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I’m asking this question, because I constantly see articles and receive advice from family/financial/ estate planning about getting Medicaid coverage, and how to “protect” the aging’s assets so they can qualify for Medicaid.
Here’s my question, if your loved one spent their whole life saving for “retirement” trying to put themselves in a good financial position, however started experiencing health problems, why is it a goal to put them in a position where they only qualified for Medicaid level care? Wouldn’t you want their hard-earned money to go towards a quality of life?
I think Medicaid is great for those who don’t have the financial means to care for themselves, are disabled and could never build a proper income , or perhaps towards the end of life, when assets run out, they aren’t put out on the street.


I’m just wondering what the other reason is besides moving their assets so the family can inherit after their passing when it should technically be theirs? What is the benefit for the aging loved one, that I’m not seeing?


Recently became POA for my mom who suddenly started to decline and only come across advice on trusts and Medicaid when I know my mom worked hard and made good decisions for what she has. I’m thinking what was originally meant for her retirement, should go towards quality care for her. What else am I missing??

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I'm going to relay the situation and feelings of a friend of mine that is pertinent to this thread. My friend and former coworker is 90 and has lived with his wife in his house for over 60 years. He is still mentally sharp but does have mobility limitations. His wife has the beginnings of dementia and has been hospitalized twice in the past year with pneumonia. Now, after this last hospitalization she was sent to SNF for rehab and spent about 2 weeks there before she started going downhill, was tested for COVID, and the result came back positive. Now she's back in the hospital, has stabilized (good news), and the hospital wants to send her to a NH with other COVID patients. My friend knows he is not able to care for her anymore at home, but what he told me made me think of this thread. He told me it has been his goal to leave his estate to his son and 4 grandchildren and he is angry that potentially he is going to have to drain his savings and lose his house to pay for NH care. He feels the country should be doing more for people like him, hard working middle class folks who have done the right things, been prudent, and saved a few bucks. He really wants to leave something to his family and now likely won't be able to. In fact, he won't unless something unfortunate quickly happens to his wife and him. FWIW.
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worriedinCali Nov 2020
I’m sympathetic to your friend but his situation is exactly why people need proper estate planning. He is 90. All assets could have been placed in irrevocable trust a long time ago and wouldn’t have to be used on long term care costs. It’s one simply thing to many elders simply don’t do. It is so easy to set these up, attorneys will even come out to the house with their notary. My MIL did this, took less than 2 hours and she paid $1200 an irrevocable trust, POA documents and a living will. It is not the governments responsibility to take us financially when we get old, so that we can leave our children and grandchildren an inheritance.
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My mom and dad worked all their lives and finally were able to buy their first home when in their 50's. Both, when of sound mind and body, stated that they did not want their assets to go to the State, but rather to their only child and grandchildren. When Mom was declining, and needing constant 24-7 care, and after being released from the rehab nursing home, we were told that Medicaid would provide her with that ongoing care. When one is desperate for assistance with caregiving, the Medicaid option is considered a blessing. I would have applied for it, for the purpose of the 24-7 caregiving, however she passed the night before I was to have sent in the paperwork. The assets that she had left were so minimal, that it would have only covered her for less than a year. My mom and dad had their home placed in a life estate over 20 years ago, so the home was not a factor. After mom and dad paying into the "system" for over 60 years of their lives, I don't consider asking for Medicaid for their care to be a negative. The government should be taking better care of the elderly, without taking all they've worked for all their lives. Just my thought - don't judge.
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It's one thing for a person to use their assets to pay for their care in old age if it was fairly priced, but it's not. A regular middle-class senior who may have worked their whole life, sacrificed, and made good financial decisions because they want to leave something behind for their family should be able to. A middle-class person's entire life savings and property is gone in a few months when they have to go into a nursing home. Eventually pretty much everyone in a nursing home ends up on Medicaid unless they had long-term care insurance (which most people can't afford to pay the premiums on), or they're independently wealthy. Middle class people are finally catching onto what rich people have always done. Rich people put their property and assets into trusts for their families so the wealth and assets can be passed down. Then they get everything paid for when they're old. Why do middle class elderly who worked and saved their whole life have to be the ones that set the example of financial honesty when far wealthier then themselves protect their money and get it for free? Years ago, I worked in an AL facility that was very nice. We had a resident who owned property and land which was valued at around 10 million. It was put into trust for her family and they also got a special break because the state considered it farmland. It had been a farm 50 years before. One of her daughters who was rich as King Midas had a little, quaint vanity business selling flowering plants she grew in a greenhouse on the property. Mom's bill for her homecare then AL was paid for by the state and Medicaid. So, I say more power to the little guy who can hold onto a few bucks that the nursing home racket can't get its greedy hands on.
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pblise Nov 2020
I concur entirely with your assessment - the small guys always gets the short end of the stick and if the system works for the rich, the same benefit should apply to everyone.
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I think if people have accumulated a substantial amount of wealth then the moral and ethical thing to do is to spend that money taking care of those individuals who earned it. The best way to do that is probably to purchase long term care policies for both spouses and any disabled children still living at home.

