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Do I have any options?
Tough Row
Posted: Thursday, January 9, 2020 12:59 PM
Joined: 4/22/2014
Posts: 7


Hi all -

My mom has been in memory care in NC for a year (she was in AL for three years prior to that).  Mom is 84 and at about a Level 2 care.  We have been using the money my father left for her to pay for her care, but we'll soon be scraping the bottom of that barrel (she has about 6 months left of that money).  Her current facility raised its rates in January, so we started to look for somewhere new.  We were working with "A Place for Mom" and they gave us some names, but when I asked what happens when her money runs out, I was told that she wouldn't be eligible for Medicaid (her SSI and my Dad's pension) put her over the limit. So, she can't stay where she is because it's too expensive, and she can't move because she won't be able to stay for the long term.  My DW thinks we should bring her home to our house and use her funds for day care - does that seem like the right path?  Is this what usually happens?  I admit I've been in denial on this and am now panicking, so apologies if I sound extremely desperate.  Thanks.


feudman
Posted: Thursday, January 9, 2020 1:07 PM
Joined: 6/5/2014
Posts: 1516


You need to talk to an elder law attorney asap. In almost all cases a Miller (income only) trust can solve the "too much income to qualify" problem.

It's a shame you didn't look into this sooner, because most places in my area require a "self pay" period before they will allow you to stay there on Medicaid. The ones that take Medicaid patients "in the door" may not be your first choice and often have waiting lists.

Best wishes to you.


Victoria2020
Posted: Thursday, January 9, 2020 1:27 PM
Joined: 9/21/2017
Posts: 519


What feudman say- a certified elder care lawyer with experience in medicaid and Miller trusts. ASAP.  An elder law specialist not someone who "also does some"

Don't depend on friends' advise , admit counselors etc -  get someone experienced.

Have your wife read this Board , she may be underestimated the work involved in having a memory care level patient at home. A few hours help a week won't cover the needs or the stress issues it involves.

Good luck.

 

https://www.medicaidplanningassistance.org/medicaid-eligibility-north-carolina/

https://www.justia.com/lawyers/elder-law/north-carolina      not recommending any certain one , and I'm sure the state has more,  but a good place to see what certifications or advanced education is available to help you cull someone for a phone interview.

 


LicketyGlitz
Posted: Thursday, January 9, 2020 1:51 PM
Joined: 2/3/2018
Posts: 854


Just echoing the elder law attorney advice! They are the experts who can navigate the finances to qualify for Medicaid.

Good luck!


King Boo
Posted: Thursday, January 9, 2020 2:56 PM
Joined: 1/9/2012
Posts: 3326


A Place for Mom has no interest whatsoever in helping you because you have no more assets for private pay.  This company refers people to different facilities who enroll with them and A Place for Mom receives a commission for every resident enrolled.

So, there are many facilities you will not hear about through APFM.

Is Mom skilled nursing eligible?  Have you begun your Medicaid paperwork?  Consulted with your elder law attorney?  Did you set aside any 'key' money to possibly pave her way into a new facility?  Is your state one of the few who accepts Medicaid for MC?

As to bringing a LO home, - you must  have done a realistic evaluation of your caregiving skills and her care needs.  Adult day cares vary by the acutity of the population they deal with; if Mom is incontinent, not sleeping or exit seeking, those escalate care needs exponentially and are key reasons why people place.  Day care is also limited to a few hours a day. Will you hire help at home?  Are both you and your spouse retired and available to do care in conjunction with hired aides?  It can be done - but her care needs are increasing.  Evaluate accordingly.

Generally, it is easier to place directly from facility to facility - MUCH easier.  No wait lists to be placed behind scores of others.  Does your facility have a nursing home?  They generally accept Medicaid.  See your attorney about Miller Trusts, etc.  Peer volunteer JoC has written well on the topic of Miller Trusts.

For others, this is why, when placing, if you have the option of placing in a facility or community that has AL/MC and SNF, your money will go farther.  Most have entry requirements o f a certain number of years of care; then they will accept you on Mediciad in their snf.  The theory being, you've spent your life savings with us, we will take care of you till the end on Medicaid now that you've spent down.

