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My mother has an investment account of more than $300k. She is 79, in ok health and is moving in with one of her daughters in Massachusetts. We are looking into Mass Health as a provider and realize her assets will disqualify her.

We also understand that if we were to sign up for adult day services or a nursing home facility, they will tap into her assets first.

We would like to protect those assets and wanted to know our options.

I understand there is a 5 year look back, so this is something we need to consider now. Can we change the ownership of the account to one of her children or create some type of independent LLC? What is the process for each and what are the tax implications, if any?

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She has funds that should be spent on her care. You may find advisers or get advice on this site as to ways to protect her money and get on Medicaid. Personally, I think these schemes are risky and I don't appreciate funding care with tax dollars for people who have money.
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Your 79 year old mother should have medicare, why does she need Mass Health? An irrevocable trust can be established to answer your question.
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Why do I have to pay for your mom's care? Mom has $300,000 and you don't even want her to use that money for daycare services? Unbelievable.

See an attorney who specializes in elder law. Be careful about transferring assets into someone else's name. Very risky. First of all, it would trigger a gift tax. Next, the money would BELONG to that person. In case of divorce, it's marital property. In case of a lawsuit, it's fair game.

Seriously, it's one thing to try to protect assets legally from nursing home expenses. It's quite another, in my opinion, to do everything possible to spend NONE of mom's money on her own care. Lordy.
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Thank you for your perspective Windyridge; I appreciate and respect your opinion.

She does have medicare. But I have heard horror stories from people who have said their life savings got sucked up by nursing home costs. I'm trying to be proactive and fair and find the best solution for her while protecting her finances.

ArmyRetired, thanks for the irrevocable trust suggestion. She is currently on People's Choice in Louisiana, so I wanted to find comparable coverage for her in Mass. I believe she does have Plan B, so I'm not sure why she would need Mass Health - you raise a very interesting point! This is all new to me, so I appreciate you pointing that out! Thank you!
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I guess I'm going to play the devil's advocate here and ask the obvious question: Why are you trying to protect mom's assets if she needs care? To what end? If her assets are not to be used to take care of her in the "golden years", then what are they for?
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It is my understanding based on what our accountant advised - that when they look over the past few years they will look at gifts, trusts and the like, anywhere the money may attempt to be hidden or stashed. He said gifts may be required to be given back and trusts undone. As Army said there are irrevocable trust that could be different. Not sure if all irrevocable are the same - my son has one - and the language in it states the money can not be used for things that can be funded by other means. This might complicate things like medicad given their requirements for funding.
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I think we all want to minimize elder care costs, leave a little something for the kids and so on. But they really is, nursing homes and assisted living is crazy expensive and ya gotta spend your money first, when that's gone you're looking at Medicaid. I appreciate your responce, but again, watch this stuff. I have friends who have bragged to me about some sharp finance whiz, You should call him, He's great! Saved us a bunch of money with this trust thing!..........Well guess what........My friends now in deep s.....t. With Medicaid, the IRS, and probably some leg breakers in Vegas. So tread very carefully.
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I also am uncomfortable with protecting assets while considering what might be available through Medicaid, which is a program for disadvantaged people with limited funds. I do respect your position but with your mother's considerable investment funds, they should be the priority for her care.

If you do plan to take this asset protection approach you should hire and be willing to pay for a highly qualified estate planning attorney with experience in recommending asset managements. A guy who has a one shop elder law legal practice with emphasis on Medicaid might be suitable to provide Medicaid qualification advice, but with $300K you're talking about a significant amount to invest and I think would find better resources in a mid to large size law firm with an actual estate planning practice for people with what I'd consider high net worth.

I also ask the question: what else should her money be used for if not her care?
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Speak with an Elder Care Atty in MA... She can set up a family trust.. The trust will be included in the 5 yr look back..

Also remember your sister will be taking on a "thankless" job and the expense is high... She should inquire about a Caregiver Agreement with Mom's funds...

