ISO insight/advice on nursing homes, Medicaid, etc

[Anonymous]

Anonymous wrote:


If you truly do not know how to approach things with MIL, I would contact the local Office on Aging for their advice since they must get this question all the time. You may want to see if her resources are limited if there is any chance to get her into subsidized senior apartment housing with perhaps as mentioned an aide coming a couple of times a week to assist her as needed.

If you know her assets, could she afford to go into a place offering assisted and nursing care services as a private pay client for a certain length of time and then shift over to Medicaid. In this area, a friend was honestly told that if one can pay for three years privately or with insurance, then there is no problem adjusting to Medicaid, provided, of course, there are beds available.

You do want to be sure DH does have the Medical Care Directive and the her Health Care Directive has been completed. A Power of Attorney would also be good to get. Aging parent even with money are difficult to deal with.

They only asked us for about six months of private pay. We told them no, so most places that said they'd take medicaid refused worried if they'd get paid. Only one place took her (it worked out for the best as they are wonderful).

[Anonymous]

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

[Anonymous]

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

Than what does her house being underwater create a financial burden for you?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

Than what does her house being underwater create a financial burden for you?

It depends on who is paying for the housing. If it is gov't subsidized, probably not. A private landlord, yes. We got my MIL approved for an HOC program with debt no problem but ended up declining as the program had other crazy charges that she could not afford and we could not supplement. Why not try to keep her in her home and call the county and see if they can provide an aide to come in a few hours a day until she gets worse. If you do not want to help, don't. If she is having cognitive issues, very few programs will take her with limited income. She needs assisted living and there are a few lower cost, including one in Silver Spring but even that one is $2000+ a month with very limited assistance. The only way to get assisted living paid for is to get onto the waiver program - here there is a 5 year wait list or the only other option is finding a nursing home, which we had to do.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

NP, I have a lot of experience in this area and I know for a fact that she will be denied MEDICAID if she has ANY assets. She cannot "gift" the house to anyone or put it in someone else's name either, that will also disqualify her.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

Than what does her house being underwater create a financial burden for you?

Us is meant in the familial sense - it is a burden as we are trying to figure how we manage her limited assets. There is a chance my DM will not be considered "worthy" of a nursing home, so we will need to get her into assisted living where we will need to combine her monthly SS check with her remaining money until that runs out. But until we get her into assisted living, she needs to make her mortgage. I have spoken to a number of assisted living and subsidized housing facilities in her community and nearly all of them have indicated that poor credit can have a negative effect on their decision to admit her.

Regarding the other PP, yes, I am intimately aware that her assets need to zero out before she can qualify for Medicaid. What we are dealing with her is a purgatory of sorts. She is not well enough to remain @ home, but may not be deemed in a poor enough cognitive state to be admitted to a nursing home - and Medicaid only covers nursing homes.

Finally, she does not live in Maryland so some of the more granular insights offered here do not necessarily apply to her situation. I do appreciate a PP sharing that they were able to get a parent admitted while Medicaid was pending and will mull on that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

NP, I have a lot of experience in this area and I know for a fact that she will be denied MEDICAID if she has ANY assets. She cannot "gift" the house to anyone or put it in someone else's name either, that will also disqualify her.

The house is underwater and in relatively poor condition, so there is no attempt to game the system and gift anything - there is a five year clawback on any asset liquidation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

As I think I mentioned her house is underwater, so that is an additional financial burden for us

16:46 again. I know how very hard this is but you should not be paying on your DM's house. You are only postponing the inevitable and harming your own financial stability. Your DM has to face some very hard truths - as do you. You need to set emotion aside. It is not your fault if her house is foreclosed on. One way or another, she has to get out of that house.

We are not paying on her house. I don't know how much background you have in this area, but she can be refused admission to certain housing programs if she has poor credit.

Than what does her house being underwater create a financial burden for you?

Us is meant in the familial sense - it is a burden as we are trying to figure how we manage her limited assets. There is a chance my DM will not be considered "worthy" of a nursing home, so we will need to get her into assisted living where we will need to combine her monthly SS check with her remaining money until that runs out. But until we get her into assisted living, she needs to make her mortgage. I have spoken to a number of assisted living and subsidized housing facilities in her community and nearly all of them have indicated that poor credit can have a negative effect on their decision to admit her.

Regarding the other PP, yes, I am intimately aware that her assets need to zero out before she can qualify for Medicaid. What we are dealing with her is a purgatory of sorts. She is not well enough to remain @ home, but may not be deemed in a poor enough cognitive state to be admitted to a nursing home - and Medicaid only covers nursing homes.

Finally, she does not live in Maryland so some of the more granular insights offered here do not necessarily apply to her situation. I do appreciate a PP sharing that they were able to get a parent admitted while Medicaid was pending and will mull on that.

