Assisted Living Questions

[ugadog99]

This is going to be long, so please bear with me. Last week, my father passed away unexpectedly. He was 72 , and he and my mom were divorced. However, they were always together, and she depended on him for pretty much everything. (yeah...dysfunction with a capital D) Last March, she (now 71) had surgery on her neck related to her severe arthritis. She is close to immobile. She has to walk with a rolling walker or cane and moves at about turtle pace. She hasn't driven since March. She can give herself a bath and do minimal household chores. She has a plethora of medical issues. My brother and I live about 45 minutes to an hour away from her. She is living in the too large house that I grew up in. My father was still taking care of things for her: grocery, errands, doctor visits, etc. Obviously, all that help is now gone.



My mother worked very little in her adult life. She is drawing some SSI, but it is limited. My father was a self employed contractor. There is, essentially, no money anywhere. However, she does own the house she is living in now. She has medicare, but I'm very unclear on the medicaid issue. (She is also not the most coherent person in the world, either, and gets facts confused often. This isn't due to age as she has always been this way.) From the little bit of research I've done, medicare will not pay for any assisted living. Apparently, it is all paid for privately by the families, but it does appear that medicaid may pay some. Neither my brother nor I are in a position to pay for this.


I'm sure you can see where this is going. What are we going to do with her? At the moment, I think we have to get daddy's affairs handled and out of the way. That will take FOREVER, so we have to have a plan for mother. The way it looks right now, she will have to come live with my girls and me-at least for a while.


Those of you that have been through this, what did you do? What did you learn? What advice can you give? Is there a direction I need to head? I truly have no idea where to start.

 

[kim929]

After the divorce, who owned the house? if she did, then it would have to be sold and the proceeds pay for the assisted living. If she didn't own the house, and has nothing then she should beable to get help from the state. In RI she would be evaluated to see if she is elegible for assisted living, depending on how bad her forgetfulness is and what she can do for herself, some homes won't take her. Once the evaluation is done, they would also help her get state aide which would pay for a small home like facility, very rarely do they pay for the big facilities. If she isn't assisted living home eligable then the only option then is to put her in a nursing home, or have her live with you. You are not responsible for the bill for your mother unless you want to be.

 

[golfgal]

Medicaid will pay for nursing home care, not assisted living, for those that meet income guidelines-which it sounds like your mom will. Medicare will pay the first 100 days IF a qualifying hospital stay preceded the admittance to the nursing home-which is neither here nor there in your mom's case. It sounds like she is a good candidate for this and you will want to contact her county to see how you can go about applying for assistance for her.

She is not eligible for this but buying a Long Term Care insurance policy would have helped greatly in her situation-consider one for yourself. It would have given her a lot more options, like being able to stay in her home if she wanted--just an FYI because a lot of people don't know these are available.

 

[pls5286]

I see you are in GA. I am not sure if medicare pays for Assisted Living in GA, but I do know they will pay for nursing homes. The house, if it is titled to your mom, would become an asset of the state, and your mom would be put on both medicare and medicaid, and you would not have much out of pocket expense at a nursing home, unless you opted for some extras.

 

[barkley]

call adult services in the county your mom lives in. they can tell you what programs she might qualify for-they might also have ombudsman who can help you understand what your mom currently has (medical wise) and what she might qualify to apply for.

as for assisted living-it comes in many shapes and sizes. there's the kind where someone comes into your home and helps with daily needs, there's adult family homes (where you live in a private home and get assistance), then there's places like where my mom/mil live which is an independant apartment in a hotel like setting (one large building) that provides for everyone 1x per week housekeeping, and 3 meals in the dining room per day (these places can offer levels of individual assistance services, cost depends on level of assistance you require). the costs vary-and if i remember right some services might have some limited coverage under medicaid or medicare but it's not a tremendous amount.

VERY IMPORTANT-do not go about selling her home until you speak to someone who specializes in medicaid law FOR HER STATE. different states have different laws even though the feds have theirs-and what might have been the case for one person who has dealt with this in one state might be entirely the wrong thing for you to do in your mom's (there can be real advantages to her retaining her homeownership due to exemption rules esp. if the time comes that she needs to go into a nursing home or has extensive medical bills).

i know you said your dad was self employed-do you know if he ever may have worked and contributed to social security? you might want to check-depending on how long they were married she might qualify to draw based on his quarters-which could be a higher check.

one thing you need to consider if she moves in with you-will she retain her current doctors (in which case you need to know what kind of appointment schedual she's on) or will she need to change. if she needs to change then can the current doctors do referals AND (BIGGIE HERE WHICH I CAN ATTEST TO BECAUSE I'M ON MEDICARE) are those doctors currently accepting new medicare patients (most doctors put a limit on the number they carry within their practice and it's not unusual to have to get on a waiting list until a doctor's accepts new ones). this was a big issue with my mom-it was a big factor in her decision to go into assisted living closer to where she originialy lived vs. where any of her adult children lived at that time, she just did'nt want to lose her established doctors.

