Wellness

[Hoovermom]

On 6/25/2014 Gooday said:

On 6/25/2014 lovestoteach said:

Have just been through some of this. We found out that mother-in-law was eligible for veteran's benefit due to DFIL status. Not much money, but some.

My husband and brothers are in the process of setting up a trust so she would qualify for medicaid if necessary. I am told the facility where she lived WOULD have some rooms for medicaid (impoverished) situations. I don't know if this is true... if ALL complexes are required to offer SOME percentage of rooms at a reduced rate.

Good luck... I hope you are able to find some accommodations for him. I was just told "Obamacare" by another household member...

You would be surprised the amount of Medicaid beds that are in these facilities. It's a fact of life. The best thing you are doing is getting your MIL's home in a trust. We got my mom's name off the deed of their place and put everything in a trust. Of course, you need an attorney to handle all this, which it sounds like your brothers have this together.

When a patient is Medicare, I don't think O'care even enters into it. That's one of the things they did not touch.

DH had an uncle whose wife was in a facility for her dementia. They had little money and she was put on Medicaid. He made a huge mistake and NEVER had her name taken off the deed. He died a few months prior to her passing and when the family went to sell the house, the state of Illinois had a lien on the property for the costs of her care. Talk about adding insult to injury. All the years they worked, lived in a paltry pension and SS and then BAM!

Help me with this. Is this to avoid payments to the home or what?

[LTT1]

The trust is called a "________ family irrevocable grantor's trust. DH and brothers are finalizing all of this b/c DMIL passed away before some things were signed over. The reason for putting a trust together is that ALL of your assets will go to the facility/medical care, etc. The brothers are using a person from an investment firm (well-known) and that firm doesn't know their stuff. A lawyer has interceded.

I think the main question is this: for your dear husband you want the best... but my fear would be living in poverty because of his care.

The beautiful facility my MIL was in might have been less expensive or not at all had we inquired as to the availability of beds. The trust was originally formed to hold for use for HER incurred expenses, but the "executor" of the trust was to be one of the brothers. I hope somebody else can clarify what I have tried to say.

PS You have my extreme sympathy for having to deal with this at such an early time... or for anyone dealing with the memory matters of a loved one.

[151949]

When a person goes into a nursing home and uses up all their money the home will place them on Medicaid (welfare) but they must turn over their assets like a house or their monthly income to the nursing home - which can leave the remaining spouse in bad straits financially. The state doesn't actually take your home and sell it till everyone living there is passed but when they take away the person's monthly income that can be devastating to the remaining spouse.

Believe me - Medicaid is on to the ruse of suddenly turning over property to a child etc - they will refuse Medicaid until the transaction to rid yourself of assets so you can get Medicaid is 5 years old.

IMO - the best idea as far as the remaining spouse goes is to sell your home - put the money aside and use it to pay for your loved ones care and an apartment for yourself. It may not be an ideal situation but at least your assets are safe from the state, and you will still have your DH's monthly income. probably it would be best to discuss this with a financial planner or lawyer before you make any moves at all.

God bless you as you go on this journey - don't go into this blind - pay for an attorney or a financial planner to inform and assist you.

[LTT1]

On 6/25/2014 happy housewife said:

When a person goes into a nursing home and uses up all their money the home will place them on Medicaid (welfare) but they must turn over their assets like a house or their monthly income to the nursing home - which can leave the remaining spouse in bad straits financially. The state doesn't actually take your home and sell it till everyone living there is passed but when they take away the person's monthly income that can be devastating to the remaining spouse.

Believe me - Medicaid is on to the ruse of suddenly turning over property to a child etc - they will refuse Medicaid until the transaction to rid yourself of assets so you can get Medicaid is 5 years old.

Yes, it is now the five year rule... I would advise someone facing this cost to look into the trust since the care may run longer than five years. A financial advisor might know the best way to protect oneself.

[pistolino]

If I had to give 1 piece of advice, it would be to remain open to other types of facilities and don't limit yourself to "memory care" - that term is a marketing term only, there is no standard of "memory care", it is whatever the facility wants it to be.

My mother did very well in a skilled nursing facility - and ironically at least half of the residents had some level of dementia too, so the staff was very good at dealing with behaviors and using positive reinforcement to reduce the antisocial type behaviors.

Also be open to group home settings as well. I've seen some extremely good group homes, but I would be wary if the owner actually lives in the home with family--I feel those aren't as good as one where all of the staff is hired from outside, because the owners tend to think nighttime needs no staffing and there is also the issue of who's coming into the home (children's friends, friends of family, etc.) and I just prefer that anyone in the home who isn't a resident be there in a professional capacity.

[born2swim]

I have a couple of additional points to add. First, not all facilities will transition someone from paying to medicaid. Check first. I have a friend whose mom was in one in NC and they called him one day to tell him to pick up his mother. Second, it sounds like your husband has early onset alzheimer's which is hereditary. If you have kids they may at some point want to be tested. I'm not sure how accurate the tests are but if your kids get the gene (50% chance) they will end up getting early onset alzheimer's as well unless someone figures out a cure for this darn disease.

Best of luck and sending prayers your way. My dad had the 'regular' alzheimer's and had a stroke and died before he got really bad but it was awful going through it and especially bad on my mom.

