How do you deal with the anxiety of paying for care?
I keep running into roadblocks with trying to find options for paying for Mom’s care.... and the anxiety is setting in. I have posted some of this before, but…
The goal is to keep Mom in her home. Since about February, Mom's evening care has been paid for out of her savings account at about $5,000 per month, and we are going to be out of money soon.
Last week, I applied for a home equity loan in her name and she was pre-approved (good news). But, a few days later, I found out that the POA I had set up did not include loans. That was my fault because when I did the POA last year, I didn’t include loans as an option. All I wanted to do was be able to pay bills since she couldn’t add me to her checking account because she didn’t have a valid ID. So, I did the POA. Never having been through this before, I had no idea at that time that we would even have to hire caregivers. So, the HELOC is now on hold, until/unless I get guardianship of person for financial.... to the tune of several thousand dollars.... Or a redo of the financial POA with a physician certifying her incompetent (she can no longer sign her name…). We will probably be out of money by the time that goes through the court system…
Today, I talked to an elder law attorney, and made an appointment for 2 weeks from now... more $$....
Over the phone, I inquired about the Medicaid waiver in order for Mom to stay in her home once her assets are paid down. I was told by several people that there was an 8-year wait list. Well, as it turns out, the State of Maryland put a hold on in-home Medicaid waivers two years ago because the list was too long. The lawyer told me that the only way around it is to go into a nursing home until Medicaid kicks in and then go back home. Then the waiver would kick in.
The lawyer also gave me the name and number of a Case Manager. So, I called her. She seemed very knowledgeable. When I heard her fee, I told her we couldn't afford it....
I feel like it is all on my shoulders, with my siblings letting me do whatever I feel needs to be done. I am the only one who sees the problems and tries to resolve them by making phone calls while I am sitting with Mom... (I am making one of my brother go with me to the appointment with the attorney, though.)
My stomach has been in knots all day after getting all this news, thinking of all the money that has to be put out just to make sure things are right… Worrying about Mom running out of money... And trying to face the fact that Mom may have to go into a nursing home -- not because I cannot take care of her -- but because she has no money...
I really thought by now, she would be bedridden -- after all, a PT told me almost two months ago that Mom probably won’t be walking in 3-4 weeks…Wrong. Even after her last fall 4 weeks ago (and 5 stitches later…), she has been doing surprisingly well.
With Mom being 94, how can anyone even guess how long you need the money to last??
This has been a real learning experience – and one I do not want to go through again…
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Thankfully they saved for these rainy days, but once it started pouring I was wondering how long would all their savings would last.
I also couldn't believe the cost of items like Depends. Good heavens, run through a pack within a week or so. I was cutting out coupons left and right just to save my parents a few dollars.
And the cost of eyeglasses, dentist, and hearing aids that aren't covered by Medicare nor by secondary insurance. Come on guys, this is when our parents need these things on a more frequent basis.
My Dad, after my Mom had passed, was ready to sell their house. Whew, I was Power of Attorney... so on days that my Dad was back in his time machine to the 1940's, I could sign for him. Otherwise he was still able to read house contracts. That equity was a good buffer, but I still worried because I didn't know how long he would live. He came from a very long line of people who even back in the early 1800's lived into their late 90's. My Dad was the same age as your Mom.
I'm assuming your mother has dementia? How serious is it? Could she respond verbally? I have a vague recollection of working for an estate planning attorney who video recorded execution of documents b/c the individual couldn't write, or might have been blind....I just don't remember that much about the situation.
I'm thinking an elder law attorney could prepare a new POA, simple and straight to the point, but thorough, and explain it verbally to your mother for her agreement to sign with an x (with someone guiding her hands), or record the entire session to document that the POA was executed freely.
This isn't the best way to get it done, but it would give you authority to execute legal documents for a HELOC on her behalf.
Are you absolutely sure that the existing POA doesn't give you execution authority for a HELOC? Are there any catch-all provisions allowing you to perform "any necessary acts: to obtain financing, or care for her in other ways?
