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pdpsinc - it doesn't look to me as if your question was really addressed. This thread where you have posted started back in 2011 and pretty much concluded in 2012. Please post your question as a new topic so it will get current dated activity. Look to the right side of the page where there is an empty box and the caption above says "Ask a Question". If you would please do that, your? Be lost in this old material and you will get some fresh and helpful answers. See you over there!
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HI,
Home Health Care service is the best option for your mom,With home care services patient can live independently and happy and you can get almost any type of help you want in your home.
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My Mom has lived with us for 5 years with Alzheimers. My wife was compensated for caring for her but she has deteriorated. We are trying to see wheher we can have P/T Nursing come in or transfer to a NH. I have POA and Healthcare Proxy. All of her assets are depleted and my wife has files taxes for the payments. Where do I turn now?
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Billiejean - can you post this as a new question,. this thread is back from 2011 and your ? will get lost. I'd post 2 questions one on how to deal with a reverse mortgage (RM) and then asking about other who have dealt with frontolobe dementia. OK?
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This is new Question: we have reverse -mortgage on our town-home and our HOA payments cover utilities,insurance....but we pay property-tax.My husband has frontalolobe and is becoming difficult to control. I do not want to put in nursing home but I'm afraid he will escape and we live close to heavy traffic. Will I be able to keep my pension and part of savings.I'm only 82yrs.old and I do
not mind paying what we can..but want to stay in our home.explain how they will divide our savings ?
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This is all a lot of information and I'm trying to digest it all, but if you all can give me some helpful information regarding my situation I would greatly appreciate it.
Here it goes.
Mom-85
Has mobility issues due to a disease called Arteritis -Inflamation of the small arteries in her brain, which creates a lot of havoc in her body. Lots of pain. Has good days and bad. Compounded issue with her bad back and now walking issues.
Her mind is in tact. No dementia. Just plain Narcissistic Personality. Hell on wheels. Those who have one of those, know what I mean.
Still handles her check book. I was finally able to convince her to let me open it. on line . Now I can see her accounts, but she still insists to write her own checks.
She owns a Condo. It's in a Trust, with my name on it. In fact I just paid the yearly fee.
She is very guarded about her assets. She stated lately she has Cash in the House. Car is in both of our names. I'
I'm an only child. She lets me in on some things but still holds control and I have a hard time discussing as to what will happen to her if she can't take care of herself. I will not move in with her nor will I take her in. The nastiness of her personality I believe would be detrimental to my health. I'm not willing to sacrifice my mental and physical health for a woman who has been horrible to me all my life, but I do have a soft spot for her because she is my mother and I'm nothing like her, so I want to be able to handle the situation when it will come.
My mother does not want the Government to get a nickle. To a point that she keeps her cash at home.
Her total income including her SS is about $1400.00 per month. Condo paid for. She only pays the Taxes and Association. Supplemental Health Ins.. Car is all paid for. She is frugal and manages her money well.
The question is: If she becomes in capable of caring for herself and needs to be in a NH, will she have to surrender her Condo even though it's in a Trust? It's been in a Trust for over 25 years. Half of it is mine.
This sounds bad but I have to ask. Will I loose half the Condo Trust or be financially responsible for her in any way?
Any advice or input is greatly appreciated.
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Karen - 86 is still young and the real hurdle in this for you all will be that most places will want her to go into AL rather than NH as she appears still independent and capable of most of her ADL's. AL in most states is all private pay which range from 3K - 6K a month and most states Medicaid program do NOT pay for AL. Although some states have a Medicaid diversion program that does this but you have to be on a waiting list and qualify for Medicaid in all other ways except for skilled nursing needed. Call to see if your state does a AL diversion program. Start looking at NH and look at lots of them and do this without mom & only those that take Medicaid. It can be depressingly overwhelming so pace yourself and do what you can on-line. I've been where you are, sort-of.

Most NH admissions come from a hospital discharge. If an individual covered by MediCARE is discharge from a hospital to a nursing home for continued care (rehabilitation) after an inpatient stay of at least 3 days, Medicare will cover 100% of the first 20 days and MAY pay up to 100 days, subject to a co-payment by the patient of $141.50 per day for days 21 to 100 (for 2011). Medicare does not pay for the many months/years that some people reside in a NH for long-term custodial care. In general, Medicare is limited to short-term acute care.But this MediCARE paid period of time in the NH is when you need to get the documents together to apply for MedicAID. This is the easiest way to get them into the NH.