[ennui1]

OP, have you looked into home health care services? Perhaps you can get by with hiring some help, and keep your DH at home. Your local hospice foundation will have a list of suggested services, with prices.

Also, there is a program through Social Services where you can get paid to take care of your DH, if he is on Medicaid.

I read where they are looking at the law that allows assisted living facilities to take your assets, but that's how it is now.

RE trusts, every state is different, so contact a local attorney for advice.

[pitdakota]

Pianomamma, my heart goes out to you. Not only can the experience of trying to find placement and navigate the ins and outs of finances be overwhelming, it is also an emotionally trying time to face putting a loved one into some type of facility as well. So please be kind to yourself during this time.

I don't know if any of this will help, but here are just a few things to think about:

Almost all care centers whether skilled nursing care or assisted living facilities will have someone that can provide information as to whether your DH would qualify for any veterans benefits in terms of long term care, so don't hesitate to ask people at those facilities for their assistance in researching your questions about VA assistance. You can call the local Veterans Affairs office as several others have suggested, but they tend to be very busy and sometimes it is difficult to get in touch with someone right away. HERE IS a website about a program called Veterans Aid and Assistance. It might provide some useful information for you. I am not sure if it applies to those who served in the reserves or not. Perhaps you could even email via this site and get an answer? Just a thought.

Also, I agree with the previous poster that pointed out about asking about Medicaid beds since there is a possibility you will have to go the Medicaid route for your husband. Although things are different in the various regional areas of the country....in this area the number of Medicaid beds available in skilled care facilities has been steadily shrinking. The national trend of long term care facilities is to put more of their resources into rehab beds that Medicare does pay for in certain cases such as knee/hip replacements, etc. Nursing homes lose money on Medicaid patients and make far more money off of Medicare patients for rehab, so naturally there is a trend to decrease the number of Medicaid beds. There are many cases around here where families have placed a loved one in a nursing home on private pay while they are spending down the assets required before Medicaid will come into play. Then when they apply for Medicaid the facility does not have a Medicaid bed available and requires the family to move the patient. I would suggest that you ask those types of questions and get as much information about those types of practices and policies for each facility you are considering.

Also, a number of assisted living facilities will not take Medicaid at all.

And although this may be something more typical in this area, I have found that long term care facilities that have separate dementia care units tend to have the best practices and care when it comes to dementia. Most of the time those facilities require the staff that work in the dementia care unit to have special training and education regarding dementia. And staff that do not routinely work the dementia care units are many times assigned to work on that unit when their area is covered, but the dementia care unit is short staffed for a shift. So the other staff learn from the staff that have specialized training. Of course that is not always the case 100% of the time. And there are some long term care facilities that don't have special dementia care units that still require their staff to have some type of dementia training. So it is always a good to ask if they require their staff to have any type of training for dementia patients.

I send you big hugs. I know this is a difficult time for you.

[pitdakota]

On 6/25/2014 lovestoteach said:

On 6/25/2014 happy housewife said:

When a person goes into a nursing home and uses up all their money the home will place them on Medicaid (welfare) but they must turn over their assets like a house or their monthly income to the nursing home - which can leave the remaining spouse in bad straits financially. The state doesn't actually take your home and sell it till everyone living there is passed but when they take away the person's monthly income that can be devastating to the remaining spouse.

Believe me - Medicaid is on to the ruse of suddenly turning over property to a child etc - they will refuse Medicaid until the transaction to rid yourself of assets so you can get Medicaid is 5 years old.

Yes, it is now the five year rule... I would advise someone facing this cost to look into the trust since the care may run longer than five years. A financial advisor might know the best way to protect oneself.

The 5 year rule is commonly called a "look back" period. Meaning that once an individual applies to Medicaid the state looks back to see what assets (especially a house) has been signed over that would qualify as a gift. It gets very complicated which is why an attorney that specializes in this area is a good thing! But for example, if an individual just signs over their house to a child that is considered a gift.

If that occurs within 5 years of applying for Medicaid, it results in a disqualification period. It is my understanding that they determine the disqualification period by taking the estimated value of the "gift" at the time and then use that to calculate how many months of disqualification it equals.

So in terms of Medicaid....if the individual lives more than 5 years after the transaction occurred and before application to Medicaid is made, the state cannot intervene. Which is a good thing!

[KathT]

Pianomama, I am sorry you are facing this. I wish we had known more when we needed to make decisions for my mil, who had Alz. She moved to a retirement home with independent, assisted living & memory care units. When she moved, she had early Alz, but none of us or her doctor realized it. It was an interesting journey.

We learned that you need to fully explore what the memory care provides. Many of my mil financial resources were depleted at a facility that did not have Medicare approval. Neither the assisted living nor the memory care. The process took about five-six years, so even though your dh is not Medicare age, it is an important consideration.

Long story short, my mil ended her days in an excellent skilled nursing facility that was outside our town, about 40 minutes away. We discovered late in the game, that just because there is a memory care unit, it may not be able to provide needed care, at a very high expense. When she transferred to the skilled facility, her care cost went down $1000 per month & there was a higher staff to patient ratio. There is a section on the Medicare site which rates skilled nursing facilities. You can find out how they are rated & valuable information on things like violations, whether they have them & how many. I would highly recommend that you check on this.

I had posted a longer detailed post with more information, but it must have timed out, because it didn't show up. I wish you & your dh the very best. There is a solution for you.