Where to get help? I am running out of money, taking care of my mom.

[Anonymous]

Curious what your DH has to say about this mess? Do you have separate finances? Is he on board with you spending your own retirement savings and child’s college fund on your Mom?

[Anonymous]

You can “spend down” for long-term care Medicaid in the sense that you private pay with your assets until you basically have nothing. But it’s very hard to admit to a nursing home from the community; typically people are admitted from the hospital to a rehab with their Medicare benefit, and then work with the business office to transition to LTC Medicaid/a nursing home bed.

Community Medicaid is different than LTC Medicaid - if I were OP, I would consult with an elder care attorney; they are experts in this area. But with MD Community Medicaid, there is a waiver program that enables people to remain in their home and get private-duty caregiver support. It’s pretty hard to get 24 hour care, however, even if someone qualifies, due to staffing shortages.

I think the elder care attorney is the right first step. It’s too complex to solve here and the available resources through the county (like respite care) would not necessarily suffice for someone who has lost the ability to swallow/has a feeding tube, etc.

[Anonymous]

Mom has no money so there is nothing to spend down.

[Anonymous]

Anonymous wrote:You can “spend down” for long-term care Medicaid in the sense that you private pay with your assets until you basically have nothing. But it’s very hard to admit to a nursing home from the community; typically people are admitted from the hospital to a rehab with their Medicare benefit, and then work with the business office to transition to LTC Medicaid/a nursing home bed.

Community Medicaid is different than LTC Medicaid - if I were OP, I would consult with an elder care attorney; they are experts in this area. But with MD Community Medicaid, there is a waiver program that enables people to remain in their home and get private-duty caregiver support. It’s pretty hard to get 24 hour care, however, even if someone qualifies, due to staffing shortages.

I think the elder care attorney is the right first step. It’s too complex to solve here and the available resources through the county (like respite care) would not necessarily suffice for someone who has lost the ability to swallow/has a feeding tube, etc.

The waiver program is maybe 10 hours a month and you have to be in a nursing home first.

[Anonymous]

Anonymous wrote:Mom has no money so there is nothing to spend down.

Are you OP?

OP said that her mom does receive some social security but they save it for emergencies. She also indicated that she's been providing for her mother for at least 14 years. Even if the social security is a relatively small amount, like $1k/month--that could be a substantial amount of "emergency savings" by this point.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You can “spend down” for long-term care Medicaid in the sense that you private pay with your assets until you basically have nothing. But it’s very hard to admit to a nursing home from the community; typically people are admitted from the hospital to a rehab with their Medicare benefit, and then work with the business office to transition to LTC Medicaid/a nursing home bed.

Community Medicaid is different than LTC Medicaid - if I were OP, I would consult with an elder care attorney; they are experts in this area. But with MD Community Medicaid, there is a waiver program that enables people to remain in their home and get private-duty caregiver support. It’s pretty hard to get 24 hour care, however, even if someone qualifies, due to staffing shortages.

I think the elder care attorney is the right first step. It’s too complex to solve here and the available resources through the county (like respite care) would not necessarily suffice for someone who has lost the ability to swallow/has a feeding tube, etc.

The waiver program is maybe 10 hours a month and you have to be in a nursing home first.

Not in MD. There is a long waiting just but you do not have to be in a nursing home, and I’ve has many patients with daily care, far more than 10 hours a month. But OP’s mom is ineligible without community Medicaid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Mom has no money so there is nothing to spend down.

Are you OP?

OP said that her mom does receive some social security but they save it for emergencies. She also indicated that she's been providing for her mother for at least 14 years. Even if the social security is a relatively small amount, like $1k/month--that could be a substantial amount of "emergency savings" by this point.

I’m sure it won’t take too long to spend it down, however much it is.

[Anonymous]

Have you looked into the Maryland Department of Aging? https://aging.maryland.gov/Pages/default.aspx

They have resources for all sorts of scenarios. Hard to say without knowing your mom's exact medical needs, but based on her low income she should definitely qualify for some sort of services/help. The hard part is figuring out which specifically and reaching the right people to guide you. It took us a while in a different state but we eventually got a "free" spot in a home with memory care for dh's grandpa (SSI gets taken and the person gets a tiny stipend).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Mom has no money so there is nothing to spend down.

Are you OP?

OP said that her mom does receive some social security but they save it for emergencies. She also indicated that she's been providing for her mother for at least 14 years. Even if the social security is a relatively small amount, like $1k/month--that could be a substantial amount of "emergency savings" by this point.

I’m sure it won’t take too long to spend it down, however much it is.

Right. You can qualify for Medicaid by spending down paying for care. You could also spend some of it on an allowable expense, like a funeral trust. This is what we did to qualify my MIL for Medicaid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I will address the situation of your daughter. As a family, it's ethical to ask your daughter for help too.

Regardless of whether you continue private school, your daughter can help by keeping her grades high and by becoming a great candidate for scholarships.

I have been impressed by the amount of free money out there for kids with excellent track records and no college savings. The selective universities are trying to level the playing field.

You might also want to make sure that your daughter is being mentored by people who can help her tap into local opportunities. Make an appointment with the school guidance counselors who work with seniors and find out what they know. Have your daughter make it a job to figure these things out.

By taking free actions to prepare your daughter and asking her to assume some responsibility, you may be able to strengthen your family and somewhat ease your heart. One of the things about financial privilege is that it makes you aware of opportunities...sometimes less financially privileged kids just don't know where to look. But information is "free" as is help with curriculum and career planning. Even library books can help.

We all wish we could do everything for our children, but sometimes we can't. If your family is close, your daughter will likely understand. It is a already a good thing that you are modeling a loving, conscientious home.