It does NOT work like this with a free standing MC.  Once you have spent your money, you are not especially attractive to a new facility, presumably another MC or nursing home that accepts Mediciad.  You will join a long wait list for a Medicaid bed, unless you are being admitted directly from the hospital, when it is rather a crapshoot as to which facility has an open bed AND accepts Medicaid for after rehab.

Visiting a CELA (www.nelf.org) can assist you with long term care planning. 


savstein
Posted: Thursday, January 9, 2020 9:58 PM
Joined: 12/17/2019
Posts: 31


Your wife sounds like an angel to suggest her coming to live with you. My advice is to speak to an attorney first FOR SURE and agree with everyone else’s comments regarding that issue....if you do move your mom into your home even temporarily; my advice for you and your wife is to have a really really honest and upfront conversation about the hard topics regarding your moms care. Talk about care duties, how you’ll be dividing care between you, and what your expectations of each other are. My husband and I did not do this and assumed we could work it out along the way and that has been exceptionally hard on our family and our marriage. Caring full time for a memory impaired LO is a massive undertaking, don't underestimate the work involved. This board is great for advice and support - wishing your family the very best.
eaglemom
Posted: Friday, January 10, 2020 12:27 PM
Joined: 3/7/2012
Posts: 2546


You have received some excellent advice here. I hope your taking it all in and reviewing your options.

King Boo thanks for your help on this subject.

eagle


Tough Row
Posted: Friday, January 17, 2020 3:39 PM
Joined: 4/22/2014
Posts: 7


Hi All - 

I want to thank you for all of the great advice.  A couple of updates - 1) you are right about "A Place for Mom" - they dropped me quickly once we started to talk about spend down and the possibility of Medicaid.  2) I talked to an Elder Care lawyer who I worked with on POA issues when my mom first moved here (NC) from Florida.  Basically, it seems like I have very few options, which is panicking me - here are the sad statistics:  my mom has about $50,000 left - between her Social Security and my Dad's small pension, she is over the limit for Medicaid.  Also, NC does not do any type of Miller trust.  He asked me how close she was to needing a Nursing Home bed, and honestly, she's still pretty healthy for 84 - he suggested that I talk to her physician to see if there was a way they would agree that she needed a SNF.  That seems a little dicey to me, but I'm open to it (just don't think I'll get a positive response).  I also asked the lawyer if they had a trust situation in South Carolina, and he didn't know, so he owes me an answer.  Scares me a bit to move her far away, but I have to add that as an option at least.  3) I knew about the Medicaid piece, because I tried to enroll her in Medicaid and was told the same thing (my first appointment with the attorney wasn't until mid-February, so I thought I'd try on my own).  The Medicaid lady felt bad, but told me there was nothing she could do.  She did give me a list of facilities - a lot of group homes, and told me that if she needed a nursing facility bed to come back.  So I have some calling around to do (anyone have any experience with a group home?).  I can't imagine that I'm the only person to experience this situation, so if anyone out there has been in my shoes and has had success, please let me know.  Again, I can't thank you enough for responding and providing great advice. 


lizziepooh
Posted: Friday, January 17, 2020 5:54 PM
Joined: 5/2/2019
Posts: 305


Hi Tough Row,

 

Thanks for posting the update. Your update got me wondering because my mom would be in the same boat - her monthly income is greater than the medicaid eligibility financial amount. 

She is in California not North Carolina but it got me wondering if a Miller Trust would be allowed in California. So I have been doing a search and came across something that I thought may be helpful for you.

The link is https://www.nolo.com/legal-encyclopedia/how-does-medicaids-medically-needy-program-work.html

There is something called medically needy program within some medicaid programs which allows you to spend down the income by paying eligible medical expenses like the nursing home. North Carolina is one of these states so you may want to have your lawyer check into it and see if this would work for you.

