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My mom is in a memory care unit and the LTC policy, according to my brother, won't back pay what she has already paid for the 3 months that she has lived there. I know that I have mentioned it before. In reality, can her assets be touched since she has that plan? And if so, how?

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Judy, if the facility that your Mom is in is a "stand-alone" Memory Care facility and not a "regular" nursing home, the LTC Insurance might not recognize the facility as being "in-network" and refuse to pay for your Mom's care in that facility. Some LTC Insurances do not pay for Assisted Living facilities, only "nursing home" type of facilities. You can contact the LTC Insurance Company and see if they will honor your "Healthcare POA", but they might only honor your Mom's "Financial POA"(which is what your brother is) resulting in the insurance company refusing to tell you anything about your Mom's LTC insurance policy.

Once your Mom is in a facility that the LTC Insurance Company approves of and is willing to pay benefits to, then your brother should no longer have to pay any premiums for your Mom’s LTC Insurance because the insurance is in the "Benefit Mode". It is possible that if your Mom leaves a facility approved by the LTC Insurance Company and the insurance company quits paying the benefits, then they might require that your Mom start paying the premium again. It depends on the insurance policy.

You are correct that your brother needs to continue to pay for your Mom’s insurance with Medicare and the Medicare supplemental insurance while she is in the LTC/Memory Care facility.

You mention that the LTC insurance policy is $160,000 and $110/day up to 4 years. I think what that means is that the "cash value" of the LTC policy is $160,000 (similar to the cash value of life insurance); and that whenever your Mom enters an approved LTC facility, the LTC insurance will pay $110/day for 4 years while your Mom is in an approved LTC/nursing home facility.

You ask if your Mom’s attorney has to abide by the “updated healthcare rep” if you send it to him. Yes, he does. HOWEVER, he only has to abide by those areas of your Mom’s care that are listed in the document.  What part of your Mom’s care do you want the attorney to “abide by” that he is currently not “abiding by”?

If an area of care, such as your Mom’s finances, are not listed on the “updated healthcare rep”, then there is nothing he or you can do about it. If the “updated healthcare rep” document states that you are responsible for choosing the facility that your Mom lives in, (and your brother’s POA does not state that he can choose the facility), then you are the person who has the responsibility to choose the facility, not your brother. His responsibility is to pay the facility that you choose for your Mom to live in. Clear as mud?!?

It sounds like a majority of your problems are the result of lack of communication and past misunderstandings between you and your brother.  I agree with the other people--until you and your brother can sit down and talk calmly about your Mom’s care and finances without accusing each other of hidden agendas or motives or questioning each other’s decisions; you will continue to have misunderstandings and conflicts about your Mom’s care up until the day she dies and even after she is dead. 

Maybe you need to talk to a counselor and discuss why you feel the way you do about your brother and then plan how to interact with your brother in a more pleasant manner so that you both can decide together what is best for your Mom at this time in her life. {{{HUGS}}}
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Judy79 Oct 14, 2019
Thank you very much! I have been talking to a counselor where I work several times. And she has told me that my sil needs to stay out of it. He is talking to me via e-mail as right now, that seems to be the best mode of communication. He won't ever approach me for anything. I am the emotional one and he isn't. He means well by what he is doing. We don't know when she will die. Hope that the rapture comes soon but we will never know. One of these days, I'll talk to him. Maybe I will do that on Wednesday after the meeting and he sees the phone that she is getting. It is a caption phone. Then she can talk to her brother who lives in Newfoundland, Canada. She hasn't talked to him for a while. At least the phone is free due to her hearing loss. And if she is moved, then she can take the phone with her. Will keep you all updated.
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"He said something about her insurance ending."

Which insurance? Her LTC insurance? Did he mean that she will no longer need to make premium payments once she is claiming benefits?
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No, Judy, you're not saying anything wrong.

I just don't understand what the issue is.