Mom can't take it with her BUT she can be comfortable through her remaining years without being a financial burden on her family...
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This can be a sensitive subject and one that hits close to home for me. I'll try not to babble and stay on point - but I'm going to start with an old fabel. The grasshopper and the ant. In summary the ant stored all summer long for the up coming winter. The grasshopper played around all summer having a good time and when winter came he had nothing. I do not mean to imply folks on medicade screwed around - that's just how the fabel goes. My parents were teachers - not a particularly lucrative profession but one with a good pension, in Oregon at least. In addition they managed to save a hefty amount of money and made good investments. My uncle was not a planner/saver and both he and his wife have had medicade for years and years - even their housing, first AL and now NH have been paid by medicade for at least 15 years. My parents - now just my mom - have Medicare to help with some rx costs but for the most part have used their own money - sometimes to the tune of $15,000 a month. But along the way my mother had her pick and choice of the nicest of housing and has had in home help sometimes up to 16 hours a day, 7 days a week. When my father was in his last few months mom did not have to lift a finger. Money is power and money means choices. It is foreseeable that my mother will live very comfortably for the rest of her life. Thankfully we live in a society that attempts to look after and assist those not as fortunate as my mom. No one should live/die alone and/or in pain due to a lack of money. So that means those who can - do. And those who can't are helped by programs funded by the "haves". If everyone used these programs regardless of need they would be bankrupt and cease to exist. At the end of the fabel the ant takes in the grasshopper. I'm sorry - it really isn't my intention to preach or judge. I'm just saying I get the desire to want to tuck away my parents hard earned resources. I just may be long winded in saying it - lol! A long time ago I heard someone say "therefore the grace of God go I". It changed my life.
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One option to protect one asset that nobody has mentioned is her home. Does she own it outright? Does she need 24/7 care? You or one of your siblings could move in with Mom, provide her 24/7 care and if you are able to withstand two years the house can be transferred to that sibling without penalty.

Any additional expense is required to be for Mom's needs and bills from her assets. Medicaid calls this "spenddown" to the amout of $2,000.00 then Medicaid will kick in.

Or another way would be for mom to purchase a long term care policy that will pay her expenses for a number of years until the benefit runs out.

And the elephant in the room? It is not at all appropriate to protect Mom's assets so there is inheritance remaing for the children when she has care needs. How would your Mom feel about being on a publicly funded program? How would you feel about being on a publicly funded program? Doesn't Mom deserve the best care options available?
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"And the elephant in the room? It is not at all appropriate to protect Mom's assets so there is inheritance remaing for the children when she has care needs."

Thank you for saying that, Glad. That's exactly the point here. In my post, I was trying to say pretty much the same thing, but you said it better than I. Why are the assets being protected when Mom needs care? Doesn't she deserve better than being treated as a 2nd class citizen (which, lets be realistic here, is what happens when you go on Medicaid in a nursing home). With her assets, Mom could have a very nice private room and all the "extras" that someone on Medicaid cannot afford.

I'm going to describe a couple of personal situations here, so forgive the length of this post - but this is exactly what can happen if you try to "protect" those assets and leave your Mom on Medicaid.

I have seen firsthand what happens when someone enters a nursing home on Medicaid - with both of my parents. Unless they require a private room for medical reasons (my Dad had C-Diff, so he had to have a private room to avoid infecting others), they will be placed in a shared room - and unless someone happens to pass away just before they enter the facility and leaves a window-side bed open, your loved one on Medicaid will be placed in the other corner of the room, which means a space approximately 10' wide and as long as their bed, behind a curtain that will likely remain pulled shut most of the time - so they can't even see out the window. Ever. Unless they happen to get a nice roommate who is willing to leave the curtain open, but 9 times out of 10, it doesn't happen that way. And if a Medicaid recipient wants a private room, someone else has to pay for it - because even with Medicaid, if the resident is on SS, the nursing home takes all of their income, with a small "discretionary" amount left each month.

Oh, and those private rooms? There's a difference in some nursing homes between a temporary private room used for a patient there for physical therapy and rehab after an illness or injury vs. those that are permanent residents. A temporary resident there for therapy gets a large, bright, sun-filled room on the front of the building, where they can look out and see the street and activities going on outside. They have a private bathroom and even a pretty electric fireplace, nightstand and 2 chairs with plenty of room to move around. A private-pay permanent resident room is about 3/4 of the size of a temporary room, with barely enough room for the bed, a recliner and nightstand, a window facing the rear of the building where if they're lucky, they might see a tree or two and a parking lot - otherwise they're looking at the other side of the building - so a wall. No fireplace, no room for any extra chairs, and they share a bathroom with the person in the next room. And someone has to pay $465 a month for that private room, in addition to what Medicaid pays and paying their SS to the nursing home too.

