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If dealing with doctors is not a great experience, change doctors! We have fired several doctors on the road to my mother's health and welbeing. The first one caused her to develop heart failure due to an oversight of her having not been properly diagnosed with hyper thyroid which led to A-fib then to a stroke. I took Mother to an acupuncturist who aided her almost complete recovery from all but the A-fib and hyper thyroid. Maybe I should have continued it longer, but medicare doesn't pay for healers. Now Mother has a great cardiologist, a very good geriatrician and a fair endocrinologist (I may fire her next). Remember YOU are in control of who provides health care. You are the customer of the doctor and the customer is always right! I've learned how to be assertive and how to be an advocate. Hopefully this is not off topic too much, but I'm following the thread.If you have a DPOA, they have to do what you say unless your loved one objects.
Now about reverse mortgages. If she "abandons" her home for more than 90 days, (is put into a nursing home) the mortgage company may be able to take it from her. That's in the fine print. One of my clients is dealing with that right now. It is in litigation. Her parents took out a reverse mortgage, not understanding the ramifications and they lost the house within 6 months and all the pending payments that should have come to them were down the drain because they were not living in the home. READ THE FINE PRINT!! Or better still avoid the evil banksters.
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Send a written letter to the doctor, and then follow up to see if the letter has been placed in her chart or on her electronic records. If your parents' doctor is not responding to your communication after multiple tries, it is time to change doctors.
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I have tried talking to their doctors. Usually I only get the assistant and I never know if they tell the dr. Once, when I tried to get them to suggest a cognitive test for my mom, I was told to there HER to request the test. In my experience dealing with doctors is not a great experience.
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Mhaines - just to correct a misunderstanding about HIPAA - you, or indeed anyone, can give information to a doctor about a medical problem or potential danger - you just can't get medical information from the doctor without the HIPAA papers in place. So you can inform them, tell them, yell at them, or whatever, but they can't give info to you. Not the best situation, but definitely helpful option, particularly when a real danger is present and your hands are tied.
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Fast worward 15 years, my aunt, already on Medicaid, falls and breaks her hip. The nursing home didn't think she should be discharged because PT thought she was a fall risk. She was 91. She wanted to come home, and that is PT's goal. The SW contacted the Area Office on Aging, and she was approved for the Passport Waiver program. In our state it only pays for 21 hrs/wk care. It also pays for a personal alarm, Mobile Meals, Depends and wipes. It has pd for a few other items over the years, including her very own wheelchair ramp. Wish I would have asked about that sooner. All this is cheaper than a nursing home. Plus she has regular nurse and social work visits.
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I was buying my mom's house on land contract because at one timr, that was acceptable for Medicaid. Then mom landed in thr NH for therapy. By then the land contract was considered a resource and she was ineligible. I had to bring her home. I was working at the time. We used the money from the land contract to pay caregivers $10/hr ( rate in '94h) whilr I worked/was away, til the money was within resource limits. She was readmitted to the NH for the remainder. By then, she could barely swallow and needed a feeding tube, which is skilled care.
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She can also look into a reverse mortgage if she owns her home. Certainly all resources and programs must be considered and researched, but the reverse mortgage should not be overlooked - especially if her desire is to age in place.
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I am in Massachusetts. My Dad is 92 and has been in a NH for 2 1/2 years now. We did pay for the first month and 1/2 then applied for Medicaid. I would highly recommend using an attorney that specialized in Medicaid which is what I did as my mother is still living also so things got a little confusing for me to do on my own. She was worth every penny as my mother was allowed to keep the monies she had and my Dad went on Medicaid to pay for the NH. Now my mother is in the same nursing home in the assisted living part and the money she did have is flying out the window. Good luck it is a tough road!
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I agree with Craig that preventative is smarter than doing a panic response to "the fall" after it has happened. I'm trying very much to put safety first, yet my elder does not always work with me. Our generation of caregiving family members have a lot to manage, yet we do have this site to share ideas!
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Long term care insurance coverage can help pay for different types of long term care services such as nursing homes, home care, adult day care, CCRCs and assisted living facilities.

www.agingcare.com/articles/Definition-of-long-term-care-insurance-143436.htm

Life insurance is also a good payment option. Your mother can use accelerated death benefits, life settlements or viatical settlements. There are also government programs that provide long term care like Medicaid but your mom should qualify first before she can receive benefits. Reverse mortgage is also another option but it's too risky so make sure that your mom will pay on time in order to avoid foreclosure. I hope these things can help you determine the best payment option for your mom.
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To Craig at Give a Hug, just how do you convince an elderly person to do the modifications? I have suggested many of these things to my parents and they refuse to do anything. Grab bars, lighting, higher toilet, moving the laundry upstairs, nothing. I can't force it on them, even when my dad falls several times a week they say they don't need grab bars. They are so focused on keeping thinks unchanged they will not see the danger to themselves. Unless a medical practitioner suggests it of course, but I can't discuss that because I don't have permission.
