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My aunt didn’t do any financial planning before her stroke and going into a bad nursing home, needless to say. She was dirt poor and had nothing but a car and a few thousand dollars to her name. She never went to a lawyer because she thought she was too poor for one. I just need advice on her situation re Medicaid and don’t know what to ask or even if they would talk to me (I’m her niece and don’t have POA for her and my aunt cannot see the lawyer herself).



She won’t be driving again so we need to sell her car and as it may put her over the asset limit we need to know what is the best thing to do. She is already on Medicaid but will come up for recertification in September.



(sometimes I feel that elder lawyers aren’t interested in low income people, even if someone else can pay for a consultation)

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Some questions that might help narrow down our answers:

1) Are you the only one in a position to help your aunt navigate all of this? In other words, she doesn't have a child or other closer family member who is willing to advocate for her? (I ask because if we start talking about the process of becoming POA or even guardian, we should know if you are the person who would be in that position.)

2) How incapacitated was she from her stroke? Is she able to make sound decisions for herself right now? If not, is she expected to recover that ability? (I ask because this will inform whether we talk to you about acquiring guardianship, acquiring POA, or just giving her some assistance as she recovers. If she has lost the capacity to make decisions for herself and is not expected to recover that capacity, the nursing home will petition to have a professional guardian appointed, or you or a family member can try to become guardian, though this is a long, expensive process—for this you will definitely need that lawyer. If she's not mentally incapacitated and can make good decisions for herself, but can't handle things like bill paying, and is never expected to handle that again, then you or a family member can try to get her to sign off on a POA. This will allow you to do things like sell her car for her. If she's not that old and is expected to make a full recovery from her stroke, a POA wouldn't necessarily make sense.)

3) Have you or anyone in the family spoken to the social worker at the nursing home? He or she may have guidance about the recertification. It's very much in the home's best interest for your aunt to be recertified, because if she loses that, they lose their money. On the other hand, there's often a high turnover of social workers at Medicaid nursing homes. Getting a knowledgeable and helpful one can be a crapshoot. But in talking to the social worker, you might find out something like that they've already started the process of petitioning to have an outside guardian appointed. That's something you'll want to know about before you get too involved.

4) Is it your goal to get your aunt out of this nursing home, or do you feel she's getting adequate care where she is?

If she's very incapacitated and is never expected to recover the ability to make sound decisions, and if you don't hate the nursing home where she is now and expect her to live out her days there, then you don't need a lawyer. The nursing home will handle everything, via petitioning the court to appoint a professional guardian, who will then be in charge of selling the car, keeping the Medicaid, etc. I wouldn't fight that from happening.
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TerraOcculta Jul 6, 2022
I am the only one in a position to help her, being her only living relative who is not incapacitated, or is willing to help her. She has no husband and no children. One sister who is not capable of helping either physically or psychologically. Another niece is not interested in getting involved.

She has anomic aphasia from her stroke and probably a mild amount of cognitive decline mainly manifesting as occasional confusion as to what day it is (not surprising considering the bedlam of a nursing home she is currently in). Anomic aphasia is when you can form sentences properly but cannot choose the right key words. For instance she will try to say "The nurse came to change my bandage today" and it comes out "The cook came to change my detriment today." Random words or words heard on TV are pulled in and substituted, sometimes decipherable and sometimes not. When she is relaxed (or home for visits) she speaks quite clearly. When an old friend calls her, she speaks beautifully (and she is so happy when she does, as she knows she is not making sense at other times). As for sound decisions, she seems to understand well when I bring her medical bill co-pays to her and explain what they are, ask if she wants to pay them and she signs the check. Sometimes she says "no" or asks for explanation of the bills in a very reasonable manner, just like anyone considering finances would say. She has experience with paying bills, having lived alone most of her adult life. I consulted a lawyer early on about guardianship (during thick of COVID) and he advised me to have her sign her own things as long as she could. Honestly I do not think a court would find her incompetent, unless they don't understand aphasia. Astonishingly, most of the nurses at the nursing home seem unaware of what aphasia is and it's been horrible to see they've written "dementia" on her records. Her hospital records said "aphasia" and how did that turn into "dementia" at the NH?! She definitely has a mild cognitive decline but she's so much better than she was back in September. But no one at this severely understaffed NH ever spends any time with her. She gets virtually no rehab attention. I visit her at least once a week and check her out for home visits almost that often.

I am terrified the nursing home is trying to do something like petition for guardianship but if you go to https://vanduynlog.wordpress.com/home/ you can read just how incompetent this NH was when admitting her (blog goes in reverse chronological order to scroll back to the oldest page). It was a nightmare and that blog only covers the first month. Here is a news story about this nursing home from just yesterday: https://www.localsyr.com/news/local-news/your-stories-family-of-loved-one-who-died-at-van-duyn-finally-getting-some-answers/ These are the people I am dealing with. She has had 4-5 different social workers. Last time I left a message for her current social worker, I did not get a call back.

My goal is to get her out of there and bring her home with me into a LTMC Medicaid funded program or PACE. My next task on my day home from work is to contact the corporate office and ask why they haven't billed us for anything other than the NAMI (the amount she owes the NH because her income was slightly too much for Medicaid). I think they want to become her representative payee and I do not want that because I want her out of there. I want them to send us a bill for the SS amounts that are piling up in her bank account that should not be there.

The reason why the car is an issue is because we need to DISPOSE OF IT as she will never drive again.
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In my own state and in almost all others one car is an exempt asset that has no relevance in applying for Medicaid. If your Aunt is competent she can add a family member to title through any AAA office if she's a member, or at DMV. This would mean the car title would pass to you or another chosen relative at death. Call medicaid in your own state or go online to verify that your Aunt's car is an exempt asset. You don't need an elder law attorney.
Aunt got on medicaid having the car. Why would you imagine she cannot remain on medicaid with the car?
You cannot become POA if your aunt suffers now from dementia. If she does NOT suffer from dementia, you may serve as her POA if she appoints you with her attorney drawing up the papers. Watch what you wish for. This is an onerous and difficult job. You Aunt is in care and the Nursing Home will be certain to get her recertified, would be my guess.
Elder law attorneys should be (SHOULD BE) paid by the hour. They do not get more from any one hour of time spent than any other. Just because someone has money doesn't mean the elder law attorney gets a portion of their money. I think you are wasting your time seeing an Elder Law Attorney for an aunt who has no money, and without a POA he can do nothing for you.
I wish you and your Aunt the very best.
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I don't think you need to consult anyone. If her income didn't increase in any way (like selling her house, getting an inheritance as a few examples) she will be requalified. Sell the car for cash and purchase necessities for her (Depends, clothing, shoes, buy a tv with connecting headphones for her room, fund her Resident Trust at the facility, etc.) Eventually she won't need to reapply. FYI 1 car is usually "allowed".

Also, if she's in a county Medicaid facility: be sure to put her name on everything and in every article of clothing unless a family member will be doing laundry for her. If the facility does it, she'll be losing clothes all the time. Then the staff will dress her in clothes left by deceased residents. That's what my MIL's facility does. Drives me nuts. Good luck!
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babsjvd Jul 5, 2022
Also , when I was looking at spend down for a few thousand, an iPad was eligible….
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You may get your questions answered with your county office of aged and disabilities..

if your aunt has none of the end of life documents done ( durable POA, medical POA, ) And she is not incapacitated, you can Google the documents and fill them out for little cost . Have a notary come and witness it for you. I had an addendum done to my moms will this way. I found the notary thru the county office of aged and disabilities. She arranged for the witnesses as well.
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