Alzheimer's home making my Mom leave. Any advice?
I never thought I'd be asking for advice on an elder care forum but here goes. I'm 53 & live in California. My parents (Dad is 83, Mom 78) live in New York. I'm the only child. We put Mom in an Alz home last summer. Dad will run out of money to pay for it, probably this year. We tried to apply for VA "Aid and Attendance" but since he's the vet and he wasn't disabled, and he's still alive, they said we didn't qualify for a benefit for her care expenses. They turned us down for a VA pension because we didn't have enough supporting info from her doctor to justify her living in a home. (We just appealed that decision last week).
I just returned from visiting Dad to help him with his taxes & various things, to find out that Mom's home might make her leave and go somewhere else, because of a bowel incontinence problem she's having. He was shocked, didn't realize it was happening so often & didn't know that the facility couldn't handle that. The director gave him a couple of eldercare lawyers' names and a list of nursing homes. They said that Mom won't be moved from the home immediately but for Dad to be ready in case she has to go.
I thought that the first step should be to see if there's anything that can be done medically to help with the stool issue. She's on various meds for Alz and other things, I'm going to research her drugs and have asked Dad to ask her previous doctor (who had been her doctor for 13 years before she was admitted to the Alz home) if she thought anything could be done.
Dad still lives in his house, it's paid for. It's clean and tidy but in bad shape, needs painting inside and out, some of the wood is rotting, nothing's been updated for years. He wants to stay there. The garage collapsed in February under all of the snow and ice New York had. He got paid from his insurance company and put all of the money into the bank account which pays for Mom's care. He always puts her first.
So my questions to you are, assuming we cannot control her situation medically:
1. What should we do first? Consult an attorney? Apply for Medicaid? Or?
2. I am 99% sure I read on this website that Medicaid would kick in after Dad ran out of money but not make him leave his house; then AFTER he leaves the house (either dying or selling it) then any money Medicaid paid would be repaid to Medicaid after the proceeds.
3. Any other advice for us at all? I didn't realize that Mom's home would actually kick her out for having a medical problem, is this the norm?
Thank you so very much
7 Answers
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Other people here know much more than I the in's and out's of Medicaid so I'm sure you'll get plenty of information.
Your mom is very fortunate to have such a devoted father and concerned daughter. It must be very difficult dealing with this from the other side of the country.
My guess is that the current facility really isn't skilled nursing care, so although they are fine for the "happy wanderer" type of dementia patient, it just doesn't work for those that need a higher level of care. It sounds like they are being flexible with you all. I would call the social worker @ the facility to see what places she suggests. You are likely not the first one to have this issue.
Perchance does she have C. Diff? Try to find out - if so that may limit who will take her as a resident without her coming from a hospital discharge.
About Medicaid, as Jeanne said, your dad does NOT have to become impoverished for your mom to get Medicaid. Dad is considered the community spouse and as such is expected to keep fund to enable him to do just that. Most states have this @ 113K in liquid assets plus his home and a car & his monthly income. It is only mom who needs to be impoverished for Medicaid and only her income paid to the NH. I wouldn't be surprised that mom could have been on Medicaid for months now and Dad has been private paying (and depleting his funds) without needing too. It's really hard for men who have always taken care of their family not to even when they shouldn't.
Now under Medicaid for NH, the resident is expected to pay almost all of their monthly income to the NH as their co-pay. But IF dad should find that he needs some of mom's money (like her SS check) in order to make his ends meet, dad can file for MMNA - minimum monthly needs allowance. Kinda like alimony for elderly couples. Each state has a formula on this too. MMNA is not done automatically, seems that it has to be filed for. The usual scenario is a younger 2nd wife who's hubby goes into NH and she is still living in their home and has a mortgage or perhaps a child. She needs his SS & retirement income to stay in the community. But there is no reason (except for perhaps his pride) for dad not to apply for MMNA if he needs too.
You draw a pretty difficult picture for dad. I bet he loves the house. Now how is he in managing living? Can he do for himself? If he went through this winter on his own, I bet he is one tough old rooster! and not at all ready for a NH. I'm just wondering if he would be up for selling the house and buying something smaller, newer, and geared for an older group (especially with ramps, etc). If he could find a house or a condo close to mom's new NH, would he be up for that? It would need to be about the same value as the old house so that he isn't having any increase in his assets. He would have to be careful in how this is done so that he is able to keep everything within his asset limit, you all definitely need to have an experience elder law attorney guide you on this. You know this site has a drop down list of them by state - you can use that as a start.
About MERP - Medicaid Estate Recovery, all states have to have this in place and each state runs their program according to their laws on death, property, etc.
For my mom in TX, if there is a house and the Medicaid recipient is survived by their spouse, then upon the death of the NH one, the state sends a letter asking about exemptions or exclusions to MERP. The surviving spouse fills out that they are living in the home and the MERP claim against the estate is removed. Other states keep the claim or lien on the property till the surviving spouse dies. Speak with the elder law attorney as to just what Mass does. Also since you live out of state, ask if he can deal with MERP if need be. MERP seems to be very very timeline oriented. Like for TX you have 30 - 45 days from death to get all documentation for exemptions to MERP, if not then it's over and the claim fully enforceable. I think it's a terribly unfair burden to family who may be totally still bereaving but it's the rules. Good luck.
Your Dad needs to save what money he has left for his self.If he has a savings or investments,cds ect he needs to be pulling his money out as cashing in.Sounds harsh to say but,truth hurts.He needs to be hiding his money and transfering assets now.Millionairs do this all the time to get Medicaid and foodstamps.He is aloud to keep his home,car and one bank account less then $2,000 and one credit card to appliy for Medicaid.
I had a Uncle about 5 yrs ago do this same thing.His wife died from a car accident.Life insurance paid him $200,000.With the $200,000 he took a $100,000 and placed it in CDs at his bank.The other $100,000 he wrapped it tin foil and placed it in a safty deposit box with a joint family name.If they ever would attempt to seek the box they can't touch it with a joint account attached to it.A yr later he found he had cancer.He was placed on in home oxygene.He noticed his money was going down fast from paying for oxygene as $6,000 a month.
Here's what he did,
He cashed in his $100,000 Cds.Took some home and hided it in his freezer.(If ever a fire money wont burn in a freezer and a robber wont think to look in a freezer)And the rest in his safty deposit box at the bank.
Then,he transferred his vehicles and other assests into other family names.
After he got all his money at home or locked away.He waited one yr to apply for Medicaid and was approved.If ever asked where the money went he would say gambled it all away on lottery tickets and call the 1800 hotline for addiction once a month to cover his butt.He had a Millionair friend that told him how to do this.
My Uncle died 2 yrs later.I found $100's of thousands of dollars in his home and walls.So,hide the money and wait a yr to apply for medicaid.The holy grail.
Medicaid looks back over a FIVE year period when reviewing how money has been spent. Dad does not have to be completely out of money before Mom is eligible for Medicaid. The allowance for a married couple is much different for a single person.
Do consult with an attorney specializing in Elder Law, as soon as practical. He or she can help ensure that Mom is cared for in a way most advantageous (and legal) for Dad.
"Hiding" money is fraud, illegal, has consequences, and in my opinion is immoral. Your parents are not in any need of that kind of activity.
SHe's definitely in the Alz unit of her assisted living home.
I didn't know what "C. Diff" was so I googled it & I don't think she has that. Dad can take care of himself (he certainly IS a tough old rooster! LOL) and I doubt he could sell his house for anything but a "teardown" and wouldn't get much for it.
Thank you again for your help, everyone.
FASkid