BUT if If they are living at home or in IL, like your mom is and my mom was, AND they need to move to a NH, you will need to work with their MD to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, or forget stuff, etc. is not enough. They have to have documented need for skilled nursing. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. Sometimes the MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med to one that needs to be compounded daily which you can’t do at home. Understand? Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH and often are denied because they don’t have enough “critical” conditions because there is no history when living@ home (unlike coming from a hospitalization). You will have to work with NH and your parents MD’s to get whatever done to establish the need for NH if they are coming from being at home or IL. There is a whole Medicaid medical appeals process in each state for this and separate from the financial appeals.

For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is really good as they will know how to create & write up the overall health history chart so that it passes Medicaid medical review to get them into the NH they are medical director of. It may not be the NH that is your first choice but once they are in and on Medicaid, it is easy to get them moved to another NH. My mom is now in her 2nd and much better NH.

Now this isn't very kum-ba-ya, but if she should have another fall that provides for a 3 or more day hospitalization (3 day minimum needed for rehab orders to be done), then social services at the hospital can expedite finding a NH for her.
Good luck and keep a sense of humor.
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Hi, I am in a positon that I need to find out how to go about getting my 86yr old Mother transitioned to a Facility. For the past 11 years my husband and I have been taking care of her and now for the past 6 years her health is failing. She has mild demetia, parkinson, high blood pressure and we have been informed just this past Aug with a trip to the hospital, that she has had mini strokes and has had a heart attack at some time. She continues to fall, uses a cane but is very off balance the stairs have become very difficult for her and because she lives with us and we have a two family and we are on the top floor she has a converted two bedroom made into a studio for her. She is still somewhat independent that she washes,dresses, cooks for herself. We are just finding it extremely had to work and take care of all her needs. She only has ss, medicare and blue cross. Do we need to get her on Medicaid? How do I get started on getting her on waiting lists? There is no other money for that is why she is with us and we certainly are not in a postion to pay privately.
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There are great answers above especially from Igloo-first you need to see an Elder lawyer that can be paid from the elders assets-Medicaide is for those people who are really needy not for those whose relatives are able to hide assets-when you choose a nursing home the social workers can do the paperwork and very soon you will know how to proceed-if they have assests above what is allowed they will have to be self pay until they spend down and really that is what their money saved over the years should be spent on care for them when they can no longer take care of themselves.
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Tweet - 2 years? So I'm guessing mom about $125,000 to $200,000 in assets. You are fortunate that this $ enables you to do things for her - like new top of the line hearing aids, wheelchair or walker, expensive dental care, several pairs of new glasses, new durable and easy on&off clothing, cable, etc and other items that Medicaid will not ever pay for and you can buy for her. Also you can buy and pay in full for all her funeral and burial expenses with her $. She can pick & choose which NH to be in & pay for extra caregivers. You are not loosing $ per se but spending mom's money on mom's needs & mom's care when she needs it most

This site has articles on Medicaid Medicare and how they are different. Also if you go back on this post to the beginning there are posts from myself & others with our experience in going thru the NH & Medicaid.

What you need to realize is MedicAID is a needs based program. So in order for your parent or anyone to participate and benefit from MedicAID you must be at-need. "At Need" basically mean they have +/- $2K each in assets and monthly income in order to qualify. But can have a home and a car (which are exempt assets). At-Need basically means they are poor and at poverty level. All their assets and income for 5 years prior to admission to a NH must have been used for them or their care (like private duty nurses or home health care agency) or their wholly owned property (like their home). If everybody could go and empty out our parents bank accounts and transfer all their property for zero to others today, and then apply for Medicaid tomorrow, the system could not pay for it and there would be no Medicaid program for anyone to be able to use.

If any assets or monthly income are transferred to you or others, then the state can impose a transfer penalty against the elder via their representative (this would be you as her DPOA) for the amount of funds based on the state's NH Medicaid reimbursement rate. The transfer penalty is a total cluster to deal with as it usually happens after the elder has been in the NH - perhaps for a few months - and then the state in it's require due diligence has found that mom transferred a car worth 20K and cashed in a 10K Treasury bill before she went into the NH. 30K transfer penalty. What will happen is that the state will send whomever is the residents family contact and the NH a letter that the elder is out of compliance with Medicaid and the $ amount and length of time. NH will require you come up with the $ and sign off a promissory note &/or hefty deposit or you get the dreaded 30 day notice (that they have to move and believe me no other NH will take them except by private pay contract with a deposit upfront). This is a total panic situation to be in and a terrible situation to place you parents in.