With that said, some people have worked all their lives and have a total net worth of 100-200K outside of the value of their home. That may sound like a lot of money to someone who lives paycheck to paycheck or has only been able to save <50K during their lifetime (not for lack of trying but due to the types of jobs available to them, whether one or both spouses worked, if they raised children, still have a high mortgage, are still paying off college loans for themselves or their children, or are paying off medical expenses related to extended hospitalizations, accidents or injuries, or other unfortunate life events).
Unfortunately, if one spouse should end up in a nursing because of a catastrophic event which incapacitates them such that they will never return to their previous independent functional state, that couple's life savings will be taken by the nursing home and then the individual will be eligible for Medicaid once the couple's life savings have been wiped out. This is not a loss for the individual who is in the nursing home, but for the remaining spouse living at home who now may be so financially restricted even devastated, that they may lose their home if they had not "made plans" for the possibility of such a life event occurring to either spouse.

It may sound immoral or unethical to prepare for such a devastating event by setting up legal provisions to protect the remaining spouse living in the community, but looking at if from another perspective, is it fair that the savings the healthy spouse contributed to during his/her lifetime is snatched away before their eyes in a heartbeat on top of facing the devastating reality that they will never be able to live their life with their spouse as they did before. If the spouse was working and is now incapacitated, that income now disappears. That remaining spouse still has the same amount of bills and financial responsibilities as before the devastating event. Once the nursing home depletes their financial savings, they will then take any income in that spouse's name. If it's the husband who let's just say has a massive incapacitating stroke, then both his pension and his social security checks will go to the nursing home unless the wife seeks out legal assistance so that she is allowed sufficient funds to remain in the community. She still is at risk for losing her home or having to significantly cutback on her lifestyle and/or quality of life.

Now if that just means she can't travel to Europe annually that's one thing, but if she now has to apply for food stamps, fuel assistance, and other city, state, and federal assistance then is that really fair to her? Nursing home prices are incredibly high for the (in my opinion as a nurse practitioner who has worked in long-term care for 10 years) piss-poor minimal care that is receive in most (but not all) nursing homes either due to insufficient staffing or insufficient compensation such that morale is low and staff are just burned out & don't care.

I guess the bottom line as to whether it's a good decision to make plans to protect one's assets in the event of a catastrophic illness or injury would depend upon the financial circumstances of the individual's who lives will be impacted by such an event. However, if they don't make they plans ahead of time, they may end up at the mercy of their children who may be more motivated by receiving a large inheritance rather than doing the morally and ethically responsible thing of ensuring that their patients receive the care that they require in the environment they'd prefer to receive it in. Some children will do the right thing though!
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I didn't take the time to read thru all of these, so sorry if this was already brought up. Nancy Pelosi was on tv today talking about Medicaid. She made a point to say Medicaid was also for the middle class and long term care for elders. She said there are provisions in Medicaid for middle class elders. So there ya have it! Why this wouldn't be in Medicare is very odd to me. Almost as odd as me actually listening to Nancy Pelosi and her talking about this topic. Weird.
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worriedinCali Nov 2020
Nancy Pelosi is wildly out of touch. As we see on this forum almost daily, there are seniors who are far from middle class who are still over the income limit for Medicaid. Especially those who are in states that don’t allow miller trusts and/or have a pathway to eligibility (pathway lets the elder spend down their excess income on their health care each month in order to lower their countable income). I would love to know what provisions she’s talking about because Medicaid’s financial eligibility requirements by design prevent the middle class from eligibility.
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I care for my mother at home. I have a caregiver come in 2 days a week for 4 hrs/day to help with showers and all the other things that I'm incapable of doing now that I'm getting older and more infirm myself. The problem is, the home healthcare agencies charge us $31/hr, while the healthcare aides working in the home with us only make $15/hr. Yet very often, when we need extra days/times, no one is available. My mother in law died last year after several year first in assisted living, then a nursing home. It started at $3500/mo, and rapidly went to $6500/month at AL, then $8000/mo at the NH. My MIL thought she had planned well for her retirement, but she was "lucky" and lived a long time after she retired. She had a fully paid for home and a government pension and insurance. She was proud, as a single Mom, that she would be leaving her home to her son. In the end, it went to pay for her care.
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Keepurheadup Nov 2020
That’s exactly what’s happening with my mom now. After working hard, paying off her home and saving for 30 years, she retired feeling quite pleased. She broke her hip two years ago, I relocated her to Atlanta because she couldn’t live alone anymore. 18 months of assisted living care has depleted her savings and mine. I had to use my savings because her house hasn’t sold. Her entire monthly pension goes for her stay and care. I supplement other needs. Sadly, when she passes, there will be nothing left. I hope there’s a way I can recoup my savings after her house sells. Aging in America shouldn’t require you and your child to go broke.
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People are saying about using LO's money to provide "the best" care possible. The thing is, you don't know how long LO is going to live. So, unless your LO has a good millon+, or a "short stay," they are going to end up on Medicaid due to the ridiculously high price of ANY elder care.

