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My brother who is divorced currently lives in my mothers home. He currently takes care of her. If she accumulates high costs say from a nursing home. will he have to sell the dwelling to cover her costs. She never worked and is living on my dads social security.

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If your brother takes care of your mother for at least a two-year period immediately before she enters a nursing home, and such care enables her to delay going to a nursing home, there is no penalty on that transfer for Medicaid eligibility purposes. If you qualify, that would enable your mother to get the house out of her name: if not, then the house would be subject to a claim by your state following her death, for the amount of Medicaid benefits it paid out during her lifetime. An elder law attorney can assist you with this if you qualify.
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No, she does not have to sell the house. If she goes into a nursing home, Medicaid does not take the house or the car while she is still alive. But they do take all her SS, so brother would have to pay the taxes, insurance, utilities etc. himself.
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my husband and I have a small nestegg, he is suffering from Alzheimers and I can see what the future has in store. I am concerned that this illness (with all the associated cost including an ACLF in his future ) will drain all our money and leave nothing for me when my care when the time comes. What are our options?
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You need to consult an certified elder care attorney. With regard to a spouse of a patient requiring a nursing home, the "community spouse" can keep significant assets and the family home, but this is not a do it yourself project.

Protect your future by working with a CERTIFIED eldercare attorney who is familar with CURRENT Medicaid regs in your state.
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Care giving can be a full time job because if they are incompetent to care for themselves. Sadly there are no options when it comes to nursing home care--the person has to get on Medicaid which means a process of "spending down" -- you can spend it on the home, or funeral arrangements. Or the cost of their care. The maximum a person can have in their bank account is like $2,000. If you "gift" out the monies there is a five year look back law. You also have to be careful about transferring the home because if you quick deed it, Medicaid can view that as gifting and will penalize the person by the value of the home. You really have to see an elder care attorney for all of those particulars so it is DONE CORRECTLY.
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When my bio dad entered a nursing home, he already had a transfer on death in place for his home, so the nursing home couldn't touch it even if they wanted to. I'm not sure how his costs were covered, I don't have any of that information. However, I'm sure they got their money somehow without touching the house
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As for the small nest egg, it probably won't be enough to cover the cost for the Alzheimer's patient. What you may want to do is invest that money toward your own final expenses, or even his. If there's enough to cover both, I personally would go ahead and make your preneed now while you can. Find out what he wants while you still can. Then, decide on a funeral home and go with a preneed. You can potentially go ahead and pay off the funeral, or you can pay the insurance company that you get through your local funeral home when you set up a preneed. It's safer to actually pay the insurance company who holds the policy that it is to pay the funeral home in case the funeral home ever goes under. Another option is to go through your bank and open a special account designed just for final expenses. I heard about this option through an online article, and this may be your safest bet is to be sure your money is being properly directed and kept safe. Guarding the money for your preneed will guarantee your wishes will be met because they will be paid for since the money will be there. Investing in my final expenses is exactly what I would do with that money. You don't want nursing home costs to interfere at the time of a funeral and final disposition, cutting you too short to be able to cover the cost of the wishes of either of you. This is why I advise making a preneed to assure everything's covered now while you have that money and before he needs nursing home care.

Meanwhile, if you're not eligible for Medicaid, there are other coverage options. If you are eligible for Medicaid, then you can apply for that. I personally would go ahead and take care of my preneed first and foremost before applying for anything, but I would do it right after taking care of my preneed and getting it paid for out of that money. I personally would not surrender that money to nothing but preneed. Whatever is left over I personally would keep for my own needs. Again, the small savings is probably not going to be enough for what the patient will later need, so definitely take care of yourself with that money
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MonaLeisa, When my bio dad did his transfer on death, I'm not sure whether or not he was competent, this is something I would need some help to find out because people influence elders all the time. I personally would think that in order to make a major decision on one's own that they were definitely need to be competent. If you have guardianship over the person and their assets, then this would give you power over everything. A POA could sign papers and such, but a Guardian has power over everything regarding the ward. I know each state has its own laws, so definitely research the laws of your state regarding this type of situation. A good idea is to speak with an elder care attorney to who can guide you through the process. I'm in Ohio, and my dad did a transfer on death of his home in 08 before they became unavailable in 09 according to something I found online. However, I don't know if he was competent or if the POA may have influenced him and transferred the home themselves, I don't know that without getting the right help to find out. I was also told that the person who got the house probably also got all that insurance money, and they weren't even entitled to it if this was the case.

