Mother had a stroke. Went from hospital to rehab center, now is being moved to skilled nursing home for rehab. Medicare/insurance pays for the first 10 days and day 11 to 100 mothers cost is $50 per day. She may be able to return home or may need to live in nursing home. Her house just sold last month and I would like to help her retain some of that money if possible. If she has to live in a nursing home will they just take all her money? Is there somewhere, legal, I can keep some money for her? Can she legally give any to family members as gifts? How much?

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The problem is that personal resources are exhaustible and it is unknown for how long mom will require care.

There are some accuracies and inaccuracies shared above.

First, as described above, Medicare will only pay for the first 100 days IF she requires skilled care and is improving.

Second, Medicaid is the only other payor source other than personal resources.

Third, to qualify for Medicaid the applicant must have less than $2,000 in assets. There is also an income limit which varies by state. All of her income (Social Security, pension, etc.) will go to the nursing home if she qualifies for Medicaid.

Fourth, the asset transfer rules prohibit uncompensated gifts within 5 years of application for Medicaid. The annual gifting exemptions mentioned above apply to the Federal Estate and Gift Tax and have NOTHING to do with Medicaid qualification. It is irrelevant.

Fifth, if mom does go on Medicaid she will still need funds to meet her other needs. She will need clothing, glasses, hearing aides, dental, other personal needs, etc.

Sixth. There are several techniques available to move money legally so she can qualify for Medicaid. This is NOT about kids getting the money. It is about assuring that mom will be well provided for. For instance, look in to having her gift the money to a Supplemental Needs Trust. Gifting to this irrevocable trust will allow her to immediately qualify for Medicaid and the funds so transferred can be used for her health, maintenance, and welfare while receiving Medicaid benefits. You do not need an attorney to do this. Do a search for such a trust in your state. They are run by non-profit organizations. Compare several as costs vary (not surprisingly, some are run by attorneys and are very expensive).

You can also use part of the money to establish a Personal Service Contract between you and mom whereby you would be paid to perform services for her above those that are provided out of love and affection. This will allow a lump sum to be legally transferred from her to you and she will also thereby immediately qualify for Medicaid.

Again, this is to provide for her needs...not to enrich family members. Prudent planning of this sort makes sense.

Good luck!
Helpful Answer (1)

kerry - Whatever route you take for your mom it will be expensive and she will run out of $ eventually. IMHO what you need to decide is how her care is going to be paid you & the other family plan on spending all the house sale $ on a facility and when that's gone have her apply for Medicaid OR do you all plan to continue to pay for her privately. If Medicaid is in the plans, then try to get her into a facility that takes Medicaid so you don't have to go thru moving her again. The social worker at the SNF can tell you how they handle this or recommend other places. I've found social workers are better on this than dealing with admissions.

Whatever $ she got from the sale of her home needs to be used for her care & her needs. Because the sale was so recent, it would come up in Medicaid asset review & look-back which can be 3 - 5 years depending on how her state manages Medicaid applications.

Remember for Medicaid for NH, they must show that
1) are 65+,
2) medical condition requires that level of Nursing health care,
3) monthly income is less than her states ceiling +/= 2K,
4) countable assets are less than $2000 and
5) not gifted away anything of value during the spend-down & look-back period.

However, you do have the advantage of where the $ is “spent down” – which means getting her assets (excluding homestead & car) under the state’s Medicaid asset ceiling. You can buy her funeral and burial policy, small term life insurance Whatever they need to be irrevocable NCV. Glasses, dental care (spotty on Medicaid), hearing aids, walkers, clothing suitable for being in a NH. She can own a car. No $ gifted to others but if she went to live in a family members home she could possibly do a personal services contract for managing her care ( I don't think she can do this if she is in a SNF but that's an attorney question). Basically everything must be for their care or property.

All this being said, alot of this depends on what the house sold for. If we're talking
a very modest amount, I would just spend the $ on her care at the SNF &/or NH and apply for Medicaid. If the $$$ is significant then go and see an elder care attorney who practices in the county that she resides in to see what the options are as her state law allows. All these issues are sticky, you'll need to hire an experienced lawyer to help so you don't run into a Medicaid penalty period later on. To begin your search for the best lawyer for the job, contact the local bar association and ask whether it has a lawyer referral service that includes those who specialize in elder law or conservatorships. You can also contact the National Academy of Elder Law Attorneys for a referral to its members in your area.