Does your brother want to move her to a less expensive place to make her money last longer OR is he thinking ahead to move her to a place that will accept her LTC policy for the time period it covers (4 years) and that will THEN allow her to stay as Medicaid patient in the same facility, all the while protecting $160K of her assets?

That seemed to be the plan that mom had in mind when she bought the policy?

What will happen if she stays at this facility, using her own funds to pay (because they wont' accept LTC insurance? Or because they don't have the correct license to bill the LTC company?) and runs out of money?

This facility does NOT accept Medicaid. At the point that mom is out of funds, she would need to move. And I assume that she would have to continue to pay for the LTC policy. I guess at that point she could start to use the LTC policy, but she wouldn't have had her assets protected the way she planned.

Do you have any idea what her total assets are? And what her SS and pension are per month? In other words, have you worked out a plan so that she is within the bounds of a "safe withdrawal rate" from her nest egg?

This is the sort of planning that the person who is financial POA does. (My brother was mom's POA; my SIL has an MBA and I was SO glad that someone else was managing mom's money so that I could concentrate on the medical stuff.)

My mom was in a NH for 4 1/2 years after a stroke; the cost was approximately $10K per month, so she spend a LOT of her money on her care; that's what it was there for. We ascertained, before moving her into this particular NH, that they would accept her as a Medicaid patient after several years of private pay.

In fact, working out what her finances were was the very first thing that the discharge planners at the hospital did with us.

It would have been short-sighted of us to move mom to a place where she couldn't stay.
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Judy79 Oct 14, 2019
Keep telling me more. I'm listening. So much to learn in a short time. He did tell me that he wants to stretch her money out longer. The only assets she has are her investments. When she moved my brother did the packing. Not sure what the ss and pension is but I think about $3500 or so.
It was just a very quick move for us. No time to plan or anything. Just needed to get her into a place that could care for her better than we can. If she has to move, then she will have to. If the facility where she is now can't help then basically she is screwed and will have to move to her a cheaper,which I doubt,place that will be able to use her LTC policy. We won't know anything until the facility sends the documentation to the LTC place.
Since this just happened last year, it's taking time to figure this out. His wife doesn't know anything about this. I have done a lot of figuring out. He was going to look at this facility close to us but I told him that I found out that it's $255/day compared to $178/day where she is right now. Unless she is put into a cheaper facility that won't provide as much as where she is right now. God can change things for the better for her.
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I agree with you, Real.

Still not sure why the facility is balking at accepting payment from an Insurance Company. In any event, its Judy's brother as POA who needs to sort this out.
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Judy79 Oct 14, 2019
He just wants her moved to a cheaper place to spread out her money. I just pray that they can somehow work it out. You see, I wasn't at any of the meetings when it came to talking about the costs. I was totally left out. In a way, I am upset because he didn't include me in the discussion. I was taking care of my mom. But I could have come back to discuss the situation. Doesn't matter that he is taking care of paying for it. Just don't see his reasoning. Even if he is my oldest brother. Did I say anything wrong with this?
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When you say "facility is private pay", does that mean that they don't accept insurance as partial payment?
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Isthisrealyreal Oct 14, 2019
I think private insurance is considered private pay. It is Medicaid that fails to meet private pay.
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"Maybe I need to get the number for the LTC policy and fax them the new updated healthcare rep form that my mom signed. I'll still work with my brother about where she will live. I won't be selfish and tell him that he HAS to pay it. But my question is, she has investments also.  If necessary, couldn't she start to use some of that money?"

Judy; just understand that your brother doesn't have to pay for Mom's facility; mom's policy, her SS, pension and investment principal and income can all pay for her care. Your brother is not personally on the hook for any payments.

What would be the sense in having an LTC policy that is designed to protect some of mom's assets (that's what the Partnership Program is all about) and then have her in a facility where it can't be used?

