Mods Please Delete

[PlutoPony]

if your husband can't get off the couch as you say, and can't fix his own food, etc, how is her going to get up, get dressed to go through the process of hiring a lawyer.
if you are not going to help him do that, how is he going to seek and hire a lawyer?

Maybe that will be the kick in the rear that pushes him to be an active participant in his own life.

 

[Goofy_Disney_Dad]

I've always heard telling people that are possibly dealing with mental health issues that just pulling up their bootstraps and doing it seems to cure them almost immediately. Who knows, maybe it will work in this case too.

 

[macraven]

if the husband is full of talk only, and the op doesn't cave, the legal separation might be eaiser to go through.

it is quite possible that he will not apply himself for contacting a lawyer and stay on the couch.

 

[barkley]

I just finished reading through all of this, I wasn't dis'ing when this thread started because I was in the middle of dealing with a rotten/complicated issue for my disabled adult son for whom I'm legal guardian. i'll make a few suggestions based on my (admittedly dated) social services experiences, current guardianship status, having recently dealt with scores of community and government agencies, and prior p.o.a. experience for mom/mil.


here goes-

you can't force someone into a nursing home. if you've got a p.o.a. usually they only kick in if someone is deemed incapable of decision making. in our experience (w/mom and mil) it takes an act of god to get a doctor to do that if the patient is even remotely lucid. with a senior citizen you at least have adult protective services that might be able to come in to a home and make an evaluation that will substantiate the person's inability to care for themselves-before a person hits 60 though it's almost impossible without their buy-in to make the nursing home move (and that's if it can be financially afforded). even with the full blown guardianship I have on my son-in my state I am VERY restricted on decisions that entail putting him in care or rehab facilities (rightly so-there have been abusive cases in many states where guardians basically warehoused disabled persons to retain control of their assets/incomes so I absolutely support this provision and oversight).

financially affording it-as others have said, there are strict rules before Medicare or Medicaid will cover it, and then a hospital stay generally has to precede the placement (and the doctors have to be on the same page that it's necessary). the link you posted o/p-it's from that state's department of aging, and from personal experience I would suggest before you base ANY decisions on it (or what a lawyer who refers you to it says)-check with the actual agency to see if you or your husband (who I am guessing is under 60) fall under any of it's provisions. speaking of lawyers-if you are in low income housing-don't pay for a lawyer, call legal aide b/c you probably meet the criteria (though if your dh had $4000 sitting around that he could give/have taken by his sister-then if he's receiving SSI you need to watch out b/c if they find out he (which includes you) are misrepresenting your assets it's not only losing eligibility to the program it's defrauding it and a violation of federal law). I think though, from the dollar amount you mentioned trying to protect w/the spousal impoverishment rule your husband is getting ssDi in which case there's no issue w/ assets (though your low income housing could have rules about it). if your husband is on Medicare though (which comes with ssDi after a period of time)-is he also on Medicaid? if so-again those assets have limits so be careful. if he's not on both-you need to look into it b/c Medicare only pays for a short amount of skilled nursing care which is why unless people have the financial resources to pay for it the whole issue of looking at Medicaid and the spousal impoverishment concept comes up.

as for figuring out what to do-just for the heck of it, call the ombudsman listed on the link you provided. 'yes' they are technically only for senior issues BUT they can likely give you the names of resources for non senior situations like this (awesome people the ombudsman). they may tell you about things like 'in home care' which provides subsidized or free caregiving on a daily basis.

for yourself-you MUST see a doctor and get evaluated. it is not child abandonment or elder abuse if you leave your husband alone for a couple of hours to go to a doctor's appointment. you are not his legal guardian so it's not neglect either. his medical providers have currently deemed him capable of being in the home w/support. they've not said that he needs 24 hour care or he would be in skilled nursing-so call your doctor's office and tell them you need an appointment ASAP. self medicating is never a good idea (and alcohol is a depressive so using it w/potentially preexisting depression just compounds the problem).

choices-your dad, your husband's family, the lawyers......none of them are living (or more so just existing) in the situation you are in. they can have their opinions but you know what they say about opinions (would quote but it's not dis friendly). you need to take care of yourself first and foremost-even in the best case scenario if your husband made a complete turnaround about appropriately addressing his circumstances, in your current mental and physical state you are not capable of providing him the support he would still need unless and until you address your own circumstances.

take care-there's help out there, ask for it and if that doesn't work DEMAND it.