 

[ugadog99]

Wow..thank you all for the information. It is certainly a lot to process, isn't it? So, it's looking kind of doubtful that Medicaid will pay for assisted living. That would put us into a nursing home situation. I don't know how my brother and mother will feel about that one. The house is in her name. I do think we probably need to talk to someone in this area about what the laws are and how to proceed with selling her house and what she might qualify for. We had already thought about the doctor situation. Fortunately, I am the one who lives only 30 minutes away from her. If she lives with me, it is possible for her to keep her current doctors. The nursing home situation does worry me. I only have horrible, horrible memories of my grandfather dying in a nursing home, so maybe things have changed since then.

Thanks for all the ideas. Please let me know if you can think of anything else.


Melanie

 

[Traveliz]

In Illinois seniors with a very low amount of money and who get Social Security are eligbible for assisted living in a variety of residential settings. My dad lives in a great assisted living center and the cost to him is just a little shy of his social security check. In return he gets all his meals, his studio apt (one bedroom ok too), help with his meds, laundry and housekeeping and all the typical type activities.

We found the service by talking to the Department of Social Services (I think - my brother handled that part) and they recommended this to us.

You need to talk to someone familiar with the programs GA has to offer.

Liz

 

[minniebeth]

You've gotten good advice here to point you in the right direction, so I won't add to it, but wanted to say that I'm so sorry for the loss of your father.
Also, for wanting to help in being part of your mother's care and well-being. It is not and will not be an easy road, I know this as I am currently experiencing this with my own mother and family. I hope you are able to get things sorted out and get a good plan that will work not only for your mother but your family as a whole. Remember to take care of yourself through it all.

 

[Tiggeroo]

I can't give you financial advice. I can only say that we were very happy with my grandmothers assisted living stay. She had a medical problem and so was able to get into an assisited living facility that was beautiful right from the hospital. This center was required to reserve a small number of rooms as medicair/caid rooms so it was affordable. The nice thing about the center was that it gave her a good deal of freedom. When she entered she really had an apartment. There was a communal kitchen she could use to make meals. She could request a guest bed in her room for guests. There were many trips out and while she could drive she could have a car there. But it had levels of care so if she had a problem she would be placed somewhere with more support. Preference for the higher levels of care was given to existing patients.
The one negative, once she had to go into the hospital for a period of time and some rehab. When she came back she was no longer able to get into her lower priced room. Family helped with costs and we sold her home.

 

[LadyZolt]

She doesn't sound like she'd qualify for nursing home level care. You can research this, but basically there are "activities of daily life" and where she is on the scale of performing them is a factor. They are:

Bathing
Dressing and undressing
Eating
Transferring from bed to chair, and back
Voluntarily controlling urinary and fecal discharge
Using the toilet
Walking (as opposed to being bedridden)

I know you have a lot to think about, but one other thing -- if your mom owns her house, she could do one of several things: (1) rent it out as she moves in with you or one of your siblings and use the money to aid in her care; (2) consider a reverse mortgage and she can use that money to hire some in-home care for a few hours a day to help when you and your siblings cannot. And you can also (3) check into senior citizen facilities where she can live based on her income (she would have to have no assets to qualify for this, but in some areas the house doesn't count, so you'll have to research it) since what you said about your mom sounds like a senior citizen place might work as they have independent living, but they have a nurse on staff, a dining room where they can eat two meals a day, someone who takes them shopping, a hair salon and post office, etc.

Legally speaking, she should grant someone a legal power of attorney, a medical power of attorney, and she should create a will and a living will, too. I know it's a lot, but now is the time to handle these details and talk things over with her as much as possible. I am sorry about the loss of your father and hope that your mother is able to get to a living situation that is good for her.

-Dorothy (LadyZolt)

 

[ugadog99]

Again, thank you to everyone. I am going to print all of this out and send it to my brother. We do have so much to consider. I appreciate all the kind words and thoughts on the passing of my father, too. I may be back with more questions.

