How can I document everything for Medicaid when I have a million other things to take care of?

I think you may be thinking of what you will need for mediCAID, not medicare???
What do you mean by "documenting for medicare?" I did all my brother's POA and Trustee of Trust, bill paying and record keeping. I had a separate folder for everything. I kept all medicare payment notices in one folder, all supplemental insurance payments in another, phone in another, and kept a running monthly documentation of all assets he had, increases in and payments out. Once established it was easy to keep up.
Might your mother's funds go now to hire a beneficiary to help with bill paying and document keeping (only about 90.00 an hour, and not much time needed monthly after monthly routine is established. Your mother's funds go to pay this.
I am wondering if you are speaking of something other, such as applying for mediCAID. If so, that is burdensome, as Igloo suggested, some one hundred pages in her case. Your monthly expense in and out will really help you here, as you have ALREADY thereby documented her assets, her income, her expenses. You will also keep her account, which I assume you are the POA of. You will keep all receipts in individual folders.
If you are financial POA for your mother you have to do this ANYWAY. You also keep a folder with all her bank statements, one with last 7 years of taxes and so on.
Originally I had one wine box for my brother's "file" folders. I branched into a nice black file box eventually. But once all this was established, with all his mail and bills coming to me and with POA handed in to all entities it was a somewhat smooth flow.
And no, if you are doing in home care you will never receive financial recompense to be certain.
And yes, if you are meaning entering a nursing home, going on MEDICAID, all of this will be audited. ALL of it. And if anything looks like gifting it won't be good news, so I am thrilled to hear you have your elder law attorney. Do allow your Mom's funds now to hire a fiduciary if that is needed. If Mom's funds stretch to do so she can pay both you, the attorney, and the fiduciary for the care she needs. And you will have the documentation you need all ready to go, the fiduciary there to help you apply. Do remember, you want a fiduciary that is hired to do this, not to invest money (that's a financial manager or some such.) Your elder law attorney works with fiduciaries you can bet and will have a recommend for you, as often courts need to appoint them when there is no family, or a family-at-war.

I too wonder what documentation Medicare would require.   I documented doctor trips, mileage and any other out of pocket expenditures, even though I rarely could deduct them from taxes b/c they didn't reach the 7.5% minimum.   

You wrote:

"I feel like I have to entertain and/or manage her activities all day.    If I give her a task, I have to monitor to be sure it is done correctly, or sneak in after the fact and re-do it, creating even more work. "

This raised a potential red flag for me.    What kind of tasks are you giving here that have to be done "correctly"?   Perhaps tasks that don't require that standard would be more appropriate.  This isn't intended to be a criticism, so please don't take it as such, but I think you're seeing her more as an employee than a mother.

I also question the effect of redoing and correcting her work.    Is she aware of your feelings on this?  If so, I think that would really undercut her confidence, and perhaps that's why she's become so reliant on you for directions.

Think about that issue and consider other tasks or not requiring them to be to your level of satisfaction.   That's not an intentional criticism, but rather an observation.   She needs to have a morale boost; can you think of tasks that provide that?

This is from one of the OP's previous posts:

" I live in Missouri and am the sole caregiver for my mother. A contract was arranged through Elder Law that pays me $17/hour, but not more than $2500/month. That is what they advised."

So, guess the question is how much documentation does Medicaid require to show that this was paid for caregiving and not "gifting".

I would make up a time sheet with hourly blocks. Each meal is one hour. Dressing and toileting at least one hour each AM. Getting ready for bed, at least one hour. That's 5 hours of each of 30 days each month.

Start by keeping records meticulously and in a separate folder/notebook than ANYTHING else.

Every time either DH or I have a medical issue that I know wil engender quite a lot of paperwork, I start a new folder and have a calendar in it to document the dates and times of calls, appts etc. Also a plain sheet of paper where I document CALLS, including the name of the caller and what we discussed.

It takes minutes, once you're established with the system and gives you the sense of comfort that you need to be able to function efficiently, also the mental backup about appts and calls.

All bills go in this folder, and when they are paid, they are marked as such.

For example: "james" called on May 7th, He was representing Images MRI. He had a $27.50 copay amount he was trying to collect. I can look in my records and see that this was paid with my flex spending acct on the 31st of March and received by them on the 5th. I even write down the time of day.

It's a little bit of a learning curve, but wow, it saved my bacon when DH had his liver transplant and we were getting bills for 2 solid years. It does take a little time, but is so well worth the peace of mind.