Also IMHO you should have the following done if you haven't already:
- Durable Power of Attorney (not just POA & not a "springing" DPOA)
- Medical Power of Attorney

- Living Will &/or Advance Directives (DNR)
- Declaration of Guardian in Event of Incapacity

- HIPAA Waiver
(general release one)
- Will or a Living Trust

I'm a firm believer in having an elder care attorney take care of all this. It will not be expensive as most is done by the paralegals. But is invaluable if there should be a problem later on. You do want to go in prepared with what the information is for the documents (e.g. Ann Smith, wife of John Smith, with the info on all the births, deaths & prior marriages) as well as valid ID for the elder. If the decisions have been already made, this should all simple, straightforward paperwork. Should take 1 - 2 hrs for intake & then 1 hr a couple of days later for the signatures to be done.

If mom has assets, then all this should be paid from her assets. This also is important if you ever get challenged. If you pay for all, and you benefit, then other family could go to court to find it a coerced document. Good luck.
Helpful Answer (4)

The rules for rehab (after a minimum hospital stay of 3 days) are that medicare pays full for days 1-20, as long as rehab can show need/improvement. Then days 21-100, medicare pays 80%. If you have secondary insurance, they may pay part of the remaining 20%. You will have to check with them. Same deal, rehab has to show need/improvement.

As posted above, medicare doesn't pay for nursing or assisted living after rehab. You should begin to check out options in your area now while your Mom is being well cared for in rehab. This process took me 3 months of constant looking!

In my area, skilled nursing is over $10,000 ... a MONTH! After a certain number of months some of the nursing homes will take the resident on as medicaid. I found them to be few and far between and frankly, not the nicest ones!

Assisted living runs $7-8,000/month in my area. NONE of the ones I visited take medicaid residents. They all ask for your financial status during the initial meeting!

Current gifting rules are $13,000/per person/per donee a year. But as the previous responder said, before Medicaid pays, they look at 5 years worth of spending. Before you select a nursing home, determine if an assisted living facility would work for your Mom.

The rehab section of the skilled nursing facility told us we would need skilled nursing for my Mom. ($11,900/month at theirs). We checked out a few other choices and one in-take person asked why we were looking at SNFs. She thought my Mom only needed an assisted living (AL). We took her advice and for the past 6 weeks my Mom has been doing fine at the AL ($7100/month) . This helps the resources last longer and in this case it is working fine.

The journey is interesting. My feeling (and my sibs too) is that she and my dad accumulated the money and it should be used for her. The places that take medicaid near me are not places I would want for me or a loved one. Good luck.
Helpful Answer (3)

Mother is in a nursing home at this point May or may not have to stay She wants to gift each of her sons (4) $5000.00 for Christmas.May she do0 that??? If so, would they have to come up with that amount to give back if she has to eventually go on Medicaid in a few months or years ??
Helpful Answer (3)

Gosh, there ought to be a law on the amount a nursing home can charge for a resident. YES they will take all your money. Now days I think that is the idea...for the GOV to get ones last penny.
Helpful Answer (3)

Let me first say that nursing homes are EXPENSIVE. Medicare/supplemental insurance doesn't pay for nursing homes. So your looking at least $2000.00/mth just for her to live in a nursing home. Thats for room and board. Usually, things like medication, medical equipment,etc.. are not included and is an additional cost added on. Since your mom just sold her home, she is unable to qualify for medicaid(welfare) which would pay for Nursing home. But, there is a five year look back review of income & assests. I don't know too much how that process works.

I will tell you that a neighbor told me her sister whom needed 24/7 care paid out over $100,000 dollars in 2 years for home care. So you need to plan for costly care before you split money or set aside. The worse thing would be running out of money that was your moms and you will have to pay for living expenses. Just something to think about.

One is able to gift money I think up to $10,000(check irs website) However, if your mom is in a questionable mental status, I would not proceed unless I 'd talk to an elder attorney. If your POA, check your papers. There are limitation clauses. What your able or not able to do. I have Durable POA of mom. However, One thing that is stated that I am not allow to give "gifts". So be careful.

