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When I applied for my mother's spend down for Medicaid they never questioned her monthly expenditures for living. We had bought a house for my parents a few years earlier since there wasn't room for them to live with us that was nearby. Our only requirement for them to live there was to pay the yearly taxes which were in our name and the utilities also in our name. We paid the insurance and they maintained a renters policy. So I don't see why they would question the expenses they are paying each month to you unless they are unreasonable. I was actually told by SS that we could have charged them an additional rent but then that would have gotten into a tricky Tax burden with needing to depreciate the property and claim income. The part about MC in my mother's case was an extension of the AL service with no further cost to her. She simply moved to a locked area of the facility and there was staff to assist her at a somewhat higher level with direction and activities etc. They kept her there until she could no longer take care of her own ADLs and fell several times. All the time she was there she was on Community Care Medicaid and had the spenddown. Now she is on Chronic Care Medicaid in LTC and has to pay all but $50/month for her care. She is allowed around $12000 in savings and assets but has no where near that.
After reading through all the comments and replies, there might be some issues. The first one that might be an issue is:
"They are giving us money each month, “room & board”, to cover utilities, internet, satellite, phone, food, sundries, etc. We agreed on this before the move."
Great that this was "agreed" upon, but do you have it in writing, a legal document? Medicaid *could* look at this as "gifting", which will be tallied up and that amount will need to be spent as private pay before ANY Medicaid would be approved.
In response to other comments/postings:
“…plan to not leverage our retirement in the care…” Excellent!
"I believe, or at least hope, that the social services agencies involved are not looking at families member’s assets when determining eleigibility!"
No, Medicaid looks at the recipient's assets. Your assets play no part. You indicate they have no savings, which is good as far as Medicaid would be concerned and income is fairly low for 2 people. However you also mentioned giving up their home of 18 years - was that their own (sold) or an apartment? If sold home, where did the money go? Medicaid also varies widely between states, so you would need to contact them to inquire about what, if anything, is available for AL or MC. It is a state benefit, bolstered by federal funding, so that's why requirements and benefits vary.
"We want to plan for care for them here for as long as possible, but state eligibility states, “ eligible recipient must meet need for care in skilled nursing facility”, before receiving benefits."
This is something I have tried to explain to some people. A SNF would have criteria for accepting a person. They would need skilled NURSING care, not just AL or MC care. ALs/MCs have nurses on duty, but don't provide skilled nursing care. That said, I have read that some SNFs have MC units, but haven't explored to know if the resident would need to meet the skilled nursing care in addition to MC. I would suspect they do. Sounds like your MIL would only need MC at this point, not SNF.
"She was already evaluated and determined to need 8/7 care for ADLs in Texas almost three years ago. Since she thinks her, “brain is better now”, she is refusing to prepare for the future. I’ve been told that we can start the approval process in AZ without her."
Most likely there would need to be another evaluation - of concern is the time frame. I have read there are residency requirements, but have no idea what those are, certainly not state-by-state. At least one instance indicated 2 years, which would be okay for you, but you really need to talk with someone at the Medicaid office or an Elder Care attorney.
"They are here now, so think they are set." Isn't that always the way? In combination with wanting to move in and then saying they had to give up their home!!! Dementia is not for sissies!
While many here have good advice, your situation is a little complicated. Mom has dementia, but mom and dad are somewhat "independent." If you move MIL, would FIL go with her or stay with you? Do you already have all the legal documents (POAs, including medical, wills, etc AND something in writing for the monthly "payments" they make to you) in place? Have good records for all their income/spending for five years? Do you have an EC attorney you can consult with? Have you searched for any/all facilities? There are some search engines that can be used (w/out email!) and some have "filters" that allow you to select Medicaid facilities. Medicaid AL/MC are generally in short supply, so better to get everything started now, Medicaid application, VA benefits if applicable (these are mutually exclusive - some minimal funding might be had, but not full bennies if the other is approved), getting on wait lists for places that take Medicaid/have space. Some in-home $ can be available via Medicaid or VA as well.
