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They are both 75, and my dad has already lost one leg (below the knee) due to diabetes. He will most likely lose the other leg soon. She wants to keep him at home as long as possible because she can't fathom losing everything they have worked and saved so hard for. My mom has had to take care of the house (inside and out) for a couple years now, and it's difficult. They need to sell and get into something smaller (like a patio home) with no steps. Currently they have 5-12 steps, depending on which way you enter the house. I know the community spouse gets to keep the home, so can she sell it now and put the money right back into another one, without penalty in near future? I hope I'm making sense.

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Yes it makes sense and given the information the sale and move to a house that is more accessible for him is actually for his benefit.
I am no expert but I would think if the house that is purchased is of the same value then there is no problem. The problem might be if the house they sell is worth $900,000 and the one they buy is $200,000.
This might be the time to sit with an Elder Care Attorney and ask these questions.
Also..if your dad is a Veteran it is possible that you (your mom) can get help through the VA. And it may be a lot of help depending on where and when he served. They have changed a lot of the criteria for what they determine to be "service connected disability"
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gdaughter Oct 2019
Definitely make the investment of investigating and finding a certified elder law attorney to consult with now before you and your family make any moves...financial or otherwise. Mistakes are costly and it is a complicated business. Try to find someone who works on a flat fee for consult and tasks.
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Carrie, I think your mom would be a good candidate for sitting down with an Eldercare attorney so that she can be reassured that shes not going to "lose everything".

Don't let mom become overwhelmed by caring for dad and for the house! This is a change that needs to be made soon
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They can sell the house and buy a smaller / better accessibility one.

BUT whether it’s going to be best to buy it outright so no mortgage or have a mortgage and use some of the House sale $ in other ways, that to me are the bigger issues to think about. At 75, if mom is pretty healthy & likely to be even healthier once dad has moved into a facility, she could have another decade or two ahead of her. And she’s going to need all the $ she can possibly keep so she can maintain her living standard till years & years from now.

Your mom as a community spouse is NOT required to impoverish herself for dad to be eligible for LTC NH Medicaid. Only dad has to be impoverished. Her income does not count & her income does not have to be paid to the NH. However dads income does. The “income” can be sticky to deal with for couples.....
AND for LTC Medicaid all their assets are counted but mom as a CS is allowed to keep a certain amount of $ as her own assets. For most states this is $126k. You need to find out exactly what the CS asset max is for your state. And then what they have in non-exempt assets & without counting whatever the house might sell for.

are they over 126k in assets right now?
what might house sell for? & likely cost to buy a new house?
what’s her SS or other monthly income?
And does she right now need dads income in order for thier current household (including her medical costs) to run?

depending on what the #$’s are, it might be better for mom to have a mortgage and instead use some of house sale $ to get for herself a SPIA (single premium immediate annuity, if your state allows for these) and the SPIA pays her the lowest amount allowed under actuarial tables as income each month. Then since she has a mortgage, atop her regular living costs, she files to get CSRA (Community spouse resource allowance). CSRA waives some of dads income from all basically going to the NH as his required by Medicaid copay and instead some of it goes to mom as she needs more income as she has that pesky mortgage. Financial planning when there’s a healthy youngish CS and a NH spouse is imho flat not simple. Personally to me for these situations your folks are best off meeting with a CELA level of elder law attorney.
as they can give you all options as to what works best for how Medicaid runs for your state and deal with the speciality underwriting needed for doing a SPIA.

btw I hate annuities in general& think they just don’t work well for most, but a SPIA is a very unique very restrictive type of annuity that can work for healthy younger CS.

