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My 77 year old mom and 88 year old step father live alone but need help. I live 2500 miles away. My sweet parents are still living in their home in Boise. My sister is handicapped and in a care facility that does a terrible job taking care of her. Parents visit her almost every day but have no control over her care. Mom has dementia but not diagnosed. Dad says she's fine just a little forgetful. He refuses to tell me what will happen if he passes before she does. Other than another sister that is estranged from the family I'm the only child. I live in Houston where I'm based as a flight attendant. I cannot move to Boise. Nor can I quit work. I'm extreme worried and concerned about what will happen to my mother AND my sister if dad should pass away. They have NO savings. I have no way to pay for care. I can't stand the thought of burdening society but I don't have any idea where to go for guidance? Dad keeps saying that she will die first or they will die together "Notebook" style. Mom forgets her meds, forgets things I say within five minutes, heart problems, diabetic, knee and back issues. Has had over 40 surgeries under general anesthetic through her life time. My only brother passed away very suddenly a year ago at age 53...Thoughts?

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Hi DLHM1939

Your feelings of being overwhelmed and lack of ability to answer some questions is totally normal. Working as a Geriatric Case Manager, I have seen and helped others as they launch into the abyss family. The first thing I would tell you is to take a deep breath. Overwhelmed comes from a situation coming into your consciousness at one time, when there is a lack of education and planning. Planning is a multiple step process. First – define, by your particular situation, what the questions are housing, in-home care, answers to medical needs, and so on. Now seek out what services are available in your parent's residential area. Many of the services will be available and paid for through social services (don’t discount these as a ‘handout’). Your parents worked hard for these resources and are proud of this community service they have provided. Sit down with a counselor from Area Agency on Aging, government funded program primarily paid for through the Old Solider’s Act and discuss what is available for your situation, from Veterans Benefits to Railroad Pension to private resources are very possibly available.

Second, pull together a plan of action to guide you when the time comes for, the necessary, helping your parents (This step rarely happens with adequate time for evaluation.). Knowing what resources are available is a key, to reducing the emergence in the in the event you have only a few minutes to get to their home (impossible, right). Pull together a list of your parent's friends and neighbors to put in place to give you four days to get there. Have in front of you what the final wishes your parents want are (not your wishes their wishes) being prepared at this juncture, of family caregiving, to initiate this a plan while on the road. Who is their medical provider, their clergy, their Attorney or legal representative that would know last wishes? Knowing where the resources are to help pay for final direction by parents. We can sit down with Funeral Home staff and have a plan of action before there is a need for it. These arrangements can cover costs of their final wishes and go as far as who speakers are, what information is in the flyer for services, down to music and possible physical help with memorial or refreshments following the service.

Third, marshal together your resources to depend on when the need arises. Knowing your parent's legal agent is a big part of this third step. Again many of these can be put together for you to activate in the very beginning of the situation, while you are making arrangement to get there. Have all of this written down with contact information from step one to step three. I would suggest a five by seven hard bound book to be taken with you on any trip or use when documenting any arrangements.

The planning, in the beginning, will very possibly stave off the overwhelming feelings as you are now knowledgeable in the situation. Delegation is the path to achievement; this is the culmination of which friends and neighbors have knowledge and can step -in with information giving you time to get there.
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I'm so sorry to hear what you are going through. I know its overwhelming trying to make arrangements for two elderly parents. I would start by talking to a social worker and see what supports you can access.
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You won't be able to soldier on without help. Seek respite, else you drop over and faint. That is not meant to be hyper critical. It is meant to imply it's the truth.
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You have received some very good advice here in other posts. Another idea would be to see if your parents, then your sister, could relocate to the area where you live in Houston. Just eliminating the distance would make everything easier for everyone. There are good elder care attorneys, medical facilities, assisted living centers and group homes for the disabled in Houston and nearby.
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Contact the local Office on Aging in the county in which you live. Your local library can help you get the number and location. That is a good starting point to obtain information. Good luck.
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Be wary of what novices tell you about LTC, Medicaid, etc. It's not simple and only a person who is specifically trained to know the rules and laws can give you specific advice. Which you should seek.