To handle this situation properly, please speak to an attorney.
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I don't know about the state you live in, but in Arkansas, they went back 36 months on my mom's property and assets. In order for her nursing home care to be paid for - (nothing fancy at all about her nursing home) her bill is 5,000./month- she only received a little over 700./month soc. sec. Fortunately, my mom didn't want to stay by herself in her home after my dad died- so she sold the house to live with my uncle about 5 years before she was diagnosed with dementia and 6 months later was in a facility. I am talking about medicaid making up the difference. Her home does take medicaid- not a bad place, older building- but clean, and taken care of.
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I do not know where you people live, but my Mom is in a Nursing Home here in New York that costs $450. a day....not different from other Nursing Facilities here. And...NY charges over $700. a month in Room and Board tax. The money goes down very fast. We have a few months before we apply for medicaid....and it will cost us to do that as well. Whatever my Mom needs after she is approved for medicaid, (they allow her $50. per month personal money), I will provide for her. You want your Mom to have the best care...that is the most important factor. We went to an eldercare attorney 9 years ago and had her house put in a life estate. He also did the poa's and the health proxy forms. But she would not allow us to do anything else. Do see an attorney, and get the advice you need in your state.
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Daisy - as others have said good legal is needed.
Do you understand the difference between MediCARE & MediAID? This site has
a couple of good articles on what they are and more importantly are not. Mcare is a federal entitlement program basically for hospitalization and medical costs and everybody who paid into SS also paid into Mcare and has it available to them once they hit 66. Maid is a joint federal & state entitlement program for the very poor and will pay for long term care for those that qualify for it both financially and medically.Maid has an asset & income review within 5 years back from date of application. So that would mean your mom in order to avoid any lookback could not apply for Maid before Sept 2017. If she applies between now and Sept 2017, there could be a transfer penalty imposed on any and all $ not spent on her care or her homesteaded property (exempt asset). Sales or transfers of real assets - like a car or house - is recorded by the state so all that information is easily available for Medicaid review. All her financial records - like bank & insurance- can also be reviewed for 5 years back. You sign off an all access is OK when you apply.

You really have to be especially careful when you are co-mingling assets which is what you would be doing by using mom's $ and your $ to build a new house. Co-mingling puts everybody at the same risk or exposure to the others debt if there should be a problem later on even decades from now. Not just for Medicaid but also if something else happens like a lawsuit against you.

Ideally you want to work with an Elder care attorney who is certified for that speciality in your state. They might suggest doing a personal services contract for you or your brother to divest some of the $; they could suggest doing a trust; or a medicaid compliant annuity. Alot of this is dependent on what your mom's financial & health situation is & where she sits on probability of need &/or death.

In general, IMHO you should have the following done:
- Durable Power of Attorney (not just POA)
- Medical Power of Attorney
- Living Will &/or Advance Directives (DNR)
- Declaration of Guardian in Event of Incapacity
- HIPAA Waiver (umbrella/general one)
- Will or a Trust

The Declaration of Guardian is one that most don't have - this is really important to be done as it sets whom mom wants in her current & cognitive state to be her guardian(s). Once they get a dementia that can change on a whim due to their changing mental abilities.

I'm a firm believer in having an elder care attorney take care of all this. You do want to go in prepared with the information for the documents (e.g. the residence located at 123 ABC street, aka parcel #5678; Ann Smith, wife of John Smith, with the info on all the births, deaths & prior marriages) as well as valid ID for the elder. If the decisions have been already made, this should all simple, straightforward paperwork. Should take 1 - 2 hrs for intake & then 1 hr a couple of days later for the signatures to be done.If mom has assets, then all this should be paid from her assets, so bring her checkbook This also is important if you or other family ever get challenged on who is DPOA or end of life issues. If you pay for all & benefit, then others could go to court to find it a coerced document. Good luck.
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Well luckily mom was thinking..she did already purchase a niche in a mausoleum next to my father and older sister. She had money put aside for creamation but when the dementia set in ..she found the money in her drawer and spent it. I know all her wishes because we sat down 10 years ago and told me right after she had me assigned as durable power of attorney. We have a DNR filled out and the money in the bank was to be divided only 6 ways because one of my siblings had exhausted her share years ago. What was left in her checking was suppose to go to me. She appreciated everything I did for her up until the dementia got ahold of her. Up until last year July..she was the old mom I knew and loved. She is not so anymore. I don't know who she is...but it's not her. My sister inlaw is a para legal and I have her support when it comes to legal matters. As for the rest of my siblings they are the best support family I will ever have. They are totally behind me whatever my decision is. My mom raised us all sad that she can't see it that way anymore. It's stressful for sure..but I will do it as long as I am able. Thanks so much for your advice.
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