about “keeping” the house.... Medicaid requires all states to do an attempt at recovery (MERP) of all costs paid. But there are exemptions and exclusions to MERP. & just what these are dependent on your states administration of Medicaid and laws for probate & property rights. A lot of states place a unsecured lien onto the property that exists until property is sold or it’s a claim against the estate if she dies. If there’s still a mortgage, the mortgage Co is a secured creditor, so they get paid first & foremost. If there’s no $ after mortgage paid off, then there’s no recovery as no $. Sometimes having a mortgage in your 70’s or 80’s can be a good thing......
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CarrieLockhart Oct 2019
Gosh, thank you so much for your detailed explanation. They live in TN. I guess I better tell her to skip these estate planning attorneys that she has been referred to, and find a specific Elder Law Attorney. The first one she had a consult with kept getting medicare and medicaid mixed up. I knew right then to tell her to move on.
She has already told us kids that she cannot even afford to stay in the house without my dad's SS check, so......... her income is well below the state's minimum monthly maintenance income level.
I do not know what their assets are, but there is no way her half would be over the allowed $126K. I just hate that they have to split the amount of money they have, only to have to spend his side all the way down to $2,000. It makes no sense when the CS needs that money to survive. That's why she said she'd like to try keeping him at home, because what if she "spends down" all that money, and he dies 3 months later in the nursing home? She is out all that money. This process is very frustrating.
I will let her know what you said about paying off a new house vs. having a mortgage. It sure makes sense. She could possibly live another 10-15 years if she makes it through this stress.
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I think that igloo's thorough (as always) advice, shows it could be important that you and Mom pay for a few hours of time with an Elder Care Attorney wise in the ways the real estate stuff works. It seems involved, and would be tough for me to do on my own. To do this wrong at this time is something that can't be afforded. And States vary. Please get expert help here.
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My Mom is all set up with an Elder Care Attorney. She'll have all of her questions answered soon and understand more about what is ahead of her. Thank you so much for your help. I really appreciate this site.
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igloo572 Oct 2019
Carrie, please go with her. Actually what might be better is for whomever will be their DPOA to go and perhaps someone else in the family to silently take notes of what’s said.
I’m guessing your to be the POA? If you have siblings and they for sure won’t be all huffy & challenging to your decision making as dpoa in the future, have a sibling go to be the note taker. If siblings likely to be difficult, I’d suggest a friend takes notes.

if atty sends a questionnaire, fill it out in detail in advance

if they have any old legal done - like a will or existing DPOA- take copies of those.

Find the paperwork on the house - like Warranty Deed, Release of Deed of Trust -& take those as well as the last Tax collector bill (this one should be going out right abt now for January, 2020 due).

if you don’t have a pretty solid idea of what their monthly income / to expenses are, now is the time to spend couple of weekends pulling all that together for them. Like this years bank statements, ‘18 & ‘ 17 taxes if they still file, anything that pays them $.

also find their “awards letters”. These are a trifold mailing that SSA & federal type of retirements send out usually in Nov. Other retirements also send these out but can do them close to EOY 2019. “awards letters” state to the penny what monthly income will be for 2020.

If the plan needs to be that dad flat requires a higher level of care & needs a NH, clearly ask just how state of TN Medicaid evaluates “at need” eligibility for skilled nursing care. Often families get all in the weeds on the financial aspect of LTC Medicaid BUT he also must show to be “at need” medically for skilled nursing care (aka care in a NH). A lot of states really have narrowed medical eligibility and now require an assessment w/fat health chart that clearly shows he needs skilled nursing care. Not just AL or MC but skilled nursing care in a NH as most states LTC Medicaid do not pay for AL or MC. I was able to have my mom go from IL to NH and bypassing the AL phase entirely a few years back, & she went into the NH as “Medicaid Pending”, but if the situation was now in 2019 she likely imo wouldn’t have met the current much tighter standards for “at need” medically for NH.

