We moved 2500 miles in June to take care of mother in law she is manipulative, mean (but not to people who baby her and tell her what she wants to hear and do what she demands when she demands) and a narcissist. She recently fell and broke her leg above the knee, the hospital is saying she can only stay in rehab upon discharge for 84 days as that all Medicare will pay for. She gave up part b 24 yers ago, so she’s private pay. Most of the skilled nursing homes here won’t take her again since she owes so many of them thousands of dollars and refuses to pay even a little. She squanders her money on supplements and can’t afford caregivers anymore, or they won’t work for her since she falsely accuses to eps, that they are abusing her etc.
She pulled that with us said if we don’t treat her like a queen and do what she wants when she wants she’ll report us for neglect. We’ve already contacted eps and senior services and they know, we got cameras as suggested to cover our butts. They are saying we have to take care of her after her time runs out at rehab, she can only walk to chair and commode in living room about three feet with walker before she fell. We have told both social workers there is no way we can take care of her if she can’t walk , the hospital social worker says we have to. We don’t know what we can do, feel bullied and lost. Mother in law is so demanding we’d never be able to sleep as she changes depends when she barely gets a dribble and it would be worse if she’s bed bound. And will be wheelchair bound. My husband and I have back problems so that isn’t an option to do it if she can’t walk.
Sorry if this is hard to understand just overwhelmed right now may not be best question or explanation.
forget about Medicaid caregiver exemption, as mortgage co is getting the house & selling it. RM repay costs are huge, not likely affordable.
So MIL has history of non-compliant for care, owes past rehab stays, filed false reports to APS/EPS, went thru 225k, won’t pay bills and now down to $700. Plus a RM. Horrors! Really your choices are limited.....
The bright spot is - to me - is that tomorrow MIL goes into rehab at a facility & covered by MediCARE for hopefully 20/21 days minimum. Please make sure hubs does NOT ever just sign his name on anything. It always must be as “Jim Smith in his limited capacity as dPOA for Jane Jones Smith” and get a copy of all paperwork.
Try to use the 20/21 to find & organize all the legal and financials on MIL. Like the RM contract; search to see if she’s current on property taxes; ditto for all property insurance required by the RM; find her 2020 awards letter from SSA (these got sent like 3 weeks ago); at a minimum 3 years of bank statements; her debts. Look for anything over $600 that could possibly be “gifting”, like a check to sibling for $987.65 or odd bigger cash withdrawals. You need to see just what type of issues are looming for her eligibility for Medicaid & for her to stay in compliance for the RM.
if hubs is not a signatory on her bank accounts, or doesn’t have a debit card on her account to use, go to the bank with the dpoa and find out what exactly needs to be filed to have these happen. She really must pay required Medicare rehab copay ($abt 175) for her stay after initial 20/21. AND by her doing this, it buys you even more time to come up with a doable plan to figure out just what you & hubs next steps need to be first & foremost and then if it can dovetail for meeting the level of care her needs assessment shows she’s at & possibly done in-home.
whatever the case, if she has a life insurance policy with cash value - like whole life - these funds will need to be cashed out & spent down either by paying you all legitimately to be a caregiver or/& has to be spent down other legit ways before Medicaid will deem her eligible. Hubs as her dpoa can put this in motion this week.
Your 43, hubs 54. Your really young & need to use this time to build up your own finances and retirement future. Not giving up a job to caregive for free. Military retirement is great but is it alone enough for another 30+ years? MIL is not going to get healthier or easier in personality. I imagine the now absent siblings & their spouses 86’d her as she’s toxic. You at 2500 miles away didn’t have real time on MIL like they did. You misjudged the situation, but you can now use the rehab time to clearly figure out what options are for you all and then for her.
Also if your 43, what’s going on with your folks? What’s going to happen if they, or your favorite Aunt, need help years from now? Is hubs willing to move & to do for them what you’re doing for his?
This office advocates for the patient and the family.
This is the second post I have read today about terrible social workers. Your MIL should be going to a rehabilitation center. Medicare covers 100 days of inpatient care which includes rehab. The Dr. needs to send her to a rehab facility and the social worker can help. I believe that the patient has to have at least three days admitted to the hospital and that can not be admission on observation only.
Lastly, she can demand all she wants but one thing caregivers need to do is to train themselves to STOP enabling bad behavior. If she fed and clean and settled into a comfortable chair with a snack and a drink, tune out the shouting and demands. There is a commercial (I think it is for Amazon) which shows kids in a house practicing with their little band and at the end you see the father wearing some good headphones and listening to calm, classical music.
MediCARE rehab benefit requires elder to be sufficiently “progressing” in their rehab based on the ICD-10 codes in their discharge notes. So like hip break & new hip will have a set amount of rehab to be done & measurements taken to see if they are progressing in rehab for post new hip surgery. The progressing markers for hip will be different than for stroke care or broken foot. Comprende?
Plus you have to think about if the elder will actually do what’s needed to meet the progressing markers. My late mil (most difficult) would not work with PT & OT in rehab. She would be all, it hurts & I don’t wanna get out of bed, get dressed, etc. They aren’t going to make her. Instead they will notate shes “noncompliant for care”. Couple of days of that & she’s written up as not progressing & MediCARE rehab benefits stop cold. Adios MediCARE. Yes MediCARE stops paying the facility. If she’s going to continue to be there she goes from being a rehab patient and instead transition to being a LTC resident. LTC NH is either private pay, LTC insurance coverage or LTC Medicaid. If your not-so-delightful MIL has old outstanding bills at various NHs, none of them will easily take her again. & new ones can look at her health history & where she went before & can find a reason to decline her placement.
