FIL divested assets and now has no way to pay for MIL's nursing home care.

[Anonymous]

The agency considers or “looks back” over the previous five years to see if any assets were sold for less than true asset value, given away, or otherwise transferred within the same time period when determining eligibility for Medicaid coverage and any violations that restrict or delay eligibility.

https://www.seniorliving.org/medicare-medicaid/look-back-period/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What were the details of the sale of their house to BIL? I don’t understand how they sold a house 3 years ago and have less than $50k in savings. Just how far below market price was the sale? Why would elderly people with modest savings think they could give $125,000 away? None of this makes any sense.

Ok, these aren't the exact details down to the dollar amount.

FIL inherited the home about 50 years ago. I believe it was mortgaged to 17K in the 1970s.
The house was sold for approximately ~450 in 2021.
325 was owed on the home. FIL did cash out refi's every few years.
The home was appraised at ~575 (DH and I assumed it would be worth 700K, but we were incorrect)
FIL "gifted" the 125K in equity to BIL and walked away with (roughly) 100K.

FIL spent about 40K on an exterior building on his cabin property, building a workshop for himself. He spent about an extra 10K on various things: diamond earrings for MIL, etc.

FIL gifted the equity to secure a quasi-tenantship in the home, to come/go as he and MIL please to attend her Dr's appointments. FIL never moved out of the home. All of the original belongings, furniture, clothing, and dishes remain. FIL and MIL still occupy the master bedroom. FIL lives there almost full-time now.

He didn’t gift the equity. He sold it for 125K less than appraisal which considering he still has all his crap there and is living in the master bedroom years later was a deal in his interest not the people who bought it.

It is unlikely that FIL would have actually gotten 575 without inspection and doing nothing to the house.

yeah well, that’s not how the government sees it. if he wanted to make some kind of bona fide deal, he should have done it in writing. now he’s screwed himself.

Wait did they not actually sell the house to BIL and skipped transaction costs, taxes and title changes? If he sold the house legitimately for 450 and walked away with only 100 k after mortgage and taxes and then spent 100K, I don’t think he’s triggering the look back.

FIL giving BIL a price break is not gifting money.

yes, it literally is! it’s hiding assets from medicare.

No, it's not.

you’re going to need to provide some support for that.

I've been through it and my loved ones money and belongings were stolen. I just had to show I didn't steal them and had proof of some things so they let it go and approved them. This isn't a big deal. Especially if the house wasn't updated.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What were the details of the sale of their house to BIL? I don’t understand how they sold a house 3 years ago and have less than $50k in savings. Just how far below market price was the sale? Why would elderly people with modest savings think they could give $125,000 away? None of this makes any sense.

Ok, these aren't the exact details down to the dollar amount.

FIL inherited the home about 50 years ago. I believe it was mortgaged to 17K in the 1970s.
The house was sold for approximately ~450 in 2021.
325 was owed on the home. FIL did cash out refi's every few years.
The home was appraised at ~575 (DH and I assumed it would be worth 700K, but we were incorrect)
FIL "gifted" the 125K in equity to BIL and walked away with (roughly) 100K.

FIL spent about 40K on an exterior building on his cabin property, building a workshop for himself. He spent about an extra 10K on various things: diamond earrings for MIL, etc.

FIL gifted the equity to secure a quasi-tenantship in the home, to come/go as he and MIL please to attend her Dr's appointments. FIL never moved out of the home. All of the original belongings, furniture, clothing, and dishes remain. FIL and MIL still occupy the master bedroom. FIL lives there almost full-time now.

The original house is not relevant. Nor is the equity as they bought the house. What is relevant is how proceeds were spent and since they are married he can keep the house and have some assests. People here are giving you bad advice. FIL needs to call your county/state long term care office and get guidance from them. There is nothing an attorney can do as there is no money to hide. He may be having cognitive issues as well.

the original house is absolutely relevant for the Medicare look-back. how FIL spent the proceeds is irrelevant. FIL can’t keep the house because he already sold it, so not sure what you’re talking about there.

He keeps the cabin. Keep up.

[Anonymous]

How Does The Medicaid Look Back Period Work?
The Centers for Medicare & Medicaid Services (CMS) explains that when applying for Medicaid to pay for nursing home care and other services associated with senior care while in a nursing home, the Medicaid eligibility worker asks if the individual recently gave away any assets such as vehicles or money. The representative also asks if the person sold property for less than its fair market value at the time of the sale within the past five years.

This transferring of assets usually results in a penalty, meaning that the person seeking senior living at a nursing home is ineligible for Medicaid, “For as long as the value of the asset should have been used” to pay for the nursing home care.

The site uses the example that if nursing home care costs $5,000 per month and the individual transferred $10,000, then the person is ineligible for Medicaid for two months. The penalty begins the month of the Medicaid application, not the month the individual transferred the property.

