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Hello. Sorry for all the questions. Things have been piling up.


My mom just got a Medicaid determination and is in a NH with dementia. She has no POA and I am trying to "manage" things long-distance.


Being an idiot, I think I should've had her final expenses pre-paid before she was accepted on Medicaid? In any case, she has about 25K in the bank, which is going towards keeping her house going so she can visit her cats and get a break from the facility.


I have not discussed what will happen after she passes. My thoughts were cremation, service, and burial. I would like to keep her house going for her as long as possible.


What would be the most cost-effective path for final expenses? I looked at some of the costs and they are insane. It does not seem right to charge that much. There are so many things to deal with and I may have dropped the ball managing this.


Thanks, Ken.

That’s a tough spot to be in, and you're not alone. When your mom has dementia and no power of attorney (POA) in place, it limits what you can do financially on her behalf—but there are still steps you can take.
If she’s still mentally capable enough to understand and sign legal documents, you might be able to establish POA now with the help of an attorney. But if she’s no longer able to make decisions, you may need to petition the court for legal guardianship. It’s more involved, but it would allow you to manage her affairs, including buying insurance or arranging prepaid funeral plans.
When it comes to final expenses, here are some immediate ideas:

Guaranteed issue life insurance might still be an option, but only if she can sign the application herself.
Look into prepaid funeral plans directly through funeral homes. Some accept payments even without insurance.
Start setting aside funds in a payable-on-death (POD) account in your name, so it passes to you quickly without probate.
In some states, you may qualify for state burial assistance programs if your mother has limited income or assets.
Finalexpensequoter has helpful info on guaranteed issue policies and alternatives for seniors with health or legal limitations.
You're doing the right thing by planning ahead, wishing you strength as you navigate this.
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Reply to eveh073
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My brother died without poa (which I believe ends with death?)
Fortunately we had most of his expenses covered beforehand.
And we had gotten some of his money and his social security transferred to a bank account finally).
Although I was listed on the “pay on death” as per the bank officer who opened the account, the bank did not honor that, saying that all7 siblings had to come from all over the US for the small amount on money in his account ( someone had already stolen the money that the social security debit card company would not allow a bank officer to transfer to the bank with my brother in front of her).
I had to pay for the required casket vault that somehow did not on the list of burial expenses at the cemetery.
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Hi Ken,
You say you are trying to manage this long-distance.
I'm wondering who is going to take her to "visit" her cats at home to get a break from the Nursing Home. This doesn't sound sustainable for very much longer.
When is the last time you have seen her? Do you know how she's really doing?
If she has dementia and is in a nursing home, she probably will not ever return to her home. Do you have someone to look after her house and her cats for her?

She has no POA now, and you have not discussed what will happen when she passes. Now is the time to have that discussion with her, or for you to simply decide - and yes, I believe cremation will be the most cost efficient way of managing her final expenses.
You can either have her go to the bank with you and have you added as a signer on her accounts, so you can manage payments for her. Or get POA. If she has a lucid moment she can sign the document assigning POA to you, or you will have to go to some trouble to get it court ordered. As far as making decisions for her care, the nursing home or any doctor or nurse will turn to the next of kin, and let you make the determination in the absence of a designated POA.
And, if you are added as a signer on her bank account, then you don't need POA either. It all just depends what she is capable of at this point
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Reply to CaringWifeAZ
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I’m not legal mind by any means, but
if an individual with dementia is no longer able to sign a POA due to a lack of capacity, family members may need to seek a guardianship or conservatorship through the court to appoint someone to make decisions on their behalf.
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Reply to JenJen24
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More than likely she is going to have to self pay at the NH if she still has $25K in the bank. She'll probably have to get that balance at or below $2K. You need to talk to nursing home to find out what her part is. If you did not list her bank account on the Medicaid application, you better call and update that info ASAP to avoid having to pay the state back for an overpayment on their funding.

I'm very surprised you don't already have a letter giving you the estimated date that she stops paying for nursing home and state Medicaid starts picking up the tab since she has that much in the bank. It is very doubtful to me that the state knows she has that much. Since all her needs (utilities) are being paid for her at the facility, she doesn't get to use her money to keep up her home. Someone else will have to do that. Additionally, when you completed the Medicaid application there was also a MERP (authorization to recover funds paid by the state for her NH bed when she passes away) form that had to be signed where there was agreement to pay back the state out of assets she has left at time of death...whatever is left in her estate is considered.