For most serious Qs, EC attorney can provide the best help - may cost you a bit, but worth it.
First of all, I'd get an Elder Attorney to advise you (in your state). It will be the best investment you can make. Many people balk at paying an attorney, but they KNOW the legalities, and can walk you and the elderly couple through them. They can also assist with any legal documentation they need. They can assist with POA's, Medical POA's, and any other legal documentation of their finances and property. There are all different answers here talking about Medicare and Medicaid (Medicare DOES NOT pay for a facility long term care - only rehab with qualifying criteria). Second, start looking for placement - it takes quite awhile to be placed anywhere and if it's important that the couple be placed in the same facility, there needs to be openings within a reasonable amount of time to get them both there. Don't pay their bills - all spending must be out of their own income to give a true picture of what they can/cannot afford.
They are giving us money each month, “room & board”, to cover utilities, internet, satellite, phone, food, sundries, etc. We agreed on this before the move. Other than shopping for food, cooking them dinner every night, and driving whenever we go anywhere together, they are independent. And other than mums nasty behavior and refusing medical treatment, things would be fine at this point. The dementia diagnosis explains Mums behavior, so now we are concerned and need to make some plans for changes.
Hi... Well they can't! It's almost a given that our folks need to be either Rich or Poor, according to at least in calif. Ya really need to pik one, unless they did everything by the book, worked fir 50 yrs, have retirement & IRA. Etc: I personally know one person. Now, having said that, $2k a month, .is more that many, but not enuff, so basically you need to 'DUMB IT DOWN' that's the phrase used .. & go for the medi-medi life . Retirement + state funded assistance.. to access our folks for any type of caregiving facility. Inthe meantime, usually the kids take care of their needs from our own wallet. Everyone has a story. Indeed.
In NY there are some facilities that offer Medicaid rate rooms. I think you need to look into getting a Medicaid spend down to qualify. My mother got placement that way. Her income was about $1800/month and they allowed the cost of her supplement off that and the cost of Medicare premium and any copays for meds, supplements, incontiency products, Dr copays. It doesn’t take long to get down to the spend down. Just once and get extra help with drug costs. Just getting the Medicaid spend down set up qualified her for the lower price room. You’ll need to check around at AL facilities to see who has those rooms and sometimes there is a waiting list.
Are there significant assets? Spending down to qualify for Medicaid is an option. In many states, Medicaid won't cover AL, they'll only cover SNF or give waivers for home care. In some states, Medicaid has AL waivers, but they can be scarce. If neither of the couple needs round the clock care, finding an affordable apartment in a building with an elevator then bringing in scheduled home care may be an option. They may want to invest in a sit down with an elder law attorney if there assets to consider or just to plan for spend down if that makes the most sense.
Try getting them qualified for medical/housing senior services in your state. Google Aging and Adult services or Senior Services in your state, contact your local Ombudsman as they protect our seniors, It may not help solve all of your problems but they may tell you about services you didn’t know were available. Low income housing, Veterans services other than medical, they may even be able to rent a room from someone. We need to discontinue services for those who don’t want to contribute to society and provide for those that have given everything. We will all be in the same boat one day.
It depends on what state you live in. My mother was in assisted living in Illinois, they filed for Medicaid for her payments. Moved her to Virginia. No Medicaid for assisted living in Va. You either have to have long term care insurance or cash. Good luck to you!!
Chittman, based on your use of ALTCS I assume you are in Arizona. You are fortunate because you have literally thousands of options.
If they plan on staying together I would research care homes that have a maximum of five or 10 residents. These places are a lot more affordable and they usually allow aging in place, which not all facilities do.
It is great that you and your wife are on the same page with how the support will happen.
