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POA for 71 y/o mom who’s a widow with mid to late stage dementia who has too much income for Medicaid but not enough money for her home health aide needs (at least 14 hrs per day). She lives in a multi family home owned by her sister in law and only family lives in the home (my aunt and my siblings) I don’t live there I have a family and home of my own. Her assets are dwindling and are below Medicaid requirements but her monthly income is too high for Medicaid. Her care agency is expensive but going rate for CT and she is about to be unable to afford it. Agency on aging approved her for 36 hours of care 3 days a week but she still can’t afford to pay for the other 4 days. She needs 14 hours of care during the day and she gets up multiple times at night. All her kid’s work. We promised we would keep her home per her wishes but we can’t afford it she can’t afford it and we can’t afford nursing homes either. what do we do for the person stuck in the middle of the income bracket not poor enough and not rich enough.

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Don’t trust anything I say but consider moving your assets into a trust. That way you can show no assets. Also depending on how you get paid consider forming a corporation.
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Is there anyway you can hire private or agency sitters to cover some hours? Usually private sitters are less expensive but understand they probably are not cna's and will need a lot of direction and monitoring. Anything will help for now. Check the local churches, nursing schools, etc.

I have used this combination in the past for my parents & husband's aunt.
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Alodocios: Sometimes promises to keep the elder at home can't be kept as situations change. I will never expect my daughter to provide care for me.
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I had a similar situation with my father n law.He had no assets except a car and he made too much to qualify for Medicaid.He was diagnosed with dementia and he's 88.On faith filed for Medicaid and they accepted him,but they take all his pension and ss check, accept for 60 or 70 dollars. I'm ok with that because I know the memory care facility will take better care of him than I could.Ihope this post gives you some hope.
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S00lin Apr 2023
Except what happens if the SS check and pension is needed to pay the bills, ie utilities etc?
I can't afford to lose this monthly income that covers these bills. My SS check is not enough to cover my Dad's bills plus mine.
I ABSOLUTELY WILL NOT sell/give up my Dad's house and become homeless myself. I am 71 and single.
Medicaid WILL NOT get it!
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have you check with Elder law attorney, check with AARP to see if there is help for elders who can't get medicare. here's is what happened just recently with my brother who is 74. he had medicare and medicaid, they sold his house and paid any bills, etc. money will go to pay monthly assistance in a nursing home. when that is done medicaid will kick back in. check on this bc after your mothers house is sold and money used she won't have any money to continue. so maybe she will be able to get medicaid or something similar. check everything you can.
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Look for an Assisted Living program where they will accept Medicaid when the money runs out. Sit down with the social worker or meet with an Elder Law Attorney. Memory Care needs to be looked at too, if she is headed that way.

Google, "medicaid accepted assisted living near hamden CT."
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My advice is to retain an eldercare attorney to help apply for Medicaid. A pooled trust may be the way to go. Don’t give up trying just yet.

Good luck to you.
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Laws must be changed. Contact your government representatives. That won’t help immediately, but all, and there are many in this situation, need to do this for long term changes to occur. My husband is in a similar bind as his SocSec is over State Medicaid limit. It’s just not fair that those in poverty get home health coverage, but those with a few dollars more, have to deplete all their assets and still won’t qualify for help.
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Community Medicaid (in NY)has a spenddown program so for instance if mom makes $3000 per month but can only make $1000 per month, she can open a pooled income trust where you Will pay her monthly bills thru the trust …including aides etc to get to the $1000 eligibility ….and then she qualifies monthly for aides etc
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My spouse is in Memory care in Fl. He was approved for Medicaid after seeing an eldercare attorney. A Qualified income trust was set up. His pension was too high. Medicaid pays a portion of the expense. Trying to balance the funds to help me, the healthy spouse at home with household expenses.
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I have a house but don’t know how much homecare will be I want to stay at home
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There has to be an organization that can help. I'm not sure how In Home Supported Health Services IHSS functions regarding income brackets, but perhaps reaching out to them for guidance can help point you in the right direction.

I used to be a CNA in a sanitarium in my younger days. I thought I would never put my mother in one of those places, but if and when the time comes I'll have to weigh out the Pros & Con's.

Fast forward decades later, my mother is in her 80's, and her cognitive functions are dwindling. She makes bad decisions from her emotions (anger). Example giving a 30 day notice for her luxury Independent retirement home apartments.

