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Hello,


I moved my aunt to South Carolina 3 years ago, after her husband passed away and she could no longer, stay on her own.


She has been in assisted living facilities, but her finances are running out and her health is deteriorating. I’ve been advised that she gets too much social security to be able to get Medicaid in South Carolina.


I have asked other family members for help many times and they say they will try but procrastinate and don’t find anything in their area. Her IRA is being cashed out at the beginning of the year and she will have enough for a month or 2 left to pay for the assisted living.


I had not seen this aunt for 35 years before I had gotten a call that her husband passed away.


I am at a loss of how to help her any more. I can not take care of her. I am her power of attorney in healthcare and finance, but I don’t know where to turn any longer. We filled out paperwork for veterans assistance in August but still don’t know if she qualifies. She gets social security and some IRA. But her assisted living is high and they just raised another $200 a month starting January, plus with the extra care she needs it’s about $4000 a month.


All her siblings have passed or are to old to take care of her and honestly I’m not sure how I end up with the job, I just knew I could not leave her to die alone in her house which since she was not on the mortgage and would have cost her to much to sell we let it go into bankruptcy. Now with her money running out I am sick to my stomach and can’t sleep nights.


I can not continue to keep doing this. This has been the last 6 years of my life. She can be mean and very ungrateful at times. I feel sorry for her and know some day I may be in this same situation but I can no longer do this.


I go see her once a week and I don’t want to live with this scenario any more. My mom, her sister, passed 5 years ago and my dad was very upset when he found I had moved her here. He advised she put herself where she is with no one wanting to help and he is aging also and he will be needing me soon. How do I turn her over to someone else’s care?


Please give direction.

Sept - I’m going to approach this from another angle... I’d suggest you try to clearly find out what her capabilities are and if she actually would be “medically at need” NH resident if she was not paying for extra services at this AL.

It may well be that she is already legitimately “at need” for skilled nursing care aka a NH. If that is the case, then keeping her at this AL is just putting band-aid on a much bigger problem as she will get eventually beyond whatever this AL wants to get private paid to do. And your back again in dealing with $ & placement.

Regarding not being eligible for LTC Medicaid, are you sure about this?
Most states have LTC Medicaid income limit about $2100 a mo. Elders in their 80’s - 90s maybe get a SS$ $1200-$1500 a mo. as their working years based on lower incomes from the 1950-1970s. Some get like a only $800 a mo. ((Imo You’d be a higher income baby boomer going FRA at 70 to get the SS max of $2861 for 2019.)) If it’s the AL telling you she won’t qualify for Medicaid, it may actually be that the AL does not partipate in your states AL Medicaid waiver program or that AL is never ever covered by your states Medicaid programs. So its more that AL is not eligible for Medicaid. Could this be the situation?

For Medicaid, it is only skilled nursing care aka a NH that is required (dedicated) funding for Medicaid under federal rules. Look at her SS awards letter for 2019 (was mailed like in Nov to her) to see to the penny what she will get paid and then carefully look at your states resource limits for LTC NH Medicaid to see if she’s under the $max. If she’s over, then either an atty can do a Miller Trust for the overage or whatever pooled trust system your state has to get her financially eligible for LTC NH Medicaid. Not all states allow Miller. And I’d set up an elder law atty meeting ASAP for you as her dpoa to do this this month and it’s her $ paying for this. Atty shepherds her Medicaid application too. So like in Feb she enters a NH somewhere in the state as Medicaid Pending. Once she clears Medicaid, you can move her to a Medicaid accepting NH closer to you (you put her on waiting lists if need be). I moved my mom from IL to a NH Medicaid Pending- totally bypassing AL phase - and then moved mom from NH#1 to NH#2 at abt month 9. Medicaid totally allows for lateral move & without penalty although you kinda have to time & plan the move in advance is my experience.

I’d be concerned that getting through VA months long process to get Aid&Attendance will not be the solution in the long run. VA A&A is great - especially for couples- to pay for in-home care or stretch out a preMedicaid LTC spend down or pay the extra $ needed for AL. But if she needs a NH, those run 6k - 15k a mo at private pay rates. If she’s average elderly SS it’s like $1500 & VA A&A spousal benefit maybe another $1700 so combined will never ever cover the monthly private pay NH cost. If in a NH, one is better off applying for Medicaid as LTC NH Medicaid will cover all room & board costs with all health care costs covered btw Medicaid and Medicare (she would become a “dual” on the M&Ms).

