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He has SS income and a union pension which could about cover the cost but there would not be anything left to support the wife and home expenses. We own our home. but utilities, gas and food run more then her small SS income. What can be done?

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Garden Artist, A PLACE FOR MOM
Burbank Senior Artist's Colony
Burbank, CA
Senior Apartments, accessed through AC site.
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igloo has hit the nail on the head, as usual. the community spouse will receive a very favorable package of benefits if the ALZ spouse is committed to a nursing home. She might even be much better off that way, financially she will not lose her home, she will probably receive some of her spouse's pension, even. And, the best part is she will finally get to have some time of her own again, without having to deal 24/7 with an ALZ spouse who is probably disrupting her life (she can always go visit him at the NH or memory care unit of AL).
If she's lucky, she could find an AL with a memory care unit attached to the building, and both of them could move there. But I don't think Medicaid will pay for both of them, there, and she would have to have quite a lot of assets to self-pay there (cost for her room alone, plus things like cable, phone, her prescriptions, clothing, non-household expenses) her costs alone will be around $50- 60,000/year if she has a private 1 BR apartment.
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SendMe, what's the name of the place in Burbank that caters to artists? Not that I'd want to move to CA, but perhaps it's part of a larger chain that may have facilities in someplace that's not in an earthquake zone.
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You could look into assisted living or even independent living apartment/condo, for the two of you, husband and wife. Then, pooling your funds might help. If the living accommodations include other levels of care on the same campus, such as convalescent care ward, skilled nursing care, alzheimer's memory unit, etc.the husband could transfer as needed, and still be together.

These places do exist, when I interned as a nursing student at Atherton Baptist Homes, that was the only known nursing care home that did not smell of urine in the hallways. There were little cottages surrounding the campus where people retired and lived. One did not need to be of any religious persuasion to go there.
There are many well-run places, Burbank has an AL facility dedicated to the artist community.

If you even had to buy in a retirement home by selling your home, these steps would help delay placement of husband apart from you because there would be resources at hand to help both of you. Only you and the professionals can determine your husband's needs.

People who wait to make these plans early are forced into selling their home, separated to one parent with one sibling, and the other parent with the other sibling.
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If its the situation, that the $ is going to be used to pay for AL as this AL does not take a Medicaid waiver or that your state does not do a Medicaid waiver for AL at all, then you are stuck in having to private pay for him to be in AL.

If this is the situation, I'd forget AL & gear for NH for him.

Now all states Medicaid program do pay for skilled nursing services in a facility, aka a NH. Rather than him being in a AL, I'd suggest you do whatever to get him placed into a NH that takes medicaid. The wife who is at home is considered a " community spouse" and as such is entitled to keep some of his income to enable her to live in the community under Medicaid rules. You get CSRA or MMNA - it's like alimony for the nonNH spouse & varies by states. CS stuff - as Jeannie said - can get quite complex to get the maximum for the CS; deal with perhaps changing assets to those Medicaid compliant, etc are not DIY projects. Only hubs has to be impoverished not you as the CS. Whatever you do, it needs to be done in advance of the Medicaid application for best option & strategy. Often that means private paying for either the NH or fir in home health caregivers a bit of time till paperwork clears on financial restructuring, then apply for Medicaid with him going into a nh " Medicaid Pending".

CSRA can be high. Like for TX it's about $ 2,700. So say hubs monthly income is 3k; if the CS shows enough need, she gets the $2700 max CSRA. Hubs only has to do a $ 300 copay (his SOC /share of cost) to the NH. A good NAELA guy can wade through all this for you. Really it's a lot to deal with and your focus is all on hubs and his daily needs (& rightly so) so you need an ally in all this which is what your legal is. Good luck in your decision making.

There may need to be some MD visits for hubs to get in his medical history documentation to show the need for skilled nursing care. Most NH admits (80%) are from them being released from a hospitalization to rehab at a NH. So they come in with a fat medical file, have at least 21 days Medicare pay rehab, & then determined unable to return home so not to stay at NH. But for those of us who have a parent or spouse still living at home or in IL (this was my situation with my mom), that fat file to qualify medically for Medicaid in a nh isn't there. For us, it took about 6 mos of md visits & the visit mom had a 10% weight loss, bad H&H lab report and a couple of other issues, her MD wrote the orders for skilled nursing care needed & she moved into a NH within 5 weeks.
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pamstegma is correct about determining the correct placement for your dear husband. Let the professionals help with that.

But whatever level of care he needs and whatever kind of facility he winds up in, the fact is that you do not have resources to support the two of you living in separate places.

I think it is time now to visit an attorney who specializes in Elder Law and explore your options, including applying for Medicaid. The specialization is important. This is not something to take to your cousin's daughter who handles family law or your neighbor who is a corporate lawyer. You need things set up to protect as much of the income for the community spouse as possible. Someone specializing in Elder Law will know how to do it. Yes, a consultation will cost you. But in the long run it is the least expensive option. Learning through experience will be painfully expensive!
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Bear in mind that Assisted Living cannot accommodate Alzheimer's Dementia in advanced stage. The resident must be able to find his room and attend meals. Assistance with dressing can be done, but he needs to toilet independently and accept direction/correction from staff. Ask your MD about what placement is appropriate, such as Memory Care.
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