Which left me scrambling to look for a place for her to rent. I found one with a lot of daily prayers at the last minute but that added anxiety and drama I don't need in my life.

She realizes she made a Big Mistake, she has mentioned it 4 times already. Why the Independent Retirement home didn't reach out to me is a mystery. I am her guarantor for those apartments.

I am her only adult child and family member. I am dealing with my own newly diagnosed health issues. Stress is one thing I don't need. Stress is something she can guarantee to give me.

She's not a kind person to me, nor is she grateful. She is more entitled with a Borderline and Narcissistic personality combined. (Not easy to deal with) It's always been her way or the highway and now that she's aging, it's worse.

She has adult tantrums when she doesn't get her way and pounds her fists on her legs. This frightens me when I'm driving.

She does not take my advice and ends up making more mistakes, I have to clean up again. I'm nowhere near being young but oddly she still sees me as an inexperienced "kid".

If she hears the same advice from a stranger, then that must be "good advice". I'm in a situation where she can't live with my wife and me due to space and cherishing my sanity.

I need to focus on myself and my health right now to get well. I don't feel well all the time, it's ebb and flow but I do my best to help her during this situation almost being homeless.

I believe it was divine intervention that helped, when there were only a few grains of sand left in the hourglass, the apartment I inquired about went from being taken to it falling through and being available again. (unbelievable)

I too felt guilty that I was unable to help move her items physically to a storage unit. My health would not permit it physically, not right now.

I know what it feels like to "feel" guilty but I also know I can't do it all, even if I want to. So I pray and ask for guidance, and things seem to fall into place. I can research and find resources when I am "feeling" good. There's always a way out of a long dark tunnel, keep moving and seeking the answer.

Do what you can with the resources you have (The Internet). If anything you can Research Resources out there and keep reaching out and asking questions. Good luck to all of you in a rough situation with an aging parent/s. Angel from The Bay
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StressedOut99 Apr 2023
So sorry you’re having to deal with this. I can relate as my spouse who is 85 has similar characteristics. I at 73, have worsening health problems myself and am often at ropes end dealing with his. It becomes so complicated because every State is different.
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First of all no one should ever extort the promise from their familiy to "keep me out of a home". It is wrong and the very height of selfishness to ask this. No one should ask this of their children and no one should ever agree to it.
Most of the time families end up having to renege on that promise and there should be no shame or guilt in that. It should never have been asked in the first place.
What a disgusting society we live in when love and loyalty for our elderly family members is judged by how much debt we will take on to keep them out of a "home". Or how much we are willing to neglect our own lives, health, jobs, families, and selves in order to keep them out of the hands of managed care and professional staff in a care facility.
I think it's okay to refuse to make this promise, and if you have it's okay to renege on it.
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Breezy23 Apr 2023
I get what you are saying but it doesn't help or offer a solution to the poster.
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If you have never applied for medicaid, I would suggest that you contact your local medicaid office to get all the free advice before going to an attorney. If you still feel you need an attorney you probably will better understand what they tell you along with having better questions. We are blessed that our attorney offered a free consultation so we only paid for the work they actually did for us without a fee for the first visit. When I say "contact" I want to emphasize that this should be an in person visit because I have found the reps are sympathetic of your need and seem to listen better when they see your face and you see theirs. Search online to see what information they will need and your visit can be more productive if you go in with as many documents they are going to ask for. If you use an attorney, hopefully it will lessen their work and be more affordable... but be sure it is one who specializes in elder law to get it done right the first time.

If you have never actually applied, the Medicaid office can only give you information based on the general population without taking all your facts in consideration. You may be denying yourself of valuable benefits when the agency may have approved the application. We missed out on SS and VA benefits because we did not apply as soon as we could have have based on what we "knew" by listening to others experiences.
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I agree, begin with an Elder Law assessment and, directions.
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You need to visit an elder lawyer. My mom's pension was over the limit to qualify for Medicaid. The lawyer advised to set up a Miller Trust and filled out all of the paperwork for Medicaid. An Elder Lawyer can advise you appropriately for your state.
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Look into possible State grants for elder care.
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Needs to be placed into a Medicaid facility to age in place. Contact an eldercare attorney for assistance with Medicaid.
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I am an elder law attorney in Connecticut. I’ve heard this concern before that people are told they are over the income allowance and don’t qualify. Period. It’s heartbreaking to me when I hear that people are not given all of the facts that can help them. There is a program in Connecticut to work around the income problem. It’s a Pooled Trust. Please go to planofct.org and find an attorney on their list near you to contact to get a pooled trust and help get her qualified for the CT Homecare Program for Elders waiver program. It may not pay for the full 14 hours/day but it can help. ~Joan
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mstrbill Apr 2023
Thank you for that Joan. We see that a lot here where people mistakenly believe they or their loved one doesn't qualify or can't qualify for Medicaid. It is heartbreaking and frustrating people are misinformed.
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I’m beginning to think of this kind of family situation as a “false promise”.