If there's nothing like that, I think maybe this is a time to call your elected representatives and see if there's anything they can do, like get a waiver from the Medicaid stay so that you can access Medicaid for payment. I'm sure someone could "pull some strings" for you. Or maybe some support from a local tv station (although I really wouldn't want to go public with something like this).
I hope someone else can offer a good suggestion. Sounds like you're really, really "between a rock and a hard place."
I used a POA form from eforms and removed what wasn't necessary (at the time). I have only submitted it to her bank where she has her checking account, and their lawyers approved it. Then recently, I submitted it to my credit union, who did not because the part about the loans definitely says I don't have the authority to do that in her name. Again, that was my fault for leaving that out.
Before we can apply for Medicaid, her assets have to be down to $2500 (or maybe $2200). We have about 5 months to go before that happens. If she went into a nursing home, it would be about 2 months.... For the Medicaid waiver for in-home care, your assets have to be down to $11,000 before you can apply. But, that community-based waiver is not an option because the State is not accepting applications for it (as of 2 years ago). One question I have for the attorney is how long would she have to be in the nursing home and on Medicaid before we can bring her back home....
I did submit the form for Medical Assistance for the advisory level of care -- which is used to determine if she is even eligible for a nursing home care. That is the first step apparently. Then I have to see if we (my siblings) can have her admitted to a nursing home because she is not able to sign herself in, and does not have a medical POA... I have heard conflicting stories.... One was that we need a guardianship of person set up for medical. Someone else told me that the Surrogate Law will allow her children to do it, provided we all agree. So, there are many more hurdles to jump...
Guest, thanks for the insight. As with the signature issue, I was trying to figure out some way that MaPotter could get help, and politicians have been known to sometimes do something for their constituents.
Your points on what's probably become overwhelming in getting on Medicaid are well taken. I think we're heading for a crisis in elder care, sooner rather than later.
I watched part of a good PBS program last night, and plan to post on it separately. The "golden years" are anything but, and with a redirection of priorities that definitely are not humanitarian oriented, care will probably be more challenging, and as you pointed out, people are going to slip through the cracks in the safety nets.
Or maybe they could be recruited to build walls, as it seems as though a certain individual continues to alienate other countries...and who knows? Maybe he'll want to waste billions of dollars building a wall on our northern border.
In my state - Louisiana- the current state budget does not have the $ to pay for the required state coshare for Medicaid programs. The governors office (D-Edwards) via DHHS sent out a letter last month to abt 40,000 medicaid recipients in LTC programs (AL and NH programs) that as of July, 2018 state funding for Medicaid would cease unless legislators prioritized Medicaid to have it fullly funded in the budget. Legislators were pretty peeved that Governor Edwards did this but he said it needed to be known as families needed to plan.... Their in a dual “special session” & regular session right now up in big Baton Rouge to deal with the massive shortfall of $ due to the clusterF that was the whiz kid Bobby Jindal R-governor years (huge tax cuts and tax abatements along with some less than stellar tax credits programs). But something definite has to be placed by this Monday, 6/4 otherwise no state share of Medicaid paid to facilities starting July. Several NH owners have said that if that happens they will close within months and the fall back is to send residents to ER and let them then become a problem for the state Charity hospital system to deal with.
Aging in America will not be pretty unless there’s a dramatic change in governing.
The midterms are super important.
Unless you’ve dealt with an aging “at need” elder or special needs child, most folks are clueless as to the costs and availability of programs.
As far as the cognitive issues, aphasia effects the part of the brain associated with speech -- first not being able to find the right words. Eventually not being able to speak and understand speech. It eventually effects the ability to write and understand the written word. The difference between other dementia-related diseases and aphasia is that aphasia doesn't start with dementia. It starts with not being able to find the right words. I have started to see some short-term memory issues with Mom. She still recognizes everyone. Whether or not she can say their names is another story....