Thanks! Happy to know we have so many options. They are still functioning well enough in our home, be we can see the signs of where it is going. Mum already feels she was displaced from her home of 18 years, even though it was their choice. They asked us. The idea of having to move to a care facility anywhere outside of the luxury options, is untenable for her at this point. We are going to need my wife’s brothers support in creating a plan. Obtaining ALTCS eligibility is a must as far as we are considering concerned, I’m just not sure how we are going to pull that off if they refuse to talk to the needs assessor.
In my area, assisted living for $2000 doesn't exist. Cheapest I've seen is about $4500. Medicaid can kick in for assisted living residents who run out of assets, but rarely provided to someone not already there. There is money available to supplement for rent in assisted living through the Veteran's Administration and business offices with Assisted Living Facilities should know how to navigate that system. You should know that the process of applying for VA benefits can take up to a year. My state also has Frail Elder Waiver Community-based Care. If someone has a certain income or lower, they can qualify for in-home assistance in the form of 5x a week meals on wheels and a Home Health Aide for anywhere from 6 hours a week to 24 hours a week. Other things can be provided like Lifeline and Medication Machines. Eventually, my dad required nursing home care and mom received in-home community care for a couple years. Luckily, they were in the same town so when I couldn't, mom could take the council-on-aging van to visit dad. My parents resisted my offers of help for years. I wish I could have begun the process sooner. You are right in trying to line up their options now.
Only problem is that because they think they don’t need it now, they won’t consider planning for it for their future. It’s all classic signs pointing to the need to plan. If they didn’t already live with us, it would be easier to look for support and options. They are here now, so think they are set.
I would check with Medicaid in your area and see if they have Section Eight housing, or something akin to that to see what people in similar financial straits do for housing like AL.
Contact your local Area Agency on Aging. If your income/assets are low enough you may qualify for the PASSPORT or similar program and they may have waiting lists for assisted living type places that accept it as a waiver type program. Or start with your local office on aging.
Just about every senior information office will have a subsidiary that you can make an appointment with to check into things like Medicare/Medicaid qualifying. They can inform you about things like how to spend down income legally in order to qualify by purchasing a small vision or hearing health plan. These are not things most Medicaid offices will tell you. Being over by a small amount of income (like $14) should not keep a person from qualifying if you spend it down in that way. Having more than $2000 in savings or investments will disqualify a person though. I believe that if you gift your money the wait time is three years before you could qualify for Medicaid but check with your local office. Once a person qualifies for Medical or Medicaid, if your state has an Assisted Living Waiver Program you can begin the process of seeing if the person qualifies for the program. It’s a great program that is meant to keep folks out of nursing homes if they do not require skilled nursing but need assistance with every day living. There is a waitlist in many states that have the program and Assisted Living Facilities have to opt in to the program so not all ALFs are involved in it. I recently placed my nearly penniless uncle in a beautiful one in our area through the program in Calif. It took time and lots of patience but was well worth the effort. I found out that I could get around the long waitlist in the program by calling Adult Protective Services to get them to open a case for my uncle, saying that he was a danger to himself (which he was because he was running out of steam to care for himself at 89). Once a case was opened by APS they put him at the top of the list and within 2 months we moved him!
Good suggestions! We are trying to work through mom's “wall of denial” to get the approval process going. She was already evaluated and determined to need 8/7 care for ADLs in Texas almost three years ago. Since she thinks her, “brain is better now”, she is refusing to prepare for the future. I’ve been told that we can start the approval process in AZ without her. We may report to that soon.
I am in SC. All AL facilities are different. There was 1 place I talked to here who accepted self Pay for a given period but then would accept Medicaid once all the asserts were spent down. My Mom was in a shared AL room in PA until I moved her down here in with me. It was a very nice award winning facility. It was $1,700 a month. Investments will be used for the spend down. Whole life insurance policies will need to be cashed in. Term life insurance policies will be safe. Not sure about annuities since they are all so different. I saw an elder lawyer and will go back for 1 more visit.
Reading your reply made me feel that there is a light at the end of this tunnel. My wife and I don’t want to get caught in the “despair trap” that I read so many caregivers are coming from. Thank you for being compassionate and real!