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We started with $18 an hour caregivers, then found private caregivers for $13 an hour, now found a woman who had come to us before to help who is skilled and experienced and willing to work for $10 an hour! My Mom and I are paying 24/7 caregivers since my 90 year old father who fell has only been home from rehab in the hospital 15 days. As we get him more on a schedule, we hope to watch him ourselves during the day whwen he usually naps. Yes, expensive, but cheaper than a nursing home.
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Are you wanting to shelter assets to put someone in a nursing home on Medicaid? Better get a good estate planner/attorney for that, as the rules are getting harder because of the cost to the government and the low amount given to the nursing homes. Most states allow the spouse to keep their home and the equity in it, a monthly amount of income, their auto and (at least in CA) about $100,000 in savings. The right attorney can shield just about any amount of assets to provide income for the at-home spouse. With the baby boomers coming, the Medicaid option will become problematical. The best bet for quality care at home or in assisted living for younger folks is to save, invest and insure for disability as early as possible.
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Can you tell me more about the SPIA and how to go about it. I am a younger spouse and will need to shelter some of our assets safely, thanks
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I found nothing good in calif.
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Annuities are IMHO totally the wrong option for anyone over 80. They are going to die before they ever get the entire policy benefit. If they need the funds, the penalty for cash out is restrictive and severe. Ask in detail what the commission paid is and what the structure period is; ask what the penalty & fees are for withdrawal. I'd tell the salesman (& no matter what they say they are, annuities are an insurance product so they are insurance agents) that I'd consider buying the annuity IF they decease their commission by 50% for the life of the policy. That ought to clear the room.

Now a SPIA can be a good option (cause its simple & quick & you can do it for a specific amount) for a well spouse who needs to park 100K someplace fast so that their ill spouse can get their assets down to whatever your state has as its maximum allowed assets under Medicaid so the ill spouse is now impoverished.
For a much younger spouse, this type of SPIA solves the Medicaid extra assets problem & she is likely to outlive him & still work or acquire income so doesn't need the SPIA $.

Sherry - yeah RMs are the devil.
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Sorry that the plan was faulty for your friend's situation. That is why I mention using the cash from the reverse for the impaired risk SPIA. The SPIA payment continues as long as the person lives, no matter where they decide to live. Because they are ill with a shortened lifespan, the payments are higher than for someone who is healthy. If they recover, or live longer, the payments continue, so there is reduced risk to the remaining assets. It is imperative to consider all the financial details with the family and trusted professionals. Reverse mortgages were dreadful some years back. That past abuse has created a lot of consumer protections today. It is sad to see someone need help and be beholden to available family members or forced into a nursing home on Medicaid when there is still value in their home and they could use that asset to live where they want..
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Personally I think reverse mortgages are of the devil. The bankster steal old people's homes and their life savings. I have a friend who is going through h*ll with her parents reverse mortgage now because they have to actually live in the house. If they are out for more than 30 days the mortgage is called due. How about renting out her house for income? That would bring in some cash. If not that, how about just selling the house. The reverse mortgage will expect for you to give them a big discount off the full value and you won't get what you should get.
Donna, that's awful for your mom to lose out. I will lose out on my Ex husband's VA as well since I married again. Maybe we should just all live in sin lol...
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Does her home have equity in it? A cash out reverse mortgage could give a significant amount to be available for care. If she is facing a limited lifespan, use that cashout to fund an impaired risk immediate annuity to give a monthly benefit as long as she lives.
There may be students in healthcare or folks in need of housing in the area. They may be able to help w/ care for no rent or a reduced payment. Some communities have immigrants who may be willing to live in and care for her, too.
Does she have life insurance? It can repay a family loan after her passing, or she could get (for any type life insurance) cash now.
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I didn't hear any monitory restrictions on the VA pension, but my Mom lost out because she remarried to a non-veteran. He did die after 17 years. We had asked before he died and was told "didn't matter". Didn't ask if he was a veteran.
What a disappointment for her and us! Dad had purple heart, was shot in the shoulder, has shrapnel and a bullet near his heart. Refused a partial pension.
He deserved this for his wife of 35 plus years. Blessings for all dealing with caregiving. We need it!
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My mother has no income other than her small social security check. I was just successful in getting the NJ SLMB program to pick up the Part B part of Medicare, which had been previously deducted from her net SS. Also, my stepfather was a WWII vet and, since he served during wartime, the VA has a program that pays for 10 hours of in home aide care per week. Veterans Home Care helped walk me through the onerous application process and I was put in contact with them through Visiting Angels, the agency we had been paying out of pocket for the 8 hours per week aide assistance. You might check this out as I believe Visiting Angels is nationwide? Good luck!!
