different state than her current residency, you should become familiar with the requirements for her to become a resident of that new state and become eligible for Medicaid. States don't like it when people move there and want to start collecting Medicaid right away. So there is usually a time period they are required to reside in that state in order to qualify for residency-based Medicaid assistance.

I believe that in my mother's case, she would have needed to reside in a Kansas facility for a year before becoming eligible for Medicaid. We figured that wasn't going to work for us, so we limited our search for a LTC facility to ones located on the Missouri side. Not optimal, because most of the better ones were actually on the Kansas side of KC.
This is our situation, frustrating and time-consuming.
The attorneys want $$ first before they will answer questions.
And each one we spoke with only works in one of the 3 states in question.
Topic Author
zeldak
Posts: 173
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

maroon wrote: Wed Jun 05, 2024 4:12 am Hi OP, I have recent experience with this, so a few notes:

1) Before moving your MIL to a new state, check out the state's requirements for Medicaid eligiblity. In my state, a person needs state residency to qualify for Medicaid. And it takes living in the state for a year to get residency.

2) I got an extended relative on Medicaid without using a lawyer, but it was a long, involved, time consuming process. I contacted multiple non-profit agencies and also the local area center for aging, and not one organization was able to help; either they didn't have the resources or they had a multi-month waiting list for services. I suggest getting a lawyer to facilitate if funds are available.

3) Medicaid does cover assisted living facilities (in my state, anyway). When my extended relative qualified for Medicaid, I was given a list of approved assisted living facilities. I called upward of 30 facilities and visited several before choosing the facility my relative now lives in. Note: Medicaid only pays for shared rooms.

4) Once my relative got on Medicaid, I learned that NONE of my relative's previous doctors accept Medicaid patients. I had to find all new doctors/specialists.

5) You mentioned you're 90 minutes away, be prepared for many trips or find someone in your MIL's immediate area who can monitor her care. In my experience, the assisted living facility provides required services/support, but that's it.
Thanks for the tips.
If we keep her in MD we cant monitor her care as we have a life in PA. MIL has no one else to help. At best we could check on her once per month.
If we move her to close to us in PA she may run out of $$ before residency kicks in. Medicaid may or may not be possible. She could end up placed in an awful situation.
Not sure which is the better of the 2 evils.
She will be mad at my wife no matter how much she helps her mother, and no matter what decisions are made re. location/state.
DW and I will NOT fund MILs care, which could become very expensive to us, over potentially many years, as she ignored ALL of our advice and recommendations over the past 10+ years.
And we want to stay happily married.
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