We're seeking guidance in securing financial assistance for current home care & future memory care.

Keeping a log of all of these suggestions/options so we can bring them to the attorney. I appreciate your input so very much!

Hi. If your father has his discharge papers, you might try the Veterans Services, Aid and Attendance program. I understand that you have to have only 80K in assets to qualify but there is no lookback policy on it, so if there is more from the house sale, and it can be transferred into the one of your or your sibling's names then you could qualify.

If possible your plan to quit should start with checking about FMLA (family medical leave act.) As noted you will not get paid, but should circumstances change it can protect your job. You may need to return at some point, and all the years you do not have income are factored into your SS. No income for extended periods can seriously reduce your SS! YOU may need as much as you can get when your time to retire and maybe need services come!  Getting a new job later may be difficult.

Lyndal: Your sister should not give up her job. And yes, good idea that you are seeking elder law attorney.

If you want more info on caring for dementia patient, join us on the forum at AlzConnected.org. There is a wealth of information

Thank you all!

I'm contacting three different elder law firms this afternoon, so all of your input is extremely helpful.

As I said, the addition is already underway -- exterior is virtually completed except for siding. Plumbing is roughed in. All of us siblings are still in agreement that we have made a commitment to the addition, and there is no disagreement whatsoever with the life estate being purchased from our sister. This arrangement was pretty much the only way we finally convinced our parents to move from their little piece of heaven in northern Minnesota -- about 3-4 hours from the nearest sibling, so too far away when the extent of Mom's health issues became known. Sister and BIL are amazing! We all are truly grateful for the way they have put themselves, their home, and their family on the front lines to do the day-to-day things the rest of us are unable to do. We are united in coming alongside them in various ways -- research, visits, extended stays to give them relief, help with appointments when necessary, explaining certain information to Dad, etc. In short, we are doing our best to follow what God asks of children...to honor our parents. It's our responsibility and our privilege.

That being said, we must protect the little bit of cash they got from the sale of their mobile home in order to finish the addition. Sister and BIL even refinanced to get additional funds and partner with our parents for the build. None of us have much money, so we're doing all we can to qualify our parents for available assistance with care.

My son is a licensed CPA/auditor in Atlanta and has been incredibly valuable in helping to explain things to Dad. He also stressed the importance of securing an attorney who knows Medicaid and tax laws.

BobbiJanke, thank you - I will definitely look into those two programs!

Since her hospital stay, Mom has had weekly visits from a nurse and PT. OT came to do an assessment of her ability to function and to make recommendations for equipment in the home...mostly in the bathroom. PT released her from their part today, and it is my understanding that there will be another assessment by the nurse or hospital social worker in a couple weeks. I'm wondering if this would trump any assessment we try to line up with one of these state programs?

Mom is able to walk, preferably with a walker, but she is VERY unsteady. She doesn't like to do her exercises and fights us on it. But the biggest concern we have besides her heart condition is her dementia. She absolutely can not be left alone. We're fearful that the medical professionals will simply come and talk with her, not us (even though my sister makes a point of being there for every visit), and draw their conclusions based on what she tells them. Mom usually doesn't even know what month it is. She sometimes complains that she hasn't eaten all day...this can happen 10 minutes after she has had lunch or dinner!

I work with aging/disability programs for people on medical assistance in Minnesota. Call the senior linkage line and ask them to make a referral for waiver services. If their income/assets are within medical assistance eligibility criteria she could be eligible for home and community based services. There are two programs for elderly, ask about the elderly waiver and alternative care programs. They will have a nurse or social worker come out and do a needs assessment and see if they are eligible for these programs.

Consult with an elder law attorney asap. Different states, different rules. You need to protect your folks so if something happened tomorrow Medicaid would not be an issue.

Is your sister and Brother in law going to change their real home title to a life estate? Maybe I'm confused. Wouldn't it be better to have a contract and charge mom and dad rent to make payment for addition. How do you feel about not getting an addition? This is why we didn't do that, my sister said it wasn't fair if I was to get an addition and she didn't. Even though I gave up my job to help take them to every appt. medical and personal. Buy groceries....etc....

One clarification by my sister...Dad was in boot camp & the army reserves, so evidently he is not considered to be a veteran.

Thank you all for taking time to respond!

First, we do really want to care for them in the home as long as possible. That was our whole premise in convincing them to sell their house & make the move. Basically, nothing has gone according to plan since then, so we hesitate to add that huge change into the mix so soon while Mom still makes it her mission to be aware of what's going on at all times. She would not do well being away from Dad, & they do not want to live in a facility.

Yes, it is so true that needs will increase! We have already said that God was watching out for us with slowing the build...we wouldn't know everything we know now if they were living out there already!