I have been dealing this for two years for my parents and I have researched everything. The best way I have found are Personal Care Homes. In researching you will likely find many in your area. They run from $1500 a month to $2800 per month. My grandma spent her last 3 years in one. Many are monitored by the state. But you must do your research. Look for reviews and talk to families. There are good ones out there and good people who run then! The research takes time, now is the time to start it...not when they need it! Dimentia is an approved hospice reason. You may not need that now but in the future, they are a great resource! good luck and God bless!
I don't know of anything in my area, I'm surprised to see some responses here that say there are assisted living situations available for less than $2k a month. I'd be suspicious of the level of supervision and comfort of the facility at such a low cost.
To the OP, you'll know when the time is right, via your stress level, to place Mom in a nursing facility. I would suggest you start now getting them approved for LTC Medicaid. It will be easy based on their income. You likely can do it online at your state's social services website. Then start looking at nursing homes in your area. If there is a waiting list for one that you desire, put them (or him or her) on it. Also look into in home care covered by LTC Medicaid. It may be available (in my case it wasn't, but I've heard in other states it is more readily available). The state doesn't look at your assets, only theirs. Hope this helps.
Another possibility: Sometimes , if an AL is affiliated with a religious organization the price is much less. Here in OH, for example there is a nice Christian AL for just over 2000 mo.....
I live in Maine and help my friend who will soon be 82. Recently she was hospitalized for a serious illness and upon her release needed to go to an ALF at least to recuperate. I was able to find one room in our entire county, that room is $5,000.00 per month with the highest level of assistance. There are lower levels of assistance that start around $3,500.00. This is for a private pay room. I also looked into home assistance for her at her apartment. For 8 hours a day, 7 days a week, that also cost $5,000.00 per month but would leave her alone at night. That figure would include meal preparation, light housekeeping and personal care. While I realize that your wife’s parents do not wish to apply for benefits at this time, now is the time to help them apply. The process takes time and with an income of around $2,000.00 per month, they should be eligible for assistance. Finding a facility also takes time and if they were already approved for assistance, the transition to an ALF would be faster.
There are veterans homes and county run assisted living facilities that are cheaper than the private run ALF's. My SIL's father lived in the veteran's home and only paid about $1400 a month for care, meals and room. My father lives in the county run ALF. The care is only $250 a day and he's on medicaid which is accepted by the ALF (His previous place was $450 a day). If one of the people that you are talking about is a veteran, then check out Veterans homes in your state. You may also want them to see if they are eligible for medicaid, most ALF's are covered by medicaid (at least, where I Live).
Chittman, the couple could consider starting with in-home care provided by a reputable company. In FL, my LOs pay $22 p/hr, per person for minimal care that includes light housekeeping, cooking, running errands, driving, entertainment, bathroom + dressing help. As the elderly needs increase the company needs to provide a different skill level caregiver with a higher hourly rate. The couple can stay in their home until the cost of this type of care starts to exceed what AL (or another living arrangement) would cost. It buys some time and allows them to age in place a little longer. Good luck!
Thanks for your reply! They are aging in place in our home at this point. They are doing well, besides cyclical behavior disturbances from dementia for mom. We want to plan for care for them here for as long as possible, but state eligibility states, “ eligible recipient must meet need for care in skilled nursing facility”, before receiving benefits. They are not willing to move forward with becoming eligible yet, so we wait...
I found a small board and care for my dad. He was over the limit for Medicaid by $14.00, so finding a facility that he could afford and age in place was important. They are referred to as care homes.
He had a roommate and they would go get into mischief together and take walks. All of his needs were met, they just don't have the organized activities. Part of why it didn't cost 3k monthly.
Where are they located? Not every town has this type of option, but the kind posters here can help you figure out what you choices are based on location.
Judy, See an elder care lawyer. May have suggestions. However, Medicaid is for the low income. One is expected to use their assets to pay for their care, not to gift or leave inheritances.
