After four years, I am the one who does it all. And I am realizing how much they took off of here from sorting her records while living out of state. I never stuck my nose in 6 years ago other than to call her 3 times a week. I was called by her doctor to come "rescue" her after 2 years of her under the brother's care. She says just let them have it. NOW they want to know where everything is of hers that I brought up with her. 5k in bank account and a twin bed and dresser, and a recliner, clothing was all she had left. Legally can I do anything on mother's behalf???
Medicare Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospices.
Any person who has reached age 65 and who is entitled to Social Security benefits is eligible for Medicare Part A without charge. That is, there are no premiums for this part of the Medicare program.
Medicare Part A covers up to 100 days of "skilled nursing" care per spell of illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent. Here are the main requirements:
•The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay (meaning admission as an inpatient; "observation status" does not count) that itself lasted for at least three days (not counting the day of discharge).
•The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
•The patient must receive a "skilled" level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered "skilled," nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)
As soon as the nursing facility determines that a patient is no longer receiving a skilled level of care, the Medicare coverage ends. And, beginning on day 21 of the nursing home stay, there is a significant copayment equal to one-eighth of the initial hospital deductible ($152 a day in 2014). This copayment will usually be covered by a Medigap insurance policy, provided the patient has one
Nursing homes often terminate Medicare coverage for SNF care before they should. Two misunderstandings most often result in inappropriate denial of Medicare coverage to SNF patients. First, many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status (or to slow deterioration) then the care should be provided and is covered by Medicare.
Second, nursing homes may wrongly believe that care requiring only supervision (rather than direct administration) by a skilled nurse is excluded from Medicare's SNF benefit. In fact, patients often receive an array of treatments that don't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision. In these instances, if the potential for adverse interactions among multiple treatments requires that a skilled nurse monitor the patient's care and status, then Medicare will continue to provide coverage.
When a patient leaves a hospital and moves to a nursing home that provides Medicare coverage, the nursing home must give the patient written notice of whether the nursing home believes that the patient requires a skilled level of care and thus merits Medicare coverage. Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will issue a "Notice of Non-Coverage" terminating the Medicare coverage.
In order to be eligible for Medicaid benefits a nursing home resident may have no more than $2,000 in "countable" assets (the figure may be somewhat higher in some states). Note that Medicaid is a state-run program, so the rules are somewhat different in each state, although there are federal guidelines.
The spouse of a nursing home resident--called the "community spouse" -- is limited to one half of the couple's joint assets up to $117,240 (in 2014) in "countable" assets. This figure changes each year to reflect inflation. Called the "community spouse resource allowance," this is the most that a state may allow a community spouse to retain without a hearing or a court order. The least that a state may allow a community spouse to retain is $23,448 (in 2014).
Example: If a couple has $100,000 in countable assets on the date the applicant enters a nursing home, he or she will be eligible for Medicaid once the couple's assets have been reduced to a combined figure of $52,000 -- $2,000 for the applicant and $50,000 for the community spouse.
All assets are counted against these limits unless the assets fall within the short list of "noncountable" assets. These include the following:
•Personal possessions, such as clothing, furniture, and jewelry
•One motor vehicle, regardless of value, as long as it is used for transportation of the applicant or a household member. The value of an additional automobile may be excluded if needed for health or self-support reasons (check your state's rules).
•The applicant's principal residence, provided it is in the same state in which the individual is applying for coverage. In some states, the home will not be considered a countable asset for Medicaid eligibility purposes as long as the nursing home resident intends to return home; in other states, the nursing home resident must prove a likelihood of returning home. In all states and under the DRA, the house may be kept with no equity limit if the Medicaid applicant's spouse or another dependent relative lives there
•Prepaid funeral plans and a small amount of life insurance
•Assets that are considered "inaccessible" for one reason or another
Long term care planning combines the goals of estate planning along with
the concerns of protecting and preserving assets from the very substantial
costs of long term care, such as extended home bound or institutionalized
nursing home care. Long term care planning addresses the question:
“What if I become seriously ill and disabled and will need extensive home
bound care or need to live in a nursing home for a long time”?
