What are our options for care?
I am trying to figure out next steps for Mom. She is 94 and has aphasia. Her speech is not understandable most of the time. She does let you know if she wants to eat or go to the bathroom. Her balance is also bad, and she is a major fall risk. More and more, she needs assistance walking. She also has dysphagia. She is still in her home. I currently have caregivers coming in at night 8 p.m. - 8 a.m. M-F. My middle brother spends the night on Saturdays, and I spend the night on Sundays. I am also at her house about 12 hours a day. My older brother lives with her, but has his own health issues so he cannot help Mom, especially when she gets up several times at night or doesn't sleep at all (hence the reason for the evening caregivers). She receives in-home palliative care through a hospice program. They have her at 40% on the palliative care scale. She really needs someone with her all the time. The evening care costs about $5k per month (24/7 care would cost $12K). In about 2 months, I am going to start worrying about Mom running out of money. We are all on fixed incomes, so pitching in to afford her care is not an option. Other options to keep her in her home would be to get a reverse mortgage (always sounds too good to be true...), or a home equity loan. We don't want to throw our brother out on the street by selling her house. I understand that if a disabled adult is in the house, it would be exempt from Medicaid for paying down assets. What other options do I have if she is still with us in 2 months? I realize Medicare covers nothing (except medical expenses). What type of residence facility is covered by Medicaid? Assisted Living? Memory Care? What would be best?
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Your mom has to be medically qualified as well as financially qualified for medicaid at the time you file. Utilizing a certified elder attorney well versed on medicaid might be a good course of action especially since you have a handicapped brother to also be concerned about.
In some states, Medicaid covers Al's , but not not in others.
In NYC, where I live, Medicaid covers 24/7 in-home care. Go figure.
It so much depends on your individual state.
I believe the local Area Agency on Aging would be a good place to ask questioms.
What is her prognosis? Do the "experts" think she is in the end stage of her life? Is hospice care likely in the near future?
I suggest you consult an Elder Law attorney and get some guidance about applying for Medicaid. If the money will run out in a few months, get started on this now.
Best wishes to you all. Keep us informed about how this is going.
Most hospice groups do both in-home hospice and also in-facility hospice. Hopefully your current hospice does both. If so, I’d start by asking the current hospice group which NHs they currently go into. Then contact each of those NH to ask if they take Medicaid, will accept residents as “medicaid Pending” and if any open beds. Then go to see all with open beds.
Even if the NH is somewhat far, go to visit. Once your mom clears Medicaid, she can transfer to a NH more nearby once they have an open bed. Medicaid allows for transfers and without any 30 Day Notice penalty placed.
The NH will likely ask from the onset what mom has for income, it’s often referred to as her “awards letters”. As it gives NHs an idea as to what her copay or SOC (share of cost) will be and if she’s within Medicaid income limits. For those on SS, the awards letter is a trifold from SSA in Oct/Nov that state to the penny what SS will be paying her for the incoming year. Pensions and civil service annuities also send out “awards letters”,so if mom gets those too, bring them to NH visits. In theory what a resident has for “awards” is not supposed to make a difference as to admissions but thats not what I found.... my mom had abt $1900 a mo and the NH were positively giddy about the 1900 as many elderly have just a small like $800 SS income. The income shown in the awards letters will be the only $ the NH is getting till your mom clears Medicaid & Medicaid starts the daily reimbursement for room&board. That could be months to process (my mom’s was 5 1/2 mo).
Remember that her assets have to be under 2k. So any savings, life insurance that has a cash value, investments will need to be spent down. If anything like this exists, try to get started on this ASAP. Cashing out a whole life policy could take 3 weeks or so.
Your mom’s house will be an exempt asset for her lifetime, then upon her death goes from exempt to a nonexempt asset of her estate & subject to an attempt by Estate Recovery / MERP to repay Medicaid from its sale. MERP has all sorts of exemptions and exclusions. It sounds like your older brother maybe might qualify for disabled heir and perhaps you for caregiver exemption (full time caregiver 2yrs to NH entry). You need to find out clearly if this can exist for you all and that means mom sees an elder law atty ASAP & one with MERP experience.
Also IF your older brother is considered a legal dependent of your mom, (like he’s her dependent on taxes filed) that too will affect her Medicaid. If he’s actually a legal dependent of hers, he can apply for a waiver to get some of mom’s SOC to instead go to him. He should be getting SS from her or his late dads SS earnings. If he’s not already her legal dependent, establishing this will be sticky & will probably have its own thicket of paperwork & needs an atty to deal with. I’d guess it will be a pretty high hurdle to do. But if he’s a dependent the Medicaid spend down still is required but mom could likely shift funds into a SNT for the disabled dependent son without a transfer penalty. These are NOT DIY projects but need an atty with disability experience as well as elder law Medicaid. You know the situation best, is bro truly disabled or more shiftless
If mom’s going to keep her home, she can spend down by paying on house costs. Say mom has 9k in savings, she’s over Medicaid asset limits by 7k. So she pays utilities, taxes, insurance, whatever house to get slightly over 7k spent & cleared through her bank account this month so that next month when she applies for Medicaid she’s totally under Medicaid's income & asset limit for how it appears in her bank statements.
Remember the copay or SOC must be paid each month, so if older brother is dependent on mom paying utilities, groceries etc each month, that goes away once she’s on NH Medicaid if he cannot establish legal dependent of hers.
Most important, see an elder care attorney NOW. First visit is free and he will shower you with questions on financial status and health condition. Know the basic answers before you go. It takes a few months, normally, to even get the Medicaid. Some nursing facilities will allow the patient to stay there, knowing their Medicaid is pending.
to investigate both States. Also AARP is, as it happens, sponsoring a one-day
program in late April in Denver focusing on us 24/7 folks, so AARP may have lots of good information on this particular topic.
on this very topic!
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