When Mom's money runs out

Don't know about a Medicaid Diversion Program.

RE the question in above post: Can they put her on the street?

That's where I am at right now. My Mom went into the nursing home private pay, then when she spent all her money on the nursing home and has under $2K in her account, we applied for Medicaid and they approved it without much of a hassle at all. Fast forward to a year after her original application and it turns out she has to reapply AGAIN.

I did not know this was going to happen. Well, some how or another her account went over the $2K a couple of hundred dollars and Mediciad denied her this time. The
Nursing home Business Mgr, told me to private pay them for the month of September and we can inform them of the payment and request that Medicaid be approved. After all - she has been on it for a year!

THey then asked for her bank records for 3 years and receipts of everything in and out of the account for the 3 years. I take care of my Mom's stuff and we have ALWAYS done everything on the up and up regarding her finances and paying for her care and made no attempt to try and hide money like some folks do. Problem is I don't have all
the receipts for everything. I tried keeping receipts over the years here and there. I also thought once she got approved she would be good to go from that point on. I had no idea we would have to reapply every year!

I turned in 3 years of bank statements, but am sure they will be asking for receipts, etc. I can't believe how difficult they make this. My mother is 90 years old. We have never had anything handed to us, My parents worked very hard their whole lives.

Now, I am afraid that they may put her in the street if this new application doesn't get approved. I am her POA and am praying they will not expect for me to pay the bill that is accruing while they look over the application and bank statements.

I am at my witts end, my brothers don't bother with helping me and it gets very frustrating and is such a big disappointment to me. I don't know where else to turn.

The best bet would be to try and get Medicaid. I was in the same situation when my mother ran out of money. I was unable to get medicaid so out the door she went. Before you ever put some one in a NH make sure you get an elder attorney to explain the laws to you. There is a federal law that states you can be kicked out for non payment. Before you ever put someone in a NH have an attorney. He will help you apply for medicaid. You should always apply for medicaid before you put someone in a NH this will save you a lot of grief down the road. I found out the hard way.

CAN THEY PUT HER ON THE STREET?

SHES BEEN N ASSISTED LIVING FOR 3 YEARS, HOW CAN THEY JUST NOT
ARRANGE A NURSING HOME

my mom will run out of every penny she has, had been living in a rehabative facility for a year plus assisted living she now has to leave since shes broke. what r her options

GS - so mom has $ 2,300 a mo right?
Of this how much is SS, retirement & VA? Maybe $ 900 non VA so mom will be ok for medicaid income ceiling once the VA $ is deducted. Is that about right?
Maybe 30/40K in savings? so mom could private pay 6 mos? Right?
And her current facility does not take Medicaid ever? So you definitely know she will have to move eventually, right?
And she is actively on the waiting lists of the Medicaid ok places? Like you call them every couple of weeks, right?

If all above is the story, What I would do if it was my mom, is to contact all the ok for medicaid NH with her name already on their waiting list places and whichever has several open private pay beds & takes residents as "medicaid pending" that is the winner & you have her move into 31 days from now. 31 as I'd bet her contract at the current place has a30 day written notification (send a letter & also a fax from a fed rx/kinkos so you have a transmission report verification). Read & reread the current admissions contact. Mom needs every penny so you don't want her you to have to be double paying a month.

Mom moves in next month and private pays as long as possible and applies to Medicaid as "Medicaid Pending" the month before she runs out of money if she does not have a preneed funeral done OR the month she runs out of money if she already has a preneed done. The preneed gets done for whatever amount is needed to get out of her bank account to get her under 2k in assets, it may not pay for all funeral costs.....but at least something towards those costs.

You need to be clear with all conversations with admissions that there will be at least 6 mos of private pay then she is onto Medicaid as medicaid pending. One of the NH will be ok with this. And really if this NH isn't your 1st choice, you can move mom to another NH once she clears & is approved for Medicaid. I moved my mom within the first year from her first NH to another and although it was no picnic, it was very do-able with a bit of planning.