 

[PrincessElena]

I'd love to see you take care of yourself before you take care of others. It simply can't work any other way.

 

[lovemygoofy]

If he treated me halfway decent, I would want to help more. He still has his moments, and it can just be small things that make me feel like I am still in love. However, those moments are fleeting. The reality is, I simply cannot work and take care of him. It is a full-time job. Somebody brought up the state paying me to be his caretaker...good idea but I read that spouses are exempt from being paid to do that. His family is not going to help. The handwriting is on the wall. The idea was for us to all be together in this, everybody could pitch in what they could and help. Nope... they all have their own lives, and that leaves me here alone with him.

It is like when somebody ties up every moment with doctors appointments etc... it leaves you no go out and earn any money. Employers are not going to allow you to take off as much as I need to take off.

I used to teach, I had been there a long time and had more leave accumulated than I could ever use. If I had not been tenured, I know they would have fired me for missing so much. In fact they started slamming me on evaluations etc... and giving me so much extra to do that it was obvious they were pushing me right out the door. They made it hard enough on me that I quit without incident. They didn't want me there, I was more of a liability than an asset. Somebody had to sit in the surgery waiting rooms as my husband had 3 surgeries in one month. Somebody had to take him to all those doctors appointments. My husband alienated all of our friends so it all fell on me to do this stuff. It required me not missing work. Yes I took off more time. There were a couple days when I was having panic attacks when I woke up and thought I would die if I went to in and tried to face the stress of dealing with a classroom. Yes I got sick, I had a 101 fever and simply could not work. This didn't stop my husband from making me go try to get his pain meds refilled early for him. I was sooo sick and I drove 30 minutes to try to get his prescription filled and then they wouldn't do it because it was too early. I don't think that is enabling him, it was the fact it was easier for me to drive that far just to NOT be yelled at. Sorry ranting.

No one at all is going to make any of these decisions for you. Your family can care for your and hope for your best but only you can take action. You don't need anyone's blessings or consent. People might or might not judge you but in the end if you want to save yourself you will be the one that has to take action. Your husband's family isn't going to save you. Your husband is not going to get tinkerbell pixie dust up his *** and decide he wants to take care of his diabetes. I get that he has mental, emotional and physical ailments but that doesn't allow anyone at all to act like a female cleanser and people deserve to be called on with such behavior.

When your husband starts yelling at you, walk away. Why sit and take it? Go outside. Go to your bedroom. If he can follow you around the house to yell at you, then his happy behind is healthy enough to clean up after himself. He is controlling you with his actions and his words. Manipulation at its best.

Love yourself enough to at least go to the doctor and a therapist. Take care of yourself. No one is going to look after you but you. Make yourself a priority.

Check into transportation for the disabled. I know that most places have some kind of can transportation and leave him the phone to make the arrangements for his transportation.

Have you talked to his primary care doctor at all regarding the issues? He could help with ordering some home health care if insurance and paperwork allows it. I would also talk to Medicaid about options for further help. Some states have evaluation nurses to come out to someone's home and evaluate someone. Honestly, your husband would be taken care of if you left. There are resources.

Find some give a damn about yourself. Love yourself and make yourself a priority.

 

[Pea-n-Me]

I just finished reading through all of this, I wasn't dis'ing when this thread started because I was in the middle of dealing with a rotten/complicated issue for my disabled adult son for whom I'm legal guardian. i'll make a few suggestions based on my (admittedly dated) social services experiences, current guardianship status, having recently dealt with scores of community and government agencies, and prior p.o.a. experience for mom/mil.


here goes-

you can't force someone into a nursing home. if you've got a p.o.a. usually they only kick in if someone is deemed incapable of decision making. in our experience (w/mom and mil) it takes an act of god to get a doctor to do that if the patient is even remotely lucid. with a senior citizen you at least have adult protective services that might be able to come in to a home and make an evaluation that will substantiate the person's inability to care for themselves-before a person hits 60 though it's almost impossible without their buy-in to make the nursing home move (and that's if it can be financially afforded). even with the full blown guardianship I have on my son-in my state I am VERY restricted on decisions that entail putting him in care or rehab facilities (rightly so-there have been abusive cases in many states where guardians basically warehoused disabled persons to retain control of their assets/incomes so I absolutely support this provision and oversight).

