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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.

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How about a Miller Trust? so she is eligible for Medicaid.  But Medicaid does not cover assisted living in many states. Is there a local agency for the aging in your area to talk to for ideas?  There are many knowledgeable posters on this forum who could advise you.  Be patient and watch for their answers.
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busymom Jan 2019
Can you explain a Miller Trust? We may need this for the care of my aunt and uncle in the future. They're in assisted living for now, but will run out of funds shortly. They are both 91 and will be 92 this year. My aunt is under hospice care, so I don't know how much longer she'll be here. We're hoping to get VA benefits to kick in for my uncle, but that's still several months out. I will google "Miller Trust" so I can learn, but perhaps other readers would appreciate a description here. Thanks rovana!
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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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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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anonymous434963 Jan 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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I think SC Medicaid has an income trust option but it will only pay for home care assistance or Nursing Home care. Talk with your local Mediciad eligibility workers
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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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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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That's great news.

Praying it all works out well for her and gets the stress off you.
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AsAginMyself said the AL can't just throw her out. They are obligated to help find somewhere for her to go. Given her finances that place may be a skilled nursing home which should take Medicaid. An elder attorney could help you with that process as well as releasing you from POA.

Good luck and please take care of yourself.
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I would consult an Elder Care Attorney right away -- it may cost you $300-$500, but this way you know where you stand legally.
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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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Do not get frustrated. First seek the help of an elder Attroney who specializes in elder care services. You need an accountant if you are some one who does not keep good books of account. They should be able to lay down the steps for you.
1 check her cash flow and estimate how long she can manage.
2. Use her funds to get the legal help and help to put her life in order.
3 then with the help of the attroney find out how you can be relived of your responsibilities. There are provisions in law to do.
So do not do anything stupid that you will regret. The govt may come after you since you are POA and had the power to make the decisions.
Learn how things work and follow. There are plenty of good people to help you. Some are free and some do these for living. The fact you are in this forum I am sure you will get lot of good advice from people to solve your problem.
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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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anonymous434963 Jan 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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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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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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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 2019
You are so spot on igloo! In Ohio. Take this person's advice.
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also regarding stopping being her POA, I can totally understand why as there’s always something and she’s running out of $. So it’s stressful every day..... BUT I’d try to get her out of AL into a NH as Medicaid Pending done by atty this month with you staying as POA through all this.

I’d be concerned that if you walk from or resign POA and it lands into ward of the State for her, the newly court appointed guardian could make Aunt Bea’s financials go through a forensic accounting review. It sounds like she did BK, so the guardian may need to look deeper into her past to see if BK was in her best interest. You could literally find yourself in Hades as you got a summons to provide in detail receipts or documentation for all her funds from FY 2016 or why certain actions were taken up to 5 years ago. And the court date for the hearing is 21 days from now.

Personally I’d ride it out and get her placed in NH on Medicaid. The NH gets her SS$ So no more dealing with your paying the facility. The VA allowance and Medicaid allowance gets set aside at the NH in a personal needs trust account, which you as POA draw from every so often to buy her clothing & toiletries replacement and have her on the weekly beauty shoppe visit. So that the personal needs account stays under 2k. Perhaps you get a RX for 10 mg Valium or get a bottle of hemp based CbD gummies to chill.
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She is in someone else's care right now, the AL. Have you informed them of her financial situation? If not, do it today. They may let her continue to live there pending her VA benefit or they can help you with advice. Be very open about her finances. If there's no one at her AL who can provide advice, call the county office of services for the aging and start shopping for an AL that she can afford with her VA benefit and SS.

Take care of yourself. Stop seeing her if you have to. Being treated meanly is insult to injury!
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Get an Elder Care Attorney in SC, Not in your area! Someone in your area is not licensed to work in SC!
I bank can be financial POA, Center on Aging in SC can be. Use funds left for travel, Attorney fes, court filing fees. Stop automated payments for those extra costs.

