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How does one afford a nursing home? Nobody can take care of grandma forever.

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Nobody wants to go to a nursing home. The best way to assure you never do is to give all your money to your kids. Then they are stuck with either keeping you or magically coming up with tens of thousands to pay the nursing home. Sorry, but that is the ugly truth. No exceptions either.
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Stuck -Pam's right that it doesn't matter to whom the gifting was to or for. Gifting has a transfer penalty.

Probably the only to get around this are 3 possibilities:
1. set up a special needs trust account for an already qualified disabled child who the elderly parent was providing care or support for. Like an 85 yr old mom sets up a special needs trust for her 65 yr old son who had polio in the 1960's and who is moms dependent & member of her household. OR
2. Mom files a report with police & APS naming the persons gifted $$ as stealing from her & coercing her to have given them her money. The police then get an arrest warrant on them. The police report, warrants & APS investigation will provide the documentation for an exemption to be done by Medicaid on the gifted $$. Mom & her DPOA will have to go nuclear to get #2 done.
3. Decide what room mom is going to move into for 5 years & what shifts family share & do whatever to make the giftees do their share.

The transfer penalty starts the date of the filing of the Medicaid application. So you either have to wait 5 years & a day to file to get around a penalty or start the penalty period the date the application is submitted. If mom goes into a NH Medicaid pending and a transfer penalty hit happens, realize that the facility will be notified of the penalty by medicaid and the NH will come after whomever they can in family to get the bill paid. If yours is a filial responsibility state, it will become your legal issue to deal with as the NH will come after whomever to get paid & the DPOA faces negligence issues, etc.

The choices are stark & limited.
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After asking here re exceptions (since someone said "she's all yours for the next 5 years" ~~ w/a crushed-back/can't-lift-ditz situation, I can't do it if comes to that), since this was re a "NEED," not grandma sending someone on a cruise(!!), I kept reading here & there and found something that sounded like there are sometimes some "exceptions," after all. Will try to find that again & paste here:

"But are you familiar with the various exceptions to the penalty, and will you be able to argue that such exceptions apply in your case, thereby avoiding any penalty?" (it didn't explain what they are, but we will be looking for them, because we know already what we cannot physically do)

Thanks, anyway.
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stuck1, Medicaid does not ask why the gifts are given, nor do they care. They expect the elder to use their resources for their own care. So by giving money away, grandma has assured that she will not be in a nursing home for five years hence. She is all yours until then.
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But what if "gifts" are not just superfluous "extra income" for the one who received them? For instance, mother's pushing 90, gave $$ to yet another grandchild ... this one who herself was hurt on the job, had disability advised due to other physical things that remained after surgery from the hurt-on-the-job incident. That g'child sorely needed a vehicle to get their middle-school dau around here & there (buses don't run after a certain time, to certain places, etc, etc), as hers was so rundown it became downright dangerous. All this re the vehicle happened during her time of homelessness, w/the two of them living first w/relatives a few months & then a shelter until getting help w/an apt.

Barely making it, she could not begin to be able to try to "pay back the gift b/c it was received within the 5 years prior to ...." Would hope there would be exceptions to "paying back the 'gift'" where it was re NEED, not extraneous $$.


Were she to need to go to a NH
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Daughterof - no, no you don't have to wait 5 years!! - the car transfer will come up eventually as its registration is within the states system. The transfer penalty roughly will be based on a equation of the value of the car (like the Blue book value) & whatever your state has as its daily reinbursement rate that medicaid pays for room & board @ NH. For example a car "worth" 10k resale value transferred in TX which has a $155 a day R&B payment rate would be 65 days penalty. $10,000 divided by $155. So family would need to private pay the NH for 65 days.

TP will be a # of days situation. A state that pays a high R&B rate - like many on the east coast - will have a shorter penalty oeriod. Keep in mind that Facility will get ineligibility letter as well as the elder and the elders point person. You or other family will be asked and expected to pay during the TP days.