They have low income and no saving to “gift” anyone. I believe, or at least hope, that the social services agencies involved are not looking at families member’s assets when determining eleigibility!
I doubt it. Have you looked into help from veteran benefits? Did he serve in WW11? You will get slightly over $1200 a month. With the additional money possibly you could. Do you have savings? Savings cannot exceed over a certain amount to qualify.
If they use savings combined with other money you may be able to. Some places will allow people to negotiate price. Look for an independently owned facility over a corporate facility to negotiate price.
Be open to doing an efficiency over a separate bedroom.
Only their income and saving can be considered in their eligibility for care outside of their home. The quality of care may be in question, but I’m looking for others who may be in similar circumstances. My wife and I are not looking to sacrifice our careers or our retirement savings to care for others with limited resources. I understand that ALTCS will cover skilled nursing facility care when one of them is unable to care for themselves independently. We are hoping that they will be willing to accept care when they need it.
Chittman, the prices can be a huge sticker shock. Once I saw how much it cost, I decided to hold my retirement fund hostage. My bucket list is now a thimble.
My wife and I plan to not leverage our retirement in the care of her parents. Our priorities and assets are well protected and separate from our commitment to their care when they need it.
Wish my mom could qualify for Medicaid but she has too much income. Plus she has investments. Would they take that from too? How would I find out about that?
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The part about MC in my mother's case was an extension of the AL service with no further cost to her. She simply moved to a locked area of the facility and there was staff to assist her at a somewhat higher level with direction and activities etc. They kept her there until she could no longer take care of her own ADLs and fell several times. All the time she was there she was on Community Care Medicaid and had the spenddown. Now she is on Chronic Care Medicaid in LTC and has to pay all but $50/month for her care. She is allowed around $12000 in savings and assets but has no where near that.
After reading through all the comments and replies, there might be some issues. The first one that might be an issue is:
"They are giving us money each month, “room & board”, to cover utilities, internet, satellite, phone, food, sundries, etc. We agreed on this before the move."
Great that this was "agreed" upon, but do you have it in writing, a legal document? Medicaid *could* look at this as "gifting", which will be tallied up and that amount will need to be spent as private pay before ANY Medicaid would be approved.
In response to other comments/postings:
“…plan to not leverage our retirement in the care…” Excellent!
"I believe, or at least hope, that the social services agencies involved are not looking at families member’s assets when determining eleigibility!"
No, Medicaid looks at the recipient's assets. Your assets play no part. You indicate they have no savings, which is good as far as Medicaid would be concerned and income is fairly low for 2 people. However you also mentioned giving up their home of 18 years - was that their own (sold) or an apartment? If sold home, where did the money go? Medicaid also varies widely between states, so you would need to contact them to inquire about what, if anything, is available for AL or MC. It is a state benefit, bolstered by federal funding, so that's why requirements and benefits vary.
"We want to plan for care for them here for as long as possible, but state eligibility states, “ eligible recipient must meet need for care in skilled nursing facility”, before receiving benefits."
This is something I have tried to explain to some people. A SNF would have criteria for accepting a person. They would need skilled NURSING care, not just AL or MC care. ALs/MCs have nurses on duty, but don't provide skilled nursing care. That said, I have read that some SNFs have MC units, but haven't explored to know if the resident would need to meet the skilled nursing care in addition to MC. I would suspect they do. Sounds like your MIL would only need MC at this point, not SNF.
"She was already evaluated and determined to need 8/7 care for ADLs in Texas almost three years ago. Since she thinks her, “brain is better now”, she is refusing to prepare for the future. I’ve been told that we can start the approval process in AZ without her."
Most likely there would need to be another evaluation - of concern is the time frame. I have read there are residency requirements, but have no idea what those are, certainly not state-by-state. At least one instance indicated 2 years, which would be okay for you, but you really need to talk with someone at the Medicaid office or an Elder Care attorney.
"They are here now, so think they are set."
Isn't that always the way? In combination with wanting to move in and then saying they had to give up their home!!! Dementia is not for sissies!