The individual then potentially qualifies for Medicaid benefits after the Medicaid look back penalty ends. That qualification is contingent upon the person not transferring any assets in any months while serving the initial look-back period penalty.

That the transaction was within the family and not arms length certainly does not help.

FIL is an IDIOT. Does he have cognitive issues? Or did he just think everyone else would pony up $ for her expensive care?

He can keep the cabin as it is his residence but he may need to sell it to pay out of pocket for care.

Is his plan that he and MIL will move in with BIL and SIL who will provide the care rather than HHA or a SN facility?

[Anonymous]

Anonymous wrote:OP - you said in the original thread that the house sold at or over market value for 632k. The math ain’t mathing.

OP here—I know, sorry. The original details given to DH and me were murky, and it's taken some conversations to get clarification on the final numbers.

[Anonymous]

Anonymous wrote:

How Does The Medicaid Look Back Period Work?
The Centers for Medicare & Medicaid Services (CMS) explains that when applying for Medicaid to pay for nursing home care and other services associated with senior care while in a nursing home, the Medicaid eligibility worker asks if the individual recently gave away any assets such as vehicles or money. The representative also asks if the person sold property for less than its fair market value at the time of the sale within the past five years.

This transferring of assets usually results in a penalty, meaning that the person seeking senior living at a nursing home is ineligible for Medicaid, “For as long as the value of the asset should have been used” to pay for the nursing home care.

The site uses the example that if nursing home care costs $5,000 per month and the individual transferred $10,000, then the person is ineligible for Medicaid for two months. The penalty begins the month of the Medicaid application, not the month the individual transferred the property.

The individual then potentially qualifies for Medicaid benefits after the Medicaid look back penalty ends. That qualification is contingent upon the person not transferring any assets in any months while serving the initial look-back period penalty.

That the transaction was within the family and not arms length certainly does not help.

FIL is an IDIOT. Does he have cognitive issues? Or did he just think everyone else would pony up $ for her expensive care?

He can keep the cabin as it is his residence but he may need to sell it to pay out of pocket for care.

Is his plan that he and MIL will move in with BIL and SIL who will provide the care rather than HHA or a SN facility?

OP here - right now, there is no plan for her to be discharged home. He has back problems and could not be her caregiver. BIL and SIL work full-time.

DH and I need to clarify if long-term care means possibly a short-term SNF stay paid by Medicare or if the recommendation at this point is for long-term care directly from the LTCAH. FIL has not been forthcoming with information, and DH doesn't want to ask clarifying questions. The communication problems in this family drive me nuts.

FIL is a life-long alcoholic. I've asked the extended family if he and MIL ever made any plan for their aging needs, and the answer is no. Per one of his siblings (verbatim): "They never planned for any kind of long-term care."

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am so sorry to say this at what is an incredibly devastating and stressful time, but please consider that your mother in law may be a better candidate for hospice than a long term care facility. If she is not eating, and in the state you describe... it can be very hard for family to see that it is time to transition to end of life care, as opposed to prolonging life. I say this as someone whose own grandfather had serious and unnecessary surgery about a week before he died. We would have been better off discussing a palliative care plan, but were all in denial. I wish you all the best as you navigate this incredibly challenging situation.

+1
Bring her home, have hospice care to make her comfortable.

I think only a doctor can determine whether hospice is the appropriate care.

[Anonymous]

That would explain some of the poor decision making.

What do you mean by this, OP? "LTCAH"

Medicare won't pay for home health aides. Visiting nurse, visiting OT and PT, yes. But not long term care at home. That is out of pocket, long term care insurance or in a Medicare facility once she qualifies.

He has the proceeds from the sale of the house, look back aside. That will count as a married couple asset. He REALLY needs to consult with an elder care lawyer to make a plan re: the current scenario.

https://www.medicaidplanningassistance.org/medicaid-spend-down/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am so sorry to say this at what is an incredibly devastating and stressful time, but please consider that your mother in law may be a better candidate for hospice than a long term care facility. If she is not eating, and in the state you describe... it can be very hard for family to see that it is time to transition to end of life care, as opposed to prolonging life. I say this as someone whose own grandfather had serious and unnecessary surgery about a week before he died. We would have been better off discussing a palliative care plan, but were all in denial. I wish you all the best as you navigate this incredibly challenging situation.

+1
Bring her home, have hospice care to make her comfortable.

I think only a doctor can determine whether hospice is the appropriate care.

OP here - yeah, if I were to bring up this discussion, it would be like a fart in church.

[Anonymous]

If a doctor determines hospice is appropriate, there are facilities if he is unable to care for her due to physical limitations.

[Anonymous]

Anonymous wrote:That would explain some of the poor decision making.

What do you mean by this, OP? "LTCAH"

Medicare won't pay for home health aides. Visiting nurse, visiting OT and PT, yes. But not long term care at home. That is out of pocket, long term care insurance or in a Medicare facility once she qualifies.