Now you can appeal the ineligibility & during the appeal they continue to be consider medicaid pending at the NH. You want to file an appeal, comprende? The blue book value is somewhat subjective & can be lowered with supporting documents. Like if there are photos to show damage to car; a litany of repair bills that show car has serious problems, it's on a recall list, the penny saver has almostnidentical cars selling for less than value, etc. It will be up to you to get any documentation found, organized and sent for getting an appeal. Getting car value reduced if it's an older car should be pretty easy to do if you provide the documents to the caseworker.
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why are a convicts/prisoners being treated better than our elderly who did nothing wrong or illegal, worked and paid taxes all their lives? They get showers daily, exercise, 24 hour supervision, a larger room all the free medical and dental you need...hey and if you are a 'white collar criminal" private tv's, golf,basketball your choice of meals, a suite to live in. H*ll makes granny want to commit a crime... and who pays for THAT our government- US! Let's put gram and gramps in the white collar prisons and the pedophiles, rapists, murders, robbers, pnzi schemers in the nursing homes.....they can get cold meals, 2 showers a week, no fresh air or better yet send them to the Arizona's pink panty prison where they live in tents......no one re offends there it's too hard a life 11% compared to the nationally average of what 70%! That's what makes me sick and we are all worried about our families and how to pay for their care!Our government needs to step in NOW!In the next decade 70% more elderly will hit the system then what...it is already broken...then I guess we will be homeless like the Vets that fought for our country and you and I.I see them, heck feed them everyday and hear there stories they were promised care, benefits if they served many did they had no choice to take care of their families or that was the only way they could go to college then on the GI bill...so they took the risk.....many died more are hurt severely and are getting no help at all it is disgusting!Can we help those at home before sending billions overseas?? I am all for helping anyone in need but let's take care of those who fought for our country and paid into out tax system first...then any excess please help whoever needs it! OK got that off my chest...sorry!
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DaughterofIan, maybe not - if there is a penalty, it would depend on the market value of the car and any penalty period would likely be a much shorter duration than 5 years. Get an eldercare law or estate planning consultation. And they allow people to own one car and one home uncounted as assets in any event, in case that helps any.
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Since my dad couldn't pass the driving test on his last renewal due to dementia, they denied giving him a license. He owned a car, but my brother drove it. When dad had to go to an Alz care facility to live, my brother took the car. I had POA so I gifted the car to my brother to avoid having to pay registration and car insurance. Will I need to wait 5 years before I can apply for Medicaid for Dad?
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jimmylinn, you pre-pay for a funeral or you put the money in a bank account titled "burial fund". Social Security will advise you how much you can reserve. If you pre-pay $10,000 and don't spend it all, the funeral home refunds the difference. Most burial funds don't cover it all. Funerals are expensive.
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We have applied for Special Assistance which is handled by Medicare but the funds come from somewhere else. All they are waiting for is the cash value of her insurance policy. It is whole life and she has had it since 1985. So if the cash value is to high she would have to cash it in and use it to pay for her assisted living before Medicare would take over? Then how do they think you will be able to pay for her burial? Thanks for the tip about not just signing my name
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JimmyLinn - so mom is going into AL? Please double check with the facility to make sure that her state's Medicaid program will pay for AL. Most states Medicaid program is geared to paying for "skilled nursing services" facilities - which by & large mean a NH. Now some states do have a Medicaid funding diversion program for facilities which will pay for AL, so you need to make sure that mom is on & will qualify for this.

Most states allow for a small insurance policy with a cash value if it is going towards funeral or burial. Usually about $ 1,500.00. This can be in addition to any pre-need, pre-paid funeral & or burial policy already done (the funeral/burial needs to be NCV - a no cash value policy too in order for no issues with Medicaid).

