Medicaid, life estate in child's home, and caregiver agreements.

Figured I would follow up with everyone on this. I decided not to pursue the life estate after much thought. I discussed it with an elder law attorney and while the life estate would not be an issue for medicaid eligibility down the road (provided my father lived with me for at least 1 year prior), I decided to give ALFs (likely a Memory Care focused one) a shot. My father still lives with my wife and I, however we have been looking into the local ALF respite care programs as a starting point to establish a relationship with one and see where that leads with time. Many of the thoughts/concerns expressed earlier on this topic were a factor in my decision. Thank you to all for your input.

FlaLove, make sure that the attorney that you consult to get the Life Estate set up with has a tax preparer that is familiar with the tax consequences of your father PURCHASING a life estate in your home. The calculation of how much you and your wife will need to declare as income - whether it be caregiving income or capital gains since you noted that your home's value has increased since you got your mortgage - will need to be included in your planning, not just the Medicaid planning. Your caregiver agreement will need to include provision for payment of taxes and also a rider on your homeowner's insurance for workman's compensation. Also you will need to make sure that you update your homeowner's insurance to reflect change in ownership and caregiving situation. Speaking from personal experience, Parkinson's Disease can drag on for decades with a family member and dementia is not uncommon. Your back up plan should include 24/7 care if you go out of town as you will have set up a responsibility for a vulnerable elder in your home. Purchase of the life estate also means that if your parent thinks they can stay in the home, but you don't want to continue giving care, you DON'T have the right to just have them move out. A lawyer will go through all of these items for you - you're not getting No's from all on here. We are asking you to think through for years, not just the pay-off soon in the next 6 months.

My mil set up a life estate in a second home, with her five children as joint tenants with right of survivorship (you can imagine the problems THAT will probably entail!; "last sibling standing" will end up with it all, and other sibs' heirs get nothing).

Anyway, mil said she did it so there wouldn't be a problem with Medicaid down the line for her. I had thought the 5-year timeclock started ticking, but I could be wrong. (Mil's children will never put her in a facility, I'm sure, but we're not local, thank goodness.She inherited some money a while back and blew it all, including on trips to Europe, the Arctic and Antarctica. I'm not going to be willing to contribute towards her care!)

Good luck, FlaLove. Please let us know how it sll works out. We learn from each other.

Thank you all for your continued input and suggestions. Igloo, I will definitely research and discuss some of what you mentioned when I visit an attorney. Planning to do so shortly.

I've seen several comments regarding having to take care of my father for potentially decades. This is precisely why I want to leave medicaid as an option on the table. With proper medicaid planning, why is this an issue?

I feel most people are seeing my plan as a huge risk and liability. I didn't elaborate on the numbers in detail, but I feel this situation can greatly financially benefit my wife and I with the life estate and I could maintain my income with a caregiver agreement until we can't do it anymore. With the life estate, my wife and I's mortgage would be completely paid off 25 years early and my father would be able to provide me income for at least a few years. The alternative is him paying for a facility that would drain his assets in the same time period or sooner. Most of the stress I've experienced over the past 2 years is balancing work and my father. Being able to just focus on my father without income loss is going to be a huge relief for me. It will also give me opportunities to do things that I never had time to do when I was working even without my dad in the picture. My father rests/naps a lot of the day and there's going to be huge gaps for me to do things for myself around the house. Preparing healthy meals, exercising, reading books, continuing my education through self-study, etc. I'd actually greatly be looking forward to these things. In regards to my wife, yes she is on board and supports this idea. An evening out and other local activities for part of the day is not an issue at the moment, but I do understand these activities may not be as organic and may require more thought/planning at times. Yes, I realize my father's needs will only increase from here. We would have a backup on deck.