Is she actually in AL or Continuum of Care Facility, or essentially getting NH care in NH? This is important.
I read a bit on SC Medicaid site, very restricted. Most states have Waiver Programs to cover those extra services to keep a person at home and out of a NH.
Did she pay an up front fee to theget into AL facility? Are they milking her for expensive extras instead of moving her to a higher level of care?
My advice, take $$ and get a good independent agency, bank trustee, or Elder Care Attorney to act as POA, not the state. State will move her to cheapest facility. Looks like minimal oversite on quality of care, or monitoring her needs. They may DC many services she is getting.
Another option is use $$ for Supplemental Insurance and, if you can get it, Let ng Term Care Policy, at least to bridge the gap till VA kicks in. Better use of funds than buying 2 months if Extra Services, just to have them pulled, and perhaps more list in 2 months.
Then the people avoiding taking responsibility will start blaming you! Make the changes now, and give them a wake up call.
You should be able to work locally with the VA.
Good luck!
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Heard of a similar situation which was resolved when the senior was moved to a less expensive facility.
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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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See an Elder Law Attorney. The knowledge you'll gain you can apply to your father, also.
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Hire an elder care attorney. He/she will guide you properly.
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Download the "POA Handbook" for your state. I just recently became my mom's legal guardian in Michigan. The handbook has a wealth of information, including what to do should you want to step down from your POA (or legal guardian) status. You have to petition the court (forms available on the website of probate court for the county involved). You can suggest a POA successor. All "interested parties" must be notified before the hearing. If no-one steps up at the hearing, or your recommended family member declines, the state may end up appointing an outside POA.

This is by no means a step-by-step. Bottom line is, you are not obligated to continue being the POA.

I'll add here that my recommendation to anyone consider being a legal guardian or having POA, read the handbook and see exactly what your obligation will, before you even consult an elder lawyer or (as in my case) petition the court yourself.
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First, the fact that your aunt may make too much SS is incorrect. Medicaid beneficiaries that make over the 2019 income limit, are required to create a simple document - Income Trust or also known as a Miller Trust. I would recommend that you use the funds from her IRA to get her in the door of a skilled nursing facility in SC, if she requires skilled nursing. You would have to provide the facility with a history and physical report in order to move her into a nursing home.

It could take the VA 6 months to get back to you regarding your application for Aid & Attendance - but you are still able to apply for Medicaid. Now, Medicaid will not pay for Assisted living, unless the individual makes less than $1,000/mo. - which is doesn't sound like that is the case here. So, you would be looking at a nursing home to move your aunt to - and then, IF there were no gifts (transfers to others in excess of $250 or for less than fair market value or transfers of her assets (home/car/insurance/investments) in the past 5 years, Medicaid should be approved.

Regarding the your POA/HCPOA duties, you would just need to "decline to serve" and file that Declination at the Registry of Deeds, which is where the POA should be recorded. See an attorney to prepare that document. Then, you would notify the assisted living facility, her bank, her family, etc. that you are no longer her POA/HCPOA, and then take a breath and back away. She will be taken care of in the asst. living facility and ultimately the nursing home and it is time for her immediate family to step up.

Best of luck to you in this difficult situation.
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Rip it up-unless there is a copy of it filed with an atty someone where, (of whom you can also call and say RIP IT UP) that's up to you. Call Dept of Children and Families so no one can accuse you of abuse and tell them, you are done, its not ABUSE or NEGLECT if you notify the state agency. Trying to do the finacial dog and pony show for Medicaid is ridiculous and more stressful than caregiving. NH's have social workers who lick the state's behind as they want the NHs to get paid-they don't give two shts about the pts. Its a business. The State will figure out what to do with her. REALLY. No need to jump through hoops, when you are done you are DONE. And the VA will take close to a YEAR on Aid n Attendance, NOT 6 mo as others have stated here, and then if not competent they will tack on another 6 mo to a year on that of making you or appointing her a fiduciary.
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POAs are not recorded in my County. So you need to find the lawyer who drafted it and have it revolked.

This is what I don't like about POAs. The assigned person may not know they are assigned. They are required to sign the document and where I live they do not have to be filed with the County.
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