He has the proceeds from the sale of the house, look back aside. That will count as a married couple asset. He REALLY needs to consult with an elder care lawyer to make a plan re: the current scenario.

https://www.medicaidplanningassistance.org/medicaid-spend-down/

Sorry - long-term care acute hospital. Right now, MIL has been in a long-term ICU level of care in a hospital like this: https://www.medicare.gov/Pubs/pdf/11347-Long-Term-Care-Hospitals.pdf

Next time FIL brings it up, I will recommend to DH he talks to an elder law attorney.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP - you said in the original thread that the house sold at or over market value for 632k. The math ain’t mathing.

OP here—I know, sorry. The original details given to DH and me were murky, and it's taken some conversations to get clarification on the final numbers.

So what are the actual numbers? Because you said you looked it up online.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Can't he sell the cabin?

The living situation was already fraught with significant tension (see here: https://www.dcurbanmom.com/jforum/posts/list/1174345.page).

OP here - I can't imagine FIL selling the cabin he poured his heart and soul into. Also, he financed his original home several times to pay for the building costs of the cabin, upgrades, etc.

So you think the "only possible way" is to sell the primary home that 4 people, including BIL and SIL, are living in. Because he poured his heart and soul into the cabin? OP, I think there's some denial going on here.

FIL wants to hang onto the cabin because in his mind that's the love nest for his next wife.

OP, If I were you I'd stay out of this except to murmur "Oh that's too bad" or "Gee that sounds hard" at appropriate intervals. There is nothing for you to do here.

It's so hard not to stay involved.

FIL visits MIL every single day. On days he can't go and goes to his cabin, he asks DH to go and will say he does not want MIL to be alone. DH goes once a week and has been going on weekends to visit his mom when FIL is at his cabin.

There have been various miscommunications; FIL called DH a few weeks ago in tears and said, "[MIL] is in multi-system organ failure and is septic!" DH and I rushed to say our goodbyes. All the family gathered at BIL/FIL/SIL's house that evening to support him. Everyone was crying, thinking it was the end and we had to arrange funeral arrangements. Turns out, MIL was "at risk" of sepsis and MOS due to the amount of interventions she had.

The most recent issue is that FIL was informed MIL could not return home. We are unsure how that conversation went, if she is eligible for 100 days at an SNF paid under Medicare, or if she is not eligible for SNF care and has to move to a long-term care facility. When DH asks for clarification, FIL says he will update him or gives non-answers. I may be in the wrong here, but I feel DH has the right to know if it's recommended his mom move into long-term care permanently. We assume she needs the care, but we have no updates or information besides what FIL disseminated. DH has tried to call the facility for information but was told they can't share anything with him because he's not on the chart as a contact. DH does not want to ask his Dad to be included as a point of contact.

I agree with every PP that hospice and or palliative care would be a good option. Knowing MIL, this is not how she would have wanted to live. But that conversation is not for me - it's for the doctors and her care team to have with FIL. FIL does not include DH or any other family members in these conversations.

OP how are you protecting YOUR assets? What are you going to do when FIL begs you to get a home equity loan to pay for MIL’s nursing home? If you think there is any possibility of this, you need to get started on paperwork that would ensure FIL gives you the equity cabin outright to equal the money you give him.

OP here - wait. How would our assets be impacted in any way? We didn't buy the home from FIL.

We have already been asked to help FIL with medical bills for MIL.

Your assets are not in danger. He’s saying if FIL wants money from you.

I worked in elder law and former member of NAELA but it’s been 20 years since I’ve worked. I can’t even give an opinion, it’s been too long and regulations change. All I know is some posters are giving bad advise. You need to only take the advice of an elder law attorney. He pays the attorney with his money and it’s one of the legitimate large expenditures they can make without penalty.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP - you said in the original thread that the house sold at or over market value for 632k. The math ain’t mathing.

OP here—I know, sorry. The original details given to DH and me were murky, and it's taken some conversations to get clarification on the final numbers.

So what are the actual numbers? Because you said you looked it up online.

Yeah that's my fault, I was looking at the newest property value and not the actual sale price from 3 years ago.

Here is the breakdown:

FIL inherited the home about 50 years ago. I believe it was mortgaged to 17K in the 1970s.
The house was sold for approximately ~450 in 2021.
325 was owed on the home. FIL did cash out refi's every few years.
The home was appraised at ~575 (DH and I assumed it would be worth 700K, but we were incorrect)
FIL "gifted" the 125K in equity to BIL and walked away with (roughly) 100K.

FIL spent about 40K on an exterior building on his cabin property, building a workshop for himself. He spent about an extra 10K on various things: diamond earrings for MIL, etc.

[Anonymous]

This sounds like a whole lot of not your problem to me.