My LO saved very well for retirement and didn't live a lavish life-style. He was a dedicated, hard worker at a factory job. His retirement money has to provide for 2 people -- both with dementia -- and this has already been going on for 5 years. If he could understand what he's paying at this point, he would have a fit. (I guess his dementia has some positives.)

Had I gone out 5 years ago and gotten the top of the line care for 2, they would probably be on Medicaid by now.
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NeedHelpWithMom Nov 2020
It isn’t all about wanting the best either. I used to go to a support group ran by a social worker that was held at very nice assisted living facility.

Two women that belonged to our group lived at the facility.
Their spouses used to live there as well but their health issues exceeded what the assisted living facility could provide so they were forced to live in nursing homes.

A person cannot afford a nursing home unless they are on Medicaid.
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Medicaid is for those who have not looked at their future or planned for it. If your Mother took steps to provide for her retirement by all means get the best supplemental health plan that she can afford. Some workplaces provide for their retirees so check there first. As far as trusts go that’s only if she wants to leave the family something after she no longer needs it but if she has the means to take care of herself by all means support that as long as you can. Selling her things before she passes isn’t always a good way to go do ask her what she wants to do with her things when she no longer has need for them. We just cleared out my mother-in-law’s house and sold it. There was so much she could have gotten rid of that she didn’t use or need but she just didn’t want to be worried about it. But it could have put more financial stability on her mind if she had. She didn’t need the extra funds but everyone was so worried she would outlive us all. Lol. It was useless worry on all sides. Now we have stuff from the 40’s that no one else wanted but we found it hard to just toss. Good luck.
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worriedinCali Nov 2020
medicaid is also for those who have outlived their assets!
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Tholden,

My limited understanding is that the goal is to get your loved one SIGNED UP for Medicaid, not necessarily ON Medicaid. Finding all the appropriate paperwork and getting enrolled can take a while, and you don't really want to be doing that at the same moment you need the financial help of Medicaid. It's a preemptive measure.
Moving assets has nothing to do with the actual process of enrolling in Medicaid. In fact, you'll get nailed for doing that if it's within the look-back period -- 5 years? And yes, there are people who move assets years before. Sometimes so they can game the system. But a loved one probably won't get into a top-notch facility starting out on Medicaid. Medicaid might help your loved one stay in a good facility if they've been paying privately and then run out of funds.
SO...... my takeaway here is to do the right thing all the way around: if folks have savings, that money should be used to care for them in the best way possible. Meanwhile, get them signed up for Medicaid so that when their savings runs out, they are not put out on the street.
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rovana Nov 2020
Thanks for your post. Excellent.
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This topic has prompted me to post my first comments on this site after silently following the posts for several months. First of all, I've found many of the questions and answers very helpful, so I'm very thankful this forum is here and that people take the time to offer answers and support! I hesitate to participate though, because with the way I've been handling things, I know I might tend to go off on long, negative rants.

