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Old 07-05-2007, 06:07 AM   #1
crazymomof4
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Gr'mom stroke- Long Term Care- Financial advice?

Hi!

I've always found I could draw a wealth of information from the experiences of people on disboards! Whether it be planning for WDW, childcare, budgeting, school issues, buying a car...........whatever! You guys have "been there, done that!" and always very willing to give excellent advice. So I'm hoping some of you can help me out with this one:

Last week my "Nana" (maternal grandmom- 86 yo) fell and broke her hip. She was successfully operated on, but within a few days had a major stroke that has affected her use of her L side. Yesterday she was transferred to an after-care facility for rehab. The doctor said that she would probably need long-term care (nursing home or assisted living) after her rehab stops progressing. He said we should consult an estate attorney, which we plan on doing this week. I was hoping to get some practical advice from some of you who have been in situations similar.

Here are the facts:
Prior to her hospitalization Nana lived with my parents.
Nana was never wealthy but worked very hard as a seamstress and does have a savings and an investment property that she rents out. My parents were trying to get Nana to sign over the house to them, since they would get it in the will anyway, but she never did.
My mom has power of attorney.
Nana has Medicare parts A & B and Horizon supplemental.


Are there any steps that we could take now to prevent the costs of long term care from draining her assets?

Thanks, in advance, for any info!


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Old 07-05-2007, 07:00 AM   #2
Hannathy
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Isn't paying for her care when she needed it WHY she built assets?
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Old 07-05-2007, 07:06 AM   #3
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I take it that she has enough faculties to sign legal papers on her own....

It is probably too late to transfer her assets without it looking like you are trying to "shelter" them.

I have been through this with my parents, father-in-law, and brother.

First, stop thinking of her assets as a future inheritance, they were meant to support her that is what they must now do !- definitely see a trust officer at the bank or a lawyer. Perhaps, a reverse mortgage on the rental property or sale depending on the market in the area.

Start checking out nursing homes, when my mother broke her hip and was moved to after-care she almost passed away due to withdrawal, she stopped eating, etc. HER nursing home nurse came to see her and said that "needed to get her back to their facility" - once she was back there she perked right up. Moral of the story- with in-home care your grandmother will respond better, if that is not possible, then find the best possible care ...

Coming back from hip, stroke and move to nursing home may be 3 strikes at her age but don't give up - I never thought I would see my mother come back, but now she is walking again and so happy to be in her "home."

My father-in-law has no assets and we are trying to get him a medicaid bed - the paperwork is monstrous but we will get it all filled out and hope for a bed in a good facility.

My brother has lost his independence due to loss of short term memory due to alcoholism - we exhausted all of his assets over time and now he gets assistance from medicaid - it hurt to pauper him to get care, he is only 56 and his life expectancy is unknown.

Best of luck - in our area we have an independent group "Board of Aging" which helps to advise families, perhaps you have one, too.
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Old 07-05-2007, 07:07 AM   #4
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No, there really isn't. If she moves into a nursing home they will take her assets and give her a small monthly allowance in return for care--not sure why everyone thinks this is such a bad thing--she is getting room, board and medical care from this. In order for her assets not to be 'hers' she would have had to sign them over 5 year or longer before moving into the nursing home.

Typically with assisted living you pay a monthly rent like you would with an apartment.
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Old 07-05-2007, 07:11 AM   #5
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Quote:
Originally Posted by Hannathy View Post
Isn't paying for her care when she needed it WHY she built assets?
Ummmmm thanks for your help, but at $300/DAY her assets may not last as long as she does. What then?
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Old 07-05-2007, 07:16 AM   #6
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Quote:
Originally Posted by crazymomof4 View Post
Ummmmm thanks for your help, but at $300/DAY her assets may not last as long as she does. What then?

That is where medicare comes in, basically she signs over her assets in return for care for the rest of her life. It could be a month, it could be 10 years.
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Old 07-05-2007, 07:17 AM   #7
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All that signing over of assets business has to be done either 3 or 5 years (I forget which) in advance of the life-changing incident. So basically, it's too late for that for Grandma.