Also, it's not a moral issue. The legal utilization of current law, programs, assistance is perfectly proper and no one should feel awkward about using them.
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DontAsk4Handout gave a lot of useful and strategically critical information in the first post, to his or her credit. But I also think chastising the questioner, DLHM1939, for not planning ahead was off the mark. First of all, the parents... not all elderly people alive today thought they would live as long as they are living now, so putting big sums aside for care was probably not on their radar. Second, in the DLHM's generation, not all of us have had the long-term income or investment tools to put materially significant sums aside. I was 40 years old before I could afford to nurture and sustain a decent 401(k) and when I got the opportunity, I loaded that thing up. I think chastising the questioner for not thinking of this up front was not necessary, despite the advice provided being rock solid.
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Each state operates a little differently, so call direct to their state's Medicaid. Don't bother talking to those in your area. You will need Financial and Health Care POAs from your parents if you expect to move through the application process. Anyone can obtain an application, complete to the extent of information he/she can provide. If they had no money or assets then, and have none currently, still plan to get 5 years worth of documents to prove they had nothing. Bank statements show the date an account was opened/closed. If they own their house, locate title and tax documents. Pharmacy records will likely be requested at some point. Get several copies of their POAs so you can hand them or mail them to the requesting party.
If your parents will help you "organize" their papers - what little may be in their house to organize, that would help. Any health or homeowner insurance certificates will be needed. Tax statements that show the yearly tax bill on their house will be needed. Any motor vehicle tags and fees must be provided. If they have any life insurance policies, have those policy numbers & contact information at your fingertips. Medicaid will require all this and more, so get started.
You will soon learn what entities are willing to handle your requests quickly and professionally. Others will be like pulling teeth.
In our case the Medicaid agency and my spouse's supplemental retiree health program were the worst to "work" with. The state provides no means of assistance by phone and no local caseworker with whom to make appointments. It's a "don't call us, we'll call you" operation because, as the snf lady said, "they are so busy, you will never get through". True.

If your parents can not or will not help in the process, the less said the better. If you have POA you can request all documents be mailed to your address. This will bypass some of their resistance, since your parents may not hand them over to you.
Being tired and overwhelmed is a part of this process. If you occasionally can have a good day with a few "get away" moments or hours, make the most of them.
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I am sorry about your situation. Check into medicaid, I believe it is your only hope. Good luck.
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I did check out the VA home for my husband with ALZ. Be aware that if you have over $80,000 in assets you will be paying 90% of all your assets. My immediate response was "Oh my I will have to see our house" their response well we will place a lien on it. They look at all your assets going back 3 years and required all bank statements etc. Just be prepared. I found a less expensive place for now but may have to use the VA as they are less expensive than many other places. It does leave the spouse in a tough spot.
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I understand too about burdening society with the costs of care. But believe me there are a lot of wealthy people who know how to arrange assets so they don't have to pay for care. I have a friend right now whose mother has been in a nursing home for 5 years and her funds are running out. Her husband just died and my friend and her siblings have the house up for sale for $400,000 and will be keeping the money! In fact, she brags about it! Apparently, they arranged it so the funds from the sale of the house goes to the kids NOT to the care of their mother. The mother will have to go on medicaid! Now there is something wrong with that when they can afford her care. So don't feel bad if your parents have to use medicaid!
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Agree with those who suggested an Elder Lawyer consult. Your parents may have some planning opportunities which could help not only with their own care but also to enhance the quality of life for your sister. A lot of the planning, coordination, and follow-up will fall to you, and it's a big job. Suggest you also look at http://theconversationproject.org/
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1. You can call an Eldercare attorney that has an office close to where your parents live to give you an overview of things to think about. Medicaid just doesn't happen it has to be applied for and it's a long process. And an Eldercare lawyer can
tell you about the asset management process. The first time consultation is free most the time so get all your questions ready. If it's not free call another lawyer. 
2. They are probably going to tell you to become the POA and medical POA which is a very difficult situation for someone that WORKS in another state. If anything happens you would become responsible for their care immediately. Since your Mother has dementia this would mean she would need daily care.
3. Since you are a flight attendant I'm not sure if
You are the best person to assume responsibility. What if you are in the air when there is a medical emergency? Is there any extended family that is in the state? I would push your Father to
Name people that can help that are close.
4. After you get advice from a lawyer tell your Father what you learned and have him call the lawyer as well. Living in La La Land about the whole thing is no help to anyone.
5. They probably have money from retirement accounts if they worked and they both have social security so that is some money coming in. Do they have a house? If your Father passes I think your Mother would get his social security?
6. It's unfortunate your Father is from the generation that hates to talk about money and death. If your do find a lawyer to talk to give your Father the number and have him call.
7. Also don't get talked into doing anything your are not comfortable with and can not financially manage. 
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I haven't had the time to read through all these comments, so I'm not sure if this has already been suggested. If your employer offers it, contact your Employee Assistance Program (EAP or ENI). They can help with all sorts of problems that make your working life difficult. They can also help with the stress you are undergoing. Many of their services are free, or the first few sessions are free.