I had similar experiences to many of the others who posted here. I went to an EC attorney 5 years ago with legitimate questions when my LO first became ill. Questions such as what can and can't I do as POA when LO doesn't recognize he needs help and isn't cooperative, how do I keep appropriate records, etc. Attorney automatically assumes I'm there for a consult about getting LO on Medicaid. Of course I was very new to all of this at the time, didn't know which way was up, so I didn't assert myself and say that that's not why I was there. The whole appt focused on how to shift assets to get on Medicaid, and at the end of the appt, atty told me she'd handle the application for $15,000! I'll skip a lot of details, and just say that I decided to not go that route.

At this point, LO's funds are paying for about 50 hrs/week of in-home care. It's extremely expensive, and funds are dwindling. Not to mention that I have to micro-manage the agency providing the care givers if I want it to go well. The owner actually told me that they don't guarantee to send someone for the scheduled shift. Of course, he told me this after several "no shows" rather than telling me this little detail when he was trying to sell me his service. Of course, I hadn't asked when I was signing the contract.

I'm in danger of going off on a rant here, so I'm going to try to get to my point -- if I even have one. Getting old in this country is ridiculously expensive, and most people don't know or care about this until they are in this position. I know I sure didn't. For the average person who is now working and saving for retirement, he/she can expect to pay at least 2 times more than his/her total yearly salary to pay for one year of care as a senior. How does that make sense??? You're no longer working, and you're paying out more to live than you ever made in a year while working. And, with today's medicines and medical care, this can go on for years!

I have no problems using LO's money for LO's care. It's their money. When it runs out, I'll apply for Medicaid for them. But, something has to be done in this country to make care more affordable for the middle class. We talk a lot about how expensive it is for child care -- which it is -- but from my experience, we don't talk much about the HUGE expense of elder care. (So parents, just when you thought you made it through the financial crunch of child-care, housing, and college expenses, get ready to pay that much and more for elder care!)

Going through all of this with LO has opened my eyes and made me take steps to plan my retirement/life. I believe in paying my own way, but when I need care, there is no way I'm paying more to be taken care of for a year while retired than I ever made in a year when I was working.
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NeedHelpWithMom Nov 2020
You have my empathy. It’s not easy being a caregiver. Sending hugs and prayers your way.
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I would say, Invest your time in reading on Medicaid.

You will see a lot of good benefits for people and how it can help in so many ways.
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Somebody below wrote that their attorney: "He said that Medicaid was not for poor ppl..."

I disagree, and I think the attorney is misinformed. Medicaid was initially set up for persons at or below the Federal Poverty Line who needed healthcare. It was never intended for middle-class persons. Essentially, it is a government-run insurance program for persons whose income and resources are insufficient to pay for their own health care. See their website at: https://www.medicaid.gov/medicaid/eligibility/index.html

Some States voted to raise the income ceiling for Medicaid under the ACA to 133% of the federal poverty guidelines, but the revised income criterion still does not put it into the middle-class category.

That is why Medicaid has strict income and assets limits. If a person has other assets to pay for their own healthcare, then the government expects them to use those assets first.

But, to answer the question, people want to get their elderly person on Medicaid so that "somebody else" will pay for it. Nursing Home care is horrendously expensive - many thousands of dollars per month. Few persons can afford that cost.

The more upscale Nursing Homes are generally private pay and offer more amenities; some won't accept Medicaid patients. Not all NHs are licensed and certified as a Medicaid Nursing Facility (NF). County NHs tend to have mostly Medicaid patients; they work with a skeleton crew and every penny has to be carefully rationed.
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haileybug Nov 2020
I agree with the attorney. Medicaid is not for the poor.
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If your mom actually has regular income & significant nestegg to pay for all her living expenses & 3-5 yrs future costs of LTC caregiving, based on actuarial tables, she’s not the average elder.

It seems to be -based on posts on this site - that for most elders and their families are beyond gobsmacked by the costs of care. The need for a placement is emergency / incident based...... mom broke a hip walking the dog, dad got dehydrated cutting the lawn and broke a hip. They get hospitalization and then go to rehab and realistically cannot return to thier old home, old life. And their 75k in savings (which they prudently did over decades) is gone in a few months. So LTC Medicaid is the default. Medicaid is not the goal, it’s the safety net.

Unless your really well off, if you live long enough in the US, your probably going to outlive your assets, your ability to live independently and family runs out of ability to caregive at the level needed. So Hello! LTC Medicaid.

