Long Term Care for MIL...

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills.
RetiredAL
Posts: 3736
Joined: Tue Jun 06, 2017 12:09 am
Location: SF Bay Area

Re: Long Term Care for MIL...

Post by RetiredAL »

RationalWalk wrote: Fri Jun 07, 2024 10:45 am
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.
I'll add a +1 also. We had to do a line-of-procession revision for my Dad in 2020 during Covid. He was competent but no one was allowed into his Assisted Facility. The Staff finally relented enough to allow a patio visit for getting the notarization's.
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

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.
thank you for this info..
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

123 wrote: Wed Jun 05, 2024 12:08 pm
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.
Yes. This became clear to me after visiting some facilities. I fear that a time-sensitive emergency for MIL will be an unavoidable issue in the future.
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

RationalWalk wrote: Thu Jun 06, 2024 9:48 am
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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?

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.
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

zeldak wrote: Sun Jun 09, 2024 4:54 pm
RationalWalk wrote: Thu Jun 06, 2024 9:48 am
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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?

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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?
WillRetire
Posts: 825
Joined: Mon Jun 05, 2017 10:01 am

Re: Long Term Care for MIL...

Post by WillRetire »

OP, I'm sorry for the tough situation. As for finding an elder law attorney that can advise you, might there be someone who practices in 2 of the 3 states? Say, PA & MD? Absent that, could you just prepay for a consultation with one in PA, and ask for a referral to one in MD?

Meanwhile, you can lookup medicare's rating of various facilities. Find a couple places in each state with good ratings. I realize your MIL is looking for AL not SNF, however, many facilities have both. If a given facility has a decently rated SNF and not too far, check to see if they have assisted living too.

https://www.medicare.gov/care-compare/? ... ursingHome

Also, consult your (or MIL's) local office for aging to get advice & help from a counselor.
https://www.hhs.gov/aging/state-resources/index.html
https://www.hhs.gov/aging/long-term-care/index.html (more places to get help/advice)

If I were you, I'd be inclined to start with where I'd like her to move (PA I assume), and branch out to MD or DE time permitting.

(edited to fix typo)

Edited again to add: Maybe start in MD: Look for AL/SNF facilities & for an attorney, since that is where she is currently a resident AND owns real estate. Some (many) states retain a claim on a residence if one of the residents goes on medicaid but another resident, usually healthy spouse, retains residence in the house. I am not a lawyer so I don't know exactly how this works. But a MD atty could advise you best about MIL going on medicaid from the starting point of being a joint homeowner.
Last edited by WillRetire on Sun Jun 09, 2024 5:17 pm, edited 3 times in total.
Northern Flicker
Posts: 15750
Joined: Fri Apr 10, 2015 12:29 am

Re: Long Term Care for MIL...

Post by Northern Flicker »

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 right of survivorship.
Did you discuss this with the elder attorney? Need to understand how that affects a Medicaid spend down for proper planning. It may not be as simple as just changing the title. Medicaid has a lookback-- 5 years if I'm not mistaken.
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

Northern Flicker wrote: Sun Jun 09, 2024 5:11 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 right of survivorship.
Did you discuss this with the elder attorney? Need to understand how that affects a Medicaid spend down for proper planning. It may not be as simple as just changing the title. Medicaid has a lookback-- 5 years if I'm not mistaken.
Yes, we know that this is one of the issues that must be discussed. It may be the case that the aunt is also in a challenging position due to the joint house ownership. We tried to warn them over the past 10 years to discuss this with an attorney. They chose not to discuss this with anyone. They have ignored our suggestions for more than 10 years.
WillRetire
Posts: 825
Joined: Mon Jun 05, 2017 10:01 am

Re: Long Term Care for MIL...

Post by WillRetire »

Here is some reading on a couple of the questions the OP asked. HOWEVER, this isn't legal advice, so ask a lawyer for your situation.

Medicaid's treatment of your home & the equity:
https://www.elderlawanswers.com/medicai ... home-12140

Can adult children be on the hook for parents nursing home bills?
https://www.elderlawanswers.com/adult-c ... bills-5181

Be careful what you sign. Also, be careful about MIL transfering assets or cash or giving gifts to adult children or adult children inheriting assets after death of a parent on medicaid. Those seem to be the types of situations hat cause some states to claw it back.
WillRetire
Posts: 825
Joined: Mon Jun 05, 2017 10:01 am

Re: Long Term Care for MIL...