Mom is doing better as long as she cooperates with low sugar/sodium diet & the simple exercises assigned by PT. Right now, however, she is homebound except for doctor appointments & church. We are dealing with constant paranoia & temper. Although she sometimes seems to be "herself," Dad needs to fully adjust to the fact that Mom is not the same person she has been for 57 years together. He makes their breakfast faithfully every morning & is very devoted. My sister helps him organize Mom's meds each week, & he puts them out at the proper meal times. He has been in good health for the most part & doing a remarkable job for his age & the daily challenges Mom presents. He is currently recovering from a bladder infection & also has surgery coming up to finally address blockage from an enlarged prostate that has been pretty frustrating for quite some time.

The status of the addition is that the outside is almost completely done. Windows are in; roof/shingles done; just needs siding & exterior door. Plumbing is roughed in, & we're waiting for warmer weather to thaw the ground so it can be completed. Thus, we have committed to it. The plan is for Dad/Mom to partner with sister/BIL in that investment.

We were focusing mostly on the life estate option -- parents would purchase life estate from sister & BIL. Their home value without the addition is $255k, so the table I found online would calculate the life estate allowance at $111,330.45. According to advice from CPA & the "Medicaid Secrets" planning checklist, that would be exempt/tangible personal property (no lookback) & also protected from probate later. Cash assets are just a bit over the allowance amount, but they could pay off what they owe on their car. There seem to be several other techniques on the checklist including gift to a disabled child, home improvements, personal services contract (maybe this could be an example of what @jeannegibbs mentioned)...are we on the right track?

In Minnesota the Area Agency on Aging is called Senior LinkAge Line. There is also a Vererans Linkage Line. You can easily find contact information online. They can advise you on how to get a needs assessment done for each parent. They are 800 numbers.)

LinkAge Line is a great starting point, but it is not a substitute for seeing an Elder Law attorney. Lots of lawyers can give you tax advice, but may not be aware of all the ins and outs of Medicaid. And that is crucial! You can see from Igloo's advice how complicated it can be. Get things set up correctly from the start.

I hope your sister can avoid giving up her job. Can she take family leave, with the intention of returning? It sounds like the original intention was that her caregiving role is intended to be temporary. She won't get paid while she is on leave, but she can set up a caregiving contract and get paid by your parents, this would be a way for them to spend down there assets for Medicaid. Talk to the Elder Law attorney about this.

Your parents' needs will not decrease if/when they move into the in-law apartment. In fact, with dementia in the picture they will definitely increase, the only question is will it be slowly or quickly. Your family made plans based on one set of circumstances, but circumstances can change drastically in health and needs of elders.

Call the LinkAge Line. Talk to an ELDER LAW attorney. Have a needs assessment done.

Let us know how this goes, we learn from each other (and we care!)

with low assets, cant they soon go on Medicaid and get out of home care paid for?

The biggest issue - to me - financially will be that they cannot directly fund the building of the addition onto your sisters home. The home is owned by Sissy & BIL so any change to the value of the home - like from a renovation or an addition - affects their property. It increases property value by parents funds. It’s gifting which is not allowed by Medicaid. 
What may be better is for them to do a personal care contract to Sissy & BIL that pays them every month for caregiving and living costs. And sis uses the $ to fund renovation. Contract needs to be all above board and with taxes, fica....
The info on the house sale upstate will be known by Medicaid to the penny. Has any of the $ already changed hands? Really gather all folks finances and act of sale document and whatever existing on the renovation and get them to an atty ASAP. 

The other concern to me, is that their medical needs, especially your mom’s sound pretty intense. The heart/fluid situation is it likely to be chronic? Is her diabetes under control?  The needs assessment may be that mom flat needs skilled nursing care 24/7 oversight and that means in a facility or huge sums paid for home health services & equipment. Medicaids in the community programs will have limits on the # of hours of in home care allowed. Seems to be in the 20-25-maybe 28 hrs a week range. If mom needs over 30 hrs it’s means she needs care in a facility. 

Sissy cannot do this on her own for mom. Plus there’s dad...... if they had to be apart could he adjust?

Ask assessment team if for mom, hospice is a possibility. It doesn’t mean your giving up. My mom was on hospice 18 months. Hospice can bring in equipment & care assistance esp bathing care within days of qualifying. Plus it’s all MediCARE, which they have. 

Revocable trusts usually have no protection from Medicaid. It’s viewed as an asset subject to spend down. Irrevocable trusts though can be. 

There is a poster on this site from MN who has been through Medicaid for both her husband, living at home, and also with her mom who lived with her sister for a bit and then the mom moved into a NH. I’m sure Jeanne will post some insight on Medicaid in MN for you.