Imo those rubber chicken “Keep your $ from Medicaid” seminars or direct mail pitches are about selling insurance products (like annuities with nice commissions) to vulnerable elders via fear factor. Often they are not truly LTC Medicaid compliant.
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rovana Nov 2020
Thank you for an excellent post.
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P.S. Medicaid only paid about $4, 800 dollars to nursing homes. My Aunt thru my DPOA had to pay the difference since the NH where she was charged 5, 600 per month. It's all complicated because of the rules to be followed. Yes, its complicated because it comes down to money. Every State has different rules, too! Ack! You want to run away screaming trying to understand it all !! Again, do what feels right to you!
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I became my Aunt's "caregiver", except, she lived in another state. Her own grown children lived there but were estranged. I hadn't seen my cousins since very early childhood. I didn't even know there was a fourth cousin! He is excused from this because of his special needs. And my Aunt was the common denominator to the estrangement. For whatever reasons, she and I got along. I had no idea what I was doing. I read any information on how to care for her long distance. Eventually, someone kindly pointed me to lady who visited the nursing home. She worked for an attorney who helped me save her assets. At this point in time, I was simply paying the nursing home until her money would run out and she would qualify for Medicaid. She had $70,000, an old small fish camp cabin home in the woods with rotting floors and a funeral policy. No car, she never learned to drive. She was down to $45,000 when I met this the lady working for the lawyer who specialized is saving assets. I was worried sick trying to do the right thing for my Aunt, my Mother's only sibling. My parents had passed away and I told my sister I would check up our Aunt because I lived 8 hours away and she had taken care of our parents. For three years it was ok. I would drive down once every three months. Then one day because of my Aunts friend and a crazy situation, I went once a month. Eventually, I ended up becoming her DPOA and had to make decisions for her care. I often wondered what would have happened if I had not taken on that responsibility. The VA hospital care manager told me they would send her to a State nursing home, but if I became the POA then they could find a different place (aka better?) So now, I was driving down every two to three weeks and staying 2 or 3 days. The attorney's people saved me from making some mistakes that could have put me in serious trouble. They told me her house, one car, and the funeral policy could not be taken by Medicaid. First, Medicaid helps pay for nursing home care, but they receive whatever assets after the patient dies to help repay the State. Because of the help I received, they discovered my Aunt had an annuity and were able to set up a way for me to make payments to the nursing home. She was already in a better nursing home, so I had to pay $850 a month that Medicaid did not cover. I certainly did not have that money. I spent a lot of money just traveling to see her and getting her treats, foods, and extras that she wanted. It was a long haul trying to take care of her; 7 years! Like I said her children were there but not there for her. I only met her when I was 15 or 16 and had not seen her in over 35 years! My parents just didn't talk about family. There was a lot of this story left out, but to answer the question, you do what feels right for your situation! I questioned myself and my decisions constantly. I was made to feel like a criminal when I was seeking answers to what was right! I wish people would have listened to what I was asking! I was not trying to hide money for me. As it was, I ended up with her little house and that created new worries for me being miles away with squatters and kids on atvs the riding thru. Thankfully, after several months of worry, was able to sell it for cheap to get it off my hands. It helped to repay what I had put into this situation but in no way did I come out ahead! I was able to see my Aunt get back to her home state and be with her sister and mother (my mother and grandmother). And she wasn't left completely alone. AgingCare got me through the emotional trauma of caring for my Aunt. They helped me understand what was ok and helped me be ok with all the decisions I made. I'm very thankful for AgingCare and the attorney. For my Aunt's situation it was as good as it could be because she was a difficult person and somewhere along the way she had dementia, perhaps Alzheimer's. My Aunt once told me she knew what she what was wrong with her. She said, "Jackass-itis!" Right, sh
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rovana Nov 2020
Sounds like you worked to use your aunt's assets for her care. I don't think anyone objects to that. It is what should happen. I think what people object to is the hiding of assets for inheritance purposes, that kind of thing. I'm glad you explained what you did - you absolutely did not cheat the taxpayers.
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Most people are worried they or a loved one will outlive their assets so they begin early to structure finances for that possibility. But you are right that someone with the means ought to get top quality care. Many families choose instead to save assets for children and grandchildren. Since preparing
to be Medicaid eligible is tricky, finacial planners can make a living helping families prepare therefore those are the ads you see most often.
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Hi, I do agree with you, if your mom saved for her retirement this money should be spent on her care whether at home with care givers or in a nice facility. Once her money runs out she then can go on Medicaid but if the funds are there do everything privately and let her have the best care her money can buy. Most parents want to leave something for their children that is why attorneys are always saying to move money around. I kept my mom home in her house for 4 years spending my money and my 401K all my mom had was her house. When I went broke I put her house in my name and took out a home equity loan to continue her care in her own home. When she got really bad I had no choice but to put her in the VA home and her VA benefits paid monthly. When I sold her house I paid dearly to the tax man. My only concern was for my mom to keep her safe, clean and as healthy as can be staying in her home that she loved. Good luck to you, please find good quality care givers.
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Because once they reach the point of requiring Nursing Home Care, the care they receive is often the exact same care whether they private pay OR Medicaid pays. For example, we have a 5 star nursing home near us, some people private pay at a higher rate (Let's say $12,000 month) while others receive Medicaid and are covered in full. Medicaid pays less to the State also, because the private pays subsidize the care for the Medicaid folks. They are in the exact same facility with the exact same nurses, CNAs caring for them. The only difference is that they are paying a high rate and eventually when their funds run out, they will be rolled into Medicaid as well. You never know when you enter the nursing home who is private pay and who is on Medicaid, but they are receiving the same "Quality of Life".
The only good thing about having a lot of money towards you care, is you may be able to stay at home and pay for private nursing.
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FloridaDD Nov 2020
In some NHs, the person will be moved to a semi private room when they go from private pay to Medicaid.  (In some states, relatives can pay to upgrade, not the same in others).  MANY nursing homes will not take you unless you can first pay privately for a certain number of months or years (they all determine)

