Dad is being evicted from SNF and was denied Medicaid because of Mom’s assets. She wants to keep “her” money. Can I use “her” money to contribute to Dad's spend-down?

Part 3
so Ward of the State means that for whatever reasons there is nobody within the family able to take on the responsibility of a vulnerable adult who is not competent or cognitive to manage their affairs. There is no family or others involved in the elders life to become a guardian. So the judge (heard in probate court) authorizes for vetted court appointed guardian (usually from a list the court has on file) for the vulnerable adult, who then becomes a “ward of the state”. The guardian has VERY VERY significant power…. like can determine where the ward lives, what wards $ is spent on, can sell wards assets…. And importantly can work with APS & law enforcement to go after anyone who they believe to have taken advantage of the ward currently or in the past. Your dad is viewed as a vulnerable adult and there are laws to protect him which the guardian can use to get the $ needed to pay for dads care and settle dads bill to the old NH. LSS a court appointed guardian can go after all $ & assets of your parents or that was gifted. Will not be pretty.

This is serious stuff.
Your mom cannot just go along thinking she can ignore the bill dad is accruing at the NH or can ignore his safety and security and care. I’m gonna guess that someone (looking at Sissy or her husband…) has told mom that she can do a refusal to pay for her husbands care. Refusal to pay can happen…… but to me in my not an attorney but as an Executor 3 have sat thru more than 1 guardianship hearing in probate court awaiting my turn…. that is not the issue here. The issue is your mom is refusing to allow for her husband/ your dad to have access to his martial share of their joint assets and has gifted $ from martial property sold to others excluding his % as a spouse. This is different than she is refusing to pay the balance left of dads monthly room&board after he pays his SS$ to the NH or refuses to pay the monthly note on a car in dads name.

Plus by her gifting $ into a bank account in your & Sissys name have all 3 of you involved in all this. It’s way way too complicated for you to deal with. CELA atty asap.

if I was in this position right now & was POA for my dad & I had access to that land sale bank account, I’d take out 3 months to the penny of dads NH bill and do it via a certified check or wire transfer to the NH. Being POA requires you to do your best fiduciary duty on the behalf of your dad and with his assets, paying 3 months is something to show you are doing at least something on your required fiduciary duty. Billing Dept at the NH can give you a 90 day statement. That’s the figure to use & you want the $ to transfer immediately. So no check written. Has to get withdrawn & deposited immediately. You are done to ensures his health and safety and you do it in your role as his POA with access to this bank account. It literally buys you time for an attorney to start to deal with all this. There will be fallout… just how nuclear imo dependent on Sissy.

On the possibility of being creative up w assets…. Your mom as long as she continues to live in the community… whether in her home, IL, AL… can continue to have her own assets & separate from your on LTC Medicaid dad. But rules are firm that all assets have to be looked at to determined division as on date of his Medicaid application. By her doing gifting, she’s already red flagged his application. So Medicaid has her name & SS# should she herself in the future need to apply for Medicaid. Your Mom has a LTC insurance policy, will it cover all NH costs till death? If not, what then?

fwiw my moms 2nd & eons better NH did not take LTC insurance. I was told that reporting needed to satisfy insurance co’s too onerous & slow pay to be worthwhile. It was Medicaid or private pay only.

Please please really find a CELA atty for dad. Good luck in all this too.

Part 2…
If Gifting happened, it places a $ transfer (of assets) penalty against the eligibility of the LTC Medicaid applicant that starts date application filed. Not the date the gifting happened.

It’s a math (division) equation. Divisor (lower) is fixed $ amount your state’s Medicaid program pays NH for daily room&board. Some pay $160 a day, others pay $300+. Dividend (upper) is $ amount of asset gifted. For land / homes, tends to be that years tax assessor value OR what property sold for if over tax assessor value.
Say State pays $190 day & land sold $250K; that is a whopping 1,315 days of penalty before applicant will be able to have Medicaid pay for their stay for LTC at the NH. Again 1,315 days or close to 4 yrs.