When my dad had to enter a nursing home, he had just a short time before agreed to sell my son his old van for $300. My son took possession of the van, paid out over $400 to get it insured tagged, etc - and then the van broke down the next day and was not repairable, so it had to be junked. Dad told my son to consider it paid in full, because he didn't know it was going to break down and he felt badly that my son had paid so much to get it on the road and then it died. A month later, Dad fell, was hospitalized and had to go into the nursing home on Medicaid. When Medicaid learned that the van had been transferred to my son's name, I had to go back to the junkyard that took it and get a signed statement from them that this non-running van had $0 value when it was transferred. THAT'S how picky they are about assets. So if they will go that far to pursue a $0 asset, what do you think they'll do with your mom's $300k assets?

My mom is now in a nursing home on Medicaid. The only things she owns are her vehicle and home. We have tried a shared room, and she becomes depressed because she's stuck behind that curtain that divides the room, as I mentioned before. When she becomes depressed, she talks about just "giving up" and "letting go", because life isn't worth living if she can't even look out the window. So yes, I pay the extra for a private room for her every month. If I sell the house, which is only worth about $30k if I'm lucky, every penny of that sale will have to go to the nursing home, because the transfer or divestment of that asset will make her ineligible for Medicaid until the money from the sale runs out (which would be all of about 4 months at the current rate the nursing home charges). If the house is transferred to my name, the same scenario occurs, except now she is ineligible for Medicaid, so the entire $7000+ per month would have to be paid out of pocket. When someone on SS only has about $1400 a month coming in, where is that going to come from?

If you somehow hide or "protect" your mom's assets and put her on Medicaid, all of the things I've mentioned are going to become your Mom's reality. Doesn't she deserve better, especially since she was apparently careful financially throughout her life and has the funds to obtain the best of care, at least for a while, until the money runs out and she *has* to go on Medicaid?

My advice: transfer NOTHING.
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What most of us are looking at is that end-of-life care could consume any savings, no matter how large, and Medicaid may ultimately have to be applied for. People are living longer than they used to, so often there is no money left in an estate. It is just the way it is. You can try to protect her assets to pass down to you and your siblings, but it would just be handing the cost over to the taxpayers. There are trusts that can be set up, but the last time I heard, Medicaid was starting to seriously look at tucking away money in trusts. I don't know what the future will bring.
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We are going through this now. Mom had about $300,000 in savings. Sis and I are both in our 70's ourselves. Mom did very well with Independent Living and her social security and military pension covered her costs without digging into her savings. Then she went to Assisted Living which required us to tap into savings of about $1500 a month. Her AL costs were $4600 a month which seems ok for a very nice place. Now she is in a nursing home and it is $11,000 a month and I just got a notice it will go up another $1000 in January. Its not posh, its like a big hospital, good care, but a hospital with all the accompanying smells and old people sleeping in chairs in the hall, my mother included. That is very very painful financially and her money won't last very long. I can understand how people feel when they see their parents savings drain away while others get it for free. The savings is money they worked for, earned and scrimped for. Up until this generation, costs were low and parents were able to leave some of their hard earned savings to their children or grandchildren to help for their futures, or college, etc. But now costs are so high, federal laws have closed in on them from every direction. So they have to use it all before the government will help (despite having paid through the nose to the government their whole lives, they get nothing back until they are broke and can't leave a penny to their children.) Don't get me started on Social Security which is NOT an entitlement - it is money that was mandated to be paid by both employee and employer supposedly for a worker's retirement - the payments would be MUCH bigger had the government not spent it for other things instead of investing it for 50 years for each individual! Yet, there is a federal law that prohibits an employer or administrator of a business from touching a person's 401k. But the govt couldn't keep their hands off our Social Security. Double standard.
Medicare pays very little in doctor bills, nothing for a nursing home - you need supplemental health insurance or you end up with huge bills for doctors and drugs) But there are people who live on the government from day one and get it all for free from the start. It makes me very angry.
I know this is Mom's money and it will be used for her care. Sadly she barely knows what is going on, she is miserable, unhappy, uncooperative wherever she has been. I have carried the load of the in-between care for her for 15 years up until now. Why do we wish we could protect some of the money? Because us baby boomers can see the future for us, that some day we will be needing care and the way things are going, in 20 years the cost will be at least double and we won't be able to afford it and the government will be so broke it won't be there for us. The care will not be as good probably warehousing us (too many baby boomers needing it at the same time)
My point being, when a child tries to protect some of a parent's money, it doesn't mean they are hoping to inherit so they can buy a Florida condo or Lincoln Town Car. It could be they are scared for the future. I know I am.
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AmyGrace, you are singing my song. It angers me also when I hear they are going to change the title of Social security to An Entitlement. NOT! I was self employed so I paid BOTH SIDES of the Social Security. Do you have any idea how much I could have saved if I had the option to invest that myself ? And please dont tell me that if they did not collect it that we would have nothing as many would no invest it but spend. That is a safeguard they say. Again NOT. They could have passed a law telling us we either invest it or give it to them to invest. I know what you mean about people living in the elegant Ind living places totally paid by the Government. We did not know they can go back 5 years to see what you did with your money.