Post by WillRetire »

OP: I understand your frustration that you & your DW advised MIL & her sister not to buy a house together. You were probably correct, but water over the dam. This forum is filled with stories about elderly parents mismanaging things or making bad decisions against the advice of their adult children.

You are not alone! But forget the past. MIL is lucky to have you but her situation will almost certainly be more difficult due to her poor long-term-care planning. It is what it is, through no fault of yours.

Learn from this and plan your own long-term care differently (better).

One last thought: when things start moving forward with MIL moving out of the house and (presumably) medicaid getting a lien on it or talk of such things reaches MIL's sister's ears, the two of them may have a change of heart and decide to move together to a place. This may wake up the sister that the house isn't going to be 100% hers. But you probably can't make them see that now... they have to see it play out step-by-step.

You really really really need a lawyer who knows elder law & medicaid in MD.
RationalWalk
Posts: 530
Joined: Sun May 07, 2023 12:31 pm

Re: Long Term Care for MIL...

Post by RationalWalk »

zeldak wrote: Sun Jun 09, 2024 5:04 pm
zeldak wrote: Sun Jun 09, 2024 4:54 pm
RationalWalk wrote: Thu Jun 06, 2024 9:48 am
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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?

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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?
Regarding being held responsible for another person's charges in a facility, my experience is that both assisted living and LTC facilities my mother was in required an application and approval process to be admitted, and one of the things we were asked to provide on the application was the name of person or persons who would act as "responsible parties." You'll need to ask what this entails for a given facility, but our experience was that it did include some form of financial responsibility. The specific nature of this I'm not well-informed. Something to ask an elder law attorney about.
“Meteorologists” are the MOST accurate predictors of the future -- for the next 3-days...
Topic Author
zeldak
Posts: 172
Joined: Tue May 26, 2020 10:30 am

Re: Long Term Care for MIL...

Post by zeldak »

RationalWalk wrote: Sun Jun 09, 2024 6:10 pm
zeldak wrote: Sun Jun 09, 2024 5:04 pm
zeldak wrote: Sun Jun 09, 2024 4:54 pm
RationalWalk wrote: Thu Jun 06, 2024 9:48 am
maroon wrote: Thu Jun 06, 2024 9:20 am
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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?

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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?
Regarding being held responsible for another person's charges in a facility, my experience is that both assisted living and LTC facilities my mother was in required an application and approval process to be admitted, and one of the things we were asked to provide on the application was the name of person or persons who would act as "responsible parties." You'll need to ask what this entails for a given facility, but our experience was that it did include some form of financial responsibility. The specific nature of this I'm not well-informed. Something to ask an elder law attorney about.
Thank you for this information!!
Excellent point.
User avatar
cheese_breath
Posts: 11926
Joined: Wed Sep 14, 2011 7:08 pm

Re: Long Term Care for MIL...

Post by cheese_breath »

RationalWalk wrote: Sun Jun 09, 2024 6:10 pm
zeldak wrote: Sun Jun 09, 2024 5:04 pm
zeldak wrote: Sun Jun 09, 2024 4:54 pm
RationalWalk wrote: Thu Jun 06, 2024 9:48 am
maroon wrote: Thu Jun 06, 2024 9:20 am
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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?

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.
Thank you for this helpful info.
Can DW and I be held financially responsible in any way for MILs care?
Regarding being held responsible for another person's charges in a facility, my experience is that both assisted living and LTC facilities my mother was in required an application and approval process to be admitted, and one of the things we were asked to provide on the application was the name of person or persons who would act as "responsible parties." You'll need to ask what this entails for a given facility, but our experience was that it did include some form of financial responsibility. The specific nature of this I'm not well-informed. Something to ask an elder law attorney about.
I don't know if this would apply here since MIL would be able to pay for her care for awhile. Notice too, this is 2002. I don't know if it's changed since then. Something to ask the elder care lawyer.

"What happens when a person who is in need of long-term care is unable to pay for it? More than half of the states in our country have filial responsibility laws — laws that can make adult children financially responsible for their parents’ medical bills and other necessities of life when the parents do not have the means to pay on their own. The extent of this responsibility varies by state. Currently, Virginia has filial responsibility laws; DC and Maryland do not.

The 30 states that have filial responsibility laws are as follows: Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, and West Virginia.""

https://www.farrlawfirm.com/resources/f ... 2C%20South
The surest way to know the future is when it becomes the past.
WillRetire
Posts: 825
Joined: Mon Jun 05, 2017 10:01 am

Re: Long Term Care for MIL...