I don't want this to even sound political here, but after all I have been through with Mom and seen with my sister, I cringe every time I hear "Medicare for All". If you have been through all this with your loved one, you can see what EVERYONE would be dealing with. And, the government will decide who gets treated for what.
My sister, who is disabled with MS, has a Medicare "Advantage" Plan with Johns Hopkins. She now has a $25K balance on her home equity line of credit for one year from all the co-pays she could not pay. A smaller hospital forgave a $500 bill. Johns Hopkins would not even let her pay $10 on her bill -- the only thing she had left at the end of the month. They told her they would have to send it to a collection agency.
Gotta run.
I was hoping it was just two bad fdays. But, a few days later, she wanted to get money out of the bank, so she got a check out. She couldn't sign her name, but she knew where the signature line was. Then she said that I could do it because I was on her account. (The gist of what she said anyway.)
I/we did decide to stop the evening shift. We did that initially because Mom would get up at all hours of the night and fall. My brother couldn't handle it anymore. But, now Mom seems to be sleeping most of the night. She also doesn't seem to be able to get out of bed with the rails up. If she does fall, we have a fall mat. I still think we can keep her as safe if not safer than a nursing home would. Why send $5000 per month to have someone watch Mom sleep. So, I feel a little bit better about that. If she does fall out of bed, we have a fall mat. I still think we can keep her as safe if not safer than a nursing home would. We may have to hire someone to help get her ready for bed so that my brother doesn't have to do that (she can be uncooperative sometimes). And, that way I don't have to stay so late every day.
Thanks everyone!
Does your Dr have a social worker on staff? They might be some help in directing you to services.
Ohio has a senior service called Passport that will help connect you with service providers both private and public, like rides, meals, etc. by County.
Local Senior Services in Ohio put me in touch with with pro bono (free) legal advice, you get a 30 minute consultation plus follow up calls. This alone saved us hundreds of dollars in legal fees.
Catholic Family Services was a HUGE help in providing information on local services, how to sign up for Medicaid, etc.
Call the supplemental insurance company, Medigold was able to give me some info and direction.
Get the forms and sign up for Medicaid. Don’t worry about the waitlist, this is a lengthy process and anything you can do to be ready is an advantage. Rules change all the time.
Talk to as many people and orgs that you can, compare and verify advice because aging and care is a very complicated business. I got lots of conflicting info and had to keep asking questions. Be patient and polite, apologize and plead ignorance but there are a lot of people who can be helpful if you are persistent.
I am back to hoping we don't have to do the nursing home route. If my brother passes before her, that would be a different story....
This program saved me when my wife became bedridden and I could not afford to place her in a nursing home. Everyone needs to check this program out because, unfortunately, it is not well known.
Another thing to check out, if your father was in the military, is the Aid and Attendance program provided by the VA. This program, if you qualify, provides a monthly stipend of around $1,000 to $2,000 (tax-free) for veterans and their spouses. You can go to "A Place For Mom/veteran's affairs" for more information. Again, this is a program that very few people know about.
There is a problem of doing the paperwork and the long time to get approved. However, once you apply, the VA credits your stipend to a account for each month it takes to get approved. For example, if your stipend was to be $1,200 a month and it took 6 months to get approved, you will get a lump sum of $7,200 once you get approved and will then continue to get your monthly stipend.
I hope this helps!
Today, I am going to contract with another agency to provide some help getting Mom in bed 6 days per week. That will allow me to go home earlier. But, paying for 12 hours per week is better than paying for 5, 12-hour shifts per week. And, if the V.A. comes through, that will help, too.
I have applied for Aid an Attendance. I requested that they expedite the claim based on her age (recommended by the V.A. -- so that was good to know). The date for them to make a decision is August 26. I have to send them more information, though, which I am in the process of doing. It is good to know payments will be retroactive.
And, to add to the stress... Mom has a water leak somewhere between the water meter and her house.... One estimate was $3600... Today, I will get a second.... It is a good thing I stopped the night-time care...