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Hi. My mom is starting to experience memory issues and occasional confusion. I am trying to find the best way to finance occasional home help like organizing meds and some personal help. In the future she will probably need more intensive help.


Would starting a revocable trust fund be a good idea to protect her home and assets?


Should I set this up for her now? I understand there is a 5 year wait for the protection to kick in. I would like to get her on Medicaid asap.


Thank you for any help.
Ken

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I would get the financials together and go meet with a certified elder law attorney (CELA) just to be sure. Her disease will only progress, it might be better to move her to an assisted living now that has memory care available for later, so that you can provide whatever support she needs. It's often easier for a person in the earlier stages to adapt to moves and changes. If she's foggy about what pills she's taking she needs daily help.

https://www.elderlawanswers.com/medicaid-and-trusts-12004
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kenmtb Nov 2023
Thanks for the reply.

The idea is to allow her to let her keep her home.
If she needs to spend all the money on care that is fine as long as she can be home. No one wants to inherit anything including her house!
The house is not worth anything.

I thought a trust would help her stay out of a facility until necessary.
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Moms assets are intended to be used FOR her care. Why should Medicaid kick in now when she has the funds to self pay?? This is precisely why the 5 year look back exists.....to prevent a person from hiding their assets and relying on the government to pay their way.

I used 99% of my parents assets to pay for excellent private care in Assisted Living and Memory Care Assisted Living for 7 years rather than use Medicaid to place mom in a Skilled Nursing facility with a roommate and a shared toilet, 2 blasting television sets, and all the rest of it. Yes, I forfeited my "inheritance" to make sure their Hard Earned savings were used to their advantage.
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MeDolly Nov 2023
We are doing the same for my mother & stepmother.

People don't seem to understand that this what money should be used for their care not to be hidden so someone else can spend it after they die.

The house should be sold and the money used for the mother, when her money runs out then Medicaid can be attained.

Most of these Medicaid places are substandard at best.
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Properly documented home care isn’t gifting, but this trust fund sounds like it. She won’t be eligible for Medicaid until she’s down to her last 2k, in which case she can technically keep one house and one car, in which case her family would have to pay taxes and maintenance PLUS gift tax on what they spend.

In terms of caregivers, most Indy’s like on care.com are half as much as agencies, and the reason is that they usually are paid cash for that one to one, and that one on one’s chance of exploiting the elder get exponentially greater as their hours grow. See my nightmare thread about them moving in their caregivers whole family. How caregivers can end up with everything.

The first thing I’d do personally is take over the care contract yourself. Be the one the agency or indy answers to, not your mom.
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BurntCaregiver Nov 2023
@PeggySue

Your homecare nightmare because of a hired independent caregiver is because no one bothered to check her out first.

No one ran a $50 backround check that covers the credit check, housing history, criminal history, and immigration status. No one did this. No one checked on any references of family members she worked for who could recommend her if her clients had all passed away as you told us she said they did.

She was moved into your in-laws house with no investigation at all. Care.com does not do checks on caregivers. Caregivers pay a fee twice a year to use the site. Potential employers are supposed to do these checks.
Sadly, no one did this for your in-laws.

Next time someone is going to hire independently-contracted homecare ask that they bring all of their own backround checks and references with them.

I always did. I always came with a police report (within the last six months that I always paid for), proof of citizenship, proof of residency, a credit report (less than a year old), valid and current driver's license with proof of auto insurance, and I topped it all off with a clean drug test (no older than three months). I also came with sterling references that any potential new client and their family could call upon. I always had to keep these things updated at my expense because that's what proper independent caregivers do. Top dollar though. We don't come cheap. Some illegal with a record does.

This is how you hire independent contractor caregivers.
You don't just take them at their word. If someone does and they get scammed, unfortunate though it is, they had it coming.
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Our parents saved their money and had pride in what they expected to leave to their children. They wanted their children to have a better start than they had themselves.

With much longer life in declining circumstances, this often doesn’t work today. Your parents’ own care will probably consume the value of all their assets. Be glad that they gave us an education, so that we can earn our own living.

If you can get your head around this, it will help you to work out what comes next in their lives and your life too. It’s a real head-shift for you and for them.
Best wishes and sympathy, Margaret
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How would a trust keep her out of a facility? Her home is an exempt asset under Medicaid regs.

See a CELA if you want to figure out the best way to pay for her care out of her assets.

We got my mom better care by moving her to a good facility and using her funds to private pay. This was a place that would accept Medicaid after two years of private pay.