When we love someone, we rashly but lovingly promise to assume care responsibilities for which we are totally uninformed and unprepared.

As our dearly loved family member descends into the reality of advancing dementia we slowly (or quickly) come to realize that we are in the fearful embrace of a “promise” which CANNOT FAIRLY BE KEPT, without sacrificing the welfare and resources of those by whom the promise was made.

Then realizing the consequences weeks months or years later, we slather ourselves in “guilt” because of the ambivalence caused by wanting to do the “right” thing, and at the same time meeting responsibilities to ourselves as caregivers AND other family members who are part of our social constellation.

And ALWAYS in this situation, we are confronted by the fact that there is no solution that can yield a “happy ending”.

I have told my children NOT to make their father or me CARE BASED PROMISES.
I DO NOT want them to bear any more emotional burdens than they can REASONABLY AFFORD without being aware of the REAL TIME CONSEQUENCES of care giving.

And I have told them that the promise NOT TO MAKE PROMISES is the only one I expect to be kept.
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Caregiverstress Apr 2023
Wise words. My father has never asked me to move home (opposite coast) and care for him and I have not offered. I know what will happen to my life if I do. If he ever asks, I will tell him I can’t this year and punt it down the road. I know if his body outlives his mind he will be placed in MC. I will never tell him that, but it’s the decision I have made for BOTH of us. I have chosen one that is nice and am looking for others as well. I love my father. I also know that giving up my life in my late 50’s will basically be a very early retirement that I can’t afford and do not want as I become his 24/7 caregiver. Can’t do it, won’t do it. Do I feel guilt sometimes? Of course I do. That’s normal. But kidding myself that I can do it and then watching my life go completely off the rails is IMO a worse fate than the feelings of guilt.
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my mom and i live i new york, she lives alone and she has Alzheimer's and dementia. i did the Medicaid form on my on (took a while but figured it out) i chose the CDPAS program where i can hire my own aids for mom and then picked a long term care company (Centers plan for Healthy Living) and picked an home care agency (Edison Home Care) that works with Medicaid. So i hired my own aids and had them sign up with agency and edison pays them (medicaid pays edison) .originally her social security was over the limited but did a spend down each month. You can submit any medical pills (pull-ups, medical dr co pays, etc) to spend down the overage of what she brings in for social security. as of 2023 we longer have a spend down. New law not sure how that happened, but its working. don't give up if her social is to high. put monies in your name. try stay at home route for as long as you can.
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We promised to keep my BIL in his home but couldn't because he fell and laid on the ground for 30 minutes until someone found him. We had to put him in a nursing home into memory care because he has dementia. My BIL had been living with dementia for the past 5 yrs and he is still there. You don't know how long someone has on this disease it could be years.

To get him on Medicaid I had to spend down his finances to where he was under the $2000 that Medicaid allows someone to have. Once I did that I got him onto Medicaid. With Medicaid his social security all but $50 goes to the nursing home and his pension goes to the nursing home. That $50 is suppose to supply them with some of the special needs they want because the nursing home supplies everything the will need.

I can understand you promised her but there is a time when you have to figure it out if you can take care of her. You need to think of her not her wishes. If you can't then the best place for her is in memory care at a nursing home they really take care of someone there. You can make it out that she has things from her house or bedroom there where its comfortable where they recognize their things that is what we did with my BIL. He has his recliner, his tv, his hats on the wall, and his ottoman. Also he has his bedding there too.

Prayers you find a way
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What do you mean by “Agency for aging …” approved her for care? Is that a state run program?
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GB2112 Apr 2023
I’m wondering the same and I’m in CT. Alodocios, who is paying for the 36 hours?
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Simply say that when you promised her that she could stay home that you didn’t truly know all of the facts.