While many here have good advice, your situation is a little complicated. Mom has dementia, but mom and dad are somewhat "independent." If you move MIL, would FIL go with her or stay with you? Do you already have all the legal documents (POAs, including medical, wills, etc AND something in writing for the monthly "payments" they make to you) in place? Have good records for all their income/spending for five years? Do you have an EC attorney you can consult with? Have you searched for any/all facilities? There are some search engines that can be used (w/out email!) and some have "filters" that allow you to select Medicaid facilities. Medicaid AL/MC are generally in short supply, so better to get everything started now, Medicaid application, VA benefits if applicable (these are mutually exclusive - some minimal funding might be had, but not full bennies if the other is approved), getting on wait lists for places that take Medicaid/have space. Some in-home $ can be available via Medicaid or VA as well.
For most serious Qs, EC attorney can provide the best help - may cost you a bit, but worth it.
They can assist with POA's, Medical POA's, and any other legal documentation of their finances and property.
There are all different answers here talking about Medicare and Medicaid (Medicare DOES NOT pay for a facility long term care - only rehab with qualifying criteria).
Second, start looking for placement - it takes quite awhile to be placed anywhere and if it's important that the couple be placed in the same facility, there needs to be openings within a reasonable amount of time to get them both there.
Don't pay their bills - all spending must be out of their own income to give a true picture of what they can/cannot afford.
Well they can't! It's almost a given that our folks need to be either Rich or Poor, according to at least in calif. Ya really need to pik one, unless they did everything by the book, worked fir 50 yrs, have retirement & IRA. Etc: I personally know one person.
Now, having said that, $2k a month, .is more that many, but not enuff, so basically you need to
'DUMB IT DOWN'
that's the phrase used ..
& go for the medi-medi life .
Retirement + state funded assistance.. to access our folks for any type of caregiving facility.
Inthe meantime, usually the kids take care of their needs from our own wallet.
Everyone has a story. Indeed.
Medicaid applications.
If neither of the couple needs round the clock care, finding an affordable apartment in a building with an elevator then bringing in scheduled home care may be an option. They may want to invest in a sit down with an elder law attorney if there assets to consider or just to plan for spend down if that makes the most sense.
If they plan on staying together I would research care homes that have a maximum of five or 10 residents. These places are a lot more affordable and they usually allow aging in place, which not all facilities do.
It is great that you and your wife are on the same page with how the support will happen.
The research takes time, now is the time to start it...not when they need it!
Dimentia is an approved hospice reason. You may not need that now but in the future, they are a great resource!
good luck and God bless!
To the OP, you'll know when the time is right, via your stress level, to place Mom in a nursing facility. I would suggest you start now getting them approved for LTC Medicaid. It will be easy based on their income. You likely can do it online at your state's social services website. Then start looking at nursing homes in your area. If there is a waiting list for one that you desire, put them (or him or her) on it. Also look into in home care covered by LTC Medicaid. It may be available (in my case it wasn't, but I've heard in other states it is more readily available). The state doesn't look at your assets, only theirs. Hope this helps.
I also looked into home assistance for her at her apartment. For 8 hours a day, 7 days a week, that also cost $5,000.00 per month but would leave her alone at night. That figure would include meal preparation, light housekeeping and personal care.
While I realize that your wife’s parents do not wish to apply for benefits at this time, now is the time to help them apply. The process takes time and with an income of around $2,000.00 per month, they should be eligible for assistance. Finding a facility also takes time and if they were already approved for assistance, the transition to an ALF would be faster.
He had a roommate and they would go get into mischief together and take walks. All of his needs were met, they just don't have the organized activities. Part of why it didn't cost 3k monthly.
Where are they located? Not every town has this type of option, but the kind posters here can help you figure out what you choices are based on location.
If they use savings combined with other money you may be able to. Some places will allow people to negotiate price. Look for an independently owned facility over a corporate facility to negotiate price.
Be open to doing an efficiency over a separate bedroom.
Best wishes!