I am 73, and I pray that I die before I get to one of these facilities. At the rate things are going and with no increases in SS for years now, I probably will be one of those people who have bills paid by govt.

I think if you are the POA for Financial you can add your name to the account. Ask your attorney or bank how it is done.

Good luck. You are very lucky to have a mother who saved. Not many have that at all.
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Dear careformom1936,
If you think mom will get into a decent facility on Medicaid, you are dead wrong. She can afford to live like a queen and she deserves to. Leave it in her name and make sure her final years are the best.
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Pam, I hate to tell you, but we paid dearly to live in an ILF for about 7 months. We had a fire and our kids recommended we move there until our home was completed. We found out quickly that there are many living there who have their rooms paid by Medicade,or some sort of government payment. Careformom should have stopped the bank account 5 years ago, to protect the history of money available. Some states don't use the 5 year mark. YES, she does deserve the BEST. She worked hard to save. We could not afford to stay there and went back home. We have a ZERO mortgage, and only a HOA fee every month. NEVER BUY IN AN HOA COMMUNITY. But, the kids will have to spend her money before the state steps in. Sad but true. By the sounds of how much she is paying, it won't take long. They should have drawn up a contract for care before it got this far along.
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I truly appreciate all of your honest feedback(s) and perspectives on this question. You have given me a lot to think about and consider as I venture into this new territory. Many heartfelt thanks!
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I'm glad you got honest feedback. My mother is in about the same financial position as yours is. I am very careful with her money to keep her bank balance up. I do this mainly because I know that soon she may need all that money to be able to pay for a decent nursing facility, and that it may be years. I prefer not to have to apply for Medicaid for her, so I hope that it lasts her. It is bad that the money our parents worked hard for ends up in the hands of the healthcare system and nursing home, but it is the way things are going now.
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The nursing home my mother is in - and all we have checked on in our area - we are paying $11,000 a month out of her savings - mom gets nothing different than the medicaid patient. She is in a shared room, nothing fancy. Good care, but not posh. And once her money is gone and medicaid takes over - she stays in the same room, gets the same care. There may be better places out there, but when the time comes, its a matter of whether there is a room. In NY state, most county nursing homes have gone broke, gone private. Everybody gets the same, whether you pay or the government pays.
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I can see both sides of the argument. If you save you pay for your own care if you have a great time and save nothing the state will cover the costs. The trouble is our parents didn't save for their care. As we all do, they thought they were immortal and of course they wanted to leave it to their kids....that is what used to happen Why? because we didn't have the medical advances we have today and people died earlier and quicker than they do now.