I had a coworker who used their services to locate a good nursing home for an out-of-town parent when there was just no way for her to take the time travel and visit nursing homes. It's a great benefit for employees.
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OMG, my friend. You have a lot swirling around in your head. I just have my mom and she has always been in New York. I lived in several other states over the years, one of which was Texas. I'm back in New York now and mom lives with me, 81 and later stages dementia. One of the worst things about living a long distance away from aging parents is exactly what is happening with you. The worry and not knowing are absolutely more stressful than anything.
You have to work with your parents on their own terms. Meaning, if they would be more concerned about the burden placed on you when the time comes that he can no longer take care of her then that's the direction of the conversation. If they would be more concerned that their care would be taken over by the state because they didn't have the proper documents in place to control their future care/decision making, then that would be the direction of the conversation. Does that make sense?
Your concerns are very valid. The proper paperwork is absolutely a priority. I am neither POA or Health Care Proxy. That makes everything I'm trying to do to keep mom out of a facility very difficult. Many moments of banging my head against the brick wall!
The recommendation of the book 5@55 above was an excellent recommendation. Educate yourself on the proper documents that your parents need to put in place. That way you can educate your parents on the importance of the documents and perhaps get them to move on getting all that in place.
Also excellent advice to get the phone numbers of neighbors or anybody that can help keep you informed.
Lastly, Medicaid is in place for the aging, that is not placing a burden on society because that is there for when it is needed. Everyone pays into that system all their working life. Don't hesitate to utilize the services when needed. I have found working with a good care manager has been far more helpful and got the job done to get my mom on Medicaid and activate the services she needs. It is a very broken system and you will no doubt need someone to help navigate through that system.
Take care of yourself. Get people in place that you can stay in touch with to keep updated on your parents. That piece alone will help lower your stress level and improve your quality of life. Good Luck
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Call Hospice! They offer Palliative care and most important they can guide you to where you need to be!!
People think Hospice is for the dying with only months to live..... it is more than that. There is so much they can help with, don't wait!
(800) 646 - 6460
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DLHM1939, you have a lot weighing on you. I agree with the suggestion to talk to an Elder Care attorney. You might need one in Idaho. If you are on the north side of Houston, I suggest you talk to Randall Perrier's office (on 1960). They answered a lot of my questions even before I came if for an appointment. Also, read the articles regarding Medicaid and Elder Law on this site.
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There are many people who think they know how to handle their money and end up getting duped. My dad worked his whole life for Ford and someone wormed his their way in and took everything, I'm actually fighting a legal battle right now because even the lawyer suspects something suspicious happened where are my dad and his money and assets were involved, so don't tell me my reply was not helpful because maybe something you said was not helpful so look in the mirror before judging someone else and what they've been through. Many elders can be taken advantage of. Many families are actually discovering sometimes when the person dies that their are deceased loved one was duped, so educate yourself on this topic because aging people are sitting duck and easy prey for vultures. We should all be thinking of our future and the level of care we will need at the end and how to cut back spending. You may have bury your head in the sand over this one and may have even bit off more than you can chew by judging but so many times as you may research and discover, the average person is constantly broke due to overspending for starters and don't get me started! People who can't afford insurance just don't have it and there are nightmares about Medicare and Medicaid and don't get me started there either!
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Since you say that your step father will not tell you what will happen in the event of his death and mother survives, I'd consult with an Elder Law attorney as someone already mentioned, but, perhaps in the state where they live. This is because if either or both of them become incapacitated and you are not able to make decisions, handle their finances or make medical decisions, it will be quite an issue. Apparently, they have not appointed a Durable POA and HealthCare POA. Do they have an Advance Directive? Those things are really crucial for an ailing senior, especially one with dementia.