To make matters worse…… for most states, applicant has to be at impoverished (2K in assets) or close to impoverishment (like under 14K) in order to file a LTC Medicaid application. So they do not have any assets left to pay NH bill. They will be delinquent the minute State establishes a transfer penalty exists and sends out a letter to the applicant, their POA and the facility. Medicaid can take anywhere from a mo to 6 mos (my moms took 5.5 mos) to review an application and every day there is a room&board charge accruing. Will be serious bank on the NH if it goes on too long and why a NH will issue an 30 day eviction notice &/or require the family to private pay and sign off on a financial responsibility contract for elder to remain.

The NH, if stuck in this, might at best have the residents monthly copay of income if your state allows for that to be collected by the NH. But otherwise the NH is sh** out of luck on getting paid unless family pay the delinquency OR IF the applicant is married. The NH can do a bill at private pay rates for every day dad is there and turn it over to their attorneys or to debt collection co to get whomever they can to pay or file for a judgement against whomever they can. So if NH pp rate is $345.00 day and dad is there 3 months so far as a LTC resident, that’s $31,000 and counting. Debt collection can file to get a judgement against mom or whomever they can. If your parents own a home, debt collection will place judgement attached to the home; if you as DPOA signed off to personal responsibility in any of the admissions paperwork, you too can get a judgement filed against you. If you do NOT have every page of the admissions paperwork, you need to get this asap, so you can see exactly what type of exposure you as POA have. If you don’t have admissions paperwork, getting it now after the fact, well the NH can take it’s sweet time in doing this….. it may need for your atty to do a demand notice to get copies of everything.

I’m going to guess that Sissy is not at all on any NH paperwork. Sissy won’t get the debt collectors mailing or judgements. Sissy in the clear (too bad so sad for others) UNLESS the situation with dad morphs into dad needing to become a ward of the state.

I’m going to guess that there is no way that dad can be taken care of at home. That his level of care and oversight after months in rehabilitation (MediCARE paid) and now weeks of being a LTC resident is beyond anyones in-home capabilities ever.

NH knows this and it presents a quandary for them….. to paraphrase The Clash… “darling, you got to let me know, should I stay or should I go now…. if I stay it will be trouble, if I go it will be double”….. NH can
1. contact APS and then APS contacts the court to have a emergency ward of the State action done on dad & dad stays at the NH. This will morph into serious issues for y’all.
OR
2. NH finds a reason to call EMS to have dad go to ER and then refuses to take him back under the rational that NH cannot meet his required level of care. It’s a legit move. The discharge planner at hospital now stuck placement. And if family does not deal with this, APS gets notified and Ward of state gets done.

Ward is serious… more in part 3..

RitalinNC - personally if I were you I would asap do whatever now to get in front of dad being delinquent in his NH bill in May (June?). With the issues you have, this is not a DIY project but needs a CELA level of elder law atty as others have mentioned.

Your dad still has some $ that is available as he has abt 20K left and is current to date for his SNF/NH, so imo you have a window to do this. And dad still has the $ to pay for the atty…. This is mucho importante as it kinda should be his $ paying for atty. not yours as the actions effect you. But window closing fast and be a serious problem not only for dad and mom but for you and your Sister. Yes…. you & Sissy….

Here’s imo why and hang w me on this as not straightforward:
- your parents are married so all assets are viewed as joint. Even if say mom had her own business w IRS K-1 w her SS# as 100% on the K-1, “her” biz would count as a joint asset for Medicaid if they file jointly. And along same lines, any other assets she has - like real property (land, house, car) - count as joint. So that land sold is a joint asset, it is not “hers”. To prove otherwise would need a legal paper trail from b4 married w biz or property in question being totally segregated during their marriage. Medicaid can get their old IRS & state tax filings, look into all sorts of databases; stuff surfaces. It’s just a matter of keystrokes for the caseworker to do.