So in Texas, whose transfer penalty is about $ 145 a day, a 30K transfer would mean someone would have to private pay for 210 NH days. Each state's transfer rate is different. TX is a a low Medicaid reinbursment rate state.

Remember if and when you apply for Medicaid, you, as DPOA, basically sign off on an all-access pass to all your parents financial and legal. You have to provide for 3 - 12 months of their financial and asset and income information with Medicaid application. Which the NH usually vetts before they will even accept a resident as "Medicaid Pending". Many NH which have multiple homes have a regional admissions person who reviews whatever you provide before it even gets sent by the NH to the state program along with the NH's bill.

Property records are recorded by the local assessor and then folded into the state's data base, so moving property ownership will come out. Interest paid on savings or investments are available via IRS or state, etc. All their info is just keystrokes away and eventually it will be found out. If your state uses HMS for compliance, they will be able to find out to the penny every cent spent as HMS has a extremely good system via algorithms for compliance and recognizing patterns of fraud. HMS does compliance for Medicare (via CMS) & federal insurers.

For my mom, she was in IL before the NH, so her 6 months of bank statements (sent with Medicaid application) clearly showed where all her $ was going (to pay for IL) and showed a steady decrease in assets with nothing different or unusual. Even then, I had to go to her bank and have a bank officer do a detailed letter of all accounts, CD's etc. closed and where the assets went for 3 years prior. Fortunatly all closed went into her single checking account, so this was simple but took about 3 hours at the bank and I went prepared with my legal and all her account info. This letter was submitted with her initial application which ran over 100 pages of required documentation. Is it a total PIA? Yes, but every day I am grateful that the Medicare and Medicaid program exists as there is no way she or I could pay or provide the level of care that her NH provides for my mom, who has Lewy Body Dementia. Imho, if they live long enough (my mom is mid 90's) they will eventually run out of $$ and the caregiver will run out of ability (and humor) and thank goodness there is Medicaid for them available.
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What does "spend down" refer to regarding a parent's countable assets? Just saw an elder law attorney last week. He said I will lose whatever money I was to inheirit because now I have to pay it to the nursing home and it would be at least 2 yrs. of private pay before she would qualify for medicaid. This is unreal to me. Can't I transfer these funds into my name only? I have power of attorney and the doctor has now deemed her incapable of making her own decisions.
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Mayo - Medicaid pending is critical - like 195Austin said. If they are not, then take that NH off the list. At this point, it sounds like she needs a placement super soon. keep in mind that you can always move her to another NH later on once she is on Medicaid and past that hurdle. Moving from 1 Nh to another is easy paperwork-wise although can be tough on the elder. Good luck and keep a sense of humor
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The above answers are great also I would add visit all the nursing homes close to you call ahead so you can get a tour-just visiting will give you a better idea of what they offer I think you said you had one in mind when you callmfor a tour ask to speak to the social worker-most social workers will be able to talk you through the medicaide application which is daunting and she may be able to be admitted medicaide pending while her financies are gone through-she may have to be private pay while she spends down but the social worker will be able to help. As for not wanting to place her -no one does and you have done all you can for her and now is the time for her to leave her home -you will still be a large part of her life just in a different setting and she probably will enjoy seeing other people-keep posting and leting us know how things go-there are so many people here who have been where you are and do want to help. It helps to keep a written record of who you talk to and about what it was and the answer -you will be talking to so many people your head will spin and no one can keep it all straight in their head.
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Hi all, I am in the same situation with my mom; she is 88 yrs old, with severe arthritis, has been @ the hospital for pneumonia, younger brother taking care of her, she has fallen and is stubborn as well, for the many times I have told her we need to look ahead, get a name on her bank to take care of her bills, get a power of attorney (this conversation took place 3 - 5 years ago), she now can hardly write her name. Older brother "pushed" her to refinance her home to help him, he broke promise to repay & left her, she lost her home and another brother and I were able to find a home that her medicare/medicaid helps to pay, along with her ss (less than 1k a month). Now, I need to find a NH to place her and need help on how to go about. any suggestion? Mayo
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my mother is 86 years old she recently had surgery to remove cancer from her intestines, she cannot take care of herself, she is low income on social security, i am looking for a nursing home for her can you give me the names of a good nursing home for low income people
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I am also in the same situation. I am appalled at the judgement of dfem! You don't know the whole situation at all. I've lived with my mother for 10 years and am unemployed as well for the last 3. Unemployed so I can take care of HER! And she's mean, nasty, cantankerous and hateful toward me. But she's lost her mind. And it's not her fault. But I'm at my wits end and cannot go on much longer. My family relationships have been totally sacrificed for her benefit for the past 10 years. I am stressed to the point that it's starting to manifest in health issues. But I'm desperately trying to keep my word NOT to put her in a nursing home. She does not have alzheimers, but has Lewey Body Dementia. It is simply unfair to judge someone about this. Just because you have lived with your mother for 7 years doesn't give you the right to assume the situation is the same for her brother.
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this ia great information thank you so much.
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Deedee - this site has a # on articles that go into details on how MediCARE and MedicAID are different. You really need to familiarize yourself with what they are so that you can keep yourself organized. It can be quite confusing at the beginning (and in the middle and still for me after 3 years of dealing with this for my mom and MIL - lol).