Post by WillRetire »

Regarding filial responsibility, here are some excerpts from the link I provided in an earlier post.

https://www.elderlawanswers.com/adult-c ... bills-5181
There have been few cases where adult children have actually been forced to pay a parent's nursing home bill. Often, cases in which children have been forced to pay up involved fraud or a disregard for managing the costs incurred. While the risks of filial responsibility laws are minimal, watch out when helping parents sign a nursing home residency agreement for long-term care services. Read the contract carefully. The Nursing Home Reform Act generally prevents a nursing home from requiring a person other than the resident to assume responsibility for care expenses. However, some nursing homes have a clause in their contract to attempt to bill or sue residents’ family members and friends for the cost of care.

If you're uncertain about the residency contract you are about to sign, contact an elder law attorney near you. They will review the contract to ensure you aren't held responsible for expenses once your loved one's finances are exhausted.
OP, based on your other threads, you have significant assets and an estate plan created with an estate attorney. Perhaps that attorney would be a good place to start?
WillRetire
Posts: 825
Joined: Mon Jun 05, 2017 10:01 am

Re: Long Term Care for MIL...

Post by WillRetire »

Adding to cheese_breath's post, here is an article written in 2023 by an eastern PA attorney about PA's filial support law:
https://www.barley.com/understanding-pe ... pport-law/

The article explains how the law works. It also has this advice:
The best way to avoid a filial support claim is to make sure your parent qualifies for Medicaid. If Medicaid benefits are available, they are considered payment in full for the parent’s care. Consequently, no money is needed from the adult child because the parent’s bills are covered in full by Medicaid benefits.
He's based in Reading, btw.

Here's an attorney in Maryland on the subject in that state:
https://jamescrawfordlaw.com/2022/04/09 ... wyer-says/
(filial support law repealed in 2017)

All signs point to consulting with an attorney in MIL's state to see about getting her on medicaid there, in the absence of financial support from family. Maybe it's a good time for you & spouse to visit your PA estate planning atty to get advice re:your involvement/exposure.

Good luck!
User avatar
arcticpineapplecorp.
Posts: 15527
Joined: Tue Mar 06, 2012 8:22 pm

Re: Long Term Care for MIL...

Post by arcticpineapplecorp. »

zeldak wrote: Sun Jun 09, 2024 5:25 pm
Northern Flicker wrote: Sun Jun 09, 2024 5:11 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 right of survivorship.
Did you discuss this with the elder attorney? Need to understand how that affects a Medicaid spend down for proper planning. It may not be as simple as just changing the title. Medicaid has a lookback-- 5 years if I'm not mistaken.
Yes, we know that this is one of the issues that must be discussed. It may be the case that the aunt is also in a challenging position due to the joint house ownership. We tried to warn them over the past 10 years to discuss this with an attorney. They chose not to discuss this with anyone. They have ignored our suggestions for more than 10 years.
i'm not sure the house is an issue, though it may depend on what state she moves to. In PA (one of the States mentioned you might be looking for a facilty), policy says regarding joint tenancy with rights of survivorship:
Joint Tenancy with Right of Survivorship – There are two or more owners, each owning an equal share. When one of the owners dies, his share passes to the surviving owners. All owners must agree to sell the property. A joint tenant reserves the right at any time to file a petition to partition that would end the joint tenancy and give the joint tenant his/her share of the property.

source :http://services.dpw.state.pa.us/oimpoli ... ndbook.htm
so in that clause above, even if the client wanted to sell the house if the sister didn't agree, it wouldn't be sold.

also at that link above, the MIL could sign an affidavit (or put on the application where it asks) that she intends to return to the property, which would exlude it as a countable resource:
440.421 Intent to Return to Residence Statement

An institutionalized individual’s home that was the principal place of residence before the individual was institutionalized can be an excluded resource if the person signs an “intent to return” statement. The CAO bases the intent to return home only on the individual’s statement or the statement of someone acting on the individual’s behalf. It is not based on the individual’s medical condition or prognosis.

The individual (or someone acting on his or her behalf) only needs to give the statement of intent one time. If the individual is incapable of giving the statement of intent, accept a statement of intent to return from an individual with authority to act on the individual’s behalf. The CAO does not need to review at each renewal the individual’s intent to return home.

If the individual’s intent to return home changes and the property is placed for sale or transferred, the individual must notify the CAO within 10 calendar days.