I think both the quality of care and better opportunities for many eyes on a patient are reasons that a good facility beats inexpert home care every day.
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BurntCaregiver Nov 2023
A Trust would not keep her out of a facility. A Trust would keep her real estate and other assets out of a facility. Unless the Trustee decides to do it and this is only if it's an Irrevocable Trust. A Revocable Trust can be changed at any time by the person who owns the property and assets.

Trusts can work out pretty good because they eliminate the estate having to be probated and all of those costs which can really add up.
Trusts also eliminate inheritance tax. So if a family wants a property to stay in the family they can hold onto it. Or turn it into a rental. That income is exempt if it's under a certain amount depending on what state you're in.
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It’s your mothers money . Use it for her care . If she needs more intensive care you can sell her house and use the money to get her in a better facility.

My father in law with dementia let some lawyer talk him into drawing up a trust . The lawyer charged him $6,000 . The trust is useless because he will never live 5 more years . He is in assisted living , he chose the most expensive one in our area. He doesn’t understand that if he was on Medicaid he would not get to choose a nice facility .

Medicaid is not an entitlement like social security . Basically if someone goes on Medicaid you are asking for everyone else to help pay to take care of your mother through state funds.

Medicaid is not going to pay for in home care , it’s too expensive . Facility care would be the only option .
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kenmtb Nov 2023
Thank you for the reply.
She is independent now and I am trying to figure out if the memory loss is due to meds or will get better. It looks like she may need to finance temporary assistance for minor help.

The house is not in sellable condition due to years of undocumented construction. I doubt if she would get any money for it. She has a friend living with her as well.

A trust seems like a bad idea and would not affect her staying in the house.
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Never put anything into an Revocable Trust. That is a waste of time and money and doesn't protect anything. If you're going to go with a Trust make it an Irrevocable Trust. This way it cannot be changed unless the Trustee decides to sell. Medicaid or a nursing home cannot come after it because it is considered a Medicaid-exempt asset. It also eliminates the need for probate court when the person passes and that costs a fortune too. Especially in places where there's inheritance tax.

There will still be the five-year lookback period for Medicaid though.

The best bet for protecting assets and making them Medicaid-exempt is to have them transferred out of the senior's name before they become needy and elderly and will require care.

Change over property deeds, investments, insurance policies. Pretty much eliminate the senior's name from any sources of income where possible. Social Security and pensions cannot be rerouted. Those are the income sources that cannot be made Medicaid-exempt.

If you've done this and there comes a time and it may never happen after the next five years, where your mother will need to be placed in a nursing home those assets will be safe. Without assets that can be recapped after her death, Medicaid in most states also pays for homecare hours.

If your mother is unwilling to take assets out of her name, then an Irrevocable Trust is the way to go. Good luck.
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AlvaDeer Nov 2023
I don't think an irrevocable trust can be done by someone incompetent so there is that to start with. But more serious, and even sinister still is an irrevocable trust that protects assets for beneficiaries while the poor senior goes into care on the government's dime having their assets essentially locked away from their own use by this trust. Which they cannot change. So yeah, they get to be in a medicare facility with minimal care instead of a good facility private pay with their own assets for their own care. I loathe irrevocable trusts. They benefit greedy progeny and no one else.
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Organizing meds is not "occasional help". Setting up a pill organizer generally is done on a weekly basis.

Does mom remember to take her meds if they aren't handed to her?

The first thing you need, I believe, is a "needs assessment" which can be GG often from her local Area Agency on Aging. Someone familiar with mom's actual abilities should be present at that assessment.

Some AAAs are able to provide case management services. Otherwise, a good Geriatric Care Manager can be a godsend.

Consider the idea that your mom may eventually need to be moved close to where you live in order for her care to be properly overseen.
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kenmtb Nov 21, 2023
Thank you for the answer Barb.
The needs assessment seems like a great idea. I am long distance and it seems like her local services are hit and miss.

At this point I need to figure out how to make a plan for her care. She has a close friend living in the house who is a great help.
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My Mom had 20k in assets. Her insurance policy had cash in value. I took that money and prepaid her funeral. I started her Medicaid application in April, May 1st she entered LTC. She paid for May and June privately. In June I confirmed with the Medicaid caseworker that I had given him all info needed and spent down her money. July 1st Medicaid started.

I too had a house that was falling apart to deal with. It was up for sale but did not sell till after Moms death. I got just enough to pay back taxes and Medicaid back. Mom was only on it 3 months. Moms SS and any pension will need to go towards her care, can this friend afford to pay utilities and taxes because that may be a requirement for her to be able to remain in Moms home. Even though the house is an exempt asset, Medicaid has a say how its used.
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