financially affording it-as others have said, there are strict rules before Medicare or Medicaid will cover it, and then a hospital stay generally has to precede the placement (and the doctors have to be on the same page that it's necessary). the link you posted o/p-it's from that state's department of aging, and from personal experience I would suggest before you base ANY decisions on it (or what a lawyer who refers you to it says)-check with the actual agency to see if you or your husband (who I am guessing is under 60) fall under any of it's provisions. speaking of lawyers-if you are in low income housing-don't pay for a lawyer, call legal aide b/c you probably meet the criteria (though if your dh had $4000 sitting around that he could give/have taken by his sister-then if he's receiving SSI you need to watch out b/c if they find out he (which includes you) are misrepresenting your assets it's not only losing eligibility to the program it's defrauding it and a violation of federal law). I think though, from the dollar amount you mentioned trying to protect w/the spousal impoverishment rule your husband is getting ssDi in which case there's no issue w/ assets (though your low income housing could have rules about it). if your husband is on Medicare though (which comes with ssDi after a period of time)-is he also on Medicaid? if so-again those assets have limits so be careful. if he's not on both-you need to look into it b/c Medicare only pays for a short amount of skilled nursing care which is why unless people have the financial resources to pay for it the whole issue of looking at Medicaid and the spousal impoverishment concept comes up.

as for figuring out what to do-just for the heck of it, call the ombudsman listed on the link you provided. 'yes' they are technically only for senior issues BUT they can likely give you the names of resources for non senior situations like this (awesome people the ombudsman). they may tell you about things like 'in home care' which provides subsidized or free caregiving on a daily basis.

for yourself-you MUST see a doctor and get evaluated. it is not child abandonment or elder abuse if you leave your husband alone for a couple of hours to go to a doctor's appointment. you are not his legal guardian so it's not neglect either. his medical providers have currently deemed him capable of being in the home w/support. they've not said that he needs 24 hour care or he would be in skilled nursing-so call your doctor's office and tell them you need an appointment ASAP. self medicating is never a good idea (and alcohol is a depressive so using it w/potentially preexisting depression just compounds the problem).

choices-your dad, your husband's family, the lawyers......none of them are living (or more so just existing) in the situation you are in. they can have their opinions but you know what they say about opinions (would quote but it's not dis friendly). you need to take care of yourself first and foremost-even in the best case scenario if your husband made a complete turnaround about appropriately addressing his circumstances, in your current mental and physical state you are not capable of providing him the support he would still need unless and until you address your own circumstances.

take care-there's help out there, ask for it and if that doesn't work DEMAND it.

I agree with everything you said. It's much the same of what I said, also.

(I was, frankly, astounded at the number of posters here who said, "Just put him in a nursing home" like it could happen at the snap of her fingers.)

 

[ariel71]

Please take this advice. His "income" is from the federal government and has an unbelievable amount of protection from being taken from him. If you plan to move forward in a divorce, or you plan to put him in a home in order to gain access to that monthly "income", it would be a huge mistake. It simply won't happen and I can't explain it further than that.

I looked at that link and the Federal Register sections on Medicaid (42 CFR) and there's nothing that on the surface conflicts with what the attorney said. The spousal impoverishment rules look at "combined resources", which includes SSI (if deposited in a joint account). There's also nothing I found that relates to the age of the spouse.

I'm not saying I agree with it, and of course the devil's in the details, but from a purely academic perspective I don't think people should be so quick as to discount the possibility that the attorney was correct.

http://medicaid.gov/Medicaid-CHIP-P.../Eligibility/Spousal-Impoverishment-Page.html

http://aspe.hhs.gov/basic-report/spouses-medicaid-long-term-care-recipients

 

[Goofy_Disney_Dad]

So, right now you are as dependent on his disability income as he is?