Shes toast on getting a NH easily.
You all may need to look way way outside of your city or county to find a NH who will take her & her SS $ as her copay while her LTC Medicaid application gets processed.
the discharge planner is telling you “84” as that’s the internally done max stay at a facility for post hospitalization MediCARE rehab benefits. Technically it’s MediCARE pays 20 days in rehab @ 100% then MediCARE can pay 80% for days 21-100. With elder fully responsible for the 20% copay; if they have 2ndary insurance - like BCBS or a gap/ supplemental - they usually pay the 20%, but the Advantage plans may not as NH rarely are in-network for the plan. Your MIL has no secondary insurance so the 20% is all on her or whomever signed off to be financially responsible for her. The extra 4 kinda factors in for a weekend entry & discharge OR EOD discharge as often families can’t be set up to get them that day but come to get them like over a weekend. OR discharged from Medicare at 4:30 PM Mon but you can’t get them till EOD Tues or Wed AM. MediCARE pays 2-3 times a daily room & board rate than what Medicaid pays, so keeping them an extra day or nite is ok as NH has made its $ from MediCARE. If she’s totally tippytop paid up copay, they will likely be fine with the extra time.
if MIL has a history of being non-compliant for care, it’s gonna imo be a beast to get her placed. Discharge planner knows this & will do whatever to get family to come & get her. As others have said, you & the DPOA have to, HAVE TO, say definitely that you cannot care & it’s an unsafe return situation at her old home.
Rose a ? for you? Is there a mortgage or heloc or any other securitized lending on home? If mil is a financial terrorist atop everthing else, I’d really really suggest that you look to see if there’s any lending attached to the home ASAP. County & city assessor records should have any filings (recordings) if it was put up as collateral. Most places have all this available as an online download at minimal cost. Like $8.00 for a Warranty Deed. Imho you clearly want to know this before you get too deep in paying for stuff on her place and having the plan be that mil keeps her home. Good luck!
Either way choices are stark & to me the issue first & foremost is not her but you & can you determine what is best & then will you act in your own self interest? Not MIL interest but yours.
Right now your only 6 months in on toxic Nightmare that is your MIL (guessing is 88-90 & your mid 60’s?). So caregiver exemption (filed to MERP/ Estate Recovery) that Medicaid allows is not an option if she filed for LTC Medicaid now. You’d have to do another 1.5+ (Sept 2021) yrs of care & document that it was needed by having some sort of statement on her care needs from her MD or SW. The rub on “caregiver exemption” in my understanding is that IT IS FILED AFTER DEATH. That presents other issues, like being able to get her current MD to do a legal document for you after she’s dead years from now. Once she goes into a NH, she’s not gonna be under that old MDs care but under care of MD who is the medical director of the NH. If she lives another 3 years, that’s 3 yrs removed from doing care & no current health history so old MD may not be inclined to write anything that has legal implications. If MD is part of a large health group, the policy may flat be that unless it’s a current patient, that no type of “care status” letters are done ever.
To me the caregiver exemption is smoke & mirrors. Can it work, maybe but pretty big boulders to overcome. Now IF your state allows caregiver exemption to go forward in tandem w/elders LTC Medicaid application, under that system, it can work but needs elder law atty to shepherd both her application & your caregiver exemption application so the property transfer can happen. So is Sept 2021 do-able???
Now onto other issues with care exemption, is your hubs only heir as per his moms will? If not, then each person in will is a heir & either they too need to be eligible for their own exemption or thier % ownership can have MERP lein placed on it. So 3 kids & $99k house, your 1/3 exempt but the other 66k has lein in it that has to be satisfied to get property title transferred. Or MIL does codicil to will naming hubs only.
btw there are other exemptions & exclusions to MERP, like low income heirs, cost benefit analysis to recovery. And heirs can file for probate & then everybody has to deal with probate court rules for your state.
Realize you could go hardball route on the house.
By & large Medicaid cannot force mil to sell her home except in rare situations. She can be on LTC Medicaid & still own home. But she will basically have zero $ for any property costs. So Since June move in, what are you & hubs doing for income? If she’s 88-90, your 62+ & on SS retirements? Right now are you dependent on MIL income for all household expenses to be paid? Are there others living in the place? Or could you & hubs cover all property costs for maybe 3 years? Keeping house can be done but in my experience you have to have the purse or wallet to pay all property costs for an indefinite period of time, like beyond mil death for maybe 2 years. & a pretty good sense of humor about all this & can roll with whatever issues come up. Like “ mature” tree falls on neighbors driveway & its $1800 to remove.
MIL isn’t going to get nicer or be healthier. There’s a NH placement ahead for her. But what is best for you & realistic to follow thru on?
Anybody DPOA for MIL? Hopefully it’s hubs? If not, what is their position in keeping her home or moving into NH?
I hope your husband is also onboard with NOT taking care of his mother.
Is he? Or will he allowed himself to be bullied?
You don't have to take Mom. Tell them you have your own physical problems. That Mom has no money for homecare and when she has aides she lets them go.
BUT... this also means you won’t be able to continue to live in her house. The house will need to be sold and applied towards her care facility bill.
Of course this is all assuming she won’t be able to return to her home to live independently - without your caregiving.