Are your parents in a nursing home paid by Medicaid? Are you concerned the program will get cut?

[Anonymous]

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Anonymous wrote:It’s a separate program and long term care Medicaid and not regular Medicaid. Doubt they coul cut it as where would people go?

Women will be expected to stay home.

As a woman I did this but at some point it is not manageable without help. Long term Medicaid was our only option. Most people cannot do it especially with young kids.

The current system already penalizes adult children, often single women, who quit jobs in the prime earning years and move back home to take care of their parents. The kicker is that the parents' issues are so complicated that they may must move into a LTC facility. The house must be sold before the parent can receive Medicaid, so women in their 50s, 60s, 70s find themselves on the street without a home or a job.

DP.
There are ways to keep the house, please don’t dramatize.
I haven’t seen many women on the street unless they have mental health issues.

How do you keep the house? Please share the ways.

Elder law attorney will consult
AFAIK it’s irrevocable trust or a share of the house belongs to a relative, but I am NAL

So you really don’t know.

I know that people do it. So it’s possible.

Nursing homes come under long term care Medicaid. It’s a different program than regular Medicaid with separate qualifications and rules.

So? I was talking about it being possible to keep the house

It is only possible to keep the house IF there is a community spouse. But if an elderly person lives at home and is cared for by an adult child, the house has to go if the adult child is no longer able to care safely for their parent at home and must move into LTC. There might be a situation where the house is now in the adult child’s name, but there is at least a 5-year look back period to see if there has been a divestiture of assets.

Exactly, old ppl should stop sitting on their houses titles and sign them over to kids before the government takes the house away

[Anonymous]

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Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

My FiL needed a Hoyer lift and two aides for 14 months. There was absolutely NO way my 80+ MiL and 50+ developmentally disabled SiL could’ve managed this at home. No way. OTOH, my father has dementia, remains quite amiable, and is able to remain living at home though now with a near FT aide as he is a flight risk and no longer able to manage his ADLs. If he were not amiable, then it would probably be impossible for my mom to manage, especially if he were aggressive.

How do ppl in poor countries do it?

[Anonymous]

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I work in health policy.

The Paragon Health Institute is a conservative health care think tank that will have a lot more sway over policy in the Trump administration.

Here is a recent white paper of theirs about how to reform long-term care in the U.S. They think Medicaid is the reason long term care is so expensive and that the country would be better off if all but the poorest families were required to pay for it on their own (without Medicaid’s help) or through new long-term care insurance arrangements. Better buckle up kids, this ride won’t be for the feint of heart.

Long-Term Care: The Solution

https://paragoninstitute.org/medicaid/long-term-care-solution/

“Congress should remove Medicaid as an end-of-life, wealth-preserving, fail-safe for the middle class and affluent. Medicaid should not reward people who neglect to plan responsibly for LTC by both paying for services and providing asset protection. New public policy should incentivize early planning for LTC that employs private wealth, including savings, home equity, life insurance, and a revitalized private LTC insurance market. Recent research documents lower risk of severe LTC expenses and indicates that consumers have more funds available to pay privately for LTC than previously believed. These facts suggest a way to revitalize the senior living market financially to the benefit of LTC consumers and providers alike. With more private LTC financing, fewer people will become dependent on Medicaid. Medicaid can then become a better payer of last resort than it is now. This paper explains how and why this new approach is plausible, practical, and preferable given current demographic and financial conditions.”

This "concept" of a plan has no basis in reality. My parents were thrifty and still needed Medicaid for LTC. I find this absolutely maddening.

But YOU have wealth. That's the kicker. The government doesn't want you passing along your elderly if they (or you) have resources. Medicaid is supposed to be for last resort. For the truly indigent. Like dogfood eating out on the street. Sounds like the Trump Administration is going to love this policy advice. If the government won't pay, what are you going to do?

"wealth-preserving, fail-safe for the middle class and affluent."

No, I don't have wealth. I assisted my parents, now some of my siblings as well as my college kids. I'm tapped out. This is all set up to keep working class folks working class while they privatize all profits for themselves.

Right. It’s all about rich people getting to pay less in taxes, which will result in middle class families having to spend any retirement and college savings on caring for elderly family members who pre-reform would have qualified for Medicaid help. When families have less money, they have to work longer, the supply of labor goes up and the cost of labor is cheaper for big business. Plus, if Medicaid becomes a minor payer for long term care, more people will be paying (higher) private rates for care.

Well you should clarify and make that be "the ultra rich" pay more. The middling rich--those who earn most income from a W2/CapGains/Interest/Dividends pay out the wazoo for taxes--there are no legal loopholes for them. 37% on most of income, Medicare, SS, and 8-10% on majority of income at state level. It puts them close to 55-60% tax overall. We don't need "more taxes" at that level. We need to find a way to tax the ultra rich.

