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Later, when Mom is asked what the check was for, she doesn't remember. This is the situation in our family. I have two sisters; Mom is an 88-year-old widow. I do the bulk of the errands, doctor visits, chores, etc., as I live nearby. Another sister comes every other weekend and does food shopping and errands as well. The third sister has hardly done a thing in 4 years. Now she has offered Mom to pay her bills. My other sister and I know that she and her family are in financial difficulty. Also, Mom is paying her for helping, when she's not paying either of us for our (equally valuable) help. When I looked in the check register last night, I noticed that my sister had made out a check to herself for $230 as well as one for her $50 "fee." Mom did not remember what the larger check was for. How do we get our sister to be transparent about what she is doing? We all have equal POAs. How on earth are we goint to conduct ourselves when Mom becomes less competent if we're doing such an inept job now. I would love to have some suggestions!

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And Happy New Year (Chinese version) to all, too!
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Personally, I'd prefer Medicaid be federally administered and alongside Medicare.
All done by CMS. But there is NO way that is happening as the states can use the Medicaid money as they see fit & whether or not it's in the public's interest. e.g. Gov Jindal's R-LA, NOT allowing Medicaid $ to be used for hospice (that would mean the room & board type of services and other medical that Medicare doesn't pay in full). Huge brewhaha on that and it's being "reconsidered" this on top of his decision to close Mandeville state hospital.....Medicaid $ can be diverted in ways that can benefit select causes and the states sure ain't gonna give that up!

For those who are already @ poverty level - like are on food stamps or HUD rental, section8, WIC or whatever - then doing a Medicaid for NH is a cake walk. They are already vetted and likely for years & years. Purple Sushi - that is what it seems your mom situation is. But for those who are above the 2K in assets and 2K in income monthly, have just so much work to get to the poverty level and you have to make sure that whatever you do, sell, or transfer will not be an issue for Medicaid.

If they live long enough, they will run out of $$ eventually and then qualify for Medicaid for NH. This is kinda what I went through with my mom.She finally flat ran out of $ after a couple of years of IL, so could qualify for Medicaid. But she's 96! If she had needed a NH 10 or 15 or 20 years earlier, it would have all been private pay . There is no simple one fits all answer except that advance planning does pay off.

Jeannie - yes! but we'd need like 50 editions plus Puerto Rico & Guam & USVI editions.Let's do USVI first and PR and then Guam & Hawaii

Happy Mardi Gras 2 all!
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purplesushi, oh yes, it really is frustrating! I had an Elder Law attorney guiding me through it and we still had to start over! grrr .... and yes, there should be a "Applying for Medicaid for Dummies and Smart People" manual ... Igloo, what are you doing for the next 3 years? :-)

As far as I know, you do not have to reapply when going to a nursing home, just do the annual renewal form. But who knows? Maybe it is different in California. (Almost everything is different in California, right?)
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Yes, she has already qualified for Medi-Cal (california's medicaid program), but I was confused on the issue of when/if the time comes for her to go to a nursing home do they look back and reevaluate? Or since they have done that already in the qualification process they won't need to do that again later? She was never questioned about the monthly check to me - I suppose it's because it showed up every month for several months? I wish there was a "real" book or resource that walks you through the ENTIRE process, step by step, and spells out what you need to do and why. It appears to me that a lot of the information is encrypted - they'll tell you what they need, but won't say why they need it...or if you answer something in the wrong words you disqualify yourself without meaning to - but they won't tell you anything other than "you'll need to re-apply" & that starts the clock all over again. It's really frustrating. At any rate..thanks. :)
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purplesushi, your mother is already qualified and on Medicaid, right? So apparently the rent did not raise any red flags.
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purple - no that doesn't seem to be an issue (paying family rent) as long as it seems to be an acceptable amount that is within community standards. But the caseworker will probably flag mom's Medicaid application for the amounts as to justification to be provided (by you) for it not being subject to a transfer penalty. I'd keep a journal, log or Quickbook type of accounting for mom's money. Papertrail is muy importante. You can go the elder attorney route and have them do legal on all this (which I think is the way to go if mom has any tangible assets or investments) but if it's the case were mom just gets SS and maybe a small retirement and has no other real assets, then have her do a letter of understanding between you and your DH as to what she is paying for and why. You could even run to a UPS store that has a notary and get it notarized. If you want to be all OCD on this, you could use the % guideline that the IRS has on-line on how to determine how much of a home office space you can deduct and use that formula to set how much rent she pays.