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If your mom owns a life insurance policy, she can sell it. A life insurance policy is an asset, just like your home. This transaction is regulated in 42 states and is now promoted by longtermcare.gov as a resource for long term care costs.
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Apologies, was trying to be helpful. The vast majority of people NEVER think prevention. The vast majority of caregivers end up in total family crisis and only then think about how to react on an emergency basis - immediately thrust into being a defacto geriatric care manager with no clue how to deal with dozens of life changing decisions. We see this everyday. A simple grap bar or decluttering of stairs could save society a 500k Medicare bill. If we as taxpayers are going to be compelled to pay for, in part, poor planning for aging in place, than society has a say in home safety just like existing building codes do for various design elements already. Our company does over 30% of our work pro bono and has a long history of saving families from rushing to hide/spend down money just to what...end up in a bad nursing home situation. Plan people. Be responsible please as a civic duty. Medicaid, the primary advice given in this thread should be a last resort. It ain't pretty, trust me...
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Hello everyone. After many years of helping families in the mid-atlantic stay in their homes, we are now helping in all fifty states. Here is how: in many, many cases the need for prohibitively expensive, private pay companion care is a result of not have a truly safe and accessible home for the senior to navigate/perform their ADLs (Activities of Daily Living - getting mail/food/dog out/toileting/cooking, etc.). Unsafe, high-risk fall conditions are easily mitigated with sensible, low cost home modifications that, when combined with new remote patient monitoring tools, increasingly well designed, can significantly reduce the caregiver burden/requirement. And the good news is, as a society, we are rapidly beginning to provide grants, credits and even reimbursement to pay for these resources. By far, the key is PREVENT THE FALL. It's all downhill from there for a family who will be in crisis as mom/dad will never be the same post fall in all ways, behavioral, cognitive, physical, mental, etc. We provide free home safety assessments nationally and in Canada and then also help find the money to pay for any modifications. Caregivers, ask yourselves - is there adequate lighting for night navigation, grab bars where needed (bathroom especially), safe entry to home with snow/ice, any stools in use in kitchen to reach tableware, etc.? Prevention is the key. Seniors, even if they have NOT YET fallen, have a fear of same, will not verbalize it, will resist help, but need home mods to live independently at low cost. Craig M.
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When you no longer have money to pay for 24-hour in-home care, then you most likely can't have 24-hour in-home care. Medicaid will provide some care to keep you at home, but when the need is for 24/7, then it is more cost-effective to be placed in a nursing home, and that is what they will cover. If you are entitled to VA benefits and your income + benefits will cover the cost of in home care, great.
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Your State Home Health Care via local Area Agency on Aging and Council On Aging may be able to help.
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Once your mom gets medicaid, she will probably be eligible for CBC ( community based care). That is care in the home for those meeting the criteria. There is an assessment to see if the client qualifies. Usually , they only get 6 hours a day...sometimes more depending on the level of care they need.....At least it is something.
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Is there anyway you can have your Mom in your home? Even if you work and have other responsibilities you could cut back on the 24/7 care and only have it at certain times. We have my 88 years old father with us and my husband and I both work full time but he works at night to stay up with Dad during the day. He is in our home because he wants to be with us so we agreed to have him with us. Despite having a two million dollar nursing home policy he doesn't want to go to a nursing home, he wants to be with us. Help only comes in a few times a week for him
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Without a clear picture and accounting of all INCOME. ASSETS, PROPERTY,, How $$ has been spent/gifted, in past five years, Status of the veteran, (if a wartime veteran) Medical condition of the spouse/ was she divorced or is widowed,Status of House. No action can be taken. For instance while the VA may say a home does not matter; unfortunately that only means to apply, there are are many considerations, and you may be led down the primrose path due to misinformation and misconceptions
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talk to your local/regional VA. When I did, they told me that my mom would be eligible for monthly benefits (my dad was in WWII) when she "spent down" to $80000 in assets. ( as in the answer above) Ask about the residence (if she owns her own home/condo). They told me that was exempt. They also told me it takes about 3-4 months for the application to go through the system. They will need your father's discharge papers. said the benefit is between $1100-1300 a month That could pay for a HHA for some additional hours each week(depending on what you are paying them)
Re medicaid, I was told that in NY state you have to spend down to $6000 in assets before you can apply. Also if you have transferred a home to a relative, etc it has to be done 5 yrs. prior to applying for medicaid. I don't know all the details, but my brother has a friend whose parent applied for and got medicaid. apparently something was amiss with the house issue and medicaid came after the family and wanted them to pay back the money medicaid had given them for the care of the parent. So best to check with the rules and regs in your state. Or if you can afford it hire a social worker who specializes in these types of things or attorney to help you. In the long run it might be worth the money. You could also contact your county's Dept of Senior Services for advice or to give you some contacts in the community who might help you for free. You will end up doing the legwork ( ie forms to fill out and phone calls, meetings) but it will benefit the situation
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