In your particular case you mention the patient having Alzheimer's. This is definitely no time to influence the patient, this would cross the line into undue influence and even abuse. Whether or not it's intended, people tend to do it all the time whether or not they mean to. You really want to speak to an elder care attorney and explore your options as well as the laws for your state.
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Janus - I'm assuming that you are looking into the possibility that mom will eventually need to apply for NH medicaid, my answer is based on that...so if so I'd suggest that you & bro look into just how medicaid runs for your state for both value of home, moms monthly income & caregiver after-death exemptions and exclusions for the required estate recovery MERP as the first steps & before ever applying for medicaid.

Each state runs its Medicaid program uniquely.....this will matter for property as some states have the ceiling for value ( tax assessor value) at 500k, 550k or for some east coast states 750/800k. If moms place is over the value ceiling, she's toast for Medicaid. So you have to go to a Plan B.

For income, that too has state set limits. Most about $ 2,100. if over, mom may be able to do a Miller Trust to get it down to Medicaid limits. Miller is not ever a DIY project, you need an atty to do it.

For non exempt assets, it's 2k. So if mom has a whole life policy, she'll need to cash it in and do a spend down. if mom has other assets -like any savings or investments -they too need to be cashed in. Mom has to be impoverished aka "at need" for financial eligibility for Medicaid.

Also for NH Medicaid, mom will need to show to be "at need" medically. She will need to show need for skilled nursing care.

Now moms house is an exempt asset for Medicaid & in theory she can continue to own the house the rest of her life. But upon her death, house goes from an exempt asset to a non exempt and becomes an asset of her estate and subject to estate recivery (MERP). Now although keeping the house sounds just fabulous, it poses an issue for families. Mom will be required to basically pay all her monthly income to NH as her required co-pay or SOC (share of cost in medicaidspeak). If bro or you can afford all house costs from now till when mom dies and the through the probate & estate recovery process, then keeping the house can make sense. Mom might live another 6 mos or another 6 years......but whatever the time somebody will have to pay all the nut on the house from day 1 of NH medicaid till moms post death legal is done.

Now IF bro can qualify for the caregiver exemption from MERP, all this will be somewhat easier as he can get a release from MERP. Usually they have to show they lived in the home and provided full time care which kept mom from needing a NH and going onto Medicaid for at least 2years before. Now just how it's validated is sticky.....like for TX it's a required letter from the elders MD or SW indicating care& medical needs signed off by MD or SW with state licensing & registration info. If say mom lives another 5 years at the NH, it may not be at all easy to ever get such a letter from her old doc. Comprende? So bro needs to look into all this and if feasible. If he has a job, he's probably toast on getting caregiver exemption.

Each heir will need to qualify for their own exemption. So if it's just you & bro, and he qualifies for caregiver exemption that covers his 50% but you will be facing your 50% to deal with MERP.

Now on house costs, if it's going to be that you (who does not live in the house) are going to be the person paying house nut and you are going to be the executor of the estate, you imho are going to need to keep precise documentation on all costs paid. Why? Well you are going to file these as your own claim(s) against the estate (which has the now non exempt house as an asset of the estate) in probate. Usually executor costs come off the top for probate too. Funeral costs too. MERP claim is likely going to be down on the list to be paid. Depending on the value of the home, MERP could pass on doing estate recovery claim filing in probate as its not cost effective. But you have to go probate route -with its costs and requirements - to do this.

It's a lot to mull over. Really do you research, talks all over clearly with bro as to feasibility and the go see an elder law atty to do whatever paperwork now to make all this easier later on. What seems to happen is that family is all guns-ho for the first few months in paying/doing, but within the first year dealing with house becomes a PIA...house gets placed on market..gets sold and ALL the proceeds from the sale become a spend-down for mom as she is now ineligible for Medicaid. You or family probably really can't be reinbursed for house costs either as it comes across as gifting. To me, if your gonna keep moms house, your better be able to stay all in for however long is needed.
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@rarefind1 - you may want to post your question on a new string so your answers are directed to you...just a thought. the expert will likely respond directly then. :)
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