The thing we have to get our head round is that we have no right to an inheritance. I would like to think there was something left for me but I am not pinnnig any bets on it. I would like to think I could care for Mum until the final day but there is no guarantee on that either. So people just take each day as it comes, breathe deeply and face this scary new world we live in
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That is so true Jude! Nobody is Entitled to a inheritance, and the 6 of us kid's encouraged our parents to live it up in their retirement, knowing that we would all do our best by them in their old age and ailments, and we did! But still there was a beautiful check for about 8 thousand dollars for each of us in the end. I used mine to visit our parents homeland, Wales and England, with my 3 sisters, and I felt it was an appropriate tribute to them, and the utmost dream of mine! My husband's Dad however, has been dangling a carrot of money over my husband's head for 12 years now, and I tell you, it just isn't worth it! It seems almost disgusting to me, like bribery to force us to have him live in our home all of this time, the very best years of our lives, 42-55, and he believes it is all worth while, but it is just not! I'm just not invested in him, like I was my own parents, and I know that sounds terrible, but he isn't an appreciative, kind, fun person. He is rude, grumpy, entitled, and Narcissistic, and I don't care about his money, I wish we had never invited him into our home, as ay 74, when he moved in, yes, he was grieving, not that he ever really showed it, but it was just that he was afraid to live on his own, and had Never done so before. I feel like we did him an injustice, not forcing him to be self sufficient as long as possible, and now, he is nothing more than a robot, uncaring, unfeeling, and just existing, without any outside stimulation, and therefore robbing us of the same. Yes, he never would have had enough money to self pay for the long run in assisted living or nursing home, but he could have done quite well for a very long time, in a senior apartment, until more medically nessasary housing was nessasary. The whole thing is messed up! So sorry that I went off topic!
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Reading through these posts made me wonder about the effect of the Depression on our parents' generation and their saving habits. I think there might have been the desire to save for their children, to avoid the trauma they experienced when there were literally no backup systems. But I could also see that they (a) sometimes just didn't make enough to save for old age or (b) were so traumatized by the sacrifices of the Depression that they wanted to enjoy what life they had left and spend the money they had saved on themselves.

I worry also about the younger generation saving; there are so many more consumer products that are considered essential now but didn't even exist 15 - 20 years ago. What they feel they need is so much more than what we felt we needed.

And the trend to put children through college as opposed to them working and putting themselves through college takes a pretty large chunk of disposable income away from parents. I wonder if they'll even be in a position to save, or will their children be, especially if they've been lured into the consumer trap of having the latest gadgets and continually updating them for newer versions.
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You know Gardenartist, your right, and wrong. I don't think that there is any way us working class folk, could ever save nor invest to last us through our declining years in independent senior Living, mor Nursing home care. Other than our pension (husband's), SS, an insufficient investment portfolio/IRA/401K, and our largest investment, our home, everything we were able to invest, is still not enough to carry even one of us through several years in private Nursing care, so where is our incentive. Of course, I'm not suggesting to go out and blow it all, and yes, we thankfully are a comfortable as the average American, but you just can't possibly ever sav/invest enough, unless you are born into huge money, which we definitely were not. But I did like the way my parents did it, and of course it had a lot to do with the way we were raised, but they lived comfortably, and were able to enjoy their retirement, and never see inside the walls of a Nursing Home, and a lot of that was Luck, as they were realistic, and knew of the possibilities, but being raised to care for our elders worked out alright for them, but for My husband, not so much! Ole GRUMPY, Makes our lives Difficult! And he doesn't have enough money to ever make THIS, worth our wile! And with No help from his sibling's, I see No way around this until something drastic happens.
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Actually I didn't answer the question. If your mother acts independently she can do what she wants with the money bearing in mind dementia, falls, tumours can occur without warning and the 5 year look back applies. If however it is believed that she did so to intentionally defraud the state she could find herself in hot water.

In the UK you can also only give people a limited amount, after which it is declarable on a tax return so you may find you a) have to pay some form of tax on it and b) have it clawed back anyway

If however YOU act on your Mums behalf and move all her assets - and you could theoretically, then there could be potentially a case that you did so to intentionally defraud the state ad that would be a whole different ball game. I do believe however that can protect some of the capital (at least in UK you can) by setting up a trust - however be prepared to pay steeply because this requires legal eagles and the application will vary state by state. My question is who wants this - your mum or her children. I am sure that once again the written word may have been confusing but I think the other posters are right. Your Mum has saved for a rainy day - well the thunder clouds are gathering.