Of course, the amount in savings can vary from state to state. I am speaking about how it works in Texas.
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Reply to my2cents
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Your attorney can petition the court to make you a Financial and Health POA. Once you have a POA, you can get a reverse mortgage. Selling the House would likely cause her not to be Medicaid-qualified—best wishes to you.
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I'm sorry about your situation. I'm wondering about this friend that is staying at moms. If he/she can't afford the upkeep what can you do? Does he/she have a place of their own or end up being homeless? At some point, you're going to have to become the heir/POA and quickly before mom loses everything. Whoever is staying there will have to move unless this friend is a partner of mom that she wants to include in the will? But, as you said, can't afford to pay the bills. And so many bills! The number one is homeowners insurance, really tough to sell a home without it. It's first things first, mom gets settled in a safe place and then you get POA to sell the home. Then you'll have the funds to work on the funeral arrangements, which is not cheap. Did a spouse preceed her? If so, are they to be together? This will make a difference as far as the final arrangements go. It's too expensive to hold onto the home,when she can no longer live there. This will be a factor with Medicaid, she has assets that hasn't been tapped. This is very messy and requires legal help. If she is deemed cognitive you may be able to walk around some of this? I had POA trying to sell moms house but the title company wouldn't accept the will. They had a notary public come and had mom,89 with dementia sign the paperwork. Could be a difference making out a will than having one previously? You're going to have to make the trip and spend some time getting things together, it's going to be difficult. Good journey!
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Isthisrealyreal May 23, 2025
Julia, the friend just dies this week. Mom is in a facility and that is where she will remain.

Ken has other posts and answers here that cover all this.

Just so you know.
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Is she a member or regular attender of a church, synagogue, mosque, or temple? Clergy will usually perform funeral services consistent w/their beliefs for just a small honorarium, and a pianist/organist will also provide music.i There's probably a fellowship hall and members of the congregation will probably serve a luncheon for a small fee (or perhaps nothing at all). My Anglican parish has a memorial garden, where a deceased person's cremains can be buried (although they must be in an urn). Then there can be a plaque to denote her final resting place. You'll probably have to pay for the plaque, though. I'm a lector at the parish and have been a lector for several funerals like this when the deceased had no relatives willing or able to serve as lectors. There are ways to have a simple service that aren't expensive.
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Prepaid is much less expensive. Consider how you want to deal with her remains and pay for that in advance. As for memorial and what to do with her ashes - whatever gives you comfort. It doesn't have to be a formal memorial service, but whatever gathering of family and friends in a manner that gives everybody a chance to remember your loved one and find peace.

In my mom's case (she is in her 80's and very much alive), she has prepaid for cremation and putting her ashes in a nice box. We will probably have her memorial on the beach with some of her favorite snacks and little bottles of water (she carries the little bottles all the time). Later, I will scatter her ashes with my sisters and our spouses either into the ocean (she and I live in Florida) or on my land in a hole with a nice tree or bush planted on top (she and I garden).
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Reply to Taarna
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Is the account with the 25K in the bank joint with you or in a trust? If in a trust, who is the successor trustee? If you are not joint on the bank account, be prepared for the bank to freeze her account upon death.

How bad is her dementia? If you are not on the bank account, see if you can talk her into putting you as co-owner or POD on the bank account. The reason why is because they could freeze the assets in the bank account upon learning of her death....and you would have to pay out-of-your-pocket, until you go through the legal steps to get access to the account.

In my case, my mother was cremated. We found out that all the cremations in our area, go through one crematorium and found out the fee to use that crematorium was significantly less than using a funeral home. The crematorium picked up and stored the body until the cremation was actually done. Then I picked up the ashes in a "plain, inexpensive box ($35) and stored it until the funeral. We bought my Mom's urn from Amazon. The most expensive part of the burial, was the funeral home expenses of re-opening and closing the site where my father's urn was, and the additional bronze scroll for my Mom, that was added to my father's plaque. We went to a restaurant afterwards where we invited all that wanted to come and even that was less than the mortuary expenses. If I had purchased a package from the mortuary prior to death, I would have received 15% off the package price of the services. I'm not sure if they would have forced me to use "their" cremation services, which would have easily eaten up difference in cost compared to what I did.

The other places that we had to pay out was property taxes, however, for us, that was offset by the rent we received monthly. and the fees associated of moving the house to the new owners (which included an appraisal).

Another area that we are still dealing with financially is stocks. I know that I have the stock certificate for the stock my Mom owns, however, I can't find it. If I need to have them re-issue the stock certificate, that will cost money. They have to reissue the stock certificate before I can cash it out.