But people also need to plan. My LMC parents (in 80s, never earned more than $45-50K as family in their lifetime, normally it was much lower) managed to purchase LTC insurance and have kept it up. They also were truly frugal, our home was not nice, but it was a safe place with heat, water and a roof over the head. They lived on 1/2 acre+ and raised chickens and had a huge garden. They did 95% of their home repairs themselves until age 55/60. I personally helped dad reroof 2 homes while growing up---he figured it out because it needed to happen and we couldn't afford to pay someone.

Well those parents had over $750K when they sold their home (only $180K of it) and moved to a CCRC (we had to pay entry fee otherwise they qualified). They always made savings a priority and we lived frugally. I got $25 from them for bday and xmas and that was it. If it was a bad year, we got nothing. But they managed to save save save, despite many times of unemployment my first 15 years that set them back. Even after, they did whatever to have a job so they wouldn't fall behind.

Now they are living a decent retirement

This is great for your parents - truly - but utterly unhelpful for those of us with elderly parents who did *not* save adequately for retirement. Come on.

So then it's up to you to help them, or let them live with medicaid facilities. I just detailed how my LMC/lower income parents managed to amass a decent amount of savings---because they didn't live nicely, just with the bare minimum. They didn't have AC (live-in VA) until I was out of college, drove cars without AC until then as well.
But yes if your parents don't save you have two choices

Not everyone can help financially. We could not. We have old cars, one was 25 years old before someone totaled it hike parked, a lower priced very small house, etc. my mil had zero savings and only social security. You live a charmed life.

[Anonymous]

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Anonymous wrote:Look, I grew up in a country that went through an unimaginable social collapse when I was a teen. Old ppl weren’t thrown into the streets to die though. Some were scammed out of their homes but most somehow made it. Family and hospitals took care of them. It may not have been great care but it was something. I am sure we will all survive though we may need to tolerate our elderly at our homes for a while.

And how does that work when both parents need to go to work?

If they need a nursing home, they’re not really able to work at that point.

[Anonymous]

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Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

Have you done it. My in law had severe dementia. She was a loving and kind person to turned abusive, then couldn’t do anything or be left alone. Stooped talking, bathroom, etc. I did it for a year. 24-7 care till I was to my breaking point with young kids and couldn’t leave the house. No money for help. We had no choice but a long term Medicaid bed.

No but my older family all did it, not with dementia but other ailments. Only one mentally ill relative (grandma) went to a psych ward.

So, you really have no concept of dementia. With the mid stage starting where they cannot be left alone and become abusive and sometimes violent, cannot feed themselves, bathe or toilet to severe dementia where it’s basically having a newborn for years and not verbal and scared as they have no clue what’s going on. It’s impossible without help. My mil had early onset and lived 10 years with severe dementia.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

Have you done it. My in law had severe dementia. She was a loving and kind person to turned abusive, then couldn’t do anything or be left alone. Stooped talking, bathroom, etc. I did it for a year. 24-7 care till I was to my breaking point with young kids and couldn’t leave the house. No money for help. We had no choice but a long term Medicaid bed.

No but my older family all did it, not with dementia but other ailments. Only one mentally ill relative (grandma) went to a psych ward.

So, you really have no concept of dementia. With the mid stage starting where they cannot be left alone and become abusive and sometimes violent, cannot feed themselves, bathe or toilet to severe dementia where it’s basically having a newborn for years and not verbal and scared as they have no clue what’s going on. It’s impossible without help. My mil had early onset and lived 10 years with severe dementia.

Sorry to say it but this is where assisted suicide should come in.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

My FiL needed a Hoyer lift and two aides for 14 months. There was absolutely NO way my 80+ MiL and 50+ developmentally disabled SiL could’ve managed this at home. No way. OTOH, my father has dementia, remains quite amiable, and is able to remain living at home though now with a near FT aide as he is a flight risk and no longer able to manage his ADLs. If he were not amiable, then it would probably be impossible for my mom to manage, especially if he were aggressive.

How do ppl in poor countries do it?

If you have money, you hire cheap live-in help, and you can pretty much continue living your best life.

If you are poor, usually a younger female will try to manage a small business from home (tiny bodega, restaurant, make crafts) to try to make ends meet and be available to care for the LO. Also, life expectancy is much lower.

Many, though do end up abandoned. Some countries have state run eldercare centers. The quality often is quite poor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

My FiL needed a Hoyer lift and two aides for 14 months. There was absolutely NO way my 80+ MiL and 50+ developmentally disabled SiL could’ve managed this at home. No way. OTOH, my father has dementia, remains quite amiable, and is able to remain living at home though now with a near FT aide as he is a flight risk and no longer able to manage his ADLs. If he were not amiable, then it would probably be impossible for my mom to manage, especially if he were aggressive.

How do ppl in poor countries do it?

