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This must be an unusual question because I can't find suggestions anywhere. I'm hoping this forum can give me some ideas. My mother is in late stage dementia and has been in a nursing home for 3 years on Medicaid. According to the NH, in our state of CT, she gets to keep $60 a month from SSI and $90 a month from the VA. I find it a challenge to keep her bank account below the $1600 maximum so that she continues to qualify for Medicaid. A haircut in the facility costs a mere $20 and she definitely wouldn't enjoy or need a haircut every month. I buy her clothes, shoes, special toiletries, treats from time to time but $150 a month is alot to spend on these kind of items. I bought her flowers, seasonal decor gifts, cozy outfits and blanket, Alzheimer "toys". I'm at a loss of what else I can use this money on. My mother's dementia is at the point where she wouldn't enjoy leaving the facility so going out for lunch or ice cream is no longer a possibility. She already has a TV in her room that she doesn't watch. The nursing staff suggested a medical recliner for her room but seriously there is barely room for that and I know she wouldn't use it. She spends most of her days in her wheelchair in the community room. Recently I've had a massage therapist come in to give her a chair/hand massage which she enjoys. I will continue to do that but I need some ideas for more big ticket items so that I can get her account down to a balance that is easier to maintain under the limit. I know, its a ridiculous problem to have. Does anyone else have this problem? Does anyone have some ideas to spend money on for a late stage dementia resident of a nursing home?

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How about a regular hand/foot massage by a massage therapist - very soothing and calming if your mother is willing. Wishing you and your mother all the best.
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Reply to Psyclinz
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I am so looking forward to the time that my mother will get the VA aid and attendance. I will put a phone in her room and turn on her TV. Then I can have her go once a week for a hairset. She is always begging for these things and I hate so much saying she can't afford it. I have been buying her any new clothes and undies she needs. The nursing home provides diapers but she really prefers the pullup depends style. Also she likes to have something different from institution food all the while. I take in goodies once a week but it would be nice to take in a nice restaurant meal occasionally. I also see many of her clothes are getting stained and washed out, so would like to replace some of her clothing. They loose her socks so it seems like I spend a fortune on socks. I hope this has given you some ideas. How about looking into a better quality wheelchair with the special float seat. My mother uses a facility chair and it is worn and doesn't move real easy. I know I won't have any problem with finding ways to spend that money on her. The other thing I've heard suggested is if family lives out of town, some of the money can be used to bring them for a visit and cover the cost of their stay. My brother and sister live 8 and 12 hours drive away so this would be something we could do as well.
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Reply to Nancynurse
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I love the idea of hiring private aides or sitters if they would be helpful or appreciated. How nice to have the resources for some "extras."
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Reply to RedVanAnnie
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Great ideas friends! Thank you so much for the input! Lots of ideas here.
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Reply to anonymouse62432
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Private sitters--$20 an hour.
CNA--$35 an hour (they do hands-on care)
make sure your state approves of this sort of thing--talk to the nursing home's social worker
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Reply to cetude
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JoAnn posted a great list.
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Reply to Llamalover47
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So thankful to you for posting this. I am helping my friend who is 86.
For me, the legal avenues are what I want to investigate; not just buying things . . . although some good ideas here.

I've heard that setting up a trust is very expensive. He is still in the process of deciding how to proceed. Although he wants implants. He might be able to get through VA although at his age, he might not be able to get them. It is a painful process from what I've heard. Thanks again for posting.
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Reply to TouchMatters
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Here is the list from SS website

3. 
Examples of Personal Needs Expenditures
Some examples of acceptable personal needs expenditures are:
a. 
Clothing

Disability-related adaptive clothing, bathing suits and caps, boots, gloves, hats, scarves, seasonal garments, shoes, slippers, etc.
b. 
Convenience Items

Music players, e-readers, computers, phones, clocks, clothes hamper, stationery, televisions, wristwatches, etc.
c. 
Health and Hygiene Items

Bath scale, brushes, combs, nail clippers, cosmetics, cosmetic surgery, dermatology treatments, elective or cosmetic dental treatments, hairdresser or barber costs, soaps, toilet articles, etc.
d. 
Hobby and Craft Items

Art supplies, cameras, photo albums, games, athletic equipment, etc.
e. 
Living Area Furnishings

Bedspreads, blankets, carpets, curtains, lockable chest or trunk, mirrors, pictures, pillows, posters, quilts, recliner, rocking chair, etc.
f. 
Miscellaneous Items

Magazine subscriptions, reasonably priced holiday presents for family or friends, restaurant meals, gift cards for movies or music, etc.
g. 
Staff Travel Items