The Partnership Policies are designed so that when the policy runs out, the person can go on Medicaid WITHOUT having to spend down their investment/savings accounts. If that's the policy that mom bought, then that must have been what she wanted to do.
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Judy79 Oct 14, 2019
I found out that they facility is private pay. That is the only stinky thing about it. I know more of the people there where my mom lives than he does.
I so appreciate your help with this. That is probably why they say that there might be able to "be a way around the LTC policy". Don't ask me what because I don't know..
They don't do medicaid or medicaid waivers. That is why I said that if she has to move, then she will have to move. She is pretty flexible with things. Maybe we can get her moved to the AL side. Which there will be people helping her when needed. I think that they are afraid that she will walk out of the building but I don't feel that she would. She is a people person. She was very active before she moved from her home into the apartment.
It's going to be one day at a time.
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Judy, policies likely do vary an awful lot, but you have some good advise here on what happened with other ones. Do call the Long Term Care folks and they will walk you through the policy and what and how it pays.
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Judy79 Oct 14, 2019
If I am not the POA, they will not give me any information. But if I am healthcare poa, would they?
I was told that I should just send the new healthcare rep form to the atty and not tell my brother. He is controlling her finances, because that is what he is good at plus she can't do it anymore. He wants me to do all of her healthcare so why would it matter anyway?
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Judy; is the problem that the facility won't accept the policy, or that the LTC policy doesn't recognize the facility as being qualified to provide long term care?

I'm curious why your brother was told there was a two year payout and you were told 4 years.

$100 per day for a year is $36,500. When you say it's "$160,000 policy" do you mean that's what the benefit is, or that is the amount of assets that your mother can shield?
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Judy79 Oct 14, 2019
All I know is that she is paying about $258/month on the policy. It is a $160,000 and $110/day up to 4 years. She purchased it in 2000. So it's been for 19 years. And since I am not the POA, I doubt that I can get any information. IF I send her atty the updated healthcare rep form with her totally filling it out and her signature, then he would have to abide by it,right? I told her what she was signing. I had to remind her. She would have signed it last year but I thought that I was the designee. Maybe that is only if she couldn't sign it for herself?
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Many LTC Insurance policies have a "Deductible" just like Health Insurance policies do.  And just like Health Insurance, the recipient has to meet the Deductible Requirements before the LTC Insurance will pay benefits.  Also, many LTC Insurance policies state that they will pay $XXX monthly for 3 years or for 5 years, etc., no matter how much the LTC facility charges the resident for "Room & Board" each month.  Thus any remaining amount due to the LTC Facility must be paid from the resident's own money such as SS Benefits or Retirement Funds or Mutual Funds. 

My Mom had LTC Insurance and she had to be in the nursing home for 90 days before the LTC Insurance Benefits started to pay her monthly.  Luckily, Mom had Rehab PT & OT for 4 1/2 months so she qualified for her LTC Insurance benefits as soon as she got off of Medicare.  Her LTC Insurance paid retroactively--in other words, the insurance company required a monthly bill sent to them by the LTC facility for the previous month before they would pay for that month.  (Just like Health Insurance--which pays AFTER you are treated by your doctor or AFTER you have been hospitalized).

Mom's LTC Insurance policy stated that she would receive a certain amount every month for 5 years as long as she was in the LTC facility.  The amount not paid by the LTC Insurance had to be paid from Mom's SS and retirement funds.  For example: Mom's Room & Board was $195 per day.  The LTC Insurance paid $120 per day and then I (as DPOA) paid the remaining amount of $75 per day from Mom's SS benefits and retirement funds.  After 5 years, the LTC Insurance will (would have) ended (as per the policy).  Mom died 1 1/2 years after she went to live in the LTC facility and her LTC Insurance ended the day that she died.  Her policy did not have a "Pay Back" or "Premium Return" Rider so the LTC Insurance Company did not "refund" any money such as premium and the LTC Company does NOT have to pay the person's Estate for any time/years that were not used just because the resident died before the 5 years were up.

