I am my mother's POA (I am her 60-year-old son) she has dementia, over the past 6 months, I had to sell her home, move her to a memory care unit & 2 months ago she got pneumonia and had to go to a skilled nursing rehabilitation center.
7 weeks later and some improvement she still is not well enough. During the care team meeting I had today & speaking to her doctors and even my observation of my mom, it looks as though she will not recover enough to live in an assisted living or memory care because she is not strong enough & her dementia has worsened. She is weak, confused, and now walks very slow and sleeps a lot.
A few months ago, I sold her home it was paid for & now bumped up her savings to over 6 figures. Once my mom stops improving OR her 100 days expire, she will then convert to self-pay and at that point, she will have enough in savings for about 44 months. Her monthly income will all go to the skilled facility and the shortfall will (spend down) from her savings.
To avoid that her attorney recommended a Medicaid annuity. I am in the process of looking at this. Her attorney has ALWAYS been upfront, diligent, fair & above all very honest.
He is gathering the information & within the next few days or a couple of weeks, I plan on doing the annuity. Her attorney has a large workload & he put me in touch with the company that I will purchase the annuity from BUT they only work with attorneys. BUT If Medicare feels my mom is not improving & then we convert to self-pay BEFORE I can get the attorney to set up the paperwork, will that disqualify my mom from trying to protect some of her assets?
I do not understand how you can do this and Medicaid not denying my mom? after all, isn't this is like hiding money? I want what is best for my mom & if we need to do a spend down so be it. BUT the attorney said we can save nearly half or more of her money that she worked so hard for so that it goes to me instead of a nursing home.
I just want what is best for my mom & IF I can save her from losing all her money LEGALLY, ok, BUT this seems like a somewhat shady way to save some of her income. I wish I knew and understood more about Medicaid Annuities. I am learning BUT it still sounds sketchy.
And can I apply for the annuity IF Medicare stops paying for her 100 days? Or MUST the application & annuity be purchased BEFORE her100 days ends or Medicare says she no longer qualifies for the 100 days? I am confused.
Bottom line I want what is best for my mom and will spend it down, what it takes to make her comfortable.
I agree with you.
This is hiding money.
Your mother's assets should go for your mother's care. Anything else is, to my mind, pure greed.
Whether you choose to do this or not I would be very very very careful. When these things go wrong they go catastrophically wrong.
Of course she wanted me to inherit her money. But I wanted HER to have the best care there was, meaning private pay and avoid Medicaid like the plague. So, as her POA, I spent nearly every penny of their $400k on their care, both of my parents. Had I sent her to a Medicaid SNF, she'd have had a roommate to share the bathroom with, and a shabby curtain separating them, and the blasting tv's, as if a piece of cloth could drown out that noise. Nosiree.
What better to spend a lifetime of hard earned money on than good care in a beautiful environment? And I feel really good that I did what I did for parents, with their money, bc I already have a house and a car and food on my table. I have enough.
I'd advocate to get your mom back to her Memory Care AL with hospice on board if she's weak and frail. That's what memory care is FOR: confused elders who live there until they pass. Not regular Assisted Living, but specifically Memory Care assisted living.....big difference.
Don't do anything to add to your stress right now, that's my advice.
I'm sorry you're going through this with mom. I know exactly how it feels bc I was in exactly the same position in 2019.
My mom is weak, confused & paranoid & see things that are not there These issues and a few others, make it impossible for her to return. also, she gets obsessive compulsive being alone & cleans over and over and over (the dementia) it has gotten much worse since she was sick with Pneumonia. She really got walloped and is not recovering enough to live alone.
It is not expected that she will be able, and she has a lot of trouble walking, swallowing and now often cannot make it to the bathroom in time and unable to change herself without dizzy spells.
1. Status at SNF, right now guessing as you’ve written concerns on “100 days” & “improving” that mom is actually a patient at the SNF? Like rehab or post hospitalization patient discharge to SNF.
Is this how currently admitted? If so she is there w/MediCARE being billed as it will pay for up to 100 days if progressing / improving. But Medicare does not pay for custodial care as a resident in a SNF. Find out exactly what she is as it will make a difference…
BECAUSE…
- “100 Days” not guaranteed coverage by MediCARE. Usually first 20/21 days which are covered 100% by Medicare will show she is progressing. But come day 20/21 Medicare only pays 50% & her secondary health insurance pays 50% (hopefully) only if “progress” happens. Most do 4 weeks. Type of patient who gets way into the “100” tends to be younger over 65 yr old w/a TBI as those get better under rehab.
- once her Medicare patient status end, mom is long term custodial care resident. LTC custodial care paid by private pay, LTC insurance or CA MediCal LTC program if facility participates.
So is it you’ve been told mom has too much assets to be eligible ?
- Are you sure abt that as CA increased asset max for ‘23 and it’s entirely gone for ‘24?
- MediCal still has income limits. Annuity in payout counts as income. Between it & SSA$, you imo have got to find out if all this income takes her over the CA MediCal income limit. Bc if it does, she’s not going to qualify. Her income is required to be a copay to the NH as her Share of Cost (SOC).