Using the beneficiary's funds to pay the expenses incurred by staff accompanying the beneficiary on an outing or vacation may be an acceptable use, provided:

a correlation exists between the expense incurred and a direct benefit to the beneficiary;

the beneficiary does not have unmet current or foreseeable needs;

the expense is reasonable in relation to the beneficiary's conserved funds; and

the staff member's travel expense (e.g., food, transportation, lodging, admission ticket) is not paid for by the payee organization or from another source. The payee should never use beneficiary funds to pay for a staff member's salary or hourly wage or to compensate the payee for these costs.
NOTE: A payee must obtain SSA approval prior to using benefits for staff travel items. Add a relationship note in eRPS to document the approval, see MS 07415.002 Make Note.
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Reply to JoAnn29
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How about a comforter for her room, something nice and warm? Room decor, things she would enjoy viewing? A music system, something to play the songs she likes? How about bringing ice cream you say she enjoys along with her favorite foods? I think the medical recliner may be a good idea 3specially for when the disease progresses and sitting upright becomes difficult. Given the fact it was suggested by the staff, I'm sure the facility will help you rearrange the room to accomodate it. How about increasing the hand massages since she enjoys them so much?
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Reply to Peanuts56
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You can always upgrade her funeral.  If you have not paid for her head stone you can do that as well.  I know some folks don't like to think about this but it will save you the stress of having to worry about it later.
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Reply to Medicaid216
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If it is confusing for her to operate TV or CD player, you could find a local musician who is familiar with songs of your Mom's youth--nothing fancy, just someone with a guitar or a ukulele or a keyboard, who has a fairly gentle voice, to come sit by her and keep her company now and then.

Or maybe a visit from a therapy animal, if the facility allows that.
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Reply to InItForGood
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Might want to have a nail tech come and give her a basic mani-pedi ($25-50) once a week since nails don't usually get enough attention. A regular massage is always nice since they can also do some passive range of motion exercises with her. Maybe hire somebody to read books to her.
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Reply to Taarna
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Talk to her medicaid worker who knows the rules. They can tell you if you could hire a person to come a few hours each day just to be with her during hours that you are not there. Always good to have another set of eyes to observe the care she gets. You might also ask if you could self pay some of her facility bill and let Medicaid pay the balance. That might solve the problem ongoing.
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Reply to my2cents
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Can you pre-pay her funeral expenses? Maybe on an installment plan?
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Reply to Bigsister7
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Hire some friendly person just to come and sit, give her hand massages, foot massages and hugs, sing to her or play music. Does your mom have a CD player for music, and IPOD that can be used for playlists? Arrange little parties from time to time for her favorite friends in SNF. Just small gestures you can provide via paid visitors might help keep her smiling and cheery. She is lucky to have this problem because you will probably find things you can do for her that spend down the money. If you can hire a wheelchair van (these would cost about $150 a day, then hire s nice person to sit with your mom and just take her for a little drive once a month. She doesn't need to be transferred, just stay in her wheelchair and be rolled up a ramp.
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Reply to thepianist
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Does she need adult diapers or lotion? What about her favorite bath powder or shampoo? A lot of times our mother’s just like to feel pretty! My mother really enjoys having her hair washed and set once a week, having her favorite powder put on and perfume. Your mother and the other residents might even enjoy a new dvd to watch in the community area or even a new puzzle to challenge them, it doesn’t have to be a hard one but a couple of children’s puzzles to start with to see how they can put them together
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Reply to Only1caregiver
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I charge my dad rent. Its allowed. Keeps his balance low and I am able to save for his final expenses, which he says he doesnt need to worry about. I do!
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Reply to ShenaD
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Countrymouse Mar 2, 2020
I'm not sure how this would work if your loved one with late stage dementia is resident in a nursing home?
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Where is Igloo when needed?

Hello Iggy!
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Reply to Sendhelp
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How to Use a Miller Trust for Medicaid Eligibility
K. Gabriel Heiser