Thanks,
Melanie

 

[golfgal]

Wow..thank you all for the information. It is certainly a lot to process, isn't it? So, it's looking kind of doubtful that Medicaid will pay for assisted living. That would put us into a nursing home situation. I don't know how my brother and mother will feel about that one. The house is in her name. I do think we probably need to talk to someone in this area about what the laws are and how to proceed with selling her house and what she might qualify for. We had already thought about the doctor situation. Fortunately, I am the one who lives only 30 minutes away from her. If she lives with me, it is possible for her to keep her current doctors. The nursing home situation does worry me. I only have horrible, horrible memories of my grandfather dying in a nursing home, so maybe things have changed since then.

Thanks for all the ideas. Please let me know if you can think of anything else.


Melanie

Think LONG and HARD about having her come and live with you. Do you have children, do you work? She will be a 24/7 job. My mom was in a nursing home for the past 3 years and it was actually a very nice situation for her. Women tend to do better in nursing homes than men-in general-because the social interactions are good for them. Just something to think about.

She doesn't sound like she'd qualify for nursing home level care. You can research this, but basically there are "activities of daily life" and where she is on the scale of performing them is a factor. They are:

Bathing
Dressing and undressing
Eating
Transferring from bed to chair, and back
Voluntarily controlling urinary and fecal discharge
Using the toilet
Walking (as opposed to being bedridden)

I know you have a lot to think about, but one other thing -- if your mom owns her house, she could do one of several things: (1) rent it out as she moves in with you or one of your siblings and use the money to aid in her care; (2) consider a reverse mortgage and she can use that money to hire some in-home care for a few hours a day to help when you and your siblings cannot. And you can also (3) check into senior citizen facilities where she can live based on her income (she would have to have no assets to qualify for this, but in some areas the house doesn't count, so you'll have to research it) since what you said about your mom sounds like a senior citizen place might work as they have independent living, but they have a nurse on staff, a dining room where they can eat two meals a day, someone who takes them shopping, a hair salon and post office, etc.

Legally speaking, she should grant someone a legal power of attorney, a medical power of attorney, and she should create a will and a living will, too. I know it's a lot, but now is the time to handle these details and talk things over with her as much as possible. I am sorry about the loss of your father and hope that your mother is able to get to a living situation that is good for her.

-Dorothy (LadyZolt)

Given what the OP said about her mom I would be SHOCKED if she didn't qualify for nursing home care. Keep in mind that there are different levels of care available in nursing homes as well. The medical issues alone will probably qualify her. Keep in mind that the ADL's you are applying to her care are not necessarily what Medicaid uses for their qualifications. My mom was fully capable of doing all the ADL's but because of health issues needed to have access to 24 hour care. You may be confusing the ADL's and qualifying for Long Term Care Insurance claims vs needing medical care in a nursing home.

As for doing a reverse mortgage, that might be a good idea to start but it still doesn't address the care issue. Depending on what her house is worth she MIGHT get a year, maybe 2, of care from doing a reverse mortgage then she is out of a place to live and still needs help.

OP, all states have what is called a Medicaid look back period, minimum is generally 5 years, some states are 7 and some are considering going to 10 years. What this is Medicaid looks back at their finances for how ever many years, lets call it 5 for simplicity sake, and checks to see if there have been any transfer of assets in that time. If there have been, the person on Medicaid will be responsible to pay for their care up to that point before Medicaid kicks in. In your mom's case, she will have to sell her house and pay for her care out of pocket until that runs out, then she can qualify for Medicaid-given everything else checks out. Say she sells her house for $200,000 and her care at a nursing home is $100,000/year, she will have to pay for 2 years of care and then Medicaid will pick up the tab. She is allowed to keep a small amount in savings and gets a monthly allowance (in MN is is $83/month).

Give social services a call today and get the process rolling. It takes a LONG time-you may have to wait 6 months or more for a Medicaid approved bed. I would also suggest you look for something near you if possible since you will still need to do some shopping for her, visits, etc. It gets to be more of a chore if you have to drive 30+ minutes each way to do that.

 

[golfgal]

http://www.georgiaombudsman.org/

This looks like a site you will be interested in. They have a good Word document that talks about transferring assets specifically for Georgia. They are a good first contact route as they have access to a plethora of resources for you. I looked and the Medicaid lookback is 5 years in Georgia.

One question, you said your Dad was self-employed-did he sell his business at one time or what was the situation there?