"No college savings" isn't the same thing as low income. If OP can afford to buy a second home (the condo her mom lives in) she likely is well above the threshold for financial aid.
Yes, some colleges/private scholarships have merit aid for "kids with excellent track records" but they be awarded that money regardless of what kind of money the parents have paid for college.

This conversation should not be about what the daughter (kids) can do about college. College costs are skyrocketing and scholarship funds only go so far. Rather than focus on scholarship aid, its the mother and care that need attention. I would not have her move in with you - the level of care and attention is not feasible for a working parent. The money that is currently being spent on a condo and care could be converted to a new situation - and while nursing homes don't seem to be somewhere the OP is interested in - the reality of the situation seems to suggest that is what is needed. Others have provide great resources to help my only additional comment protect your own funds and future.

[Anonymous]

Medicaid nursing home and rent out that condo for income!

[Anonymous]

Anonymous wrote:Medicaid nursing home and rent out that condo for income!

Sell the condo.

[Anonymous]

Anonymous wrote:She’s medically eligible. She lost her ability to swallow and lives on a permanent feeding tube and is also on oxygen.

I mean this kindly. Putting in a permanent feeding tube was probably not the way to go. Especially since she is also on oxygen. Both of my siblings are doctors. They adore my parents, but they are adamant that we are not going to put them on feeding tubes. They say they are painful to insert and that quality of life is dreadful. They have discussed this with my parents and have had them fill out DNRs, advanced directive saying no feeding tubes, etc. And my parents have loads of money and we could afford to support them for decades with full time care. Money is not the issue. Quality of life is.

I'm not trying to make you feel bad because if I didn't have doctors in my family I wouldn't have known all this.

But the problem here is your mother should have been allowed to die rather than getting a feeding tube.

I don't know if you are able to take a feeding tube out once it has been inserted. But if you can do that and get her put in hospice and let her die, I think you should. The medical community failed both of you if they didn't explain all of this to you.

This is ruining your life and for what? Your mother's QoL is terrible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:She’s medically eligible. She lost her ability to swallow and lives on a permanent feeding tube and is also on oxygen.

I mean this kindly. Putting in a permanent feeding tube was probably not the way to go. Especially since she is also on oxygen. Both of my siblings are doctors. They adore my parents, but they are adamant that we are not going to put them on feeding tubes. They say they are painful to insert and that quality of life is dreadful. They have discussed this with my parents and have had them fill out DNRs, advanced directive saying no feeding tubes, etc. And my parents have loads of money and we could afford to support them for decades with full time care. Money is not the issue. Quality of life is.

I'm not trying to make you feel bad because if I didn't have doctors in my family I wouldn't have known all this.

But the problem here is your mother should have been allowed to die rather than getting a feeding tube.

I don't know if you are able to take a feeding tube out once it has been inserted. But if you can do that and get her put in hospice and let her die, I think you should. The medical community failed both of you if they didn't explain all of this to you.

This is ruining your life and for what? Your mother's QoL is terrible.

Sadly, I agree with PP and my parents and I have had the same advice from my sister who is an experienced ICU and geriatrics nurse. Both parents have/had (Dad has passed) DNRs with clear guidance on no feeding tubes and, for my dad, no more than 48 hrs on a ventilator. Mom's says absolutely no ventilator. She has some lung issues and it is very likely her next bout of pneumonia (she had it last year) could be her end but that's what she wants.

As PPs have said you need to find guidance re getting her on medicare but also have a serious conversation with your mom's doctors about the path from here. She likely would be better served by hospice at this point.

[Anonymous]

Anonymous wrote:

Anonymous wrote:She’s medically eligible. She lost her ability to swallow and lives on a permanent feeding tube and is also on oxygen.

I mean this kindly. Putting in a permanent feeding tube was probably not the way to go. Especially since she is also on oxygen. Both of my siblings are doctors. They adore my parents, but they are adamant that we are not going to put them on feeding tubes. They say they are painful to insert and that quality of life is dreadful. They have discussed this with my parents and have had them fill out DNRs, advanced directive saying no feeding tubes, etc. And my parents have loads of money and we could afford to support them for decades with full time care. Money is not the issue. Quality of life is.

I'm not trying to make you feel bad because if I didn't have doctors in my family I wouldn't have known all this.

But the problem here is your mother should have been allowed to die rather than getting a feeding tube.

I don't know if you are able to take a feeding tube out once it has been inserted. But if you can do that and get her put in hospice and let her die, I think you should. The medical community failed both of you if they didn't explain all of this to you.

This is ruining your life and for what? Your mother's QoL is terrible.

OP, Sadly this is a consideration. I'm not a huge proponent of hospice but recently had Mom in hospice for 18 months until she passed and we had access to free RN's, social workers, and chaplains at the house. The last 4 months the RN's came out 3 times a week.

In Maryland you can self refer to hospice at least I've done it twice in Wicomico County. Call the local hospice and they will send an RN out or a PA out and talk over your situation and options.

I saw you have one caregiver for Mom 40 hours a week. Is Mom continent? Able to walk to the bathroom on her own? Can she get to the bathroom with a walker? Can Mom communicate her wishes to you? Is she still cognitive? Does she get outside? Is Mom able to use the phone to call 911 in case of fire or emergency? In case of fire is Mom able to evacuate the condo on her own if a fire breaks out after the caregiver leaves? My concern is Mom's safety after the caregiver goes home at the end of her shift.

The hospice social workers can facilitate other housing for Mom and access other forms of financial assistance if Mom qualifies.

There is no charge to have hospice come out and talk to you. You are not committed to work with them unless you sign the contract. I'd probably have them out to meet your Mom and caregiver and see what kind of options they can suggest.