I would get phone numbers from neighbors and friends, so that you can check on how things are really coming along. People put up a good front on the phone and you may not be informed of just how your mom is progressing. Step dad may not be able to accept the truth. I'd be prepared to make some independent inquiries. It would be nice if you had legal authority to talk with their doctors too. If this is too much, due to you beinglong distance, perhaps there is a family friend or someone in their local who can be appointed.  I'd just really try to get things on paper in advance, before there is a crisis.
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Hi, I am really sorry about your situation, but I applaud your need to reach out here to get some help. All of the responses above are good advice. You may have a long road ahead so it is good to get as many answers and options as possible. Especially if you cannot move to Boise, and comment to your base. (I used to be a flight attendant so i know what I am talking about). I had to quit my job and move from CA to NC to oversee the care of my mother, now 91, with dementia. She is in a facility here and luckily my mom has enough money to pay for her care, but overseeing all of the moving parts is still a full time job. And you just don't know how many there are until you actually start doing this. If you cannot quit your job, or move, you MUST convince your parents to sign a Power of Attorney document for you to make decisions on their behalf, or just talk to professionals on their behalf. It is one of the first things you must do, especially before anyone is diagnosed with a memory impairment. If your parents trust you, this should not be a problem. Explain that they can continue to do their own banking, legal stuff etc, but it is an insurance policy of sorts for them in case something happens to them, (stroke, heart attack etc etc). Then speak to an Elder Care attorney (yes, shell out the money for that, it is indispensable advice) and talk to medicaid. They are all there to help you and that is what they do. So use them. Then go to a support group of some sort for a couple of week when you are off duty to hear other's solutions to problems like yours. That is also indispensable advice. Good luck
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Yes agree with every one here. Medicaid will take care of them and should be taking care of your sister now. I had an aunt that was taken care of for over 30 years by Medicaid. You could talk to a social worker who knows all the programs to get prepared for the inevitable. I put both of my parents on the wait list for the VA home. If your dad is a veteran your parents are eligible.
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If you're worried about how to pay for care for yourself, it sounds like you must not have any savings and you need to start cutting back on whatever spending habits you have outside of your immediate bills. If you wonder why so many people are always broke, a very large part of that reason is overspending and living large beyond your means. People often rack up debt they can't even pay and it drains savings or prevents you from building a savings. I recently saw some articles on this kind of thing and it was very surprising and eye-opening. I don't know your age, but you probably should've been thinking of your own care long ago and you probably should've been preparing for this long ago. I don't know if you have health insurance or you happen to be on Medicaid, I don't know. However, no matter your income, perhaps you can find areas to start cutting back on extra spending and maybe even selling some stuff on eBay to make some money to tuck away. Yes, as soon as you get money, chuck it away for a rainy day because you may one day need that money for your own care or your funeral. It would be wise right now to go to a funeral home you can trust and make a preneed and make sure your final wishes will be honored and carried out. As for your healthcare, it would be very smart to invest in some sort of health insurance even if you must get Medicaid. I wouldn't recommend a spend down, especially if you have limited money and you need all of your money to survive through the month.