AND to make matters worse….
- mom placed land sale $ into an account that is owned / shared by her, you & Sissy. That’s correct, amirite?!?!
Moms doing this created “gifting” for Medicaid. By having land sale $ bank account available to you & Sissy ((I’m looking at Sissy hard on this as I’ll bet a case of Prosecco that she is driving force on all this no $ 4 dad nonsense)), well Medicaid could go hardball and view the entire sale $ of the land as gifting. If you or Sissy have done any withdrawals for your own use, “gifting” established. Gifting can morph into other issues, more on this in another post. Gifting alone is a clusterF to deal with, not a DIY, ya need CELA atty.

Couples CS / LTC Medicaid is complicated to begin with as there’s lots of segregation of assets, insurance, titles, involved, like:
- Medicaid marital “assets” division set by ea state uniquely & not necessarily 50/50 split. Most allow $128,000 in “assets” for CS to retain. There r some kinda set-in-stone givens:
1. the CS (community spouse, eg your mom) is NOT themselves expected to become impoverished. Only dad, the NH spouse, needs to have his own mo “income” at or below $2,200 (for most states) & his share of “assets” down to 2K.
2. for couples (CS/NH), Medicaid does a fixed “snapshot” day as to what income & assets are; eligibility for LTC Medicaid is based on snapshot. Say application 2/28 and on 2/28 they had $234K assets, for most states the NH spouse would need to spend down 106K.
3a. NH spouse required to have their income go as a “copay” to NH less a sm personal needs allowance.
3b unless CS can show need of NH spouses mo income to keep their household afloat. If so, CS can file (atty best on doing this) for CSRA/ MMNA, which basically waives or diverts a % of NH spouses income over to the CS.
3c Medicaid allows CS to keep their mo income in separate account.
LSS Mom will not become impoverished if dad goes on LTC Medicaid. For CS/NH situation it’s complicated to begin with and add on the whole land sold and put into a bank account that yiu & Sissy are owners of / have access to makes it even more complicated. Not a DIY but CELA atty needed.

There r more creative legal things (SPIAs) that might be done & something a good CELA atty will know about. But imo IF the CS is themselves elderly & looking like needing AL or NH very soon, doing anything seriously creative with $ is flat not happening. That ship has sailed and off at the horizon.

sp19690,

You ask on the thread who gets all the money that nursing homes charge for a resident.
The answer to that question is the shareholders who own stock in the nursing home or the parent company who owns the nursing home.
That's who gets rich off the sick and the elderly. They are the ones who profit from the financial hardship of families every day.

Medicare will not pay for 100 days of skilled nursing. They will pay 20 days at 100%, if dad continues to progress, up to 100 days will be paid at 50% after the initial 20 days. And that is only after a qualifying hospital stay.

From a previous post "Mom has cognitive issues and probably going to memory care assisted living soon. She has a LTC policy. He does not."

https://www.agingcare.com/questions/what-to-do-when-medicaid-is-denied-473120.htm?orderby=recent

Has mom been declared incompetent? Who is her POA?

You need professional help for this, likely an elder law attorney.
SNF is not a nursing home. It is a skilled nursing facility and it is covered by medicare but only for so long as SKILLED nursing care is needed. It is covered in similar ways to rehab. That is the norm. Is there some way in which this SNF is different; is there some reason that a move to nursing home was not made; it is much less expensive?
As to division of assets now Dad is in care, that is crucial. You need to see an elder law attorney because the selling of an asset belonging to both belongs one half and one half to each and should not be in a joint account with other family in any circumstances.
With two parents needing care, unless there is a lot of wealth, there is going soon to be a need for medicaid and a lookback of 5 years and I am concerned about how this money is being kept and is divided up. And whose names are on the accounts. And how the records are being kept. And by whom as POA.
See an attorney. You need real advice. Take a list of all assets and how they are held.
Be certain you sign things now only as POA if that is what you are, or not at all. It sounds like the ways of keeping and keeping track of monies, ALWAYS DIFFICULT in a married couple with one needing care, is getting really muddied up here. I can't know all the ways that is happening but it sounds like it is, and when medicaid is needed a plea of "ignornance" (meaning we didn't know) won't help at all. Your post really concerns me about knowledge of how money for elders needs to be handled and protected.
I wish you the very best, and that why I say, PLEASE see an expert.
I am hoping Igloo is out and about today as she often has good advice about these things and understands how they work.

