Paying for nursing home. Any advice? - AgingCare.com

Paying for nursing home. Any advice?

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My Dad is to the point of probably having his second leg amputated in next couple of days. They say he will go to NH because my mom will not be able to care for him. From what I have read she can stay in the house, but do they take his pension to help pay for NH? If they do mom will not be able to afford house.

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So dad is going to apply for Medicaid, correct? For community spouse situations, the rules for Medicaid are quite different. Only the NH resident has to become impoverished, the still living in the community spouse does not.

What mom needs to get is MMNA = Monthly Maintenance Needs Allowance. Think of it as alimony for the NH set. The MMNA varies by state and has a basic formula. Like for TX the MMNA max is $ 2,200.00 and that is quite high. So in theory the NH resident with $ 2,200 income would have zero copay to the NH, the community spouse will get all his income diverted to her if she can show need.

Depending on your state, it may or may not be enough under the set formula to cover mom's needs. It is critical that you get the true costs on the house; mom's medical costs (look at her prescription costs), etc. If dad has been the type to do a lot of the maintenance or yard stuff, all that will now have costs for mom so you need to look into future costs too. If the MMNA is low, you can appeal to get all of dad's income diverted to mom as her MMNA too. Personally I think the CS should go for having all of his income diverted to her as she is probably going to spend more money like going back & forth to the NH daily, buying things to take to dad like a snack or extras to make his room more homey, etc.

Also you want to clearly find out what the liquid asset limit is in your state for a CS. Some states have it at $ 113K (some have it much lower) but whatever the case, you want to make sure she keeps all of it. You don't want her to herself become impoverished if you can help it.

The whole CS / NH Medicaid situation really can get complicated. It probably would be good to have you & mom go and speak with an elder law attorney BEFORE she ever does the Medicaid application. If dad is being discharged for the hospital to a NH for rehab, his stay for at least 3 weeks is being billed to Medicare. So you all can use that period of time to come up with a plan to best set mom's situation to her best advantage. You want to do whatever financial done and cleared through the bank before dad applies to Medicaid too.

Some of the things that couples do often are not a good idea if one of them goes onto NH Medicaid. Like for example, most couples have each other as their insurance beneficiary. Now if mom should predecease dad, he inherits the policy $ and is now ineligible for Medicaid as his income is too high. (Bad idea and who is going to deal with all this for him too) So their insurance situation may need to be changed. You want to do all this before dad ever applies for Medicaid. Another example is say that dad is 20K over in assets, if the house needs work you want to get that done (like new roof 10K, new AC system 10K) and cleared through their bank account before the Medicaid application. Once he applies the extra $ is supposed to go for his care or his needs and not for something on the house. If mom could realistically stay in the house for years & years, you want to spend down any overage on repairs and maintenance so that mom won't have those expenses in the near future. A good elder law attorney can come up with options on all this that will work and not be an issue for how Medicaid runs in your state. Good luck and keep a sense of humor in all this….
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Go up to the Money and Legal tab and click on Paying for Care. Lots of info.
In the meantime, put together a list of her monthly expenses for the house, medical, insurance, taxes, food and the car. They will make sure she has a Community Spouse allowance.
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Go to Medicaid.gov. Search for spousal impoverishment. It will help you figure for your mom. Every state is different. In a nutshell........... the community spouse gets to keep the house and one vehicle. They also get enough income to live on. The remainder goes to the NH spouse's care.
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