My perspective is that with states facing shortfalls and with Medicaid being such a huge amount that the state has to pay (joint federal & state program), declining a Medicaid application is the route the state prefers. The caseworker (which doesn't get paid very much) has a very short time to review the application and anything that isn't cut & dry & obvious will make the application red flagged.

What I think they are looking for is patterns of spending. So say your mom pays you and your DH, $ 500 a mo in rent and you can show this as an established set amount for the past 3 years. Then it makes sense. BUT if say 8 months ago, mom gave you and DH and all siblings each a check for $ 5K or whatever, then today you apply for Medicaid for NH for her, then that $ 5K amount is suspect and probably will generate a transfer penalty inquiry. One issue with having problems with a Medicaid application, is that if the state has a ? or concern, you (or whomever did the application for your elder) has like 48 - 72 hours to submit whatever the caseworker is asking about and get it faxed to them asap. After that period of time the application seems to go into a "documentation not provided" group and then off to be declined. This has been my experience in dealing with Medicaid with TX & LA. So the papertraill will come in handy. The caseworker needs a reason to justify the approval; you need to provide the paperwork that is aclear and understandable reason so they can do this.

If HMS has a contract with your state to do Medicaid, they have an algorithm that ferrets out compliance. HMS does this nationally for CMS - Centers for Medicare & Medicaid. HMS also does MERP (estate recovery) for some states.They come across kinda ruthless & sticklers for timeframe compliance.
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@igloo572 - since my mom moved in with my husband & myself over 2 years ago, she insisted on paying us a set amount for "rent" each month and for me helping her out with trips back & forth to doctors, etc. She qualified for Medi-Cal the end of last year, and at some point she will need to be placed in assisted living or whatever if her health continues to decline. Are you saying we should have that monthly amount written up as services rendered for when that day comes? That had never occurred to me.
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With AvidReader's mom being 88 and already having cognitive issues, the probability is that mom is going to need help in the future - whether it's AL or NH or in home care, it's going to happen. This is going to be expensive no matter how you look at it & $230 here and $ 230 there and $ 50 "fee" here and $ 50 there will add up. If Avid's mom has mid to high six figures in savings or investments, then the probability is that she will outlive her $$. So if that is the case, she can give, gift or loan or fritter away her $$ to whomever she can or can't remember. But I bet that isn't the case and I bet that mom has a modest amount set aside which 1 or 2 years of AL or NH stay will evaporate. Then the family will face having to do a Medicaid application and probably dealing with a transfer penalty without having documentation to show that the $ 230 here or whatever spent was actually for mom's care and needs.

About the "fees", personally I feel, that if mom has the $$ then having her do a legally drawn up "personal services contract" which pays each of the daughters $ 50 or whatever a month, and states what their responsibility and payment is for is totally OK. Now mom would issue a 1099 on the $ and the daughter's would have to report it as income but this is all above board, equal and no issues for Medicaid.
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There's some very good advice in here about keeping good paper trails.

I want to comment on another aspect, also touched on by purplesushi. Your mother can do as she likes with regard to paying fees. And she is not required to treat everyone the same. If you would like to have a small compensation for her services, ask her.

As a parent and as a daughter, I understand that while all siblings are equal and may be equally loved, they are not identical, don't have the same needs, and have different abilities to take care of themselves. Parents can take that into consideration when give out gifts, "loans," payments, etc. Parents are not required to treat all children as if they were identical.