 

[Goofy_Disney_Dad]

I looked at that link and the Federal Register sections on Medicaid (42 CFR) and there's nothing that on the surface conflicts with what the attorney said. The spousal impoverishment rules look at "combined resources", which includes SSI (if deposited in a joint account). There's also nothing I found that relates to the age of the spouse.

I'm not saying I agree with it, and of course the devil's in the details, but from a purely academic perspective I don't think people should be so quick as to discount the possibility that the attorney was correct.

http://medicaid.gov/Medicaid-CHIP-P.../Eligibility/Spousal-Impoverishment-Page.html

http://aspe.hhs.gov/basic-report/spouses-medicaid-long-term-care-recipients

Can you show me some case law to support this happening?

Edited to add: Yes, the devil is in the details and the details provided here in this thread is what I'm basing my statement and opinions on. None of which have changed based on any quick case research I've performed.

 

[littleblackegg]

I understand your frustration with this and wish it were a circumstance that had simple, easy answers. I want to be very honest but also very kind. Patients who have a double-whammy of severe mental health illness AND physical disabilities often become, for lack of a better word, helpless. This is not their faults. Years and years of illness and depression and anxiety and depending on Social Security and hospitalization after hospitalization creates hopelessness and often a loss of desire to care for oneself. These patients do best with lots of teaching and training and physical rehab and a culture that makes them care for themselves. If they return to an environment where someone else does all the cooking and cleaning and toiling and insulin shots, they will immediately regress. Those facilities will not say he can do things that he can not. Nobody is going to risk her license. Getting better and functioning at your highest is hard work. Some people are not ready to do it. He sees you running around calling people trying to rescue him and he has no incentive to be at his highest level. Maybe that is somewhere in the middle. He should already have a case manager-it sound like his treatment plan needs to be adjusted. They will not put him in a SNF as long as there is a home to go to with a caretaker. Be well. Remember to open your own parachute first.

 

[RitaE]

No you cannot force a mentally competent person into a long term care facility but without a person in the home to provide caregiving and the other family members lack of willingness, he isn't going to have many options. He can of course choose to remain right where he is with no caregiver, and suffer the consequences. The medical and social services people in contact him will do their best to discourage that, but the choice will be his own.

Right now, she has agreed to be that caregiver. If she no longer accepts the duty, and she has every right to no longer accept the duty, then the viable options available to him change drastically. So while she does not directly "put him" anywhere, her presence does play heavily into what happens to him. He might attempt disabled housing with in home visiting caregivers and meal service, but he is going to have to increase his ability to at least move around inside the home independently or it's going to go bad, pretty quick.

If the OP is in Illinois, there are Medicaid funded Supportive Living facilities for persons under age 65 with physical disabilities, which are similar to Assisted Living. However they do exclude persons with a primary mental illness diagnosis so I'm not sure if he would be able to gain admission with a bi-polar diagnosis in his records. But, that isn't the OPs job to sort out if she choses to remove herself from the situation. She isn't going to put him anywhere. That will be his own responsibility.

I'm actually kind of glad Goofy_Dad posted his opinions on what he thinks about the situation because this is what the OP needs to realize. No matter what she decides to do, there will be people who will believe she is acting wrongly. It goes right back to, the only opinion that really matters in regards to what she decides to do is hers.

 

[ariel71]

Can you show me some case law to support this happening?

Edited to add: Yes, the devil is in the details and the details provided here in this thread is what I'm basing my statement and opinions on. None of which have changed based on any quick case research I've performed.

Um, the whole point of the regulation is to do exactly what we're talking about - set aside a portion of the Medicaid recipient's income (which includes SSI) for the support of the spouse remaining in the "community" if the spouse's resources are below a certain monthly amount.

Considering I've linked to federal government policy statements that show the actual federal statutes, I think it would be more relevant to show the case law you found that disputes it. Case law is more limited in terms of applying to a very specific set of circumstances, so it would be less likely to apply to OP's case.

 

[littleblackegg]

I've always heard telling people that are possibly dealing with mental health issues that just pulling up their bootstraps and doing it seems to cure them almost immediately. Who knows, maybe it will work in this case too.

Hee hee hee hee.

 

[barkley]

D

I looked at that link and the Federal Register sections on Medicaid (42 CFR) and there's nothing that on the surface conflicts with what the attorney said. The spousal impoverishment rules look at "combined resources", which includes SSI (if deposited in a joint account). There's also nothing I found that relates to the age of the spouse.