My understanding is that her assets will be "spent down" until gone, then she will go on Title 19/Medicaid, which would pay for her care. Title 19 allows a certain amount of money each month for minor expenses and such, and an amount to be put aside for burial expenses.

Speak with an attorney who is familiar with estate planning/elderly care. The Social Worker at the nursing home is another good resource.
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Old 07-05-2007, 07:23 AM   #8
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It sounds like it is way too late to transfer any assets. And as someone said, arent' her assets there to pay for her care? It will be much easier to get her into a good facility as a "private pay" patient. Then when the money is exhuasted, they will generally have to keep her there as a Medicaid patient. The nursing home gets all her income as well (social security or a pension if she has one). You could consult with an attorney who specializes in elder care issues for the final word in your state - the rules do vary. And I agree that the social workers assigned to the homes and the hospitals can be a great resource.
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Old 07-05-2007, 07:24 AM   #9
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Crazymomof4 . . . I feel your stress and pain.

This is my experience . . . my MIL suffered a massive stroke on 12/26/04 and was not expected to recover. Well, she did recover and was transferred to a rehabilitation hospital and then to a Skilled Nursing Facility (this is where your Nana is now). All of this happened when my MIL was 56 and below is what we had to go through.

My hubby and sisters had to petition the courts for a power of attorney (luckily your parents already have one). I'm going to skip all of the Social Security stuff and medical retirement stuff since your Nana is already retired and probably receiving Social Security.

We had to apply for Medicaid and do what was considered a "spin down" of her assests. She could have more than a certain amount per month including her life insurance policies. With the spend down she was allowed to transfer so much per month to a child without it being considered a way of cheating the system. Medicaid told us the amount (I don't remember how much it was). We also had to sell whatever assests she had (home, car, etc.) and turn in her stocks and show receipts for what was spent. We purchased clothes for her, a power lift chair, TV, Furniture, and durable medical equipment.

After she was approved for Medicaid she was transferred to a Nursing Home Facility that takes all of her Social Security and most of her retirement pay. She is left with $38 a month for personal use. She is now on Medicare and if you are on Medicare and transferring to a Nursing Home Facility you must have a 3 day hospital stay before Medicare will pay for Long Term Care.

This is how my MIL insurance works, she has her private group health insurance (pays 1st), then Medicare (pays 2nd), then Medicaid (pays 3rd). You will want to check out fully the Nursing Home Facilities before you choose one (make sure they are Medicare/Medicaid beds availiable). Check it out during the day time and also go in the evening times/late night and check to see how the facility is ran. Go on line and do a search or check with your states health boards to see if they have any issues against them and to make sure that their license is suspended or under review.

If you need anymore information, please feel free to PM me.
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Old 07-05-2007, 07:35 AM   #10
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Check with an attorney/social worker before you try to gift any amount during the Medicaid spend down - this varies by state. I know that VT does allow transfers, but other states do not. The rules can be pretty complicated and are determined at the state level, not the federal level. Medicare payments for a skilled nursing facility are extremely limited. Good luck to you and your parents. Navigating the maze of paperwork can be difficult.
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Old 07-05-2007, 07:45 AM   #11
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Is her coming home totally not an option?

Depending on the level of family support (and willingness) even folks with major strokes can come home with help.
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Old 07-05-2007, 08:03 AM   #12
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Quote:
Originally Posted by yeartolate View Post
Is her coming home totally not an option?

Depending on the level of family support (and willingness) even folks with major strokes can come home with help.
It depends on her level of confusion and mobility. Right now she is so confused that yesterday the aide told us she put plastic wrap from her breakfast in her mouth, was chewing it and would have choked if she hadn't caught her. My dad is 71 and just completed cancer treatment. My mom is partially disabled. Lifting and transfers would be an issue. I live next door and could help a lot. Having an aide come a few hours a day would help. Right now, we are basically going by what the doc said yesterday and that was that "she probably will not rehab to the point where she can come home" (his words).