Agree, care will be the same.
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I think this - people work hard all of their lives to provide for their later years and then to pass it on to family. That makes sense. However, sometimes doing this just does not work when a person must have professional care in a facility. This is extremely upsetting to all involved because the COST OF BEING IN A FACILITY IS SO HORRENDOUSLY RIDICULOUSLY HIGH - THOUSANDS MONTHLY - that the money goes very quickly. I truly believe if the costs of professional care were not so extremely high, more people would be willing to use their money for their care and when it runs out go on Medicaid. But the prices have to be FAIR, JUST AND REASONABLE. If you really stop and think about the dollars for this or that, what you are actually receiving does NOT justify the many thousands each month. That is the crux of the problem.
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Lockett2166 Nov 2020
I forgot - if the first person goes into a facility, then what provisions are there to provide for the remaining member who is still at home. Not much.
Medicaid is supposed to be for people who do NOT have funds from which to draw to pay for their care.
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I also just became POA and the attorney gave me extra powers to disperse 70% of the inheritance prior to my Mother going into a home. He said the 5 year clock can save 100% of inheritance. My parents have an irrevocable trust with quite a large sum of money. I didn't really understand what he was talking about, so figured I would deal with it, if the time came. He said that Medicaid was not for poor ppl and more ppl needed to understand that. Wish I had more info to help but it was a bit overwhelming at the time. Maybe, it's something more ppl should check into. The place my Mom would go is 9k a month and the only ppl that can afford it are ppl on Medicaid. Lol My MIL was there, they took her SS and Medicaid picked up the rest. Very interested in someone knowing more about this.
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rovana Nov 2020
The issue with the five year lookback is that is does favor people who "hide" money well ahead of time.
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The big thing is to protect assets for the spouse of the loved one who needs nursing home care. Barring sudden death, the aging process requires people to spend quite a bit of money while they are still in their own home. It's surprisingly expensive. My dad required 24/7 care for the first two weeks following discharge from rehab. In 2014, the cheapest price for that was $4200. So, it is important to protect assets for the community spouse as he or she shouldn't be rendered penniless in the care of their spouse. That is probably the biggest reason for making advance preparations to protect assets. Private pay in a nursing home in my state costs $15,000 a month. That adds up very quickly. Yes. If the person requiring nursing home care can afford to pay the sticker price without negatively impacting their spouse, by all means, find the finest facility and pay extra for a single occupancy room.
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Imho, Medicaid is generally not advisable, though some must opt for it as a last resort.
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DiamondAngel14 Nov 2020
Why isn't it advisable? The money goes to the family instead of medicaid taking all of it....my mom's nursing home was $13,000 a month....paid that for 9 months...went on medicaid for 4. Then she passed....care was the same... didn't see a difference
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"Trying to do things in increments, because I have A baby due in December."
Congrats!

Hopefully you have enough care set up to take care of mom (you indicate keeping her in her home as long as possible) for at least a few months, even better if longer, or at least only take on a few hours yourself!