Create an Excel spreadsheet:

Date
Time start
Time finish
Total hours
Work performed
Paid or unpaid

For the work performed, create a dropdown list (if you do not know, I can give you the steps). Put on the list somewhat vague description ie) housekeeping, talked to dr, set up meds, personal needs (adl's) etc. Have the drop down fill in it all for you. The truth is you may be cleaning and doing laundry at the same time so lump things together.

Watch what you pay yourself for. For instance, unless you have a license or certification, you cannot be paid for it. See what your state allows.

She has dementia. She cannot properly process things. Give her tasks to do that won’t matter whether or not she does it right. Maybe a basket of small towels to fold or arrange small things that really don’t matter. You don’t need more work for yourself after the fact and she just can’t do it properly. I did this with my MIL. She was happy to be “helping” and it didn’t cause any stress for either of us. You may also need to hire someone to come in a few hours a week so that you can keep up the paperwork. Do you have respite care available to you? That helps as well.

Never had to use Medicaid, thankfully, so no knowledge of how much work it is. I did attempt to get mom VA Aid and Attendance Benefit. That was many pages of details, but likely wasn't as much a Medicaid. Sadly the buffoon who sent the forms to me sent the expired version (and denied it!) I had to start over - although the changes in the form were minimal, it drifted into a new year, so ALL the numbers changed, inc in SS, Medicare, Pension, expenses, everything! I was, by then, managing all her finances, supplies, visiting at MC AND working on clearing, cleaning and getting repairs done to her condo so we could sell it (the CCR took about 2.75 years, multiple trips/week, 3 hour round trip drive!)

I had enough on my plate, so I let that go. Two brothers weren't really of any help, and even if they could, I had all the medical and financial info, either here or in my head, so it would have been MORE work to hand it off. Also, they began a lookback like Medicaid does, so it was unclear if we'd even get anything. I let it go.

The one topic I have a possible suggestion for is:

"She has to know where I am at all times, or panic sets in."

It will cost a little money to facilitate, but if she's in one spot most of the day, perhaps have some cameras or baby monitors installed in the areas you might be in, kitchen, BRs, office, etc while tending to daily "duties" yourself and set up a display where she can see/respond to you and you can talk to her as well. Maybe try with just one, to see how it goes. Seeing may not be sufficient, but it's worth a try.

If you're doing "office" work, can it be done on a laptop, so you can be in the room with her? While doing your work, give her those "busy" tasks - have several ready to go on hand, so when she "finishes" one, you can give her another.

Are you being paid to care for your Mom? Is there a contract in place? If you are paying yourself out of Moms money with no contract in place, that may cause a problem. And at this point Mom can't agree to one. It needs to have been put in her POA. If its just a flat amount like $200 a week you don't need to list every little thing.

Medicaid looks at bank statements so do everything for Mom thru her bank account. They look for an inconsistencies and large amounts of money. If I paid with my credit card or out of pocket I kept the receipts and once a month wrote myself a check from Moms account, put the receipts in an envelope and put the check # on the envelope. Medicaid never questioned these checks but they were never much more than $100.

Medicaid will give you a list of items they want to see. One of the basic items are bank statements. If you have access to the online account you can probably download a few years of statements. Otherwise you will have to
pay the bank to get them.

You have a lot on your plate - can you outsource something?

What role do you enjoy more? Being an adult daycare organiser or being an accountant?

Is it possible to either engage an in-home aide for some daycare relief? Or engage an accountant? (you just hand over the shoebox...) Or maybe a mixture of both?

When my kids were young, I choose to use daycare for 2 days a week. It was a good compromise, although we were not in a world pandemic & mixing with others was a safe thing to do. I am a bit of a 'one thing at a time' person. I could get my housework done with littlies crawling around (but drove me slightly mad), but I was so much more efficient when they were out. I then enjoyed my time with them so much better when they got home too.

It sounds like you are paying yourself 147 hrs per month out of her money. Reduce your hours and pay someone else to come in several days a week to help with housework and caring for her.

Yes, Medicaid does audit. 5 years prior to application. And they are definitely going to scrutinize money paid to a child to make sure it wasn't gifting. If you hire someone, get the elder atty to tell you correct way to hire someone: If you pay cash, you will be giving them a 1099 at end of year to report the earnings, etc.

Being blunt - you sound as though you have not planned, and continue to not plan. You micromanage, and make work for yourself.
Sit down, make a list of what you can do and hours that it takes, Then a list of additional needs and hours needed and who can be paid to deal with those issues.
Stop trying to do everything, and thinking everything must be done your way, and apply your accounting organisational skills to the care for your mother.