You need to look at the policy to see if it is TERM or WHOLE LIFE. Whole life usually has a cash value and those seem to be required to be cashed in before Medicaid will approve. Term doesn't pay till after death, and if it doesn't have any build-up of cash reserves or dividends paid, then term life policies just continue to exist under Medicaid. But if the policy isn't paid up, then somebody other than your mom will have to pay the premium as mom won't have any of her SS or other retirement monthly income to pay on it once she is in a facility by & large.

Please make sure that whatever you sign at the facility, you NEVER EVER sign anything as just your name. If you can have mom sign off on all the paperwork that is the best. She should be able to if she is just going into AL. But if she can't, please sign whatever as "Jimmie Linn as DPOA for Mary Jane Jones" or "Jimmy Linn in her limited capacity as DPOA for Mary Jane Jones". And be sure to get a copy of each & every page of the entire contract too. Good luck and try to keep a sense of humor in all this!
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Hi there, I believe I may understand where you are coming from. Igloo gave you a very good extensive answer, however for it can sound pretty complicated for those of us who have never dealt with these matters before and just learning or trying to learn what our future holds as caregivers. The first thing you need to do is go ahead and take her to social services and help her apply for medicaid. There may also be some other programs she can apply for as well that you may not be aware of. Her case worker will give you a list of items that you will need to gather up and bring back to them. This process is also time sensitive from the time you apply. Go ahead and get that done and see if she qualifies for it. If so, there are many other ways that medicaid can help her other than just the NH. If not, then come back and repeat the question and maybe you can get more help here. My problem is that my mom lives with me, has a home mortgage, bills to pay, no money saved and gets by on her SS check each month. So I am at that point where I am just living it one day at a time and see what happens. Hopefully she will never need the NH. Good luck.
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jimmy they don't care about face value, just the cash value.
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We have applied for Medicaid for my Mama who is moving in to assisted living facility next week. They are waiting on the cash value of her insurance policy.Does that count as a resource that could cause her to be denied? Its a small face value of 4000.00 which would not cover burial expense.She has to go in as private pay until medicaid kicks in which is a catch 22 she has to be in a facility before they decide but can't afford it if they don't approve her. Thanks for any advice
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You will need an elder care attorney to guide you.
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If you get a denial, look at the reasons, if they are correctable, correct them, if they are wrong, appeal. Get help from an eldercare attorney if it looks more complicated. Keep copies of all correspondence and document phone calls too.
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IsntEasy - just as an fyi on the whole "transfer penalty", the states have pretty good basic algorithm programs to ferret out if there has been a transfer of assets that is not allowed under Medicaid rules. The applicant has to provide a lot of hard copy financial details and all this can easily be put into a formula to see what their asset status should be. So say that ma gets $ 1,500 a mo income & lives with family and she now only has $ 1,000 in savings, then just where did 90K in income go?? ($1,500 X 12 X 5 years). The "pattern of spending" for a 5 year period should mean there should be lots more $$ than 1K left. They are on Medicare so there should not be any real big health care costs (although it could happen). There likely has been some gifting or transfer of assets that will get a transfer inquiry letter from Medicaid.

What I think the initial caseworker looks at 3 things: 1st to see that all the documents required are in; and 2 that there is no cash value on any items; and 3rd then looks at a "pattern of spending" that makes sense. If in the initial level one review of the application, there seems to be something not quite right then the application goes to a higher level where they look for transfer asset issues. This is one reason why the application take months to get cleared for approval as someone within the state's Medicaid department is running a program to do match ups on property ownership or get their old taxes to see what their income was, etc. You sign off for to allow for an all access pass to the state when they apply for NH Medicaid (and no you do NOT get the cool lanyard to hang around your neck & I'm with the band T shirt to wear either!). Some states are now outsourcing some aspects of Medicaid compliance too.
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Don't assume your grandmother won't qualify for Medicaid. IF your grandmother has very little income, savings or other assets AND she hasn't given away large sums of money or property in the past five years, she will probably qualify for Medicaid.