I'm not saying I agree with it, and of course the devil's in the details, but from a purely academic perspective I don't think people should be so quick as to discount the possibility that the attorney was correct.

http://medicaid.gov/Medicaid-CHIP-P.../Eligibility/Spousal-Impoverishment-Page.html

http://aspe.hhs.gov/basic-report/spouses-medicaid-long-term-care-recipients

has she said he's on Medicaid? b/c if she's looking at this rule to try to retain about $2000 strictly from his 'disability income' then he's not on SSI he's on SSDI (max ssi for an individual is around $700, w/an eligible spouse which I don't think the o/p is b/c she's not been deemed disabled by social security-about $1100-no way he's taking down individually over $2000 a month from SSI). SSI generally makes a person categorically eligible to Medicaid, w/SSDI that's not the case. SSDI brings Medicare after the waiting period (2 years for most, w/some conditions immediately) but to get Medicaid takes a whole separate eligibility determination.

The links you've provided refer to the following (from their sites)-if he's not getting SSI and/or Medicaid it may not apply (different states have different rules for "Medicaid" due to new laws w/ ACA).

SSI and Spousal Impoverishment Standards, and

MEDICAID INCOME AND ASSET PROTECTION FOR THE COMMUNITY SPOUSE
Medicaid law was amended in 1988 in response to evidence that at-home spouses -- typically elderly women with little or no income of their own.


this is why it's VITAL for anyone researching it to use legal advice (elder law specialists are
the best in this realm) IN THE STATE they live in. one single wrong decision in the planning process can result in total ineligibility for both the spouse and the disabled person (saw it happen one too many times w/lawyers who just dabbled in these programs misadvising clients who paid their last pennies to try to set things up 'right').

 

[piccolopat]

Yes, I can file for divorce and hope he doesn't contest it. I can roll the dice and take whatever comes up and that option is becoming the most obvious I believe. I just don't want a nasty thing to be dragging on for a long time. Of course it is dragging on and on and we are still married. I just know that in this state, there is a requirement to be separated 2 years before a divorce will be granted. UNLESS, both parties will waive that requirement. If he wants to fight me on this, I am looking at a very long battle, but it may be a battle I am going to have to put on my big britches and just do it.

Why don't you file for separation now? You'll start the ball rolling to a possible divorce in 2 years which gives you time to think and gives your husband a deadline to get his act together. In the meantime, if he doesn't treat you kindly and with respect and if he refuses to take care of himself, he needs to be told that he is going into a nursing home until the situation changes. You also need to go back to work even if it means getting a home health aid for a part of the day. With his failure to take responsibility for his own health, it is likely his diabetes will completely overwhelm his system and he will not be a problem for you anymore before long. You will need to be able to support yourself when that happens and being out of the workforce now will put you at a disadvantage. Please also contact the social security and Medicaid offices soon. Since you are so young, you may get nothing from SS Disability when he is gone and Medicaid will likely take everything he gets to pay for the nursing home. It is a difficult situation but it's also time for you to think about your future without him. Keep in mind that divorcing him is not the same as abandoning him. If you choose to, you can still help him after the divorce.

 

[Goofy_Disney_Dad]

Um, the whole point of the regulation is to do exactly what we're talking about - set aside a portion of the Medicaid recipient's income (which includes SSI) for the support of the spouse remaining in the "community" if the spouse's resources are below a certain monthly amount.

Considering I've linked to federal government policy statements that show the actual federal statutes, I think it would be more relevant to show the case law you found that disputes it. Case law is more limited in terms of applying to a very specific set of circumstances, so it would be less likely to apply to OP's case.

No, SSI income and SSDI income are very different animals and both are not addressed in your links. Medicare, which people on disability get after a period, and Medicaid, mostly income based, are also very different animals as well. I understand what you are putting forward, but I don't agree that it applies based on the information we have.

 

[Frozen72]

delete

 

[Goofy_Disney_Dad]

So his income is currently from SSDI, or are there SSI considerations in there as well? That makes a big difference in how you could proceed.

 

[Frozen72]

delete