MIL owns her house. She needs long-term care and must apply for Medicaid. Can we sell mom's home before or after applying for Medicaid without them putting a lien on it? She lives with us now. Or is it best to not put on Medicaid and have hospice service?

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To me what to do is interdependent on a # of issues. The biggest is what type & level of care is she needing? In order to go into LTC care in a NH & onto Medicaid, she is going to have to show documented to be “at need” for skilled nursing care.

If what’s happening is that’s she’s still ok on doing her ADLs and is pretty cognitive & cognizant and it’s more medication management issues and redirection of her repeating stuff, that’s likely not goIng to have her “at need” for skilled. That’s more AL and most states Medicaid programs do not cover AL or do so on a very limited basis. Her doc can write orders for skilled care but it has to be backed up by a detailed health chart that shows need as well. Often for those living in their home or in IL or with families or, the documentation isn’t there. The majority of NH admits come from a post hospitalization discharge to rehab & rehab is in a facility that is also a NH. They stop progressing in rehab - hit a plateau - and it’s determined that they cannot return home and be safe, secure and functional so they transition from rehab to permanent Ltc resident. They have a fat, detailed hart showing need with current meds & codes & lab work. And go either private pay, LTC insurance or become financially “at need” to be eligible for Medicaid LTC program.

I’d suggest you get a needs assessment done on her to have a true idea of what her “need” is. NH will have names of those who do these. Usually are a 2 person duo of an RN & MSW to do a 1-on-1 with her.

If you don’t and she goes into a NH, the state will send a team out and in my experience they are pretty detailed rigorous in their evaluation. My mom did the jump to hyperspace from IL to a NH totally bypassing AL phase. It took about 5 mo. of every 3 -5 week visits to her gerontologist and lab work and mini mentals to get her to the point of being clearly documented “at need”. She was not hospitalized. Looking back on this in hindsight, it was quite quite unusual to clear the medically at need hurdles. If you go this route, I’d suggest that she become a patient of an MD who is a gerontologist and also is medical director of a NH. They will know what shows need.

As others have posted, in home hospice isn’t 24/7 care. Hospice - a MediCARE Benefit - is maybe 2-4 times a week for 4 or so hours per visit but hospice does bring in special equipment, nutritional, etc. But all other times when hospice isn’t there, family is fully expected to be present and deal with anything that comes up. Only if she is perhaps very end stage and very ill - like super septic - or on involved black box warning pain meds would she be able to stay in an in-unit hospice. Bigger cities have these. My late mil went from hospitalization to one and died abt 3 weeks later. She was super septic, contagious with cascading organ failure. Hospice is an awesome program but they have to meet the criteria to need it and from 2 different MDs.

About the home, if she’s gonna sell it to me it’s best to do this ASAP, at FMV done by a Realtor & before she enters a NH so that she still has $ to deal with costs that always creep up in selling a house. It kinda all should be paid by her as it’s her home. If you pay for her house repairs, or utilities or whatever, she really cannot reimburse you from house sale $, as Medicaid look at that as gifting. They seem to basically take position that you do for your elder out of a sense of familial duty & for free. No compensation. House sale $ will need to be spent down by her paying for the NH.& when she finally become “at need” financially can she apply for LTC Medicaid.

If shes owns owns the place since forever, you may want to get it inspected and appraised as often the tax assessor value is based on renovated comps, which her house may NOT even be close to. If there’s a big gulf in assessor & what Realtor thinks it could sell for, I’d get it appraised so no blow back from Medicaid for lower sale value.
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Also FYI Medicaid can "look back" and claim any assets for the 5 years prior to her applying.
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please remember hospice in your home is not 24/7 care. The majority of personal care is still family. They will provide supplies, a bed, a visit from nurse and aides a couple of times per week. It can relieve part of cost of care. Parent will have to be evaluated to see if eligible.
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Are you aware that the proceeds from the sale of the house will go toward her care? Medicaid won’t pay for her long term care until that money has been spent down. You can sell the house before she goes on Medicaid, just be aware that it has to sell at market value and she won’t be eligible for Medicaid until the money from the sale is gone. Medicaid may place a lein on the house before she dies, if that happens, you have to satisfy the lein and pay back the money Medicaid has spent on her using the proceeds from the sale of the house.

Are you aware that hospice won’t provide 24/7 round the clock care? If you put her on hospice, family or hired caregivers will provide the majority of her care. Medicare will pay for hospice but not room & board in a long term care facility.
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