If Mother said it was OK for Sister to take $230 to pay for some pressing need, that is Mother's right. BUT it needs to be documented. And certainly it is not OK for Sister to just help herself to funds just because she has the checkbook.
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I wanted to make a correction to my previous post:

I assumed you and your sisters were designated POA's but I shouldn't have assumed that. I don't think anyone can charge for being POA. And it's defintely a no-no if you're not poa. So, the fee needs to be paid back.
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I don't believe all 3 of you need to be a signer on her checking account just because you have POA do you? If mom wants to help her out financially, that is her business and her prerogative, but the sister should not be the one writing out those checks to herself...your mom should be. 1 person should be in charge of balancing the account (and it should't be the one taking liberties), so be sure & ask for receipts and bill payment stubs for ALL checks written to be placed in a file each month. If she knows there is someone who will be reconciling the account at the end of the month, maybe she'll be more transparent. Just a thought.
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Something is definitely fishy. It's time for both you and your involved sister to talk to sneaky sister. If you haven't already done so, set up a file with pockets for each months expenditures. Every check should have corresponding receipts (with written detail on purpose of purchase: mom's groceries, mom's 1/13/13 co-pay for visit with Dr so and so), etc.).

Have you asked her point blank what the amounts are for? Emphasize that because 3 of you are in her checkbook (and for legal purposes), documentation is critical. Anyone who doesn't provide receipts, statements, etc. will need to reimburse mom's account. Non-negotiable: whatever procedure you put in place needs to be followed by all of you, not whoever feels like it.

The "gifting" thing is important. The govt will come after your mom for reimbursement for anything without back-up. Even if she is wealthy and may never need Medicaid, explain that all 3 of you want open communication. If she balks, then you and your sister need to protect your mom.

As far as the "fee" goes, no fees should be paid unless agreed upon by all 3 and can be justified. Majority rules. Let your sister know that you and your other sister will be "auditing" the files. You can do this in a nice way. Tell her the file is available for anyone to review (and that you will be reviewing it).

Many families have to deal with the family member who's ethics are questionable. These are usually the members who show the most outrage when confronted. My mother used to tell me that, when dealing with difficult people, be "firm but friendly".

Good luck. Your mom is lucky to have a daughter looking out for her, whether she realizes it or not.
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I like "Notwellmyself" answer. Nothing is ever equal. If sister is having a few financial problems, most likely Mom knows about it, and wants to help her out a little bit. The other two sis's are very helpful, kind, and loving, but are more financially stable. Why shouldn't Mom be able to help the struggling daughter a bit now and then. $50.00 for a fee, or $230.00 for something (who knows....maybe she desperately needed a new tire, maybe she needed new glasses, or a child of hers needed something and she couldn't afford it. Mom knew about it, and sis is embarrassed to talk about to the others because she feels ashamed that she needs to ask for some help. These amounts of money are a far cry from the $ 12,000 that is mentioned! Of course the amounts need to be looked at, and questioned if it starts getting out of hand, but I would say that the sis has a valid need for help, and Mom has a valid reason to want to help her. Moms are like this. I help my children out in different ways. One daughter is way more in need of monetary help than the others. She doesn't like it that she is, and works her little buns off to change things, but she is struggling. As I say, all is not equal, but the love you feel for your children usually is equal, and it isn't expressed in money. Your Mom is losing control of lots of things as time goes by, so she should at least have a small amount of control in her ability to help her daughter who needs it. Just a different way of looking at things. Good luck and best wishes for harmony in the family!
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Notwell - years & years ago I was named executrix for an aunt who had a very involved estate. Spent more hours in probate courts that I ever imagined that I would, learned lots, saw heartbreak. In going through the oodles of her stuff to organize her estate, she had done a list with the heading: "Those who are 1 will reading from being able to buy a used car" and directions that none of them were to get a dime or any item from her. Almost to the name, they were the ones who expected $$ or stuff from her estate. So whenever there is a Sissy Spending posting ? on this site, it makes me laugh as I think of my aunt and her list.
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igloo572, All very good suggestions. I had to laugh at the Sissy Spender name and today I needed the laugh.
I have been trying to get my mother to go to on-line banking because it would be easier for me. She'll have none of it. I may approach it that my sister could then be an extra set of eyes in case I miss something.
Bless you all, have a great day.
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Please set up your mother's bills for on-line payment. This cuts down on the number of checks that need to be made out and can be monitored. Your one sister is in need of money for whatever the reason. Charging a "fee" for helping your own mother is disgusting. Stop this "feeing" of your mother immediately! Your sister is only helping herself to your mother's money and will "help" herself to more in the future because she's "owed".
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Great advise given. I'd like to add have it so that all banking is on-line so that you or your sister can check on the other sister's "management" on a daily basis. Some banks have it so you get an email for checks over a certain amount - which you can set - that might be useful and also a deterrent to Sissy Spender.