55 Pa. Code § 178.62
so it's possible medicaid would have to exempt the house if MIL intends to return and states in writing and then if/when she dies the home could pass to sister under the rights of survivorship clause. So it's possible the house could be protected from medicaid in this way and not subject to clawback, if i'm interpreting the policy correctly. Check with an elder law attorney or county assistance worker to be sure.
It's hard to accept the truth when the lies were exactly what you wanted to hear. Investing is simple, but not easy. Buy, hold & rebalance low cost index funds & manage taxable events. Asking Portfolio Questions | Wiki
User avatar
arcticpineapplecorp.
Posts: 15527
Joined: Tue Mar 06, 2012 8:22 pm

Re: Long Term Care for MIL...

Post by arcticpineapplecorp. »

WillRetire wrote: Sun Jun 09, 2024 8:42 pm Adding to cheese_breath's post, here is an article written in 2023 by an eastern PA attorney about PA's filial support law:
https://www.barley.com/understanding-pe ... pport-law/

The article explains how the law works. It also has this advice:
The best way to avoid a filial support claim is to make sure your parent qualifies for Medicaid. If Medicaid benefits are available, they are considered payment in full for the parent’s care. Consequently, no money is needed from the adult child because the parent’s bills are covered in full by Medicaid benefits.
He's based in Reading, btw.

Here's an attorney in Maryland on the subject in that state:
https://jamescrawfordlaw.com/2022/04/09 ... wyer-says/
(filial support law repealed in 2017)

All signs point to consulting with an attorney in MIL's state to see about getting her on medicaid there, in the absence of financial support from family. Maybe it's a good time for you & spouse to visit your PA estate planning atty to get advice re:your involvement/exposure.

Good luck!
there was only one enforcement of filial responsibility in PA that I'm aware of but here's the details as to what happened:
In past Pennsylvania decisions, fraudulent conduct was a necessary finding before a child would be charged with a parent’s care. However, in 2012, the Pennsylvania Superior Court in Health Care & Retirement Corporation of America vs. Pittas, 46 A.3d 719 (Pa.Super 2012), upheld a lower court ruling that allowed a nursing home to obtain payment from the son of Maryann Pittas for her nearly $93,000 nursing home bill after she fled the country without paying her bill. Maryann Pittas had applied for Medicaid but had left the country before there was a decision on her application. The nursing home then sued her adult son, John Pittas, for payment. Unlike previous rulings, the Superior Court made no finding that John had engaged in any fraudulent transfer to divert or hide his mother’s assets.

source: https://www.obermayer.com/a-look-at-fil ... ew-jersey/
It's hard to accept the truth when the lies were exactly what you wanted to hear. Investing is simple, but not easy. Buy, hold & rebalance low cost index funds & manage taxable events. Asking Portfolio Questions | Wiki
RationalWalk
Posts: 530
Joined: Sun May 07, 2023 12:31 pm

Re: Long Term Care for MIL...

Post by RationalWalk »

There can be many reasons that a nursing home resident might default on their bills. For example, they might refuse to pay. I assume if that were the case, if the "responsible party" had POA they could pay from the person's accounts. However, it could get messy. Often the wording of a POA gives the grantor the authority to revoke. All kinds of wacky things are possible, though not very likely.

I assume here that the main issue of concern would be the circumstance of the person running out of money, applying for Medicaid, going on "Medicaid Pending" status for awhile and not being billed, and then unfortunately not being approved. In this case, the nursing home is probably going to discharge. In most states, they can't just throw a person out on the streets but have to first document that a suitable placement has been identified. Once that's been done, they're probably going to seek back payment for the unbilled period of time.

So, it's important to make as sure as possible that you understand the Medicaid process where the person will be applying and that there aren't any "gotchas" lurking that might lead to Medicaid denial or delay. Things were pretty clear cut with my mother's finances. The main issue was making sure that my purchase of her condo was handled correctly so we wouldn't get snagged on that, and the EL attorney detailed just what I had to do when I bought it from her 2-3 years before she did need Medicaid. It all turned out OK.
“Meteorologists” are the MOST accurate predictors of the future -- for the next 3-days...
User avatar
celia
Posts: 17014
Joined: Sun Mar 09, 2008 6:32 am
Location: SoCal

Re: Long Term Care for MIL...

Post by celia »

zeldak wrote: Sun Jun 09, 2024 3:40 pm They are angry at us for being nosey. They ignored our requests that they speak with an eldercare attorney. Multiple times over 10+ years.
Stop asking the questions and instead, let them know what you and your spouse are planning for your own elderly (final) years.

If you have the knowledge now of what can happen and have no plans for yourself, then maybe we should ask you what YOUR plans are.
:wink:
Post Reply