Caring for a newborn AND yourself can be taxing enough without having to also care for another person.
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Having been a Certified Financial Planner with a private practice who retired when my husband was diagnosed with terminal cancer and became a caregiver myself, I understand your questioning this advice. Medicaid trusts to enable a person to meet Medicaid's requirements for a low level of income and a low amount of assets are often recommended for a variety of reasons. The major concern should always be what the care recipient's wishes are for how and where they live the last months or years of their life. Each of us has the right to decide what we want to happen. What does your mother want - what is most important to her at this time? Even though you have POA, your mother's assets still belong to her. How would she want to use her assets?
Also, get as much education about Medicaid and how it actually works in the state your Mom lives in. Medicaid is a program funded by both the federal government and each state government. Each state has a state Medicaid program and determines what is covered under that program within the requirements set by the federal government. State Medicaid programs are entitlement programs, which means all who qualify will receive the benefits covered by their state's programs. There are also Medicaid waiver programs that each state applies for. Each waiver covers benefits that are determined by the state. Many states cover Home and Community Based Services under state Medicaid waivers. A very important point to understand is that Medicaid waivers are not entitlement programs, and that states can and do set limits on the number of enrollees. This means that a person could qualify for Medicaid, but still not receive benefits provided under state Medicaid waivers if the enrollment cap has been exceeded. This means that person will go on a waiting list to receive the benefits covered by that waiver. If the only care available under the state Medicaid program is nursing home care, is that okay with your mother. Obviously, this situation should be discussed by all people involved - the care recipient, each caregiver, and other family members involved. So, if it's possible, talk to your mother about what she wants. Contact the state government department or agency that manages the state's Medicaid program and find out what is covered under the state Medicaid program and what is covered under that state's Medicaid waivers. My prayers go out to you.
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I thought there would be some responses here but I don’t see any. But my response is of course you are right. If your mother has provided well for her retirement, then it is my belief that the money should be spent on her comfort. It’s expensive though.

In our case with my stepfather his old age during which he needed assistance and oversight lasted 10 years, from the time he was 80 until he was 90. And he needed ultimately to be in a nursing home (about $140,000 a year in the New York metropolitan area and the place didn’t take Medicaid). There were all sorts of other expenses as well. Luckily there were few painful procedures and he had a DNR so without a great deal of oversight, things might not have gone well so far as making the money last.

My mother is now 90 and although seeing to her needs and keeping her company has begun to really intrude upon my lifestyle, especially with COVID19 looming, financially she and he provided well for themselves. Generally people get involved in spending down in order to safeguard their own resources, and to get their parents the care they need although they haven’t been able to save for it. Also one hears that some elders would prefer to leave their children or grandchildren provided for and to scrimp on their own care. Sometimes children and grandchildren can move them in that direction. So there are many issues here.

The desire to leave a legacy becomes very powerful for those who have worked hard all their lives without having much to show for it. But the big question here is usually whether the elder will be able to stay in her home (she will eventually need help she approves of probably in addition whatever you can do yourself) or whether she may need assisted living or nursing care. If so, then a minimum of at least weekly visits are part of the expense. If the elder lives far from you, this too can run into money, not to mention time if you, yourself, are not retired.

I find that the biggest need for both of my parents wasn’t actually financial in nature, and that was the need for congenial adult companionship and attention.
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I thought there would be some responses here but I don’t see any. But my response is of course you are right. If your mother has provided well for her retirement, then it is my belief that the money should be spent on her comfort. It’s expensive though.

In our case with my stepfather his old age during which he needed assistance and oversight lasted 10 years, from the time he was 80 until he was 90. And he needed ultimately to be in a nursing home (about $140,000 a year in the New York metropolitan area and the place didn’t take Medicaid). There were all sorts of other expenses as well. Luckily there were few painful procedures and he had a DNR so without a great deal of oversight, things might not have gone well so far as making the money last.

My mother is now 90 and although seeing to her needs and keeping her company has begun to really intrude upon my lifestyle, especially with COVID19 looming, financially she and he provided well for themselves. Generally people get involved in spending down in order to safeguard their own resources, and to get their parents the care they need although they haven’t been able to save for it. Also one hears that some elders would prefer to leave their children or grandchildren provided for and to scrimp on their own care. Sometimes children and grandchildren can move them in that direction. So there are many issues here.