A big, emotional job like this, combined with a big job period, always makes us doubt and criticize ourselves. That is not all bad; it is your conscience checking in. Everyone who answers these probably has similar doubts when they do the job. This site is a Godsend, and documenting for the government is not! You are a bookkeeper; would a Quicken account or some such for your mother streamline this paperwork? Sounds like a nightmare.

Would your mother adapt to some days of adult day care and be eased by the presence of other people, at a Day Care facility or does it have to be YOU?

Even two days a week would give you some breathing room.

You have a notebook and pen handy and when there is something to be put in it, you just do it. How difficult could that be? it is necessary - so just do it. If you have a full time job and so many other responsibilities, how can you find time to constantly entertain her? I don't think you can without harm to you. Can you get a caretaker to give you some relief? If not, do you think she should be placed so you have a life?

Imho, it is IMPERATIVE that you find respite in the form of anything for your mother so that you can accomplish the Medicaid eligibility protocol.

Please, for the sake of your life and your frightened mother's get her to Adult Daycare so she can socialize. I wish I would have used my CC and hired Senior's Helping Senior's more often. Mother and I both suffered unnecessarily. The few times I hired them (4 hour min) she was smiling and so happy entertaining the senior retired nurses who understood dementia far better than I ever did. My health has suffered from the constant 24/7 stress for over 6 years. A little credit card debt would have been so worth it as I look back. I am still totally exhausted.

Is the state paying you to care for her? And is the 147 hours with regard to her care or your work outside of her care? And from my experience, the audits are vague. Worst case, always pay for her things with a card so you can go online and print statements if necessary. Drs can also provide other info you may need. Don’t lose any sleep over it.

When it comes to the government, expect an audit at some point.

Please consider daytime care giver situation for your mom when you are working for your husband's company. Options include: home health aide in your home or adult day service in a nursing home of private home.

I am here just to tell you that “I hear you” and “I see you” and I know exactly what your days are like - so I have no doubt that your having a hard time trying to find time to also do all the paperwork trail bs and what the “rules” are.
I found my elder law appt not to be of much help and truthfully confused me more (I am a bright woman and the ELA I saw gave me 100 more things to think about and no real solution or guidance). And like you my days do not have “spare free time” to be a full time accountant.
Your question doesn’t have to make sense to everyone because not everyone walks in your shoes. I do and I validate your question and I also respect just venting about how crazy it is of what is expected from usually one family member who is also doing full care.
Every day we are “surviving” and no we do NOT have time nor the brain most days to remember to write everything in a log - you are correct in saying everyday a new medical issue can throw us another whole month into being further behind than we are.
Just know some of us understand - wishing you a good week 🌷

When you say 'claim' 147 hours a month of care for your mother, does this mean you claim it as her caregiver and are able to get paid from your mother's funds?
If such is the case then for 160 hours a month you can put her into adult day care 40 hours a week so you can do your job. You might not be able to claim the additional 13 hours a month with Medicaid. Pay for them out of your mother's income. You need a caregiver. Think of it like this. If you had a toddler that you had to look after 24 hours a day totally on your own, would you also be able to work a full-time job? No one would be able to. An elderly person with dementia is like having three fussy toddlers and ten times worse. It's impossible to do it all on your own, so please for your sake stop. Do you know that many caregivers die before their care recipients? Because no one can safely operate like you've been for any length of time. The reasons for trying to do it all alone are your own. No reason is good enough and no amount of saved money or assets will be worth the heart attack or nervous breakdown you'll have if you don't get caregiving services for your mother.
If you also need additional hours to keep her entertained until 9pm then you will have to hire an in-home caregiver that will get paid for using mom's money.
If you put her in a NH, Medicaid will do the 5-year look back. They are looking for things like gifting sums of money (over $5,000), transferring real estate, or selling off assets below market prices.
Medicaid will not be too fussy about basic monthly expenses that you her caregiver use her money for. Like additional caregiver hours, room and board to live in your house, and incidentals like clothes, haircuts, recreational activities, etc...
What will happen if she does go to a nursing home is that the nursing home will make a huge fuss over all of this and will say that it's the people at Medicaid. It isn't.
I dealt with Medicaid and a nursing home when my father had to be placed. The Medicaid people were tolerant and understanding. I produced the huge bills he owed and that's where his money went. Nursing homes think they're the only bill a person ever has. Medicaid understands that this isn't true. You'll do fine dealing with Medicaid.