Remember never personally sign off on any document. Everything must be "Jane Smith Jones in her limited capacity as DPOA for Mary Smith" or however reads best for your states laws. If mom can actually sign, that is even better. And get a copy of every page of the admissions agreement....they don't get moms check till you get the copy.

As you know mom cannot ever stay forever at the current facility, I'd move her sooner than later as you are just putting off the inevitable. She does the rest of her spend down at the new NH, becomes Medicaid Pending then gets approved for Medicaid. You get the required by Medicaid document list and start pulling that together in a binder, so you are ready 1 mo before she would be under 2k in assets. Be sure to get the VA A&A suspension (not cancellation) paperwork to have at the ready as well. The better you can be organized the easier this is.

Of the 5 NH or so I looked at for my mom, 2 of them always had open Medicaid beds & would work with me as to timing the admit day. For my mil, the NH she was in always had an open Medicaid bed. All were in older neighborhoods, older facilities so less desirable visually so lower occupancy. Remember, once on Medicaid they can move to another Medicaid facility with no problems. Good luck

Thanks so much for the great information. I have another question. When should I start the application process? Do I wait until ALL of her money is gone or can I start now?

GS - when mom applies for NH Medicaid & becomes eligible, her VA $ will drop to $ 90 a mo. Medicaid will cover all the costs in the NH but VA won't so Medicaid is the better way.

Carla - about having SS go to the NH. It does NOT have to be done this way. The NH will lean on family to do this as its just so much easier, we'll take care of it all, yada, yada....but it does not have to be done. They cannot force it. The DPOA can just continue the direct deposit of SS & other retirement to the elders bank account & write a check from the bank account for the required by Medicaid copay (or SOC - share of cost) to the facility. Your state Medicaid agency will send the elder & you if you are their point person the approval letter with the exact copay required to be paid.

You don't have to set up a personal needs trust account at the NH either. Although doing one will make beauty salon payment easier. You can fund the PNA for whatever amount seems useful. The facility should send an accounting of the PNA every few months as required by your states banking laws. Although this seems not to be routinely done with the rationale that the elder waived it being done. For both NH my mom was in, you had to go to the biz office to sign out for any $ from the PNA. So it could be not at all convenient to do this on weekends or evenings.

For my mom, this system worked well as her banking increased by $ 60 a mo - the PNA for TX - and I'd let it build 2-3 mos so that I could do a bigger shopping or more costly item for her. Also if you should ever move them from 1 NH to another, not having their income set to go to the old NH will make the move much much easier. When I moved mom, I could pay oldNH to the penny for the exact days the month of the move and pay the new (& eons better) NH to the penny for her days there that first month.

PNA varies by state from $35 to $ 105 (FL & MN).

Often NH charge a usage fee for cable or community phone, & this magically is the PNA amount.

There was a post a year back from a family member who found out that their parents PNA - which they were unaware even happened - had gone over 2K & the facility spent almost the entire amount on a very expensive walker. The NH position was they did it so that there would be no disqualification from Medicaid for having assets over 2k. Now there's blame on both sides in this story but probably mom could have had lots better use of her PNA than a walker......

When a person gets Medicaid, the SS check gets paid directly to the nursing home. The resident gets a small monthly personal needs allowance (I think around $50). I don't know about Veterans benefits, but I imagine that works the same way.

My Mom is just about out of money but she does get Social Security and Veterans benefits as a surviving spouse to total $2300.00. That is clearly not enough money to support her in the full skill nursing facility she lives in. We have about 6 months of money left. We will have to move her because the facility she is in does not have a Medicaid bed available. I have her on a couple of waiting lists in the area. Should I apply for Medicaid now? Will she still get her SS and Veterans $? How does that factor in with her eligibility?

Some corrections to the above post, now that I have re-read it. The non-medicare AL facility was covering $5000 of her monthly costs through a resident assistance fund.
On Oct 31st I applied for medicaid through department of social services, since she was being moved to a dementai unit in the nursing home section. The medicaid application takes months to go through, but the nursing home knows this. So her bill will just go unpaid for these months of waiting. She does not have the money to pay for it. Once the medicaid goes through (hopefully in January or February), since I applied in October, they will cover her nursing home fees and medical expenses effective November 1st.