Eligibility for the government program commonly known as Medicaid or Medical Assistance for long term care support is very strict on the gifting of assets and
transfers for less than fair value. Generally, all gifts or such transfers
made within five-seven (5-7) years of entering a nursing home need to be
disclosed and reported on the Medicaid Application Form and sworn to
under oath. Gifts made within five (5) years could result in the denial of
eligibility and benefits for a period of days or months depending upon the
aggregate value of the gifts and the application of a formula. However,
gifts below a certain amount or to a disabled child, even if made within five(5) years, may not be subject to a penalty period of ineligibility.
Gifting by a person who is concerned about the possibility of having to
enter a nursing home within five (5) years should seek expert advice from
an elder law attorney to understand the applicable Medicaid gifting rules what gifting may be permitted, and the “penalty” of ineligibility which would
be imposed for non-permitted gifts.
When you or a loved one enters a
nursing home you or your authorized representative will sign a Nursing
Home Admission Agreement (a contract). This contract will set forth the
services to be provided and the cost you will pay for these services. If
able, you may leave the nursing home at any time. You will be using your
money, and perhaps some payments by Medicare, to pay for the nursing
home costs.
If and when you run out of money and are still in need of full-time nursing
home care, you can apply for the payment of your nursing home bill by the
federally sponsored and state administered program commonly referred to
as either Medicaid or Medical Assistance for long term care support .If you would like to take steps to save and protect your assets before
paying everything to the nursing home, you should see an elder law
attorney for the development of an estate and long term care plan to
legally protect your savings and achieve eligibility for Medical Assistance
Stop trying to understand them and just move forward with the task at-hand. Some things in life can't be explained.
He helped alright. Helped himself to my dads money hundreds at a time. My dad had no idea and is devastated to have trusted him. But what do you do when he went to the bank with him and gave him access. My sister has no clue and doesnt believe me or take any responsbility for them using him, and so far dad doesnt want her to know how much money he gave her husband,, and how much he thefted. I only have one year of bank statements so far and with the cash he got andhhis purchases were looking at probably 60,000. But he was there at the office for over 3 years. So its alot more i know, after taking care of my dad as i always do and movng him here, helping recnsile negative accounts and paying for medications ect... watching him cry and be at hia lowest point ever. she and her snake of a husband had the gawl to want to come get him from my care s they could move n with him and squat the house. Asking me for copies of electric bills, water. Dad saw right through that, but he hasnt called em on any of it. Still acting like all is well my sister because he loves her. I love her too but no more will i stand by and watch them bleed him dry and leave him for dead. They are sorrry in my opinion and i think my last words were f you!
It is not your job to take care of your mom any more than it is your brothers' job. You chose to stay and help your mom rather than being vindictive and leaving her to her own devices. Likewise, it's their choice not to help her out/visit/etc... You are doing whatever you're doing to benefit her so whatever legal arrangements are made should be with her money not yours. You seem to be taking the high ground. Keep reminding yourself of this.
Put this a different way:
You all need to stop thinking about this as help for YOU. This is help for HER. You've given up too much of your time to her and you need someone else to help HER. It's about HER. Whatever time you've given to this point is out of your generosity. You have given away your time to her and you need to stop doing that. Give her some of your time and get HER help for the rest of it. Just remember that it's for HER. It was her money to spend on her care and it was kind of stealing that your brothers took it and want to hide it from Medicare. Or, maybe it's called "fraud" but I'm not a legal expert.
You need to remember that they are the people that want to defraud the system for their benefit. Don't remember it in a negative way, just remind yourself that it's not you that's trying to cheat anyone and I hope that makes you realize that you shouldn't use yours and your husband's money and that you shouldn't feel guilty about that for one single second!
See All Answers