If she has given away everything recently in a poorly-conceived plan to 'hide' it from the government, then she will probably still qualify for Medicaid, but there will be a period where she is expected to pay her own way with the money and assets she gave away (either by getting them back or coming up with money another way). That period of time depends upon how much she gave away.
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I found a great book on Medicaid, here is the info on my blog, soleinsurancenc/apps/blog/show/41435022-medicaid-secrets
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Great information thank you!
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While this forum is an excellent source of information and support, you should look for local resources to help you advocate for your family. Your local office of aging should have, or should be able to recommend a benefits specialist, planner or manager in your area. Go to eldercare.gov to look for your local office and call them today.
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stick your car thru their lobby window. its incredible that youd have to ask such a question.
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OMG - you need to have hard details to see if mom or gran will qualify for Medicaid. Right now it seems you are all worry about "what-if's", try to move past that to get to the documents together to see if she will qualify for Medicaid in your state. The NH will give you a list of what they need to see in order to have her enter their facility as "Medicaid Pending".

You have to get all these documents together in order for the Medicaid caseworker to evaluate their financial status to qualify for Medicaid. The NH reviews it too - as they need to look at it to see if they think there will be a problem for "Medicaid Pending" (not all facility do Medicaid Pending even if they take Medicaid so you need to make sure the ones you look at do).

Also although the whole financial $$ issues are what most fixate on, mom / gran will also have to medically qualify for Medicaid for NH. She will need to show the need for "skilled nursing services". So think if she is at that point. Just because they are old or have dementia, those in & of themselves are not enough for NH placement. They need to require "skilled nursing services" for Medicaid. So speak with their current MD to see if they will do a letter on this - this can often be an unexpected issue for those who are in their home and move to a NH. Most NH admissions come from a hospital discharge (the usual story is that they had a fall, were hospitalized for 3 or more days and now are discharged to a NH for "rehab" and all these costs are MediCARE paid), so for those there is a fat medical file to justify the need for skilled nursing. When they are @ home, that tends not to exist so you may find you have to take a few months to create the file for this. My mom was in IL (private pay) and moved from IL to a NH (Medicaid pending). She totally bypassed the AL stage (private pay). It meant seeing her gerontologist who also was a medical director of a NH and doing visits every 4 to 6 weeks with testing done. The day she was a 10% weight loss and a bad H & H and a couple of other things, he wrote the order for skilled nursing care needed. So she had the fat medical file needed for Medicaid. Had I just moved her from IL to NH without all this, she would have been denied as it was not medically necessary.

So start gathering up & finding her documents to show she is impoverished at whatever level Medicaid requires in your state and speak with her doc. Good luck.
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Yeah, well, as far as I'm concerned the states should take care of the people who paid them countless thousands in TAXES all their lives. They need to take some of those damn taxes and take care of them. The way I see it, too many elderly are being dumped on RELATIVES. The consequences to my family for abandoning my mom to the state? None.
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OMG, no the retirement home does not take out a loan, they sue the people who got her money. In Pennsylvania, a NH sued the children and the judge ordered one son to pay $93,000 to the NH because "he had the means". Abandoning relatives after you got the cash will have consequences. Too many relatives are being dumped on the state.
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"And yes, they do get to take care of grandma forever, until it is paid back in full"

Wrong. If push comes to shove, abandon grandma to the state. There isn't a single state that can force you to be someone's caretaker if you don't want to be. If you call 911 and have them pick her up and absolutely refuse to go and get her, the state WILL place her in a facility. It sounds worse than it is. Nobody is going to deny you visitation. You can visit as often as you like. Who pays? The state. They won't have a choice if she's 'abandoned'.
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Oh you were saying that the retirement home takes out a loan. I misread that
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OMG, the federal government is not telling you to get a loan, they are just saying the money was not spent on her care, therefore they will not pay. As far as the law goes, that is the end of it. Medicaid laws say if you gave it away, you are no longer eligible for help.
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I am just worried. I'm worried that if she cannot qualify then there would be no way to afford any type of assisted living or nursing home care.
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