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My sister and I have been taking turns taking care of our elderly mother in our homes. Our mother spends 2 months with each of us. Neither of us have had to make any modifications to our homes - until now. Our mother is currently in rehab and has severe dementia. The social worker has told us that she will need 24/7 care. She said modifications to our homes would be necessary to keep my mother safe if we decide to keep her at home. These modifications would include handicap adjustments to bathrooms she would be using, flooring that she may trip on (she already has tripped twice on a carpet and slipped on hardwood floors), and purchasing some items to make her stay comfortable like a new TV (she broke the one she was using last time), recliner with lift and heat, and new clothing since she has lost over 50 lbs in the past few months. We would much rather keep her at home rather than go to a home at this time.


My question is this: Can my sister and I both use money from my mother's bank accounts to cover these purchases without affecting Medicaid spend down rules? I am in the process of finding an attorney to help us with Medicaid but would appreciate any insight from someone who has already gone through a similar situation.


Thank you!

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Geaton is spot on regarding the 2 homes issue. Anything federal or state is going to require that there is a “principal residence” & this 1 address is affixed. Moms going to need 1 home to be her address.

On the “modifications”, there are items mom can buy that are not permanent, that are not a spend of her $ on something physically done to either of y’all’s property. She can buy adaptive bathing items..... grab bars that affix over a tub, bathing chairs that go from the side of the shower into the shower, toilet safety seat. She can buy for herself an extra sturdy walker. These type of items are not permanent so require no changes structurally to you or your sisters homes. Should mom spend $ to do things structurally to y’all’s homes, that’s what Medicaid will have issues with. Like mom cannot pay for a renovation to a bedroom or bath or rebuild doorways to make it easier for her..... it’s not her property, she’s spending $ on someone’s else’s asset. That’s what Medicaid will have an issue with. Comprende?

She can use her $ to buy herself new clothes, shoes, extra pair of eyeglasses and hearing aids. She can buy herself a TV or a radio or large print magazine subscriptions. It’s that what she spends her $ on needs to make sense for her use. So 18” TV is fine but a humongous 54” one isn’t. Medicaid expects them to buy things for themselves & replace clothing & toiletries. But she can’t be outfitting 2 homes with her buys.

That SW who told you things mom needed..... ask her to provide for mom a precise list on her SW letterhead (w her state licensing info) or the agency she works for letterhead as to “needed” by mom. That will help should Medicaid question a spend.

Question for you, since your aware of Medicaid spend down & you’ve been told that mom needs 24/7 oversight AND mom is right now in rehab in a facility...... why are you planning on moving her back home(s)??? Why isn’t it an option to have her stay at the facility and transition from a rehab patient (MediCARE) to a LTC resident (& apply for LTC Medicaid)? If you know a facility is in her future, why not just let her stay there? She’s likely gotten used to the staff and rhythm of the place. Plus She’ll have the nice fat health chart to show medical “at need” for skilled nursing care that Medicaid requires.

24/7 care & oversight with a severe dementia elder is not feasible at home unless there’s lots of dependable & willing family to work shifts or elder / family has the $ to hire help. Do you & yoir Sis have this? That going between 2 homes every few weeks for one with severe dementia is going to be quite challenging. Why not let her stay and become a resident at the NH?

As an aside, the “principal residence” comes up often as an issue when folks go thru a Hurricane as often house that got whacked was wkend place, or a camp or 2nd home and state / federal recovery programs will only be available for the principal residence. For H. Katrina & H. Harvey lots of folks had a home in the city and the coast & both got whacked. Only principal residence could apply for government programs. Govment strict on stuff like this
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RitaFGiel Apr 8, 2021
Thank you for your helpful advice. Mom would prefer to keep the arrangement we currently have. While she is in rehab, we are exploring all options for her.
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No, you can't use her money to make "your" homes accessible to her.

"These modifications would include handicap adjustments to bathrooms she would be using, flooring that she may trip on"

Definitely the above you cannot use Moms money. Medicaid looks at it as you will profit from the improvements if and when u sell your house. This will need to come out of your pocket.

"purchasing some items to make her stay comfortable like a new TV (she broke the one she was using last time), recliner with lift and heat, and new clothing"

These things I see no problem with. These are personal items for her use. The only thing I would question would be the 2 lift chairs. Medicaid may question the purchase of two. And why the need for heated ones? I just looked up the cost and they can be almost $2000. Better to buy a regular lift chair and a heating pad, IMO.

For the lift chairs I would look around and see if someone is selling used ones. Keep the cost down. Medicaid may question 2 chairs @$4000 but won't question a purchase of under $1000 for 2. I see no problem in buying one chair for her, I question buying 2. The motors in these are guaranteed. My Aunt got one from her sister and the motor died. Company came out and replaced it even though it had changed hands.

When Medicaid does a look back they ask for 5 years of bank statements. They look for large withdrawals and consistancy. You need to be ready to explain the large withdrawals. Lets say Mom sold her house and gave each one of her kids $10k. Medicaid would penalize her. Someone would need to privately pay for her care or care for her in their home or hers during the penalty period..
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RitaFGiel Apr 8, 2021
Thank you for your comments. All very good points! We're trying to avoid nursing home care and keep the living arrangements we had before mom got worse but it doesn't look like that may be possible. Mom does better with family and we'd like to keep it that way.
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Almost certainly these adjustments are not good for both homes, as Geaton surmised. Also, I think that it should be clear that to spend ANYTHING for your Mom you must be her POA. If that isn't done now it is too late to do it as she cannot appoint anyone. Such purchases FOR her then, such as recliner, would be done by writing check from HER account as "her name" by "your name as POA". Comingingling and spending from an account will put a hex on any getting approved for Medicaid ever, and I hope that isn't being done. As POA meticulous records of spending, reasons for and etc will need to be done, records and folders for receipts and etc. Hopefully already being done by the POA in the case, monthly account of assets in and expenditures out. Your Mom can also pay, with you as POA, for an hour of Elder Law Attorney's time. And do communicate with medicare in your state. In some areas, as we are hearing, changes can be made to the home, but only with THEIR approved contractors, and etc. You must be certain of what you do and keep meticulous records as you go here. That will be crucial if she ever hopes to collect medicaid.
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RitaFGiel Apr 8, 2021
Thanks for your comments. Very helpful!
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Thank you for your advice - much appreciated!
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The only "safe" answer is to ask Medicaid directly. The rules are different from state to state so you may not get an accurate answer on this forum. Also, if it turns out to be allowable I am very doubtful they will allow it for 2 homes, so you will need to pick one. But again, please contact Medicaid for your county to get the accurate answer to your question.
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