She cannot get both A&A and LTC Medicaid, HOWEVER once on LTC Medicaid the VA will switch from A&A to instead pay her a VA resource allowance of $90 a mo. Medicaid also has a personal needs allowance (varies by state) which usually $50-$60 per mo. So it’s good an application was completed last summer.

Clearly ask the atty if she should get A&A and it’s retropaid to date of application, how to best deal with the $ as to not jeopardize Medicaid asset limits. Usually easiest is to totally pay for a funeral/ burial preneed (like 8k) and maybe costly wheelchair, eyeglasses, hearing aids, dental if there’s still $ above the 2k asset limit.

just think all the stuff you’ll learn about now that will make dealing with your dads Medicaid later on easier.....lol! Good luck.
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Summer55 Jan 7, 2019
You are so spot on igloo! In Ohio. Take this person's advice.
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Good afternoon,

Bless you for watching out for your mother’s sister all these years even though you didn’t really have a relationship with her. And bless you for going to see her weekly even when she is mean and ungrateful. It has been my experience that most elderly people can be like this due to their aches and pains and loss of independence. It isn’t pleasant, but it is very normal behavior.

I assume you took on this role for a reason. Maybe in memory of a better relationship with your aunt when you were younger? In honor of your mother? Because she is family? You are overwhelmed now, and your first response is to flee. Completely understandable (I had this many times when dealing with the unknown with my parents’ increasing needs). After all you only had a tenuous relationship with her beforehand and she’s kind of ornery. Please don’t give up yet, because there are answers. You may find that once you see some solutions to this dilemma, your emotional anguish will greatly lessen. I won’t say go away, because there will always be some emotional pain in caring for someone or overseeing their care in the last years of their life.

Several people have already given you some excellent suggestions. Go ahead and continue with the VA angle though I’m not sure if they will pay enough to cover your aunt’s increased care, and it could take a year longer. Get a needs assessment done. She may already be eligible for a Nursing Home. Make an appointment with an elder care attorney. Our initial meeting was free. We walked out of there so much more knowledgable than we went in and with some concrete steps to take. My father made way too much money for Medicaid but not enough to pay a nursing facility. He was instructed by Medicaid to put his money in a trust in order to become eligible. All his social security (except a small portion) and pensions will go to the nursing facility in a “spend down” and Medicaid will pick up the rest. I believe every state has this sort of system. People to help you: elder care attorney, nursing home director, medicaid office. Any of these should know about the spend down.

Continuing to oversee your aunt’s care will still involve your time and emotions, but once her placement is resolved you will not feel so frantic and overwhelmed. Of course, only you know the stresses that you are undergoing and what you can handle. I just wanted you to know that there are some solutions to this transition phase, and that knowing this may help in your decision to give up your caregiving role.
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Reply to Treeartist
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I called her assisted living and explained the situation, they advised to call the VA and tell them it’s now a hardship case. Which I did and the VA advised they would need a letter from the assisted living saying she was behind on her fees. So I called AL back and said since her rent was raised and they have not deposited the remaining of her IRA she will be short $40 and asked if the could send letter to VA so we can expedite her case to see if she even qualifies for assistance.
The AL did not seem like the want her to leave so far. I think they may work it’s the cost as soon as we find out if she qualifies for VA spouse assistance.
fingers crossed
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Reply to Septmichele
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The required protections for a facility to have to set up a parallel transfer does NOT necessary exist for an AL resident. It is required for NH to do as NH residents are “at need” of and receiving skilled nursing services.

If it’s AL, they are considered to just perhaps need assistance with their ADLs, so in theory, they should be able to be competent and cognitive to do for themselves. The AL can evict them without setting up alternative living arrangements as it’s just AL.