16:40 here
Some suggestions:
- contact the local Agency on Aging...likely thru the county
they should be able to point out programs such as help with utility bill assistance and a home health nurse.
- they can set her up with a case worker who should be able to guide you all thru the process
- are you in the process of selling her house/ trying to do a short sale?
That can be a king and arduous journey so I would suggest getting started now
- yes there are some places that will take a person Medicaid pending, but it is tough and if the time comes that she is in the hospital and has to go straight to a nursing home, the hospitals will push to get her out and free up their bed. In other words, do your own research and find out what places are decent.
- Assisted living, nursing home, subsidized housing, DO NOT SIGN ANYTHING SAYING YOU ARE FINANCIALLY RESPONSIBLE FOR ANYTHING. Even if you are willing to pay for her prescriptions or her light bill, I would put the money in her account and let her account "pay" the bill. Do not, Do not, Do not claim financial responsibility. Creditors will try to trick you, but do not do it.
And if she is in the state if PA be especially careful, they have filial responsibility laws.

[Anonymous]

16:40/8:04, please say a little more on put in her account. Put in the account in the assisted living facility?

FWIW, the city government where my mom is is such bad shape that they only have aides for people over 90. Anyone younger is on own or at mercy of friends/family.

[Anonymous]

OP, you should really consider moving her here. It is extremely difficult to manage anything and make sure she is getting the care she needs without someone looking after the situation. My MIL had a son where she was at who refused to do anything. It was a problem as she got taken advantage of. At a minimum, place her on the assisted living wait lists here (and the waiver)... it takes months to years so no harm in doing it early. She can have some assets depending on the program. Many do not make you sell your house or car but you can only have so much in cash - usually ranging from $2500 to 10,000 - it is basically $2500 for medicaid.

How much is her social security check?

There are several places in MD that are income based depending on the support she needs. It is worth it to look into them.

If you sell the house, she gets nothing, it is a non-issue.

[Anonymous]

PP (social worker whose spouse is a NHA) on the other thread here. You mention trying to go the assisted living facility route for her spend down. I have to say that this does not sound like a good plan to me. What you need to do is get her into a nursing home while she has some assets and let them be spent down while in the nursing home where they will then assist you in the Medicaid application process. It's far easier than trying to get into a nursing home in a Medicaid pending status.

The reason why you need good credit to get into an assisted living facility is this. Once the money is gone to pay the bill, you have to leave. If you don't leave voluntarily, you get evicted through whatever channels the state has set up for that to happen. (Nursing Home regulations vary by state and you mention that you are not in Maryland so I don't know what the eviction process might be). The reason for good credit is to insure that you are going to pay your bill.

[Anonymous]

Anonymous wrote:16:40/8:04, please say a little more on put in her account. Put in the account in the assisted living facility?

FWIW, the city government where my mom is is such bad shape that they only have aides for people over 90. Anyone younger is on own or at mercy of friends/family.

I meant bank accounts. Get her signed up for online banking. I am sure she will give you her banking info, then get her signed up for online bill pay. Then you can pay her bills from HER accounts. You can put money in HER accounts and that way you are never givi g any creditor your checks or your info.

[Anonymous]

Anonymous wrote:PP (social worker whose spouse is a NHA) on the other thread here. You mention trying to go the assisted living facility route for her spend down. I have to say that this does not sound like a good plan to me. What you need to do is get her into a nursing home while she has some assets and let them be spent down while in the nursing home where they will then assist you in the Medicaid application process. It's far easier than trying to get into a nursing home in a Medicaid pending status.

The reason why you need good credit to get into an assisted living facility is this. Once the money is gone to pay the bill, you have to leave. If you don't leave voluntarily, you get evicted through whatever channels the state has set up for that to happen. (Nursing Home regulations vary by state and you mention that you are not in Maryland so I don't know what the eviction process might be). The reason for good credit is to insure that you are going to pay your bill.

One of the places we are looking at has an assisted living facility and a nursing home. The latter takes Medicaid. Ideally she would transition from assisted living to the nursing home as necessary. How does one get admitted to a nursing home? That's what puzzles me. My mom's doctor, whom I am not particularly fond of as he seems overly focused on preserving my mom's dignity with little interest in how that plays out when she is at home on her own, may refuse to admit her. She can't meet the ADLs (is that the right acronym) on her own as she basically doesn't trust herself. The doctor seems more focused on if I am respecting my mom's HIPAA.

[Anonymous]

Anonymous wrote:OP, you should really consider moving her here. It is extremely difficult to manage anything and make sure she is getting the care she needs without someone looking after the situation. My MIL had a son where she was at who refused to do anything. It was a problem as she got taken advantage of. At a minimum, place her on the assisted living wait lists here (and the waiver)... it takes months to years so no harm in doing it early. She can have some assets depending on the program. Many do not make you sell your house or car but you can only have so much in cash - usually ranging from $2500 to 10,000 - it is basically $2500 for medicaid.

How much is her social security check?

There are several places in MD that are income based depending on the support she needs. It is worth it to look into them.

If you sell the house, she gets nothing, it is a non-issue.

I have 2 siblings in her area, who have done a tremendous amount, but these kinds of details are over their heads. Yes, I am aware she gets nothing when the house is sold - just trying to keep her in good credit until we decide what to do.

Very interested in this waiver - worry that it is state specific and probably won't help.