Hi all, this one is a doozy, bear with me. Forgive me if this post sounds insensitive, we are Dutch, it is our nature. Thank you all for your continuing help.
Granddad, 84 with dementia, is a citizen of the Netherlands and a green card holder who has lived in the US since 2004. I am his DPOA & healthcare surrogate. He is financially destitute with a tapped-out reverse mortgage, and a $200/month pension from his home country. He's had a US bank account since 1982, but according to three different Medicaid specialists and numerous calls with the IRS, they cannot find any record of him ever paying US taxes. Therefore, he is not eligible for Medicaid or Medicare. Private insurance is out of the question at $2500+/month. He managed to burn through a quarter million in retirement in 10 years, then reverse mortgaged his house and gave his youngest son access to it, who burned through that too. He lived on his meager pension money before we moved in to take care of him. All local nursing homes' financial counselors said they can't take him. We've spent down all our savings just to prevent the house from foreclosing.
During his hospitalization for cancer earlier this year, I pushed as hard as I could to refuse him coming home as an unsafe discharge, but three different Medicaid specialists told me he was ineligible for any kind of assistance or placement, and if we didn't take him back, he would go to the homeless shelter. Even Adult Protective Services was unable to do anything, and believe me, they tried. Very frustrating.
I worry that I made a mistake by caving, and they would have placed him had I gone nuclear with my refusals to take him back. Thankfully, our local hospice stepped up to the plate and provided him medical care free of charge and still do, but they would not place him in their inpatient facility permanently. They have been our heroes in this trying time.
Granddad chose not to pay US taxes for some stupid reason and didn't plan for his future. Even if we were to sell the home right now, the remaining equity would only pay for about 3 years of private placement and he's likely to live into his 90s. Not to mention, due to his dementia he would not cooperate with the sale or renovations to the house, and he wouldn't leave unless the sheriffs forced him to go once it's sold. As his DPOA, I could just do it and force the issue, but it's just not the right thing to do. To sell the house and bring him with us will be an extremely difficult battle.
In summary: No Medicaid, no Medicare, no health insurance, no savings. I am his DPOA. Could sell the house to pay privately for placement, but the money will run out before he passes and then he'd be homeless. Planning for a family of 4 (including mom nearing retirement age), paycheck-to-paycheck. I'm assuming we're screwed, short of putting him on a plane to Holland and dumping him there. The next thing I'm going to try is giving speeches at all our local churches asking for help, as this is truly a rotten situation. Anyone have any other ideas?
I really think your best bet would to first get him out of your home. Sell his house and get him into some kind of AL or LTC. Don't worry about the money running out in a few years. Get him into placement now. When the money runs out, whatever facility he's in will work with their social workers to get him on Medicaid. Then he can either stay in what facility he goes to now if they let him, or he goes to another. Bottom line is, it will not be up to you to take care of any of this.
If Holland will take him back and provide care to him in a facility, send him back. You can't pay for his care and shouldn't even consider it. You also cannot take care of him yourself.
First, get him out of your house and into a facility. Then talk to an elder law specialty attorney and even an immigration lawyer. They will direct you on the next steps. Getting him into a facility now is the first one.
If your grandfather is a Dutch citizen and you are planning on taking him back there, you indeed will need a detailed plan for such. Where he will stay, who will care for him, who will oversee his care?
Did he have a wife who had a social security number he may have used? If so, check on that. There could be signs in SS cumulative earnings records, such as a jump in earnings under her name at times when you know she was working in an office or staying at home and he was earning big time on an oil rig. I don't know how they do it, but have experience of someone breaking into a family member's SS account, and redirecting the checks for several months to deposit in a Pennsylvania bank when family member thought they were being deposited into their own bank. This is fraud and punishable by law.
The Elder Law attorney can also advise you about the sale of the Florida house. If the sale proceeds from the house result in 3 years of self-pay coverage at an assisted/memory care facility that would be wonderful, and 3 years is adequate time to figure out next steps if/when the $ runs out.
Forget about GoFundMe and religious organization assistance - these are likely wasted efforts.
Good luck.
If he is eligible for Hospice, some doctor, somewhere, had to sign off that he was expected to only have 6 months or less left to live. Was this his private physician? Have you spoken to that person about this situation?
Did he work for U.S. companies as an independent contractor? In that case, maybe he ran his pay through his own company and used an EIN. Yet as a green card holder, he had tax obligations to the U.S. Presumably he also was supposed to pay state and local taxes. If he managed to stiff multiple tax collectors in the U.S., there may be some agencies that would be very interested in the amount of back taxes he owes. With interest. And penalties.
If he is using a wonky SSN, you've got a bigger issue of his legal permanent residency status and not just a benefits problem.
Something is wonky as every legal employee having worked for a US based company gets Medicare Part A reporting as a condition of hire. If the oil rig is owned by a foreign company, that should be noted in his social security earnings records as well.
Note: DPOA isn't accepted by SSA.
Recommend finding out his legal status within the systems as a starting place for ideas on how to proceed.
If he really is ONLY entitled to a Dutch citizens backstop, you can go to the relatives in The Netherlands and tell them he is getting shipped home because the house in the US has to be sold because it is what it is at that point.
I'm so sorry about his dementia, but he could have boarded a plane for Holland at the beginning of it and saved all of you from this sad mess. But no, selfish to the end like so many elders who didn't plan for care - that's grandpa! You need to stop using your savings to save him. If you don't look out for yourself, who will? Not grandpa!
It seems that you have two options left. Sell his house to pay for placing him at a facility in the U.S. You have the power to do that. Hemming yourself in with "it's just not the right thing to do" is wrong thinking. In this circumstance it IS one of the right things to do. Further limiting yourself to "he's likely to live into his 90s" is another unsupported supposition. None of us know how long we have. Plus he's had cancer as well as dementia. There's a good chance that he will not reach his 90s. Fix your thinking!
I'm part Dutch. I know Dutch people are often characterized as stubborn, so maybe you want to continue thinking the way you do. So let's look at the second option, which is to send him back to The Netherlands. If he's living with you, you might come to that solution sooner rather than later. Grandpa should not live with you. He has serious health concerns that cannot be accommodated for long in your home, and he needs professional care now. You running back and forth carrying bedpans from his bed to the toilet is not sustainable. Yes, that is in the near future if grandpa remains in your home.
Good luck.
You need to talk to a Medicaid caseworker. My Mom did not work 40 qtrs and she got Medicaid. Any taxes she paid were from my Dads earnings. People bring family members here that have never worked in the US or paid taxes and they can get Medicaid after 5 years of residency. No he can't get Social Security or Medicare because these are payroll deductions and are based on earnings.
"Yes, it's possible to qualify for Medicaid even if you haven't paid taxes in the US. While filing taxes is not a direct eligibility requirement for Medicaid, other factors related to immigration status and income are crucial. Whether or not you've paid taxes can impact the household composition for determining income eligibility."
Have you tried talking to an Elder Lawyer?