Any insight on Medicaid spend down and how it will be affected by hiring a CNA/Aide/PCA?

Why not use some of dad's savings for a consult with a qualified elder law attorney who understands your state's Medicaid program?

Yes, as others have said get with an elder care attorney licensed in your state so that this is all done by the book to comply with your state's requirements. Guessing or not knowing is not a defense and if wrong, there is no do over after the fact. And each state is slightly different.

Pay the attorney from your dad's fund (that is an allowable Medicaid expense, get all receipts/document it all. The attorney can help with other documents that may be needed such as a durable financial and medical POA (not a "springing" version), an Advanced Directive naming you as his "health agent," Will/Trust AND IMPORTANTLY have the lawyer review the contract paperwork with the facility before anyone signs anything. Most facility paperwork has "tricky" questions/language in their 100 page+ documents that try to get you -- the adult child -- to agree to things such as "you will pay out of your personal funds" if he does not qualify for Medicaid, that "you will take custody of him" in such case (meaning you, not the facility agrees to figure out a safe discharge). Have the elder care lawyer review any/all docs before signing them. This is a legal contract, once signed there is no easy "do over."

Given the 5-year look back for Medicaid, your state will want tax, banking, spending, financial records going back 5 years. The attorney can help w/this but getting access (online easier) to all accounts now is best and a POA is needed for you to have that access. This can take some time to process, but get going on that now. If you are not on his primary bank account, getting your name on that so you can pay his bills (including the monthly "cost of care contribution" (CCC) to the nursing home once he is on Medicaid) is key. Document and keep receipts of everything.

Your state once he qualifies for Medicaid will tell you what his monthly CCC is. The CCC amount should be paid out of things such as his Social Security and any pension payments if he gets such payments. This is NOT something that you personally should pay for.

Sad, but something to think about; final arrangements can be prepaid out of his current funds (burial, funeral services, etc.). Such expense are allowable from a Medicaid standpoint within reason; a $100K funeral service would NOT pass muster but go with something reasonable (your attorney can provide some guidance based on expenses in your state). But prepaying for this now (if not already done) is important. Did this for my mom who is on Medicaid (dementia) and in a nursing home and the "no funeral service, basic burial" still cost $15K.

Finally, as others have said do some research now on which facility is best and try to get him in sooner; do NOT wait until he has spent down. Most facilities like private pay residents who later may have to apply for Medicaid (after having spent down). Coming in as a private pay resident is is a "sweetener" to them, you'll have a better pick of the higher quality nursing homes if you go in private pay to start.

You will want to find a Medicaid and Medicaid qualified facility (w/high quality marks -- US News magazine, CMS and many other ways to search out which facilities have quality marks) AND which also have "memory care" on site. Go visit, see how they handle things. Activities, folks well kept, clean, nice staff. Are there things like a barber shop/beauty salon on site (they have this at my mom's facility, so they can keep up with this type of grooming right there). Ask how foot care (podiatry), dental, eye care is handled. At my mom's facility, a contract podiatrists makes rounds on a regular basis so the toe nails/feet are handled (my mom cannot do this for herself.) Check out the doctors on staff, who would be your dad's primary assigned physician at the facility, ask to talk with that physician so you get a feel for them.

Good luck w/this. Get w/an elder care lawyer licensed in your state before doing anything.

I would follow Barb's and bab's advice to the T. You are, I am assuming, going to use medicaid for placement. You will get a better placement by placing now where there is self paying for a while. This solves all problems at once.

Any questions, where you cannot go wrong, cannot be made on advice of any Forum, no matter how well meaning. You need the advice of experts for medicaid in your own state. That means spending at least SOME of these funds on an attorney or consultant who knows the rules in your own area.

Sure do wish you good luck. As others have said, this amount spent in home care will go more quickly than you can imagine.

Please, please consult with an attorney specializing in elder law/Medicaid *now,* before you spend a penny of dad's money. I waited until my mom's money had nearly run out before doing so, and learned that much of the money I'd spent on her care had not been properly managed/accounted for, resulting in a penalty (in the form of a number of weeks that Medicaid won't cover once she becomes eligible). It is more than worth the cost to engage a lawyer up front, to avoid making decisions that could potentially be very costly down the line. Best of luck to you!

You would need to make sure you do this legally, with a contract, etc.

But that 150K will go very quickly if you are thinking 24/7 in home care. Then it would be difficult to find a Medicaid facility if you have not been a out of pocket resident first.

I used to have to file forms for my mom's conservatorship in MA. Use one checkbook, save all paper bills, and save all bank statements as you go forward. You will have to collect at least 3 to 5 years of bank statements which you can get online or at the bank if you can bring him along with ID. I once asked a guardian ad litem where the trigger points were and he said he scrutinized checks of over $600. I also had to present the check register to one lawyer. To make things really easy as a worksheet even though you want to know about Medicaid, MA probate has a downloadable excel spreadsheet where you can itemize every penny. You just need to list the bank account start point on the 1st page then fill out 2 pages of the 4 for intake and outgo. It will automatically give you the balance to the checkbook
Yes you can pay all professional services. Make sure he has funeral expenses prepaid through a funeral home. They usually set it up as a small trust.
I recommend to find a good nursing home that takes Medicaid, go on the wait list and get him in around 6 months before Medicaid. You can file when he is down to the last 3 months of money. Since he will already be placed, he goes to the top of the list for the Medicaid bed. If you file too late then he may go to the first bed in any facility

Contact your county office of aged and disabilities.. they could probably give you insight..otherwise the elder attorney, you don’t want to be wrong on things regarding Medicaid eligibility.

if your thinking eventually your dad will need placement, now would be the time you want to look at that. Choice goes down with the less time spent in self pay.. I was fortunate to find a place for my mom who didn’t quite have the year the facility wanted for self pay prior to going on Medicaid… most want two to three years..

See: National Association of Elder Law Attorneys

https://www.naela.org/

Medicaid laws vary from state-to-state.

Some AL have a spend-down period for even 2-3 years - meaning they have to pay the AL cost for that period of out of pocket. That might be a good use of his money. My stepdad is currently doing that. I did a lot of research before my mom went on Medicaid and a book called Caring For Your Aging Parents by Virginia Morris helped me a lot. Good luck!

This is just from my own experiences and the way I understand it that you can use the money for them as long as it is medically necessary. I do agree with the others you should contact an elderly lawyer every state is different and Medicaid is very tricky. I wish you the best