Also you and your family, sisters, etc. need to realize and be aware that IF in the future mom needs to apply for Medicaid that there will be a review of her financial assets for the past 5 years. And within that review, mom will have to submit copies of her bank statements for months and possibly years. And $$ given to family can be viewed as gifting with a transfer penalty by Medicaid. So say Sissy Spender writes 12K in checks to herself in 3 years. Sissy Spender is tight financially and couldn't come up with $ 100.00 much less 12K if need be. Now say mom really is at the point in a couple of years that she needs to be in a NH and her $ is at the point she will qualify for Medicaid. She goes into the NH "Medicaid Pending" and all seems fine and all breathe a sigh of relief. Then about 3 -4 months later, you (being the financially responsible one to admit her into the NH) get a letter from the state Medicaid program that there is a transfer penalty imposed for 12K for the gifting to Sissy. NH gets the penalty letter too. NH will then ask you to come up with the private pay and ASAP for the penalty amount. 12K in NH terms is maybe 2 or 3 months private pay. And if you (you because you signed her into the home) can't come up with the 12K or do a guaranteed payment plan (credit card or loan), then mom will get a 30 day notice of discharge from the NH. Once a 30 day is done, mom is toast on getting into any other Medicaid NH too until the transfer penalty gets cleared. This is a total panic situation for family and an awful situation to place your parent in.

Could Sissy Spender come up with the $$ she wrote to herself if need be? It's something to seriously consider as to her suitability for the checkbook and planning for the future. What I've found in this journey of NH & Medicaid with my mom & MIL, is that IF they live long enough they will run out of $ (unless they are generationally wealthy) and the caregivers will run out of steam and you really have to plan for that eventuality and applying for Medicaid.

5 years is 2018 and so much can happen between now and then. Good luck.
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I like truckingangel1's answer. But before this goes on, it is my personal opinion (and only that) maybe the 3 of you need to see a counselor (financial or otherwise) about money, care of your mother and your care for each other. Rules need to be drawn up about what is expected of each of you and everyone should agree to the rules.
The reason I see this as necessary is there appears from your question to be a little friction in the family unit. In our case, I handle almost everything. One sibling has absolutely NO involvement in anything. He can't be bothered to even call my mother, much less see her even tho he lives less than 5 miles from her. My little sister does everything she can, but she lives in another state. I write all checks, but my sister is on almost all of the accounts too. She never would take any money without talking to me. It is just the way our relationship works. However, if she did take money I know it would be for a valid reason. Regardless of our division of labor, I have nothing I wouldn't give my sister if she needed it (except my husband) and it sounds like your sister has needs. I don't know your situation and maybe your sister has been a taker her whole life, but it sounds as if the 3 of you don't completely trust each other to do the right thing. I would hate for your mother's declining health and money issues to be the causes of a family rift. Better to set rules up ahead of time, maybe have a monthly family meeting to go over all issues, than for resentments to build and cause a rupture in the family.
Could it be that your mother does remember what the money was for, but she does not want to tell you because she is afraid you will not approve, or she thinks it is her business and not yours? Maybe she is afraid it will cause resentments & she is trying to prevent it.
Good luck to all of you.
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It's time for a family meeting. Define what responsibilities each will handle. When it comes to the check writer, tell her paying bills requires back up paperwork, PROOF, of every transaction. You don't have to be accusatory or mean, just plant the seed in her mind that you're on to her. Some people need help to stay honest. Since you know she's in financial straits, you're going to have to keep an eye on her. Get organized now before your mom gets in bad shape. Document everything!! Do not leave anything up for question. A sick parent or the death of a parent can bring out ugliness in the best of families. If you don't think it can happen to you, ask someone who has been through it. You have enough to handle making sure mom is ok, you don't need to add being a watchdog for the check writer!
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my mil was accusingme of stealing her money. she sees dollsr amount but cant comprehen how the statement works. so now before i give it to her to look at i draw a line out to the side and write what it is for that way she cant say anything she sees what it is. make your sister do the same thing if she is unwilling to do that then get the account set up to where there has to be 2 people signing the checks. also now you can have just about everything come straight out of the bank to be paid hope this will help take care
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