The other places that we had to pay out was property taxes and insurance and the minimal electricity, heat, sewer bill, however, for us, that was offset by the rent we received monthly.

Then there was the lawyer expenses of transferring her house to the people who inherited the property. This includes a "back-dated" appraisal, which we used as the value that was reported for federal and state "close of estate" taxes. Due to state laws, we were unable to do it within the same calendar year, so I had to pay her income taxes as well as the appraisal fee.

My Mom, when she passed, was not on Medicaid. Therefore, it is possible that I might not have had to pay all these expenses if she was on Medicaid.
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Reply to ChoppedLiver
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In NY state, Medicaid lets you keep over 30k in savings. You get $50/month for expenses. I was planning on putting her remaining fund towards the house and asking the resident to kick in some. I want to reserve the rest for final expenses. She worked hard all her life and being able to visti the hone and cats maybe keeping her alive or at least happy.
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Reply to kenmtb
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Medicaid allows certain funeral/burial/cremation expenses (up to a limit). We purchased a pre-paid cremation policy for my MIL last Sept for $3600 and she passed away somewhat unexpectedly right before Christmas. When you say you want to keep the house going as much as possible... what do you mean? If your Mom is the owner of the house then Medicaid will probably put a lien on it and do a Medicaid Estate Recovery on it so that the next owner/inheritor will have to deal with satisfying that.

I stongly recommend you consult with an elder law attorney licensed in her state. You need to know what to expect with her having no PoA. You may need to become a conservator or guardian, which will require you to go to court. The cost for this can come out of her funds. Then you can also discuss "keeping the house going" or any other hopes you have going forward.
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kenmtb May 20, 2025
Keeping the house going so mon can get away from the nursing home to relax and visit her cats. Her friend who helps out also lives there but cant afford to pay the bills. She keeps saying she want to go home. That is no longer possible but I am trying to heep her house available to her as long as funds exist.
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Berating yourself for the 'should have's' won't do you any good so (try to) stop it.
And, no. You are not an idiot. Stop berating yourself as this depletes the energy (and self care) you absolutely need to carry on. And, even if you don't need to handle these things, berating yourself never supports you to move forward and feel good about yourself.

If I were you, I would hire an attorney that specializes in this area of elder care.

It sounds like you are interested in reasonable burial costs.
While I do not know specifically or the financial end, dealing with Medicaid and a house (income/value) ... I would ask any attorney if you could become the POA. You need to get MD documentation - for everything legal - that you are the legal representative, handling needs for your mom. Do you have this letter?

I would call local funeral homes - or whatever kinds of service - you want and ask about pricing.

Personally, I am donating myself to science. It is needed for medical students and doesn't cost me (or another) anything. I do not see any reason to pay to put me in the ground, unless - which I would really like to be-come, mulch. Companies do this although it is expensive and not widely available. I would love to actually be part of the earth as I revere nature. What better way for me to continue on ... in nature, becoming a tree or something. UCSF will take me. Although first in line is another organization. Sorry to go on and on about me here.

Give yourself a hug.
Gena / Touch Matters
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Reply to TouchMatters
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25k does not compute, in my state it is 3k max. The 25k would be used for her care first, after that Medicaid will kick in.

How do you think she is going to visit her home anytime soon? Medicaid does not allow that when in a nursing home or at least where I live.

The home should be sold to care for her not wasting money trying to keep it.

As for after her death, cremation is the least expensive way to go. The idea is to use her money for her while she is alive, after she is dead it doesn't matter.

Medicaid will place a lien on it, so it will be theirs after she passes, if there is anything left it will go to her estate.
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TouchMatters May 19, 2025
God knows ... we don't want this: "Medicaid will place a lien on it, so it will be theirs after she passes." Sell the house ASAP. If possible, get in son's name. Save $ as he can however he can. An attorney should be able to help with all this. Gena / Touch Matters
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If Medicaid is offsetting the costbof her care, how does shevhave 25k in the bank? Does your State allow that muchnin assets? Mine only allows 2k.
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Reply to JoAnn29
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Cremation is the most cost effective. Skipping the burial, which is expensive and not necessary, imo.

Donating her body to science will get a free Cremation down the road a bit and you can get the cremains or they will deal with them.

Just curious, are they letting her spend nights away from the facility? I do believe that this could cause problems with Medicaid covering the NH. If she's well enough for overnight visits is she truly medically in need of NH level care. Just a heads up on that.
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