Also if you don’t get a good vibe with the atty, there will be another one to see...... most do first maybe 20-30 min visit for free or a a nominal low initial consultation fee. Getting info together in advance really helps use that first visit optimally. Good luck & try not to let yourself get overwhelmed too much!
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I wish my own Parents had been as Wise as Your Mom, Dad is now Alone on the Snow Hill, Makingit hard for my Diabled Sister to Contunue Caring for him. Both parents were so damn Mule Headed. Suggest a Place whre Asiste Living is Available, Put Mom's name on a Long List while her House is being sold. Make arrangements. She is doing the Right thing.
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I think you are referring to Medicaid exemptions. In my state of Maryland, the spouse can live in the house without having its worth counted as asset. If you sell it to buy something smaller, any extra money is considered by Medicaid as asset. The rules are complex. It is best to consult with an eldercare attorney - and they ain’t cheap!
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Do yourself a huge favor like I did. Go pay an elder law attorney who knows Medicaid well and he/she will give you your answers and they will be the LAW answers. I do know the answer to this question because I went through the whole ordeal of handling it for my parents. You will hear and see the terms “resource amount, assets, spend down, etc.” which are key words. I paid $300.00 for one hour of priceless information from a good elder law attorney. So much so, I went back again twice more over a 3-year period. Worth every penny!! Remember, Medicaid varies from state to state, so some info one gives you on here may not apply to your state. See it as a necessity to see the attorney and make a list of questions to take with you. Good luck to you and family and God Bless. I got through it. Wasn’t easy.
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You need to see an elder law attorney. You don't want to make a misstep that will cost you later.
Medicaid is very complicated. Even if it sounds like someone posting here has done exactly the same thing, Medicaid varies from state to state and individual situations vary based upon something that you may not even be thinking about.
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As they will be moving to assist his needs I don't see what problem there would be - even spending a few $$ to adjust the bathroom for special needs would be a good investment for his duration at home & he might be able to stay long in a home he can use better - when the home is sold there are many who need this sort of thing & possibly they might find something already done

Check with legal advice where you live but if it is really his needs that initiate the move why would anyone have a problem with this arrangement
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Good that mom is going to EC attorney. As others suggested, do go with her. More eyes/ears to help remember/understand everything!

The only other thing I would add is the "spend down", if it comes to that, doesn't mean you just have to go crazy spending his "share", thus pretty much wasting the funds. Hiring outside help or self-paying at a facility would qualify as part of the "spend down." So long as nothing is "gifted" to anyone and you have receipts, it should be fine. A good EC attorney can explain all this and the benefits of irrevocable trusts and "life estate" trust for the home.
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CarrieLockhart...

Selling the present homestead residence and purchasing another should not be an issue with respect to future Medicaid eligibility.

When budgeting keep in mind that even if your father were to enter a nursing home, a portion of his income may be "diverted" to your mother to help support her housing needs. The amount she may keep of their combined gross income will be between $2,057.50 and $3,160.50 (the Minimum Monthly Maintenance Needs Allowance or MMMNA).

To amplify on and correct some of the answers posted...

With respect to assets and Medicaid eligibility, at the time of eligibility determination Tennessee will allow the Medicaid applicant spouse (aka Community Spouse) to retain all combined "countable" assets up to $25,284 (amounts are adjusted annually).

Above this asset level the state will require that countable assets be split 50/50 between the couple. The Medicaid applicant spouse may retain only $2,000. The Community Spouse may retain up to $126,420 of the 50%. This compels the Medicaid applicant spouse to "spend down" their 50% to meet the asset eligibility requirement of $2,000 or pursue some other legal way to devise (transfer) the assets without incurring an eligibility penalty. Sometimes as was suggested, a Medicaid Qualified Annuity will be helpful in this process (converting an asset to income) however the higher income generated by the annuity may affect the MMMNA as described above.

This planning can become quite complex and Tennessee requires that an licensed attorney provide advice regarding the transfer or assets of income to obtain Medicaid eligibility.

On other issues...

Tennessee does have a Medicaid Home and Community Based long-term care Waiver program that provides benefits for home care and assisted living. https://www.tn.gov/tenncare/long-term-services-supports/choices/what-home-care-services-are-covered-in-choices.html

Medicaid home based benefits typically require no co-pay and the couple will be able to keep all income for housing and medical needs.