FlaLove - in re-reading your posts, have a? for you, so FlaLove really just what is your wife's feelings in all this? Would she really be totally 100% happy about your father being there "at need" 24/7 for years or possibly decades? Shifting household financial responsibility to just her income when you went into marriage as partners & having an increasingly frail old man living in the home......well just may not be what she envisions her 20's & 30's to be. Forget going on a last minute evening out; or using those free tickets to the concert that landed on her desk; or putting in the living room that awesome vintage 1960's sofa she's been hunting for since college as the living room is now dads day-room..... or even her walking around the house in a T and panties. If you prioritize dad over her - which is what you will be doing - resentment is going to build and it's not going to be pretty.

Also what about her own elders? You ready for her mom, aunt, whomever, move in with you all as well? And for a decade or two? Cause if you do this for your dad you have to do it unconditionally for her elders too.

Dads already there right? I'd suggest you meet with an atty. as suggested but also set a 6 month date from whenever he moved in to ask your wife about keeping dad there. If she has ANY hesitation or concerns, then get him moved into a facility ASAP. And you and your bride move on with life.

FlaLove - the fact that you are actively doing "planning" on this is a huge plus. And doing it before you place dads home up for sale even more so. Platinum stars to you! You've gotten some great advise regarding the reality and challenges of caregiving.

Regarding the legal & financial, I'd suggest you ASAP schedule a NAELA or CELA level elder law atty appointment. But before you do this gather together the info on dads house (like last 2 tax assessor bills, deed of trust & release); his awards letters - those are the annual statements that denote what he will make as income each month from his SS, retirements; any old legal especially his will. And do a"face sheet" on dad. I'd bet that it's suggested that the proceeds from the house sale get placed into a special needs trust with a personal services contract between you & the trust so that the trust pays you each month to provide care & trust administration. The goal of the SNT will be to defund within 5 -7 years so he can segueway into & totally qualify for medicaid. If his caregiving gets to be overwhelming for you all before the defund, its ok as the contract done will be Medicaid compliant. You & your brides house stays in your name, dad lives with you. This is a pretty safe conservative plan.

Now if you like risk and dad is still pretty youngish & owns his home, I'd ask the atty about dad doing a SCIN. Self canceling installment note. SCIN are pretty involved as its an equation based on actuarial tables & property value. I'd bet Medicaid just hates these! You could sell your place then buy & move into dads house via the SCIN at the lowest monthly payment due and if he dies before note ends, you owe zero. It self cancels. It will not be an asset due to his estate so no estate (MERP) recovery on it. Now if he needs to move into a facility, the note you pay to him is "income" and needs to be low enough so between the amount of SCIN and his SS $ is under Medicaid limits. Or you buy it and rent it out, it's yours you can do what you want with it. All dad gets is whatever the SCIN note $ amount is set at. SCINs are involved financial & requires pretty experienced legal to do to begin with plus add in a layer for medicaid compliance. SCINs used often by wealthy to move property down the line to younger family at minimal cost to the buyer and lowers the sellers estate taxes. But can be used to maneuver Medicaid if the situation aligns.

FL is a very pro-property rights state to begin with and seems to be as well when it comes to the rules for property, Medicaid & MERP. Like FL allows for "Lady Bird Deeds" (enhanced benefit deed). Only 6 states do this.
Good luck & it should all work out as you are thinking ahead!

So, with Parkinsons and some dementia, late 60s, no other physical issues like heart problems, diabetes....he could live what, another 20-30 years?

That of course is the problem--you don't know. Our elderly, increasingly infirm and sometimes demanding parents don't come with an expiration date. Something that you could see yourself doing for 3 years turns into 10 years, or longer.

I would suggest a couple of posters, specifically JessieBelle and TGengine on having parents living at home. Just go into this with foreknowledge of what " might" be. Good luck!

Babalou, maybe I'm being naive, but I have thought about many of these factors. This is where I figured the life estate would offer some financial benefit for potential lost opportunity in the workplace. My home has appreciated a lot from what I paid for it a few years ago. Using the life estate calculator on AgingCare with the current value of my home, my father would be able to purchase a life estate that would be close to the remaining balance on my mortgage. This would be huge in reducing my expenses during the next few years to take care of my father.