A senior’s income and assets must fall below certain levels to qualify for Medicaid coverage of their stay in a skilled nursing facility. If their countable assets exceed $2,000, they will not qualify until the excess is spent down or converted to an asset that is not countable.
For income, the 2018 federal limit for eligible applicants is $2,250 per month. However, many states allow Medicaid applicants to spend down their income on medical expenses to get below the $2,250 limit and thus qualify. These states are known as “medically needy” or “spend-down” states. But what can an applicant do if they live in a state that has a hard income limit and doesn’t allow spend-down? Say their assets are below the eligibility limit, but their countable monthly income is $2,275. In this scenario, the senior has too much income to qualify for Medicaid, but they certainly do not have enough money to pay for a nursing home or other long-term care facility!
It was this very situation that led to the 1990 case of Miller v. Ibarra in Colorado. As a result of the decision in this case, those states that do not permit an income spend-down all offer Medicaid applicants the ability to set up a simple irrevocable trust to hold their excess income. Funds in this trust can be used to pay the Medicaid recipient a monthly personal needs allowance (approximately $60, but this varies by state) and, if applicable, pay their community spouse a minimum monthly maintenance needs allowance (MMMNA). From there, any funds that are left over are used to pay the Medicaid recipient’s nursing home bill. The difference will be covered by Medicaid, assuming the applicant otherwise qualifies. Such a trust is called a Miller Trust (after the court case mentioned above), but it can also be referred to as a Medicaid Income Trust, a (d)(4)(B), an Income-Only Trust, an Income Diversion Trust or a Qualified Income Trust (QIT).
Each state has different rules, but in “income-cap” or “categorically needy” states that don’t allow spend down, at least the excess over the income limit amount must be placed into the trust. The Medicaid applicant cannot be the trustee of this account since they are essentially giving up their rights to the money it contains. The trustee is typically a family member, and each month they use money from the trust to pay the Medicaid recipient’s share of cost (SOC), personal needs allowance, their spouse’s MMMNA, and other medical costs and premiums not covered by Medicaid and Medicare. Assuming some basic rules are followed regarding this process, excess income will not prevent an applicant from qualifying for Medicaid, unless their income is so high that it exceeds the amount that Medicaid would otherwise pay to the nurs­ing home each month for their care.
Keep in mind that a Miller Trust can only be used to hold income going to the individual who is trying to qualify for Medicaid, and many states require this income to be direct deposited into the trust account. Applicants cannot put only portions of certain income sources into the account. For example, you cannot put part of your pension or social security check into the trust—it’s all or nothing. Assets and income sources that do not count towards eligibility limits should not be placed in this account either. This includes a community spouse’s income, VA benefits like Aid and Attendance and housebound pensions, income tax payments and some annuity payments.
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Reply to Sendhelp
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I remember posts about a trust that could be used for excess funds, used for Medicaid if necessary, but the balance available for the estate. Could you set up the trust (someone will remember the name), and make deposits to it when the balance gets too high? Better than just spending for the sake of it!
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Reply to MargaretMcKen
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Ask if your mother's medical recliner (you mean a riser-recliner armchair, yes?) could go in the community room and, in due course, be donated to the facility. As her skin becomes more vulnerable, this will be much better for her than being confined to a wheelchair for long periods of time; and even if she can't operate the controls the staff can - much better for frequent repositioning.
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Reply to Countrymouse
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A poster a while back suggested making sure that all dental work is up-to-date. It’s expensive, and it means that the person can eat more solid food. That’s a quality of life issue, compared with mush.
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Reply to MargaretMcKen
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Get a Grandpad tablet for seniors to keep her connected to family.
An electronic device easy to use.
Have bottled water and a cooler delivered.
Get a hepa filter for clean fresh smelling air.
Hearing aids cost $8,000 plus.
Send her clothes out (pick up and delivery) to the cleaners.
Stock up on an emergency supply of food, flashlights, and meds.
Any crafts, maybe she can share some games with other residents.
Ask the staff.

What kind of wheelchair? Get an electric wheelchair, or an upgraded wheelchair, a walker?
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Reply to Sendhelp
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Thank you all for these very creative suggestions! I feel supported by the response!
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Reply to anonymouse62432
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If she can hold a large book, she might enjoy a big colorful book of famous artists work. I've read looking at art can stimulate some parts of the brain. If she likes music buy her a CD player and discs of the music she liked when she was younger. The staff will keep it on for her if you ask. A really nice pillow would use up quite a bit of money and be enjoyed.
I would also hire someone to read to her or play checkers if she can. A teenager could use the money and your mom might enjoy having someone around to read to her. I would also have her name embroidered onto her clothes. I just hate names written on clothes with a sharpie.
If she likes getting her hair washed in the beauty parlor, get it washed every week. It may be soothing for her.
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Reply to Ruarbl2
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Beauty parlor. Holiday lunches are some things personal needs $$$ pay for.
hugs 🤗
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Reply to CaregiverL
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New cushion seat for wheelchair, bag for back of wheelchair to carry extra supplies, ultraviolet denture sterilizer, lip balm, new comb, hair ties, head bands, manicure set, stick on motion detection lights along baseboard. Can she hear the TV? Maybe she lost interest because she can’t hear it: wireless speaker for wheelchair. New pillow, pillow cases with her name on them. New shoes.
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Reply to GAinPA
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Does she have family, grands, children, siblings, friends she bought gifts for prior to advancement of Dementia? Maybe purchasing gifts on her behalf for special people. Was she a church goer and or member of a congregation for a long time? Maybe “tithing” or donating to the church as she might have throughout life. You obviously have chosen a good facility that is meeting all her needs since you aren’t needing to supplement, good for you!
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Reply to Lymie61
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Beatty Mar 1, 2020
I was wondering about gifts too... What would be reasonable amounts - this may not be allowed at all?

My SIL loves buying collector coins for gifts, the type from the mint. If I had to shop for her, I'd buy silver coins as gifts. Would look like I was stockpiling & hiding her assets though :(
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New mattress? It’s allowable where my LO resides in nursing home.
They have certain restrictions but this might spend down a healthy amount.
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Reply to Getkicksonrte66
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A few suggestions:
- fresh flowers delivered to her room;
- eatable bouquet;
- chocolate covered fruit;
- meals/treats delivered to her room (with delivery services like DoorDash you - - can have a whole meal or milkshake or smoothie delivered);
- manicure and pedicure;
- wash & set;
- digital photo frame with slideshow feature;
- photo book of family, landscapes, birds, animals, etc.
- if allowed a small refrigerator;
- Walmart/grocery delivery of fruit/cheese tray;
- my father enjoyed high qualify chocolates (Godiva has a subscription service to deliver a box each month);
- mouth rinses (for dry mouth or dental health); and,
- essential oils along with a diffuser.
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Reply to TNtechie
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