My MIL was in a non-medicare AL, and they paid the majority of her costs because she was down to almost no funds. They have a benevolent fund, money raised by independently living reidents, and we picking up $5000 of my MIL's costs. Then she had to be moved to the nursing care unit. I applied on Oct 31st. Not one word yet from Dept. of Social Services. I have soem more papers (such as her November bank stament showing she is down to less than $2500 - Maryland's income limit), but they have not contacted me yet. So you can be nearing the limit of assets and have several months of waiting for them to do your paperwork. What the nursing home will do is get reimbursed by medicaid when it finally goes through. For instance, yesterday I got her bill (including therapy, etc.) for $13,000. My MIL has $2200 in the bank, and that includes her ss deposit for the month. Can't get blood from a turnip. They will wait until medicaid come through, and then apply to be reimbursed. The key is that my application date is November1st. She was not transferred until 11/20. But her costs will eventually be covered for November, December, etc. I made sure I got the paperwork handed in, in person, beofre Nov. 1st so that she was eligible for the November retroactive coverage.

No one mentioned VA Aid and Assistance program. If the person or their spouse served in the military during any wartime, there is like a $1000 a month available from the VA for anyone homebound (which includes AL and nursing homes care). In my case, my deceased father-in-law's service makes my mother-in-law eligible for this $1000 a month

my aunt is also in AL, she suffers from dementia and she will be out of money in about 5 months. I tried to apply for the Medicaid waivers as she meets the income limits for assistance that would let her live in her current residence for a lot longer, probably until she passes as she is 96 years old. The problem is that her savings has to be down to $2000 BEFORE she can apply. My question is, what does she do during the 6 months or longer that it takes to get on Medicaid? The AL will not wait that long to be reimbursed. The AL is telling me to apply but I am telling them we can't until she is broke!!! I have looked and read everywhere for information, help with this situation. The only thing that we have come up with is to take her to the hospital and make them admit her for three days, then possibly they will release her to a NH that MAY have an empty bed. But she is healthy except for dementia and incontinence, so she may not even be admitted to hospital let alone qualify for NH care.....ugh....

I think it is wonderful that your sister is thinking ahead. At age 85 and in poor health, there is no certainty that your mother will outlive her money. Yes, it is worth considering, but I think it is a little too early to panic.

Your sister has taken on a huge chunk of the caregiving duties. Wonderful! Maybe you can take a small part of the responsibility off her shoulders by volunteering to research this particular concern.You can do this by internet and phone and perhaps a few in-person interviews. You don't have to be geographically near your mother to do it.

First, find out about applying for Medicaid. There is lots of information on this site about that topic, and there are good sources of information elsewhere on the Internet. If your mother has almost 5 years of ALF money saved up, she is not likely to qualify for Medicaid now. But she very well might as the money runs out. And it MIGHT make sense to make the money run out faster. Certainly not be giving it away or throwing it away of frivolous things, but if Mom needs a better wheelchair, or would benefit from a Personal Care Assistant hired to visit her a few times a week, if there are things that would make her present life better it might be worth considering, rather than automatically thinking, Oh then she will only have 4 years or 3.5 years worth of ALF payments in the bank. Also, prepaid funeral expenses make sense. I'm sure not qualified to give you financial advice. I'm just suggesting some things to think about once you understand the qualifications and benefits of Medicaid.

Next, find out for sure whether Mom would have to leave her present setting when the money runs out. Facilitiies are all over the map on how this works. I go to a caregiver's support meeting in a lovely ALF that also has a memory care unit. They do not accept new residents on Medicaid. (They cannot affort to operate on what Medicaid pays.) But they have balanced their budget on the basis of having a few Medicaid residents to average in with the private-pays. They reserve those Medicaid spots for residents that have been living there for several years and have run out of money. And, by the way, the accounting office knows who is private-pay and who isn't, but the daily staff doesn't and it has no effect on the care provided.