Thanks for all of the compassionate, understanding and helpful replies so far.


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Old 07-05-2007, 08:56 AM   #13
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I have been through all of this with my grandma too. My heart goes out to you. Its pretty overwhelming if it happens so suddenly like your grandmas did. After 2 days of my grandma being in the hospital I pretty much knew she could not come back to live with me. I couldnt pick her up. I didnt want care in my home since my 3 ds were little and I just couldnt turn my home into a nursing home. I also had surgery and could never lift her, even 85 lbs. is dead weight, you need 2 people. I had to give all her money to the nursing home and got her in as private pay. I also had to pre pay her entire funeral to the funeral home in NJ, we live in NY but she was getting buried in NJ. They kept an account with the state. She only had cash so it got spent down as the other posters said then I applied for medicaid for her. Here in NY its complicated but I did it myself.
If you live in Middlesex County, I can tell you a few good places and some very bad places too. Let me know. Best of luck.
I also had the mind set, this money is not for me (her money), its for the people who are taking care of her now (not me). That might be helpful when you look at the overall picture. You will be wiser when you have to deal with these issues with your own parents, you might want to do something now if you talk to the lawyer. (asset wise with your parents) Best of luck.
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Old 07-05-2007, 10:01 AM   #14
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def. check with a medicaid (or whatever your state calls it's version) worker for information on how your state administers the program (medicaid is a federal program, if a state receives federal funding for the program they must provide the minimum offerings that the federal program offers-but some states offer more; and if a state opts not to take federal funding-their program offerings may be lower). you can call social services in your nana's area and ask if they offer an eligibility review-this process allows a person to provide all of their information to a worker, and the worker will literaly instruct them how to structure their assetts such to create eligibility to the program (this was something we offered clients in california-i don't know how many other states do this).

you need to understand that while medicaid covers skilled nursing care in a facility-it does not cover assisted living facilities. since she is being transferred from the hospital post stroke and the broken hip-she may be going into what is considered a rehabilitation facility which her medicare and the horizon may cover (my mom broke her shoulder and went to a rehab, it was covered by medicare and her supplemental policy).

some of her assetts may already be exempt from consideration-generaly a home is, but that is usualy in the case of a person living in it and stating they have the intent to return (even if that's no way ever going to be a possibility). a person might be able to argue though, depending on weather nana ever lived in that property that she has had health issues OR her son and dil had health issues that necessitated her to move in with them 'temporarily' and she still maintains the 'intent' to return to the property she owns. she can also have prepaid for her funeral and that would be exempt. one other consideration is weather anyone else is listed on her bank accounts-allot of seniors do this for convenience if an adult child helps them with banking and paying bills-if that's the case then half of the funds in those acconts MIGHT be considered the property of that person (it's been several years since i administered the program, not sure how the accounts have to be set up at this point).

before you spend money on a lawyer check with social services and see if they have any elder advocates, these people can be of great assistance in helping you navigate the process-and may be able to provide information that is as if not more accurate than an estate attny (and if you do get an attny-get one that SPECIALIZES in elder law and medicaid-there are some out there that do it on the side and i have seen irrevocable trusts set up by them that caused ineligibility to programs).
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Old 07-05-2007, 06:59 PM   #15
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I just went through this with my father last year. He had 100 days in the nursing home with Medicare and then we had to private pay or go onto Medicaid. I went to an elder law attorney and she was such a great help. It was expensive but it was considered part of the spend down of my father's assets before applying for Medicaid. My father's house was put in a life estate years ago so that was not affected at all. My brother lives there and takes care of it now. We were told that any transfers of money or property had to have been done 5 or more years ago so it is too late now to transfer any money or property. But, as I said before, a really good investment would be an elder law attorney. They know the ins and outs and can also help you file the Medicaid paperwork. It is expensive but can be taken out of your grandmother's assets. This is a tough time for everyone but getting some help makes it much easier.
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