Also mentioned was the potential for VA benefits. Service connected benefits known as Compensation or "Disability" may be an option if your father was a veteran who has injuries or disabilities resulting from active duty service. If circumstances are such, it may be possible for an award to be granted but it may literally take years.

If, however, your father is a war-time veteran (he did not have to have served in combat) he may be eligible for and may qualify for a NON-Service Connected benefit called Improved Pension. This award may provide a monthly benefit to the couple of up to $2,230 per month to assist with home care or provide some assistance with assisted living expenses.

Medicaid home care services and, if applicable, the VA benefit mentioned above may permit your parent's to age in place for quite some time.

I wish you and your family well...
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Suetillman Oct 2019
I don’t what state you live in but In Oklahoma you can’t have anything except for two or 3 thousand in the bank and if you own a house, you either have to sell it or have the cash to pay the nursing home. We went through that with my MIL.
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Please see an elder law attorney.
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if she plans on using Medicare for a nursing home, she can’t have a house or any money except for a small amount. We had to sell my mother-in-law’s house to pay for nursing home and after the money ran out, social security or Medicare kicked in. Now, if he is a veteran, you can put him in a VA nursing home and still keep your home.
There is a way to keep your home if it is put in some kind of trust but it can’t be right before you put him in one. I think it is 3 years. You need to talk to an attorney and find out because she could lose everything if he lived a long time. A nursing home is approximately 4,000 a month. A Private home where they only keep a few patients is usually cheaper but not a lot.
Social security will pay someone to come in approximately 15 hours a week and there are home health aides that will come out and check them over and help with bathing. You need to find out these things right away.
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disgustedtoo Oct 2019
Beware quoting costs for any facilities (IL/AL/MC/NH.) The costs vary widely depending on region and/or state you live in.

"Survey reveals that in the United States, a private room in a nursing home costs an average of $8,121 a month. For a semi-private room, the average cost is $7,148 a month. Various factors impact how much a nursing home stay costs including location, size, length of stay and services offered."
and
"The cost of a nursing home varies significantly depending on the location. For example, in Alaska, the average cost for a private room is $800 per day, whereas the same room in Oklahoma would cost an average of $147 per day."

Just out of curiosity, I had checked a local, lower cost place near us - it was over $15k/m. Where you are is clearly one of the less expensive regions - lucky for you (although it is relative to standard of living - costs may be less in areas where average income is less.)

Also, stating she can't have a house isn't necessarily true. My understanding is IF there are two parents and one needs care, the other can retain/remain in the home and keep enough income to avoid impoverishment (if Medicaid is used.)
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Thank you to all of you for your feed back. The Elder Law Attorney charged $400 for the meeting. I believe it lasted 2 hours, or just under. I was included via phone. I took many notes, and thankfully had already done so much research, it allowed me to understand the terms she was using. The fee for their Life Care Planning is $14,000 for the first year. They do believe my dad would qualify based on "at need" medically for long term nursing care. He is a lower leg amputee, has non-controllable diabetes, stage 4 kidney disease, and will soon lose his other foot/leg (at which point my mom will not be able to care for him at home). She was given a lot of information which I am helping her decipher. It's very hard for her to cope with losing half of their assets (basically all in checking and savings). She understands that it isn't just frivolous spending, but knowing at the end of this that she will no longer have that nest egg to survive on is quite scary. The assets also include her inheritance from her parents, sadly. Would you believe, the attorney didn't even want mom to take her "Christmas Club" $ out of the bank, which she always does this time of year. Lastly, to save the house, the attorney recommended she put it in a trust, as long as she can make it 5 years without needing Medicaid for herself. Now mom just has to decide at what point she retains their services and starts the process. It sure isn't an easy decision.
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Carry, 14k for the 1st year!?! No way that is robbery.