Please realize, She can private pay. As long as she spends $ on legit items, it’s good should she apply for LTC MediCal in the future. By her doing this it gives you time to figure stuff out.
BC on ANNUITIES it’s sticky…
2. they are allowed as legit transfer of her $ as she is moving $ from a bank account in her name into an annuity which she owns. $ was hers and still is hers.
BUT
- when LTC Medicaid application filed, annuity info submitted as it’s an asset & also income if it’s in payout mode. State is more than likely going to require beneficiary changed on annuity. So State becomes the primary. Upon death, annuity $ is used to repay LTC Medicaid paid costs first & foremost. If $ left over, it’s yours.
- LSS annuity stays but beneficiary must change to the State.
This is what most States do. Not gonna let mom put 500K in annuity 2day and be ok for Medicaid manana. But as CA just did a sea change in how they look at assets, for their versions of LTC Medicaid aka MediCal, might not need to bother with an annuity as no asset limit.
How does CA view annuities as an asset under the new changes? That is what I’d want info on and in detail.
If the attorney has not brought up info on difference btw how Medicare and Medicaid differ on how they pay costs in a SNF & info on income maximum and SOC or info on States position on annuity requirements, and upcoming 2024 change for asset limits for CA, they imo are not Medicaid savvy. They are estate planning not Medicaid planning attorney. Your post has the vibe that your spider senses are telling you something off, isn’t it??
So guy selling the annuity, what is his commission? how structured? You want $ figures & in detail in writing. Annuity is an insurance product, no matter how they dress it up. Also info on surrender costs & early withdrawal options.
If mom has 44 mo of $ to private pay, that is what I’d do. It will give her & you total flexibility. Especially if she needs to move to yet another type of skilled facility. Or you want to hire sitters. 44 mos = almost 4 years and average stay in a NH is 2-2.5 yrs. Not to be harsh, but Her $ probably will out live her.
https://www.annuity.org/retirement/health-care-costs/medicaid-annuity/#:~:text=The%20Medicaid%20annuity%20enables%20the,place%20within%20your%20retirement%20plan.
A Medicaid annuity only allows a spouse to receive a stream of income if the other spouse needs to go into a NH. Your post says nothing about a living father. I am not sure this annuity even applies to your situation.
So it’s a #s game to work the SPIA payout best and as actuarial low as possible so the CS can still file for a waiver to get some of the NH spouse copay/Share of Cost from the NH spouses income. A CS who is themselves in their 40’s -60’s is youngish enough to have their SPIA to run a full 30 years or maybe even 40. So they keep it low and still capture some of NH spouses income and so stay hopefully financially secure; and their NH spouse still eligible for LTC Medicaid. If it ends up NH spouse copay is only $100 a month, it is what it is. That - a May/December marriage - is the ideal scenario. If the couple are both in their 80’s, can’t be done as their are close to or past their “expiration date” for the actuarial structure of the annuity. Doing a SPIA correctly are complex; it’s not an off the shelf annuity that most insurance guys can sell. (Personally I hate those as sold so often to fearful elders with a hefty commission to the insurance guy and sold at free steak dinner investment seminars). There’s really only a handful of companies that do these SPIA and do them only within an affiliation with speciality law firms.
I know someone who had one done. A significantly younger CS with kids from the needing a NH spouse. Their kids did school & a sport with ours. The Hubs was in a horrific auto accident needing extended specialty rehab; he went thru all his insurance and she was at the point of looking to selling personal items to pay for care. Someone suggested to her (beyond overwhelmed) to see a divorce attorney…. they did not get divorced but atty knew how to separate and structure assets for couples to maximize & secure his clients interests without needing to be divorced. He got the SPIA done. Literately saved her from loosing her home and going thru a dramatic lifestyle change. SPiA is an amazing creature if it can work for your situation.
My focus right now is getting my mom in a better place mentally she has paranoid delusions. I must admit, the skilled nursing facility she's in now, which takes Medicaid, has taken very good care of my mom.
The facility is very clean. The residents look shaven and clean their hair combed and no smell of urine I also see the floor cart around mopping, wiping the walls and the windows cleaned as well.
My mom's medical team has been taking good care of her. They've been keeping in touch with me in regard to her progress, which is mediocre at best. She. has a long way to go but to pull her out of there since my mom likes it there. The staff is good to her, and she's getting the proper care. I think it would be a mistake, especially since it could make her dementia worse.
At this point, my plan is to leave her where she is unless we come into other problems. Because she's well cared for.
Yes, this is a skilled nursing facility that takes Medicaid. Yes, the building is a little bit older. Yes, she shares a room with somebody. But my mom is happy, and she's getting good care to pull her out of there now, I think would be a mistake.
I think doing the annuity at this point would be a mistake. I'm going to hold off. keep my eyes on her. See the care that she continues to get and make decisions at a later time. But for now, I'm going to focus on my mom and her well-being.
And I thank you very much for your response