If you have any regular subscriptions, you can save money by cutting them off. If you have TV service, you can drop any extra channels, just eliminate them altogether. If you can get by with just watching stuff on YouTube, you can just drop TV service altogether and save a ton of money.

What you also want to do, shop around for new vehicle insurance if you have a vehicle. As your vehicle ages, it's worth less and less so you shouldn't be paying high dollar coverage for an old vehicle. What you can also do is call your current insurance company and speak to a live agent and see what all in your policy you can cut costs on. Some agents may say you're already paying as low as legally possible, but there are some sections of your coverage where are you can reduce the coverage. Someone advised me to do the same thing because the person said I was overpaying on a bike. I was paying the same thing for full cover that they were paying on liability for two cars. I was very reluctant to make any changes because the agent previously told me I was already paying the lowest amount and I told this person who pointed this out but this person said to call back my insurance company anyway. I was paying $40 for full cover, which was the exact same amount someone I know was paying for liability on two cars. I was reluctant because I previously called them and was told I was already paying as low as possible. I was actually expecting to hear that all again that I was already paying as little as legally possible. When the agent picked up on the other and I gave her my information and told her what one of my loved ones just told me. Much to my surprise, there are sections within your coverage where are you can reduce the amount of coverage. I was shockingly able to go from paying $40 for coverage on my bike all the way down to only $23 and still not interrupt my full coverage or any of its benefits.

Anywhere you can find to cut corners and cut back on cost will help you to build a savings.

However, let me warn you not to fall for any scams or to lend money. If you're already shelling out money, stop. You need that money for yourself and where will you get the money when you need something and there's no one around to be able to give you a dime when you're broke? What if you were to need a new car tomorrow because your old one is in disrepair and cannot be fixed or you can't find the parts no more and you're now without a vehicle? What if disaster struck and you lost everything? This is why you need Insurance such as renters or homeowners insurance and if you get sick or hurt or need other care, you definitely need some form of coverage.

Look at your current situation, start there. Start looking for areas to cut back spending and even look around the house for stuff you can sell on eBay that you don't use. Whatever money you make, put it away but don't put it in the house. Put it in a separate bank account and leave it there. If you can scrape enough money together to put money into a CD, do that. You may have to cancel the CD if you come up with even more money to double what your deposit was, only do this if you want to make the CD even bigger. You can also start a new one. The more you have put away, the better. Don't let anyone take advantage of you and if you own any assets, I don't know three to turn them over to a caregiver in exchange for care, definitely don't do that! This is how people take advantage of their elders especially if they themselves have money trouble. Don't ever except care from someone who has money trouble or a shortage of it because this is how they can be tempted to take advantage of you if you happen to have more than they do. I'm not trying to sound greedy but what I'm trying to say is people with money issues or a lack of money often target wealthy elders. Don't let this happen to you as you build a savings. You need your money for your own care, especially if there are things your insurance won't cover if you happen to be on Medicaid for starters. There are also nightmares I've heard about Medicare, which is probably why there are Medicare supplement options out there because Medicare is broke and can't cover what you need. I also suspect Medicaid is also broke because there have been multiple times I needed something that was prescribed, but Medicaid wouldn't cover it probably because of national debt and the program is broke. I've been hearing how care has even been dwindling for people on Medicare and Medicaid, which is why it's very strongly believed the programs are broke and if they're not broke, they're downright greedy and don't want to pay out when people have needs and need help covering them.