There is potentially another option. If you have sufficient funds to do it, you may be able to purchase several smaller homes and rent them out. That way you retain the capital and use the income to pay for your Mums care should she ever need it. You may eventually have to sell them off but you would have maximised the income.
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I don't think that an investment group will let you just put her investments in someone else's name without her being competent and willing to make such a decision on her own.

If this was done, a gift of that amount would create an unbelievably high gifting tax that would be her's to pay which would require some of the money back to pay. Currently, the max is $14,000 per person per year.

I think that the best way to protect one's assets so that they last longer for one's care and maybe leave some to give to others is to buy long term health care insurance long before you need it. My mom had it and my dad has it. It did not and has not taken them long to more than get back in financial support the amount they paid in premiums. Without long term care insurance, the cost of a nursing home could easily eat up her investments in 3-4 years.

It's her money. Let it stay her money and use it for her care now. With my dad out living my mother by 8 years, I'm almost certain that there will not be any money left. It's being spent on his care and that's how it should be.

The problem I see with rental property is first the pain of it and secondly the housing market is not all that great. My MIL has plenty of rental houses that she bought years ago, but the housing depression and where she lives has make them worthless investments to be able to sell easily and to make much money from. My own home is not even worth what we bought it for 10 years ago.

At 79, I don't think there are enough years to make much turn around cash.

The thing I would do is help her maximize with minimal risks the investments that she already has so that they will last as long as possible for her care.
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Thanks for that magnum - over in the UK that is not the case but I thought it might be worth considering depending on where she lives. House prices over here are going silly at the moment
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Jude, I think purchasing and renting house is an innovative approach, particularly if a management company is hired to handle the background checks, bad tenants, repairs and other issues. In my city, homes have been snapped up by would be landlords, some of whom are out of state, and others who are local but just don't have the experience or sophistication to manage rentals.

Others are being leased to tenants by a company which one of its workers told me owns about 100 homes in the city. Clearly, it's made an investment, and generally it kept the property up well (except for an invasive tree).

Foreclosed homes are still a blight on the real estate market; some are being snapped up for 1/2 their previously assessed value, and yield good results for the landlords. But the average would-be, wanna be flipper or landlord doesn't always have the resources to repair and manage a home that's been vacant for years, so some of these houses are just plain old duds.
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I only mentioned it because I have a friend who took a really innovative approach to caring for her mother and her 'aunties' aka mother's friends. They were thinking about buying to rent to cover care costs but my friend is a qualified and incredibly experienced carer and they actually came up with a different plan.

4 of them sold their property in the capital, clubbed together and bought an older rural property and in the UK that also usually means much larger.........once you cross the threshold as it were (there seems to be a glass ceiling and once you break through it ) the houses are very different.

This was like a mansion it was so big. They used their money to turn it into a very private care residence for just the 4 of them but, and here is the innovative bit they made it into 6 beautiful flats all fitted for disability usage. The upstairs is the domestic setting so the kitchen the laundry rooms everything that is needed for domesticity is upstairs as is my friends flat and one other which her Mum has.

Downstairs there are four flats with a central lounge for them. Now the proviso is my friend contracts to care for them for the rest of their natural lives and in return gets the flat she lives in AND her keep and she can engage staff if she needs to to cover holidays and the like. On top of that she gets a small and I mean small wage BUT as she has a flat already she will also get income from that too. Since her Mum owns one of the flats she will also own that with the option to buy out the others and open it as a rest home.

One of the owners has died and the other three plus my friend bought the flat and rent it out - Because care is built in and because each flat is self contained with alarms etc they get £800 a week for it that's 1200 dollars. Yes you have to have the initial capital and that isn't there for most people but if you live in a big city where property prices are high and can tolerate moving to a more peaceful rural setting then the options are almost boundless.
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Oh Jude, your friends plan sound great to me. This is something that I have thought about for some time now. Would love to get more details how this works, but no problem. I think this could be adapted in the U.S. as an RCFE home.

Thanks for sharing that!
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