It sounds like her income is like $ 3,500 a month? If so she will need to get at Miller Trust done even after you spend down to the 2K asset situation. You will need an attorney to do this - they are simple and done all the time but have to be done by an attorney familiar with Medicaid regulations & probate laws for your state.
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Deedee this will be long.......NH (aka skilled nursing facility/SNF or long term care/LTC) is paid for 3 ways: 1) private pay by elder or their family; 2) from LTC insurance; or 3) by qualifying for MedicAID. Medicaid and not MediCARE.

MedicAID rules determined by each state & are state specific even though it is a federal & state program. Medicaid is needs-based. You are expected to spend your assets first and foremost before the state will pay. There are things you can do to reduce assets but these need to be done by someone qualified to do this that will pass your state's review. An certified elder law attorney is best.

For NH Medicaid eligibility, an individual must show that:
1) are 65+ (can be younger if qualified disability),
2) medical condition requires skilled level of nursing care,
3) monthly income at or below their states max (about 2K),
This is the “income test”– how much $ do you make. TX is $2,094.
4) all countable assets are at or below 2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.

If you do, could be a “transfer penalty” when items are gifted. Penalty different for each state as it’s based on each state’s daily NH reimbursement rate. For Texas, it is $ 142.92 a day rate (2011).

Max look-back is 5 yrs. Most states require 3 – 6 mo. of financials with initial Medicaid application. Can require more financials if something pique’s interest. Financials are bank statements, social security and retirement statements, insurance policies, etc.

INCOME: If it is that every month they are over the states income limit BUT not enough to pay in full for the NH and qualifies for NH in every other way, then they can see an elder care attorney to do a "Miller Trust" or a "Qualified Income Trust". Say mom gets 1K from SS & 1,500K from retirement every mo. Income=$2,500. Basically $ 500 over ceiling for monthly income. No matter what is always is $500 over. So this excess $ 500 is what funds the trust and therefore mom’s income is now 2K and within the states income ceiling. The beneficiary of the trust is state's Medicaid program and upon death reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible/adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules.

ASSETS: All assets are counted, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle (some states have a limit on the value)
- their principal residence, provided it is in the same state in which the individual is applying & the house may be kept with no equity limit if the "community spouse" lives there; otherwise equity limit is 500K (750K in some). House does NOT need to be sold, is a "non countable" asset but elder will have no $ to pay for anything for house as all $ less a small personal allowance has to go to NH each mo.
- prepaid funeral(irrevocable, NCV, usually 10K max)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life, rental property) are counted.Must “spend down” to get to their states max to qualify.