The best time to think of your future care is when you're younger. It's something many of us just don't want to think about or discuss but at some point we're going to reach a point in our lives where this is necessary. What if tomorrow you need a wheelchair and your insurance refuses to cover it because the system is broke or they just don't want to pay out? The answer is simply to just get what you need out of your savings and just buy it privately. You should've been thinking of all of this before now and you should've been doing something about it if you have a lack of money or spending habits that leave you broke. Though you should've already been thinking of this, it's not too late, better late than never but you probably won't have had more money to cover out-of-pocket costs that your insurance wouldn't cover if you even have insurance. I know when Obama was in office, there was a law passed that every American must mandatorily carry some form of coverage. There was a hefty fine for uncovered Americans who didn't have any form of coverage. I thought this was a little unfair in some cases where people were already struggling and couldn't afford insurance but they couldn't get Medicaid either, that was too harsh on people who were already poor only to help a hefty fine on uncovered Americans.
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I should have been clearer - My family had a choice but Medicaid is there for such situations as you describe. Find out how that can help your parents.
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I applaud your concern about burdening society, and tell you that there are many families with resources who protect them in trusts to avoid having to fund expensive care of the very owners of those funds. I am proud to say that my parents' heirs agreed with me to use the trust funds to pay for Mom's long and expensive care. I even sold my home to pay for several years of care when all the liquid assets were exhausted. Do your research now. Perhaps investigate appropriate level of care facilities that your parents might need in the future. Do your best, and accept that you may not be able to find the perfect answer. Good will fine.
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Your stepdad is surely doing a great job of looking out for your mom now, but it sounds like they need some help in the home already with her conditions and her not taking meds on schedule. Likely, things like diet and exercise also are not necessarily going to plan either.
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This is tough situation. Try to not worry too much about "burdening society"; Medicare and Medicaid exist to help people like your parents when the need arises.

I would encourage you to talk to your parents (esp your dad) about doing some legal advance planning. In particular, it would be good if your dad could designate you as his durable power of attorney for general affairs and for health. Your mom -- assuming she still has the mental capacity to designate a POA -- may want to designate your dad as POA with you as alternate.

Older parents are often reluctant to have these conversations and complete the paperwork, but believe me, you will save yourself headache down the line if you can get it done. It sometimes helps parents if you frame it as about your concern and desire to make sure you can help them, if a need arises.

There is a good book called 5 @ 55, written by elder law attorneys, which goes over the documents older adults should complete. You could try giving it -- or something similar -- to your dad and then having additional conversations.

Also a good idea to talk to an elder law attorney, but best to have several conversations with your parents first.

Good luck!
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I don't want to stereotype here, but aren't flight attendants as a group rather underpaid? I'm just wondering if the OP will have money to spend even on a very worthwhile appointment.

I agree it would be the right investment if at all possible. Just in case it isn't, and seeing as your stepfather is independent, perhaps you could do some online research and find out what social services and support are available in their area. You can gather names and contact numbers, and encourage your stepfather to reach out for help *before* he needs it, rather than after it's too late.

Above all, don't beat yourself up for things you can't possibly help. Your family has had more than its fair share of troubles, but that will only make it all the more important to your mother and stepfather that you're doing well. I know it's impossible not to worry, especially from so far away, and especially when you begin to get inklings that they're not necessarily giving you the full picture. I hope you'll be able to identify some good resources for them, and persuade your stepfather to use them.
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DLHM1939, thank goodness for Medicaid [different from Medicare]. Medicaid is paid for by the taxpayers with grants from the Federal governments. And each State has their own rules, regulations, and programs. Medicaid will pay for nursing home care for both your Mom and for your sister.

Set up an appointment with an Elder Care Attorney to discuss what should you and/or your parents do, if by chance your Dad should pass first. The Attorney will give you sound recommendations, and explain how Medicaid works for where you parents live, or will recommend an Elder Law Attorney for that area. It will be money well spent.
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Do they have Medicare or Medicaid? Both would cover some form of home care if they need it. You just have to talk to their insurance company. That way if one goes, the other can still be taken care of.
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