Have you spent much time in poor countries? Many have an excess of labor, so some poor, young, nearly always female relative is conscripted into caring for the individual where they provide 24/7 care, probably sleeping on a mat on the floor of the ailing dementia patient’s room. Caring for the person is their whole life and when the person dies, they are often turned out and not always able to return home as they will be a burden on their household.

When the combined net worth of Trump’s proposed cabinet is $13.3 billion and that does not take into account his advisors (e.g., Andreesen, Musk, etc), we can do better. India doesn’t need to be our model.

[Anonymous]

When the combined net worth of Trump’s proposed cabinet is $13.3 billion and that does not take into account his advisors (e.g., Andreesen, Musk, etc), we can do better. India doesn’t need to be our model.

I am quite sure that the goal of this administration is to increase that net worth. Check back in 4 years.

As to the topic at hand, I am worried. My mother is self funding now, but she has dementia and is in otherwise good health. ALready her costs are 10k/month and she's not even in memory care yet--although we are looking to move her in the coming months.

[Anonymous]

Anonymous wrote:

When the combined net worth of Trump’s proposed cabinet is $13.3 billion and that does not take into account his advisors (e.g., Andreesen, Musk, etc), we can do better. India doesn’t need to be our model.

I am quite sure that the goal of this administration is to increase that net worth. Check back in 4 years.

As to the topic at hand, I am worried. My mother is self funding now, but she has dementia and is in otherwise good health. ALready her costs are 10k/month and she's not even in memory care yet--although we are looking to move her in the coming months.

I’m the PP and in agreement with you. My point is that we have the funds to make LTC possible for all who need.

GL with your mom. It can a real difficult time. We were fortunate that the nonprofit LTC in our hometown had a great memory care unit and took Medicaid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

Have you done it. My in law had severe dementia. She was a loving and kind person to turned abusive, then couldn’t do anything or be left alone. Stooped talking, bathroom, etc. I did it for a year. 24-7 care till I was to my breaking point with young kids and couldn’t leave the house. No money for help. We had no choice but a long term Medicaid bed.

No but my older family all did it, not with dementia but other ailments. Only one mentally ill relative (grandma) went to a psych ward.

So, you really have no concept of dementia. With the mid stage starting where they cannot be left alone and become abusive and sometimes violent, cannot feed themselves, bathe or toilet to severe dementia where it’s basically having a newborn for years and not verbal and scared as they have no clue what’s going on. It’s impossible without help. My mil had early onset and lived 10 years with severe dementia.

I believe in the country my parents are from they are sent to psych wards/psych nursing homes and wither away quickly. No luxury of living like this for 10 years

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

My FiL needed a Hoyer lift and two aides for 14 months. There was absolutely NO way my 80+ MiL and 50+ developmentally disabled SiL could’ve managed this at home. No way. OTOH, my father has dementia, remains quite amiable, and is able to remain living at home though now with a near FT aide as he is a flight risk and no longer able to manage his ADLs. If he were not amiable, then it would probably be impossible for my mom to manage, especially if he were aggressive.

How do ppl in poor countries do it?

If you have money, you hire cheap live-in help, and you can pretty much continue living your best life.

If you are poor, usually a younger female will try to manage a small business from home (tiny bodega, restaurant, make crafts) to try to make ends meet and be available to care for the LO. Also, life expectancy is much lower.

Many, though do end up abandoned. Some countries have state run eldercare centers. The quality often is quite poor.

So, not ideal but doable.
No living for 10-20 years out of one’s mind and as a burden to everyone.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Look, nobody knows what’s coming. The worst case scenario we’ll have to somehow manage our elderly parents at home with us. That’s what ppl in poor countries do. It’s hard but it’s not impossible.

My FiL needed a Hoyer lift and two aides for 14 months. There was absolutely NO way my 80+ MiL and 50+ developmentally disabled SiL could’ve managed this at home. No way. OTOH, my father has dementia, remains quite amiable, and is able to remain living at home though now with a near FT aide as he is a flight risk and no longer able to manage his ADLs. If he were not amiable, then it would probably be impossible for my mom to manage, especially if he were aggressive.

How do ppl in poor countries do it?

Have you spent much time in poor countries? Many have an excess of labor, so some poor, young, nearly always female relative is conscripted into caring for the individual where they provide 24/7 care, probably sleeping on a mat on the floor of the ailing dementia patient’s room. Caring for the person is their whole life and when the person dies, they are often turned out and not always able to return home as they will be a burden on their household.

When the combined net worth of Trump’s proposed cabinet is $13.3 billion and that does not take into account his advisors (e.g., Andreesen, Musk, etc), we can do better. India doesn’t need to be our model.

I’ve grown up in a second world country. Old ppl are cared for at home. If they are violent they are sent to state nursing homes for psych patients and they don’t live long.
There are state nursing homes but they are the last resort.
Most profoundly disabled old people just don’t live long.