If the ALF isn't is a position to subsidize some residents in this way, ask for their recommendation for other placement options when the money runs out. Check out those places online, for possible future reference.

The obstacle is, you really don't know what Mom will need in 4 years. Parkinson's with Dementia (PD) is a progessive disease, but no two cases progress in exactly the same way. Maybe Mom will still be functioning as she is now. Maybe she will need more assistance than an ALF can usually provide, even before her money runs out. Maybe she will be on hospice. You can't really have very firm plans that far out. (My husband has LBD, very similar to PD, and he's 85. Believe me, I take one day at a time and don't schedule much further ahead than what we are going to do for the 4th of July.)

I would tell you to just wait a couple of years and see how things go. But my heart goes out to your worrywart sister who is shouldering a big burden. If you can help reassure her by doing a little research, I think that would be the kind sisterly thing to do.

Thank you so much! We figure Mom has enough money for her to stay in assisted living for almost 5 years. However, my little sister is worrying now for what is still fairly far down the road. I will keep you advice in mind when her funds start to get really low.

My understanding is that Medicaid is for people 65+ who have run out of money (or for people under 65 who are disabled in different ways). I believe that a person has to have $2,000 or less in assets AND meet a monthly income limit (in FL it's around $2,000 and in NC it's around $1,200) to be eligible for Medicaid. I have read that one should apply for Medicaid months before assets run out as it can take a long time to complete all of the paperwork and requirements. Medicaid will pay for a nursing home, but not for an assisted living facility (ALF). In the case of an ALF, some states have a "Medicaid Waiver or Medicaid Diversion Program" that will pay a portion of an ALF (Maybe around $1,000/month?). Hope this helps!

please send comments advice and hugs god bless u and your family

Thank you all for your comments. LME--I thought that Medicaid was only for people under 65, before Medicare took over--will have to check this out.Thanks for the heads up. KSylvia I do hope that you all get along with the finances, your mother is close to my age, which makes me think that I will have to worry about my own care in the future. Best to all,

this is true their are alot of extended care facilities, and your mom wont be in bed all day unless shes bedritten, they have lots of activities even church i know its a hard decision but u have to always put your mom first,lots of prayers

my prayers go out to u & your mom. Husband and i moved in 10 years ago to help my mother & step father who passed 6 yr. ago. mom came down with oral cancer 3 years ago,very sick treatments etc. now in remission(thank god) mom is 68, her only income is s.s.plus her retirement. she is losing her home. we helped with everything from bills, house, medical,food her care etc.she too has no savings. we dont either husband is only one working, plus moms s.s. with bills kids cars medical everyday survival etc. we live week to week. we too don't know what we will do without each others income we survive with each others help.We know the fear of not having a place to live or not having food, we also fear we all r gonna be on street, we also have 2 teenage boys,this sounds bad we, even fear how it will effect them, and their friends treating them different. All we all can do is pray,pray,pray& do our best to take care of our moms like theyve always done, even if it comes down to not having a home We r family and we take care of our loved ones.

You can apply for Medicaid. You did not mention that the place does not accept Medicaid. There are nursing homes that only have private rooms. If your sister is concerned about her having a roomate, look for a nursing home that only has private rooms. Unless a person is on their deathbed, the person would not be staying in bed all day.

I have thought of this very thing with my mother-in-law. Right now she has money enough for asst living, BUT what happens when that money does run out? My husband is the youngest of 3 brothers. Number 1 brother has preempted that problem by saying that he and his wife will NOT be taking in mom. His wife would take her in for sure, but not him. So... that really means us, since #2 brother travels much with his job and his wife likes to go with him when she can. Either that, or we find a place that does take Medicare. Because, like where your mother is, my mil's places does not accept Medicare either.
I guess we'll cross that bridge when it comes. Nothing we could do now except move her into a place that does take Medicare so when the times does come ,she'll already be there. Other than that, I don't know either. It'll all come out in the wash.