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I am about to move to Boca to care for my 84 year old father who has dementia in my home. Because of our family history I know he is likely to degrade to the point of needing one of these kinds of care (assisted living/memory care). Since Medicare doesn't cover them directly, I wondered what would be the best path to take and when to undertake them in order to be able to prepare for the costs and make sure we can place him in a facility he has expressed a preference for. Like many folks with Pensions he has just enough income to need a Medicaid Income Trust to qualify for Medicaid, but not nearly enough to be able to self-pay. Naturally I will supplement and pay what I can, but looking at price Schedules with nearly $6,000 or as much as $12,000 for monthly for care costs excluding medications and supplies is a daunting thing. My wife's parents are roughly eight years younger than mine, so we may see the same thing again in the future.. can anyone provide some strong pointers on what programs and timing is best ? His preference for a specific facility rules out many programs that use their own facilities, but hopefully there are some that would fund him at any facility ?? The one he likes is a Medicaid listed and approved facility, but he may never reach the point of being eligible for that, so we are hunting for other alternatives..

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Boogerman, you may need a different eldercare attorney. There are many eldercare attorneys in Florida who specialize in Medicaid qualification and who have social workers on staff to help guide you through the process. Unless this person is directing you that way to save you money. I would ask that upfront.

There is a long thread on this board by a poster named "Dorker" who had such a person.
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You shouldn't supplement and pay out of your own funds unless you can comfortably afford it and it won't, or at most minimally affect your own retirement and ability to pay for your own care in the future, but at the end of the day its your money to do what you wish.

The money may be better spent on an elder attorney who would be able to advise and know exactly how to set up your father's finances to transition to a nursing facility covered by Medicaid.
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boogerman Mar 8, 2021
Thanks mstrbill for your suggestion,

We already spoke with an eldercare attorney about his finances, but he suggested we see a Medicaid advisor about the details for getting him covered once he requires full assisted living. I contacted a couple of Medicaid advisors, but so far haven't been called back. That may get easier when we move down to FL, since most of these advisors are 'State specific' it's possible they saw my out of state number and just ignored the call. That is essentially my next stop along with trying the local agency office again.
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When you say "programs", what are you referring to?

This sentence in particular confuses me : "His preference for a specific facility rules out many programs that use their own facilities, but hopefully there are some that would fund him at any facility ?? "

MediCARE will pay for rehab (which often takes place in a skilled nursing home or a freestanding center which may also house an Assisted Living Center) for 20 days after a 3 day hospitalization. Check out the places in dad's community so that if he needs to go to rehab, you'll have a short list of places that are acceptable. Find out if dad has a supplemental policy: these often cover more days of rehab (if progress is being made).

Medicaid is the primary source of funding for long term care for people without funds or long term care insurance. Under the Medicaid umbrella, there are often a variety of programs designed to keep folks out of nursing homes. Sometimes there are Medicaid programs that will pay a relative to do caregiving.

Familiarize yourself with your father's financial situation. You say he has a pension; does he also get Social Security? Does he have investments? Is there perhaps an old Long Term Care insurance policy? Whole life insurance?

Consider both his income stream and his assets. My mom's INCOME didn't come close to covering her long term care costs, but by judiciously spending down her ASSETS, she was in good shape. Also remember that some portion of long term care costs are deductible as a medical expense.

Remember to consider your own well-being and future as well. If you are giving up your own housing and livelihood to care for dad, what happens to you when dad needs to go into full-time care? Make sure you are not rendered homeless and broke; there are too many sad stories on this board of folks who lept into caregiving with good intentions during an emergency situation, only to find themselves out on the street a few years later.

The local Area Agency on Aging might be another good resource to look into for explaining how all these programs work. https://www.adrcbroward.org/statewide-medicaid-managed-care-long-term-care-services
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boogerman Mar 8, 2021
BarbBrooklyn, Sorry about that, I was a bit frazzled at the time. What I meant was simply that Florida has several options that are intended as Medicaid diversion programs. They handle some care expenses before a person reaches the point of being Medicaid eligible. What I read sounded like they might be bridge programs that could be used while he needs some care but not 24/7 care and then bridge him into Medicaid. We have looked at his finances carefully and he has a pension, social Security, a very basic life insurance policy, and burial insurance. We looked over all the policies and there is no clause or rider that touches on LTC at all.

I tried to contact the local Agency, but had to hang up after waiting on hold for some time. I want him to be cared for at home with us first, so we are preparing to move, but once I am in state I will go back to checking with the local agency and see a Medicaid advisor. It is mainly the long term aspect I need more information on, in the short term he will be cared for at home.

Thanks again for your help
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I always caution people against using their own funds to supplement the care of their elders. It is sad that often they must enter nursing homes rather than more suitable board and care of assisted living facilities because of a lack of funds, but the truth is that you will be in this position in less time than you can begin to imagine. You need now to build your own nest egg so that you have funds for your own care in future.
If your elder has found a medicaid facility that he actually likes then it is a wonderful thing, because being already a resident will likely keep him in care at the same time when he needs to get more care.
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boogerman Mar 8, 2021
Thank you for your reply. It is intended as our last resort but we wanted to make sure my brothers and I had agreed to share any extra costs. Just a part of planning ahead really.. Hopefully it wouldn't come to that for some time.
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BarbBrooklyn

DAD paying it is the idea, but all of the different program details fused with lack of sleep do have me confused about the best path. I am waiting for my appointment with an attorney now, but I was hoping someone with personal experience could get me started.
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Medicaid in FL does pay for assisted living. Is your dad a veteran? If he’s a wartime veteran he may be eligible for VA assistance too. In Florida unlike most other states, you can actually use Medicaid AND VA aid & attendance. Everywhere else you can only have one or the other.
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boogerman Mar 5, 2021
Thank you worriedinCali for your response.

My father is not a Veteran, so the Veteran targeted programs don't apply.

I'll check again about assisted living and Medicaid, but most of the sites I looked at said it didn't cover it except in cases where there was a safety issue. I sent a message asking about it to an eldercare attorney as well as the facility he mentioned a preference for. I hope you are correct so I can give up the alias worriedinFla..
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Along with an attorney, you may want to consult with the salesperson at these facilities. Sometimes, they can give you pointers.

Also, there are folks that are “head-hunters” (my words, since I can’t remember the exact term), who are paid by facilities to get renters. They might be a source of ideas.

Both of these, of course, may have their own interests at heart, but can be a source of anecdotal information for you.

Best wishes!
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boogerman Mar 5, 2021
Thanks cxmoody,

I actually am waiting for answers from both the facility and an eldercare attorney already, I was hoping for a informal answer so I can keep my talk with the attorney short to limit the billable hours.
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Your best source of information is to use some of Dad's funds to visit and consult with a certified Eldercare attorney who is well versed in Florida Medicaid.

Your post is very confusing and I think that you would greatly benefit from hearing the ins and outs of how DAD can pay for his care with his resources from someone knowledgable. For most of us, when we step into this Medicaid/Medicare maze, it's our first rodeo. Best to be guided by someone who understands how it's done.
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