Please go to www.nelf.org and find a certified elder law attorney in your area and find one that does free consultation. I interviewed around 12 attorneys and I was quoted as high as 12k and ended up with a certified elder law attorney and i spent 12 hundred for something that another attorney wanted 12 thousand for.

It is so important to find an attorney that can be trusted, not all can and it is a highly competitive industry, so please do interview others.
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CarrieLockhart Oct 2019
Oh goodness, really? I thought I got their name off the certified list. They are called Elder Law of East Tennessee. See, we had no reference as to how much this whole deal would cost. Of course we thought that was a lot of money, but they will take care of POA, Will, Trusts, and any forms to get dad taken care of with Medicaid. No extra fees for phone calls, emails or extra paperwork. Hmmmmm, I will let my mom know about your comment. Thank you for answering!
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Carrie, I don't see anywhere on their website that says they are certified as elder law attorneys. NEALA provides information on attorneys that do elder law but that doesn't mean certified.

I would do some research, I know that legal fees vary by region but this pay one astronomical fee annually and that is it is a common theme in the industry. I believe that you are paying way to much for services that you may or may not need.

As far as filling out the Medicaid application realize that you will be providing the stacks of paperwork for the application, so it will not be work free. I think that there should be regulations on these law firms that are selling packages. It's almost criminal the amount they charge.

It is worth the time to interview several attorneys.

We also clarified that they could act as fudiciaries and that they had a future plan to ensure that they were around when we needed them.
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Carrie - whoa! 14 large yearly for “Administration”, good god NO!

I gotta ask, just how much $ do your folks have? Are they a higher net worth couple that have all sorts of stocks, Tbills, CDs, land, other investments?, like they file business, interest & partnership stuff for taxes each year? Like 700k-1M+ portfolio excluding their home? Folks in that planet maybe, maybe need 14k oversight a year, imo. But folks on that planet, have it so their $ is actively making $ so 14k can make sense to do. & likely they have a financial advisor who already manages $ & stuff has been placed into non-probatable ownership for the future.

Most of us dealing with our parents & LTC Medicaid have it so that their at the point in their financial life that it’s all outflow..... their $ is NOT making $. It’s all spending out, no more asset building. Their on SS & maybe another retirement income and it’s all just outflow to keep up with costs of living & copays. If this is your folks, they can’t afford 14k annually till forever. Goodness if mom lives another decade, that’s $140,000.
Please look at the contract in detail, is it truly 14k every yr from now till mom dies or herself needs a facility & does it include getting her filing done whenever that is in the future & then just who is gonna pay the 14? And includes tax filing from now till forever?

it sounds like you don’t live where they are, is that right?
So anyway you can get to them for a week / 10 days to ferret out financials so you can lay eyes on stuff and set up appointments so you & mom can both go to see other attorneys? Maybe long Thanksgiving?
if they are still in the old homestead where you grew up, get on your HS alumni group and put a call out asking who others have used. There’s going to be others who have & are currently dealing with your exact situation. Ditto for talking with your folks neighbors but imo this better in person when you come in. Look at their church bulletin to see if there are attorneys. 14k is outrageous, there’s gonna be another attorney.....

oh the no Christmas club $ is cause they want to make sure no movement of $ over $600 done for last 6 months. $600 is the tipping point for IRS reporting on 1099’s. Now if mom say needs to pay $850 for the termite guy to do something or pays $50 a week for yard guy cash that’s ok as that payout can be justified and there’s an bill from a company or a person.