I want to point out that a NH cannot evict Dad. If he is 24/7 care and has nowhere to go to get that care, its an unsafe discharge and they cannot discharge him. You as his POA are not responsible to pay for his care. But as his wife, your Mom is.

This is going to make you unpopular with Mom and Sis, but you need any bills from the NH to go to Mom. She needs to receive the late notices and be told she needs to see a lawyer to help her protect her assets. You getting these bills means nothing. When Dads money is gone its gone. POAs are not held responsible for the Principles bills once no money is there. I would think the NH will be able to put a lien on Moms house for any payments due.

Medicaid allows for splitting of assets. Which your Mom needs to do. There are certain things that don't need to be split, like some retirement accts. But marital assets have to be split. If Mom transferred money within the 5 yr look back this is considered fraud, hiding money.

Your Mom will remain in the home and have a car. Their monthly income will be looked at to see what she needs of that income to live. If all, she will get it all. If partial, Dads part will go to his care.

Well, you being POA does not mean you physically care for Dad. So u better make it clear to Mom, if he can't stay in a NH then she, as his wife, will need to care for him.

I don't understand Dads money and Moms money. It may be found when all is said and done that Dad has already spent down his half of what is considered marital assets if the lawyer can go back to when Dad entered the SNF. Maybe it would be a good thing for u, Sis and Mom to all go see a Elder lawyer together. That way the lawyer can explain to Mom what marital assets mean and where her responsibility lies in caring for her husband.

Please also advise your mother to seek out an elder care lawyer, shop around look for one that has dealt with larger estates. Sure it will be costly but trust me it will be well worth it. Medicaid system is riff with loopholes that can be used to maintain your mother’s assists and get your father the care he needs.

Do not let them push you around, they operate on scare tactics if you are diligent and mindful things will be okay.

Disregard whatever the SNF says about handing over all the assets. Your mother as a legal spouse is entitled to keep half (50%) of all assets, bank accounts, and liquidated assets.
Medicaid will also leave a dependent spouse enough to live on. Your parents' house can also be a Medicaid-exempt asset if your mother lives in it. She can also keep a car.
However you and your sister are not entitled to any of it. Half of it will go towards cash-pay for your father in the nursing home until he becomes Medicaid eligible.
Please as POA for him do not give the nursing home direct access to anything related to your parents' finances. Do not allow them to directly withdraw from any bank accounts either. They cannot be trusted. Insist on an itemized written bill every month. Scrutinize every charge before you pay anything. Then pay them with a certified cashier's check from the bank. This is what I did. It's tedious but worth your effort.
Also, the "evicting" him from the nursing home is just a scare tactic to get money. They are as the saying goes "blowing it out of their a$$". They legally can't just stick him in a wheelchair and push him out onto the curb.
Your story sounds almost exactly like mine when I was POA for my father. DO NOT BACK DOWN with these people and don't let them intimidate you.
I too consulted an elder law attorney who told me exactly the same thing that the bills have to get paid and to just pay the nursing home. Yes, the nursing home has to get paid but they're not the only bill. Medicaid understands this. Communicate with them. Nursing home demands are different than Medicaid demands. Medicaid is reasonable to deal with. The greedy business end of a nursing home is not. Find out who your father's Medicaid caseworker is. He has one because the nursing home has already applied him. You as the POA have a right to this information. Then speak with that person.
You are not helpless.
Also, communicate with the probate court in whatever town your father's nursing home is in. The nursing home will very likely try to sneak getting conservatorship over your father. They will not even notify you when the court date comes up and if you're not there you will lose by default. They pulled this on me but failed. I got lucky because a lawyer who's actually a real estate lawyer gave me this good advice and told me to stay in touch with the probate court because nursing homes do this sort of thing all the time. You should do the same.
Another thing. People get up to 100 days a year of paid nursing home care from Medicare if they qualify. If father goes to the hospital and stays three days or more, some of the NH days are covered by Medicare when he goes back there. That's why you insist on a written bill every month.
Don't pay what isn't owed. If Medicare is paying, you don't. Look at those Medicare statements closely when they come. Make sure his mail doesn't go to the NH either.
You'll be okay. Pay close attention to everything. Don't back down and don't be intimidated. Keep us posted.