The financials are what most folks focus on. But remember that they also need to medically qualify for the need for skilled care for Medicaid.
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wow alot of good advice from people that know wat I am going thru. THank you for your words of wisdom. I need now to grow a spine and figure out how to get her in to a nh . she makes too much money to qualify for medicaide but lacks 3500 to get into a nh. that is where I am stuck. do I just let them take her house and everything?They said that medicare would even cash in her life insurance policies. Well how in the world do I pay for her funeral?
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deedee -
can you repost your question in the "ask a new question"
Your post comes up in a ? from back in 2011 so a lot of folks will just ignore it.OK.
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i came acrosss this message because I am in the exact same predicament. I am stuck with my mom now at my house for the last three months cause doc said she cant be by herself at home. she spent all her money down except house and refuses to sell it. even if she did it would last her one year in a NH and then what she still wont qualify for medicaid for 4 more years. What do I do. My husband left me my son is not staying home because of her I cant work am losing my house because I have to take care of her. I need help
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Your brother did what many elder children do -try to avoid NH because they want the home for themselves-I am glad things worked out and she is away from him when she gets medicaide they will own the house and your brother will have to find another place to live. You should write a letter to the hospital where the ER doc was so cluless -write it to the adminstrator and let them know in 2 weeks you will send it to the Board of health and to the Gov. of your state and to the media unless you hear from them within 2 weeks. Whatever is brought to the attention of the BOH will be included in the hospital's next inspection so even though they will try to whitewash the occurance they will not be able to avoid it comming back to bite them. If she had not been placed I would have encouraged you to report your brother to APS and they would have looked into her lack of care from your brother.
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Now you and your brother can wonder "who will put me in a nursing home and not have my family care about me?" If someone is unemployed how the heck can they not care for someone? I work full time and have been taking care of my Mom with the help of the county of aging for 7 years now. There are daycares they can transport them even if in wheel chairs to get them out of the house and around others for entertainment. There is no excuse for taking the easy way out like it sounds here. People don't know how to give up on the things and the people that take their time away from their family. I just say no to people that try to take my energy away from what I need to do for my Mom. She did it for me so I feel it's only right to do this for her. Very selfish country we live in that's what it's all about.
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I'm sorry it took me so long to answer. I thank everyone who responded to my question. My mother took an even worse turn on Tuesday and we had to hasten her admission to a nursing home - thank God we were able to get her into the one of our choice that very night. I transported her from the ER to the NH myself, where the nurse on duty picked her up out of my car and put her in a wheelchair. My worries about her screaming and crying about leaving her house were all for nothing - she totally accepted going to the NH as she knew she really couldn't get around anymore without help. The arthritis in her knees is so severe, there's no way she can walk now. All I can say is I loved her more that night than ever before because of how understanding she was about going into the home. I always thought I would have a helluva fight on my hands but, in the end, she knew it was the best thing. She's very happy every time I see her now and she's making friends and playing bingo. Someday I'll tell this board the tale of the extremely uncooperative doctors, ER and hospital social workers, who all did absolutely nothing to help me that desperate day my brother and I knew we would be unable to bring her home from the ER. It was like being in hell that day, but it's over now. Now I face the financial and legal problems of dealing with my brother, who has lived in the home his entire life and been unemployed for almost ten years. We have an appointment with a lawyer next week and, after researching elderlaw and Medicaid apps for the past 5 years, I think I know what lies ahead. He has the option of taking over the house as a "caretaker child", but he does not have an income to pay the bills. I think he's hoping to get some kind of lump sum for being her caretaker these last few years, but I know doing that will put our Medicaid app in severe danger. Well, at least my mother is finally in a good, safe place.
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My mother went to a nursing home permanently, directly from her home. I did not have medical power of attorney, or any other power of attorney. She had been paying caregivers, and when the money went down to Medicaid eligibility limits, I contacted the nursing home. Her doctor wrote orders. Someone, I can't remember who, contacted the Area Office on Aging, who came to evaluate her Activities of Daily Living, one day, and the next day I admitted her. It was the hardest thing I had to do. Since your brother is still living in the home, this could create problems. I had belonged to the Alzheimer's support group, and they were of great help. I had people who were on my side, and I had people who thought I was the worst person in the world. But, for me, I only pay attention to people with initials before or after their name, such as MD, PHd, LPN, RN, LSW, or someone in authority in the Church. You can contact the Area Office on Aging yourself. If you can't find the number, you can get it from the nursing home you plan to take her to. If the Office on Aging knew just how cluttered, and possibly dangerous it is at your mom's house, maybe there is something legally they can do. Is your mom on the waiting list? When you want to take her there, there may not be an opening. In the meantime, I would try to get more caregiver help. I realize that it will be awkward with your brother there, and he may be giving you trouble, but you need help. And they have seen clutter.
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My mother was fist admitted to the hospital when she kept falling. I toldher socia worker she was getting worce that I anted her to get 25 hour care I found a facility for her thats ho my mom got admitted to nh permittly because she was too difficult to take care of. either talk to her Droctors or social workers if your mom ha one tell them the situation. shop around for a good nursing home rehab first that's hat I did. my mom had acase orker through socail services for her being on medicaid global options and adult protecive sevics how that happened as mymom was living withmy nephew he negelcted her I took her out of bad situation.
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IF her doctor is willing to say that she cannot care for herself, she can be admitted to a NH with his orders. Some bring their family member right after a doctor visit when the doc does a history and physical for admission to the nursing home. I wish you the best in taking care of your mother.
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