I have not researched SS impact, however I would continue to contribute a portion of the caregiving income to an IRA during this time.

For health insurance, I would plan to join my wife's plan. The higher premium with me on it is relatively close to what is coming out of my paycheck for my current employer sponsored plan. I also have an HSA account that's well funded for deductibles.

For respite/vacations, I would establish a backup.

No plans for children in the next few years.

I have an idea of what I'm getting into. I know it's going to be very stressful at times, but also very rewarding to be by his side and for those little moments. I think I would be more stressed at work with him in an AL then I would as his caregiver. Maybe it's an only child thing.

FlaLove; I think you should also do some research about the long term effects of leaving your current employment; it effects not just current income but SS credits, future income increments and the like. There is an estimate out there somewhere that for every year you are out of the workforce, it costs your many times your income. Will you have health insurance? How will you schedule respite/vacations? Do you plan on having children? How long will you put that off?

Look, this is a very personal decision. My parents NEVER would have wanted any of the three of us to give up our livelihoods to care for them. I SO vehemently disagree that AL would be a bad situation for your dad to be in; I don't know if you've been to any ILs, ALs or CCCs lately, but they are some of them amazing places.

FlaLove, everything I've read about life estate suggests it's Medicaid exempt. Same thing with my father's trust. I don't understand HOW exactly, but my grandmother set up a trust so that my dad could have the benefit of a house (her house) and cash assets (well over the $2k Medicaid limit), but still qualify for Medicaid. My dad cannot cash out the trust, and that's one of the reasons it's considered exempt. In your case, I think it's possible that the same quality is what makes it Medicaid exempt. Your dad cannot cash it out, Medicaid can't pursue your assets to pay for his medical needs, therefore it's exempt.

Seems like the Medicaid $2k cash limit would be biggest issue if dad sells his home, but between life estate and other Medicaid exempt investments, you guys could sort it out. I personally think you're on the right track with the life estate and caregiving agreement and seeking some assistance for your dad through Medicare and insurance... for now. But I'm still not clear how capable/competent your dad is and what his prognosis is, and Everything depends on that.

This is an interesting topic and I'm glad I stumbled across your Question. I'm going to look into this and mention to my brother who is moving our dad into bro's home.

FlaLove, many elder law attorneys offer a free consult. I found a few online in my area and set up free consults for my 78yo father to go and speak to them to learn about his options. Might be a good idea to check out a couple of different EL attys and go speak to them for free, then go with the one who's most in tune with your goals as a family.

Here's another reference to it here: https://www.agingcare.com/articles/how-moving-in-with-family-affects-medicaid-168732.htm

Not sure if links can be posted, however it's an article posted by AgingCare so I assume it's ok.

I know I need to discuss this with an attorney, but just figured I'd see if anyone had any personal experiences to share too.

No problem, I appreciate the input regardless. I will definitely peruse the site more. I've landed here so many times for odd google queries and feel many of the topics and responses have been very insightful.

In regards to the comment that when the doctor says he can't live alone, that means two working people can't provide the supervision needed. I agree, however I do believe I can provide him the supervision needed if I'm not working.

An assisted living facility would far exceed my annual salary and while his quality of life is already very poor, I know a facility would only worsen it. I don't see a facility being a solution, but more of a last resort that I'd like to keep open as an option. From medicaid's perspective, wouldn't they realize I'm delaying his need for a facility (while providing him a better quality of life) versus spending it down rapidly at a facility and needing medicaid sooner?

Can you elaborate on what you mean by being "too" close to needing a facility to plan a life estate? I wish I could find that article I read awhile back to reference. I recall reading it on an elder law attorney's website too. I also recall reading that a child caring for their parent living in the parent's house could live with them, then keep the house and avoid recovery as long as they lived with the parent two years. If this is possible, why is doing it in reverse with the life estate an issue?