That usually does NOT happen as it’s lousy PR so AL will not kick her to the curb per se but more likely will call an ambulance or EMS to take her to the ER under some pretext. Like elder appears to have had a TIA or some other more ahem “subjective” health concern. Then once in ER, she becomes the responsibility of the discharge staff of the ER/hospital to find a placement for her as the old AL will not take her back. If there is a POA known the hospital discharge staff will contact them. Otherwise if family cannot be found or unable, usually APS gets contacted and they will ask court for an emergency ward of the state placement. Court (usually it’s a probate court judge) should have a list of vetted approved guardians at the ready who get assigned the elder as their ward. Emergency ward of thecstate assignment can be done within a day or two.

Guardian then takes over all & can find a NH for LTC Medicaid Pending placement somewhere in the state. Meanwhile guardian can get all financials, VA info, review what POA has done, etc to get her eligible for LTC Medicaid.

Its really important to understand what AL vs NH legally required oversight responsibility is.
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Agingmyself Jan 7, 2019
Igloo, Thanks for your insight!
I did say that the AL can't just throw an old lady out on the street, which, as you point out, they probably can legally do. Ethically? Morally? Public relationally? Not their best choice.
And, unless she goes willingly, an eviction would probably first require a court hearing which would bring to light her need for a guardian as you described.
I'm sure it'd be a lot easier for the AL to follow your scenario.
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There is surely a way that she can qualify for assistance--whether housing, skilled nursing, whatever. There are legal means that an Elder Law attorney can perform to get her qualified, even with "too much" income. Look for a Certified Elder Law specialist in your state. Do this before she is destitute, since there will be some expense involved. Most reputable attorneys will give you a free initial consult and tell you what they can do and what it will cost.

You can contact her local Agency or Council on Aging for help and advice. Don't take no for an answer. Ask for a referral if they can't help you.
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Reply to Agingmyself
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I believe that you give a lettter of resignation with an effective date.

Be sure and give a copy of the letter to anyone that received a copy of the POA.

Read your POAs and see if it states something like effective until...it may say until revoked in writing.
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Reply to Isthisrealyreal
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It sounds like you are on to something with the VA, and you have received a few other good suggestions here. The only other thing I know of that you might consider is filing paperwork with the court in the county where she lives, requesting conservatorship and guardianship to be established. Then decline to be named for either role, and once the court determines your aunt to be in need of those services, the court will appoint someone to manage her finances and care. If this is something that would not work for you, you may try contacting adult protective services and explain how your aunt is at risk. They may initiate these processes for you. Hoping things get settled sooner than later so that your own health does not suffer any more than it already has.
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Reply to MelissaPA2AZ
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Hello - I would suggest that you revoke the POA in writing and send the revocation to the alternate named in the POA document as well as your aunt’s family. You might give them a few days grace period to avoid any issues with the bank in case a problem arises with locating the alternate. After that, send the revocation to all interested parties (bank, attorney, etc.) The resident social worker where your aunt currently lives will sort out the details and either get other family involved or have a court appointed guardian assigned - rules differ by state and specific circumstances, of course. Good luck!
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Reply to Happyinthesnow
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Talk to the social worker at her AL, or find a private one if they don't have one, and explain the situation.. clearly and forcefully. You can not take her in, she is out of money but has SS, and she can not live alone. Hopefully they will be able to help.
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Agingmyself Jan 5, 2019
This is excellent advice if you want to just step away from the situation, which you've every right to do.
I'd expect that she'll get help from her current AL when you tell them the situation. They can't just dump an old lady onto the street, so you should stand strong and refuse to take any responsibility. They will get busy seeing that she's got off their back, which will probably start with them trying to get you to move her out. Just tell them you can't because she's broke. They can continue to keep her for whatever amount she can pay, or they can figure out who else will take over, but you are out of resources.
You could contact your Area Agency on Aging or Welfare Department or Family Services, whatever it's called in your area, and tell them she needs assistance.
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In New York State, Not sure about other States, a Medicaid Spend Down in any Nursing facility that would take in a Resident, Would do their own Spend Down to get that person Accepted on Medicaid. That includes Social Security as a "Single" Individual. You can also Get free Consultation from an Attorney who deals with cases such as this to find out what can be done in this State.
Talk to Adult Protective Services. They will help Direct you. There are places who will Screen the Individual and go on from there, They care.
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