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[quote=Anonymous]Our family is dealing with trying to figure out the next best steps for my 85+yo aunt and uncle.  My aunt is cognitively fine, while my uncle is has been slipping into dementia the last couple of years.  He is currently in a rehab place after a hospitalization for a UTI.  My aunt has been caring for him without much help but can’t really continue at that level.

My aunt and uncle live in the NY metro area, which is expensive for everything. Their son, “Jim” lives in NJ and daughter “Jill” lives in a rural Midwest college area.  Initially the kids didn’t really know much about their parent’s finances, but I went up to help my aunt and uncovered the fact that they take in close to $9k per month from pensions and SS.  They’ve donated large amounts to charities over the years, so outside of the income they have about $200k cash and a home worth $300k. My uncle served in the army for a few years and qualifies for veteran’s benefits of about $2300/m, in addition to the pension/ss.

We’ve identified a place near my cousin in the rural area that say they can take the two of them for about $7500/m. It seems like a good option, as my cousin Jill would be close enough by to visit frequently, but would not have to take on day-to-day care.

My cousin Jim has engaged a lawyer and a couple of social workers to help navigate everything.   For some reason they seem to be pushing him (and hence, him pushing the rest of us), to put my uncle in skilled nursing care ($12k/m) and drain/hide their assets so that Medicaid/Medicare pays.   The argument is that they’ll run out of money at a self-pay facility, that assisted living won’t take him, that he could end up aggressive and an elopement risk so we should put him in skilled nursing now, rather than start at assisted living and move him later because no facility will want him once he’s aggressive/an elopement risk.

Second component of my uncle going into skilled nursing is that my aunt would then have to live with her daughter, Jill.  Jill has a full-time job, a husband with mobility issues, and is generally-speaking, not big on caretaking duties.

I don’t understand why my cousin is pushing the skilled-nursing route.  Can government pensions be hidden from Medicare?   Do assisted living facilities routinely reject/evict residents with dementia?  I’ve spoken to them directly and they say that they care for patients through end of life, that they will do hospice care as needed.  Uncle does not have complex medical needs.  At a recent care meeting the rehab place said they felt he could be discharged to assisted living. He’s currently a high fall risk but they are impressed with the speed that he is rebuilding his mobility.

The family dynamics are a bit of a hot mess.  My sibling and I are a step removed obviously, and just want a reasonably good outcome for my aunt and uncle.  Sending him straight to skilled nursing and having my cousin Jill take care of my aunt seems like one of the least-desirable outcomes, especially when there’s an assisted living option near family that they could afford that would allow them to stay together.   I just genuinely don’t get what he might be being told, or why.  [/quote]

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