At this time, your dad is able to do ADLs or no? He can make his own meals, do his own hygiene?

You said in your original post that you think dad may need round the clock care soon. That's a huge commitment to make to your father, to make sure he has someone there to help with ADLs all the time.

I'm not trying to discourage you. I think it sounds like an overall positive situation for you as an only child to take your father in since he can no longer keep up with living and taking care of his own house. I don't know the legalities of establishing life estate in Florida, but that's why you're going to see an elder law attorney who can advise you on that, and the EL attorney can get a caregiver agreement drawn up.

You might want to peruse this site (AgingCare) a bit and check out some of the "worst case scenarios" that others have encountered when they moved their aging parent into their home. Again, I'm definitely not wanting to discourage you. You seem to have a good grasp of how to go about doing this, but... never hurts to see that things can and do go south in these situations. You should be aware of some of the things that have happened to others who moved their aging parent into their home and now 20 years later they've basically never gotten their own life back, now have their own health problems, are in unhappy situations. Perhaps you can care for dad for 5-10 year and wait to see how things progress with his prognosis? But be prepared for a worst case scenario and be prepared to sacrifice much (ALL) of your own time/life for your father's needs.

I realize figuring that out how life estate status affects Medicaid eligibility is the point of your post but since no one else has come along yet... lol... the more you and I post on here, it puts your Question in a highlighted area and is more likely to attract some other visitors/input. 😉

You are too close to needing nursing home care to be able to set up a Life Estate and avoid the five year look back. If there is enough from the sale of his house to provide him with a nice annuity, that will help offset the nursing home care. The more he can private pay, the more doors will open for him.
If he was a Vietnam Vet, look up VA Aid & Attendance.
Just a word to the wise; when the MD says they can't live alone, that means two working people can't provide the supervision needed. Have you looked at Assisted Living?

I also wanted to clarify that medicaid is not really my goal for him, but I know it's possible at some point that I could be in a situation where I don't have the income to sustain my bills and take care of him. I'd estimate this could be in 2-3 years. So I don't want to jeopardize his medicaid eligibility since I know the look back period is 5 years.

Dad is in late 60s, receiving medicare. I'm in my late 20s. Dad hasn't been formally diagnosed with dementia, but neurologist thinks he could have Parkinson's Disease Dementia or Lewy Body Dementia. I believe on the POA, it does explicitly say I can create caregiver agreements too.

In regards to life estate, I had read a medicaid planning article that I thought mentioned some sort of reverse life estate situation. Where a parent could move in with child and purchase the right to live there. I feel like this would be a lot easier than managing rent and put my mind at ease in regards to financial stability over the next couple years. The life estate would go directly to my mortgage and other debt (if this is possible). Moving into his house is not an option due the size of his house and my wife's work location. He's also unable to keep up with the HOA fees, taxes, and insurance now.

In regards to additional home care, he's been in limbo between my house and house until he's now permanently with me. I have something setup next month for a company to come to my house and see what kind of short term programs he would qualify for through medicare. I think they are typically physical therapy, occupational therapy, and speech therapy programs.

Yes, a caregiver agreement would be a good thing here. If dad has progressing dementia, you want to do that soon, right?

Retaining the services of an elder attorney is the right move. They can help you sort out the life estate conditionals as it pertains to this situation and make sure you follow the correct steps. I'll be honest - I'm a little confused how dad could sell his home but get life estate status in yours after one year and that would fly when qualifying for Medicaid. There are some onsite legal advisors here, maybe they'll weigh in. :-)

How old is your dad? Is he already receiving Medicare, but not Medicaid applied/accepted at this point?

Others on this forum should have some good input for you.

Other than that, I'm sorry to hear he's declining quickly. Do you need additional in home care at this time? Have you checked into going through his current insurance/medical coverage to get outside assistance for him in your home? They may not pay all, but pay some.