Plus, no one has a crystal ball and can tell the future. Situations change and we must adapt accordingly.

Discussions about growing old are important to have before we get old. It would avoid so much stress, confusion and headaches.

I have told my children that I don’t want them to be caring for me because I want them to live their own lives. If I need to be in a facility at some point, so be it. I never want them to be stressed like I was with my mom.
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You’re understanding as your mom’s health issues worsen - you never should have promised her you’d keep her at home. You didn’t know it wasn’t possible! She didn’t know what a burden that promise would place on you.

Don’t feel guilty that you can’t keep the promise. Most people who make that promise to parents can’t follow through. She needs to be in a facility that can provide the level of care that she requires.
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If you are looking for an "ideal" at this time, I greatly fear it just doesn't exist.
I don't think that you will find any help with paying for 14 hours of in-home care. I think that placement may be necessary. In that event all of mom's income, whatever it is, will go to her care facility once her assets are spent down, and then the combined Federal/State medicaid will take on the rest.

I think that you should see an elder law attorney or a Licensed Social Worker in order to ascertain exact income, exact assets, your state's Medicaid options and help with application to Medicaid. The taxpayer supported programs don't really support in home care in most cases at this stage, though with, an aging population, laws are always changing.

As laws vary greatly according to states you need good guidance here. Paying for it is one (sad) way to spend down.
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I have no idea how Medicaid works in Conn but in NJ you cannot make over the income cap. In NJ the income cap is just over 2500. So if your monthly income of SS and any pension is over that 2500 you don't qualify for Medicaid. We also allow Miller Trusts.

I agree with Barb, see a Medicaid planner or Elder Lawyer who is well versed in Medicaid. I looked it up and doesn't look like they allow a Miller Trust or Qualifying Income Trust. I also could not find an income limit only says has to be less than the cost of the nursing home. Here is the article:

https://www.medicaidplanningassistance.org/medicaid-eligibility-connecticut/
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GB2112 Apr 2023
We do have the equivalent of a Miller trust in CT — it’s the “pooled income trust” mentioned in the article.
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If your mom needs 14 hours a day of aide care she really should be in managed care.
No one is turned away from a nursing home. In truth most people cannot afford to cash-pay for one for very long. The cost here in CT usually starts around $10,000 a month or more.
They will take her income and then she goes on Medicaid. Many times the nursing home a person goes to will do the Medicaid application.
It's very sad when a family is forced to make the promise that they will keep an elder at home. No one should ever ask this of their family.
Yes, you will have to renege on that promise. Don't have a moment of guilt about it because it should never have been asked of you.
In Connecticut there are constant advertisements for Hartford Health at Home. They claim to provide live-in care.
They're a huge operation. Give them a call they may be able to help with the Medicaid.
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Hi Alodocios,

I believe Mstrbill is correct. I found the same thing in MA in my research, at least for the waiver program for care at home. My dad would qualify based on his income but mom is about $300 per month over. I asked well then what happens to mom and the SHINE counselor (they are specialists in Medicare and Medicaid programs for care) and she said nursing home. Outside of state elder services that have the copays (and as you noted not 14 hours of care daily) it has to be private pay or nursing home covered by medicaid. Care at home is out of range for those above the income caps. So mom would have to go to a nursing home with a medicaid bed if her needs were too great for the PACE program. With PACE, where she could get more services, she'd have to change to their doctors as well.

It's all still pretty confusing to me but trying to get more versed in it while I have a "window".
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It is time to place her in a nursing home covered by long term Medicaid. Don't worry about not being able to afford nursing home, that will work out, the state will pay for it. CT has fairly smooth process, you can apply online and someone will contact you the next day. I was once in a similar position and went through the process. We couldn't afford the home care, and at that point it wasn't enough coverage anyway. The difficult part is getting her into a NH. You can start by visiting homes in the area and applying mom. They will take her if she is Medicaid pending. If there are no open beds in the nursing homes you select, get on the waitlist. If you can't wait any longer for a bed get a social worker to help you, either from agency on aging or the local hospital. If things still do not happen quickly and you are at a crisis stage, the ER becomes the last option. I was at that last option, and the hospital found an open bed within a week.
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