Pls. do your best to calm mom tho’, bet she’s overwhelmed and in major fret mode. Telling her you’re coming in for Thanksgiving will help that.
good luck and let us know what all you find out. We all do learn from each other.
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CarrieLockhart Oct 2019
My parents have nothing but checking and savings, a house that is paid for and two (paid for) trucks, one that has 410,000 miles on it. They have no pension retirement or anything like that. My mother is excellent in budgeting and saving. I live in Indiana, but yes I could absolutely get down there for a few weeks, as I do not work outside the home.
What she needs is someone to put her house in a trust, help with getting my dad medicaid as he will no doubt need nursing home care after he loses his other leg, and to set up POA's & a will. The estate planning attorney's she first met with, would charge $150 each to draw up the POA & will.
The consultation fee of $400 at ELET can be put towards the $14,000 Life Care Planning fee if she chooses to retain them. That covers the first year, after that it is like $3,900 if you choose to keep in continuous contact with them. Otherwise she can just schedule a 2 hour meeting to check on things.
Also, the $14,000 fee can be paid for out of the "spend down", not that that makes it any easier to swallow. The owner of the firm, Amelia Crotwell, is a certified Elder Law Attorney. They are out of Knoxville. Attorney Bailey Schiermeyer is who my mom met with, she is not certified at this time.
I cannot thank you enough for conversing with me. This is truly an eye opening experience that a lot of people just aren't prepared for.
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Does she live near children. May be smart to be closer to family. A trust does not protect your home or assets from Medicaid . See Elder care attorney n take notes. Your mom needs someone to be with her when she goes to the attorney.
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This is why so many people try to keep their LO in their own homes. It's outrageous that we have to give fifty percent to the nursing home while the spouse is living in the house. That is ridiculous. All of your hard earned savings where half of it goes to the nursing home. That is why so many people stay right in their own homes. My Mother on the other hand, gambled all of her money away. The casino has all of her money. She has a house that she bought in 1960 for $50,000. She will be lucky to sell it for 50,000. It needs so much work, everything is outdated. Same furnace is in their. But, no money to fix it up. So if she goes into a nursing home, all they will get is the house. She has no savings left. It's a shame to save for retirment. Nursing homes will get half your hard earned money!!!
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In other words, you have to be super RICH or super POOR to qualify for a nursing home. The super RICH can pay for it and the super POOR can qualify for it. The middle class. Yeah, well, we're screwed, lol.
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igloo572 Nov 2019
To me, yes $ is always a factor, BUT, for the “poor”... the ones who are already low income or at whatever your state has set for poverty level... they have experience at navigating the questionnaire’s, documentation, paperwork that is needed to be filled out to be eligible for “at need” programs. And doing the whatevers needed to be eligible the state or the county caseworker or the giving out stuff nonprofit quickly.
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Be careful putting a house in trust. My brother was going to do it. But that meant his daughter would OWN the house. He said we could get into a fight and she could technically SELL THE HOUSE RIGHT OUT FROM UNDERNEATH ME!!! You think it won't happen. But you also see how many relationships go south. BEWARE!!!
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CarrieLockhart Nov 2019
The Elder Law Attorney said she could sell the house even while in the trust, to get into something more comfortable. It's some kind of trust (I forgot the name) to where as long as she makes it to 5 years without needing Medicaid herself, the nursing home (where dad will be) nor the state can come after it even after her death.
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Please contact an elder lawyer in your own state!! It is worth the money to speak to one, but it is enough to make your head spin. I know. I spoke to one.
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Your parents are entitled to live where they want, & if the new home is still in both their names, there's really no difference, is there? Agree with verifying this with an elder attorney, (who would probably have great ideas about how to protect the kids inheritance in the future also).
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Downsize to something smaller and easy to manage in the nicest place possible. Get financial advice re the balance of money I assume they will have for the best way to keep it. Then slowly draw it down and hide it. Seriously
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Carrie, please check your PMs.   

I've done some checking on the TN attorney and definitely would NOT recommend the exorbitant plan she proposed.    This suggests to me of someone who has a very limited practice and wants to get as much as she can from the perhaps one client she may get.

The annual "maintenance" fee is nothing I've ever heard of.   There's a word for this kind of financial squeeze, but I can't think of it offhand.
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