The desire to leave a legacy becomes very powerful for those who have worked hard all their lives without having much to show for it. But the big question here is usually whether the elder will be able to stay in her home (she will eventually need help she approves of probably in addition whatever you can do yourself) or whether she may need assisted living or nursing care. If so, then a minimum of at least weekly visits are part of the expense. If the elder lives far from you, this too can run into money, not to mention time if you, yourself, are not retired.

I find that the biggest need for both of my parents wasn’t actually financial in nature, and that was the need for congenial adult companionship and attention.
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I think part of the answer is that people (parents) want their children to have something when they are gone. Now unless the children don't need/want it...then use the money (their money) to care for them for whatever they choose (in home care or NH).  Its their money and can be used for them.  No one says you have to get them on Medicaid.  Besides you would have to spend down their money on them before going onto Medicaid anyhow.  Check with an Elder attorney and you can ask them all those questions.  they will be able to help you sort things out.  wishing you luck.
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Havefaith Nov 2020
Problem is even though most folks don't want to go on Medicaid, once their money runs out, which it will rapidly at $180,000/year, then they have no other choice but to apply for Medicaid.
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Medicaid was never a plan!
My parents had money & a big CA house near the beach. Then dad got cancer & they spent all savings/reverse mortgage to pay for his non-helpful chemo then experimental drugs. Poverty & dementia hit my mommy hard as soon as dad's funeral was done.

Moved her in with me, her only child, until while I'm at work, she walked into highway traffic thinking she was "crossing" her childhood street. Again.

With my own health, job, & finances in tatters to juggle care for her at home, I relented to Medicaid for mommy's 24 hour memory care because there's no personal money left. Awful. Heartbreaking. With COVID I can never kiss or hug her. But, she is safe now & is "ok" with her routine. I'm thankful for Medicaid for my mommy's protection & care.

Medicaid was NEVER the plan. It's a safety net.
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Because the rules and loopholes are archaic. More care and services should be provided by Medicare but they are not - so you are either forced into a nursing home when you cant manage on your own, spend all your money on long term home care OR spenddown and transfer your assets(legally) so your children can have something left AND then get on MEdicaid for home care. Im single and so when i die, i will likely spend my money on help since i dont have kids to transfer to ,etc but if you have kids, it makes sense. When My father was suppose to come home from rehab 2 yrs ago, I knew he would need 24/7 care and so I applied for medicaid for he and mom. He never made it home and passed away. My mom was approved for medicaid - we had an estate lawyer plan the irrevocable trust years ago, etc. I am her fulltime caregiver and refuse to get paid for it via medicaid program that pays caregivers. I only want mom enrolled in medicaid when it becomes too much for me to care for her alone - knowing its there gives me serenity but chances are i will probably only use it at the very end(if that) - now im doing all the chores(including bathing mom etc).....So far, we havent used any of moms medicaid benefits - she has been approved for it now 2 yrs+
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It’s also prevelant because assisted living homes take advantage. My mom is now one point into level 2 care.... that point is caused by a home visiting nurse coming in for care on my mother’s legs. The visitin nurse is paid thru my mother’s insurance . The assisted living is getting $400 a month cash from my mother. Do the math....draining her medical savings
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disgustedtoo Nov 2020
If she's low income/no assets (after it's all used up), then it is a legit usage of Medicaid, if she can qualify. I think OP's question was more about those who now use EC attys to set up trusts, protect inheritance, etc. As noted in my comments, I was not aware this was the "end game" of the plan, but I am still glad we did what we did, if only to protect her assets from herself and scum. On the plus side, the trust has been doing very well, and despite the amount we need to withdraw each month to cover 1/2 her MC, Rxes and supplies not provided in the fee, she still has plenty left. So, although the atty told me to call if/when she's ready for NH, so we can apply for Medicaid, I had already decided we're not going to do that. She has funds, use them. Additionally, recent discussion with staff, it appears that she can stay to the end. She's 97 now, has been there almost 4 years, is now (self-inflicted) in a wheelchair and recently had a stroke. I don't expect her to outlive the funds - you never know, but there is still enough for years to come! IF the trust is ever depleted, we can consider Medicaid, but I also found out this non-profit place has it's own trust fund, and sometimes one can get funded to cover what is needed - she still has a good pension (was dad's) and some SS, but they cover only about 1/2 the fee. Anyway, for those who truly need it, Medicaid needs to be available. For those who can afford it, they should PAY their own way.
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