Hope that this helps clarify LTC Insurance somewhat.  Each policy is different, so you need to read your Mom's policy carefully to see exactly what it does and does not pay for.
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Judy79 Oct 14, 2019
Currently, she is in a memory care facility.  Would that be the same thing or not?
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Good luck Judy! Let us know what you find out. It would be stupid, IMO, for moms facility to refuse her LTC policy. It’s guaranteed payment every month. Hopefully LTC policies are considered “self pay”. I’m thinking self pay refers to everyone except those on Medicaid & Medicare (Medicare for short term rehab stays).
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Judy79 Oct 14, 2019
Her facility is private pay also. Let's cross out fingers.
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Indiana and several other states have LTC partnership programs that are designed to protect assets, not income, from needing to be spent down for Medicaid eligibility. Depending upon the type of policy you select, assets are protected as the policy pays out.

When the policy term runs out, Judy's mom will be eligible for Medicaid while still having her bank account/investments intact.

The only wrinkle I see is that IL Medicaid will not cover Assisted Living, as the LTC policy does. If there is any move in the future, I'd make sure that it is one that WILL accept Medicaid when the policy monies are exhausted.
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Judy79 Oct 13, 2019
That is good to know. I'll let you know what I find out. Thanks!

As long as the policy does kick in. She is paying on a $160,000 policy and I was told that it would pay $100/day for up to 4 years. My brother was told 2 years. Hope that they were only talking about what she has paid for now.
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I meant: "make a call...... "
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https://www.in.gov/iltcp/

I believe that you are referring to a "partnership plan" which is available in some states. The link provides a pretty good explanation of how it works.
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Her LTC probably has a 90 day period of self pay before it kicks in. She needs to pay for her own care until her policy kicks in.

Nobody is going to take anything, they will kick her out for nonpayment and you will have a hard time finding another facility that will take her if that happens.

Her money is for her care and expenses that her LTC doesn't cover. By the way, you should read that policy. She could outlive her insurance and then she would have to pay for her care. You wouldn't really put your mom on Medicaid when she has the money to pay for her care, would you? It is for poor people who have nothing, not for people that don't want to spend their money.
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Judy79 Oct 13, 2019
Do you think so? I didn't hear that but I don't hear about everything. Just hope that my brother brings the policy to the meeting so the executive director can look at it. She did say that she couldn't promise if it would work out or not. But if it did, and they approve it, they would pay up to $100/day where she is. Right now, she is paying $178/day. So that would be a nice savings. We'll see.
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Are you sure she is not still in an approval process. That takes a few months but then payment is made. What exactly is the LTC company saying regarding her stay thus far?
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Judy79 Oct 13, 2019
My brother is her POA and they told him that they wouldn't pay back what she has already paid. He won't tell me anything else. There is going to be a meeting next Wednesday that he will be in. I was told that it's just a meet and greet meeting. I won't be able to be there because she is getting a caption phone in her room. Will see how it works. She just sold her house last year and my brother took the money from the sale of the house and put it in her investments.
She has my dad's ss and his pension. And whatever is left over, it comes out of my mom's savings. My brother said that is would last for 6 months. Then his thinking is to move her to another facility that would be cheaper. Mind you, she has dementia.
To add to this, the facility told me that they might be able to work things out. I know that they need to send documentation to the CNA LTC company. My brother is smart but doesn't know everything to tell them when the facility that she is in does. Will give you heads up on it when I find something out.
I like Barb's idea though.
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If you haven't already, a call to the company that issued the LTC policy with your questions. They might be able to help you.
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Judy79 Oct 13, 2019
My brother did that since he is the POA. I really need to tell him that my mom signed for me to be her healthcare POA. I am doing all of the medical anyway. I don't think that he really cares. He wants me to be called when the facility has an issue. He is next in line if I can't do it.
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Can you explain what you mean by an "asset protection plan"?
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