Your mother and sister are committing financial abuse. It doesn't matter what they "want". If your Dad has a martial interest in available funds, that money needs to be used before Medicaid will kick in. Just because your mother deposited it in a joint account in your name, it doesn't mean these funds won't be considered part of his assets. Also, all martial funds are considered joint. A court will decide on your mother's and sister's behalf if they refuse and they will side with the use of assets. If your father is evicted and/or you need to find a new place for your Dad, you may face additional charges and unnecessary change for your father. I think your mother and sister are being either selfish or ignorant of the "rules", either way, I would get it resolved quickly.

Get with a certified elder law attorney, see what they advise.

Dad is entitled to one half of the proceeds from that sale. When spent down then he will qualify for medicaid. Personally, instead of having to pick dad up, I would go to that bank and withdraw one half of the proceeds and deposit into an account in only dad's name!

DO NOT use your own funds to finance dad. The proceeds are not your funds they are half mom's and half dad's.

Call APS. This is essentially elder financial abuse, and if dad is evicted and there is no one to properly take care of him (and there won't be, properly at least), he will suffer from neglect. If he ends up in a neglectful state APS will take him and take guardianship and ensure his safety. But we don't need or want it to get that far. You with POA should have control over the funds so you shouldn't feel "helpless", you should be using all of the required funds to pay the NH to qualify for Medicaid. If APS gets involved, they are going to take control of the situation anyway, but if dad is evicted and becomes an at-risk adult because he isn't properly taken care of, you and your family are potentially looking at more legal trouble.

See a CELA attorney to do am application and divide assets. Mom and sister can't divide the marital assets to suit themselves. A payment plan sounds strange too unless they expect you to make payments.

I get it that Mom and Sis don't "want" to have to pay a nursing home... but the whole nursing home Medicaid process was riddled with things that I didn't want to do: cleaning out a house while the woman's emotionally-charged sons leafed through family photos, trashing/donating possessions which I knew the lady cherished because they simply could not be kept, dealing with the nursing home, dealing with the lady demanding to come home and forbidding me from selling her house (I was working with POA), dealing with an obnoxious realtor, selling the lady's car, consolidating her finances, resolving two liens on her house so that it could be sold, repeatedly explaining to the neighbors what was "going on", dealing with elder's sibling who was in denial, dealing with anyone else who made my journey difficult because they knew I was exhausted and desperate. And my person was a widow who never remarried. This makes Medicaid a lot simpler. Married people it's different when one is in a facility and the other is not. My understanding is that things must be divided between the spouses or Medicaid can be denied. Medicaid is for those who cannot pay any other way. If there are assets, then there are other ways to pay. I had a family member ask me to put the house sale money in a "fictitious" bank account to hide it from Medicaid. I refused. It's just wrong to try something like that. Sad that a lady who worked all her life is now only worth a couple of thousand dollars that she's allowed to keep, but that's how it is. Medicaid will not cover those who have other assets until those assets are spent.