Please keep us posted. This stuff is tough to figure out and I would be interested in hearing what your lawyer has to say since I will need to figure this out soon too. Good luck.

Below is a little bit from the link I posted.

If you live in a state with a medically needy program, then you can use medical expenses you incur to reduce, or “spend down,” your income to qualify for Medicaid. States establish a spend-down period, during which they look at your income and expenses to see whether you qualify for coverage. You must re-qualify for Medicaid after each spend-down period. Spend-down periods range from one to six months. For example, if your state has a spend-down period of six months, then you must show that you have enough medical expenses within the six months to satisfy your spend-down (that is, to lower your income below the medically needy income limit). Once you have enough expenses, then you are eligible for Medicaid for the rest of the six months. After the six months is up, you must satisfy the spend-down again. 


gubblebumm
Posted: Friday, January 17, 2020 6:53 PM
Joined: 7/12/2017
Posts: 1751


How much does the pension push mom over the limit?  What if you can somehow "deny" the pension?  Can she reject it or something and then be under the limit?  After all, you don't HAVE to accept that money if you don't want to I can imagine, 

I would say, hey mom found out dad cheated on her 50 years ago and wants nothing to do with his money....just throwing out ideas here...

other than that, the whole system sucks


jfkoc
Posted: Friday, January 17, 2020 6:58 PM
Joined: 12/4/2011
Posts: 18867


Just adding my name as one who took care of someone "in-home" with outside help. If you care to persue this option many of us can share info here and also on spouses.
Caring4two
Posted: Sunday, January 19, 2020 2:46 PM
Joined: 7/6/2014
Posts: 660


 https://www.agingcare.com/articles/how-to-use-a-miller-trust-for-medicaid-eligibility-207367.htm

 https://www.medicaidplanningassistance.org/medicaid-eligibility/

 


Ainbinder
Posted: Sunday, January 19, 2020 10:12 PM
Joined: 5/2/2016
Posts: 50


The duty of providing full-time care, at one's home, for someone on the dementia spectrum, in my case it was my Mother, is daunting.  But it can be done.  I did it for 5+ years, living with my Mom and providing 24/7 care after quitting my work in special education.  I got her out to a swim pool every day, for exercise and so that she had some form of socialization.  ADL (activities of daily living) are a challenge, but they can also be kind of fun to figure out and do together with a parent in need of assistance.  The spiritual rewards are immense, and yet the cost to the caregiver is high.  And there is no paycheck to be had.  You may want to give it a try, as it is a once in a lifetime opportunity.  There is no "next time."

I am not allowed to post a link to it, but I've written a book on my experience in solo caregiving.  Title is "Just Before the Stroke of Seven."  I've found nothing else written on solo caregiving, and I hope you and your wife to not end up in such a position, but there is a lot of information and stories about how I included my Mother in as much as possible for as long as possible.  I wish you G-d's care in your adventures in caregiving.

Shalom,

Aaron


Sleepless Knight
Posted: Friday, January 24, 2020 6:25 PM
Joined: 7/7/2018
Posts: 41


Yes yes yes Elder law attorney is imperative to the right information that you will receive. unfortunately even these websites from care home facitilties sometimes aren't what they say they are and thats having to do with that medicare medical addition. Only a elder law attorney has government information that is real . Dont waste too much time seeking free counsil, it isn't easy to find and sometimes it is hoops and ladders, it may be worth paying for one and bring people with you. dont go alone. just dont. its too emotional and I learned the hard way. dont waste time there is hope . when the attorney is in your corner and they are , you will see just how much they are crucial for your decision making. Elder law is your answer. Best of luck
VKB
Posted: Sunday, January 26, 2020 4:20 PM
Joined: 12/4/2011
Posts: 3623


It would help to hire someone to care for her at home, but often these people are not reliable and do not show up......that is what I hear.  I was fortunate to find a wonderful caregiver, but this doesn't happen all the time.To be honest, I still felt trapped.  Unless the caregiver was willing to stay overnight, we could not go away.  And evenings and nights were always our responsibility...oh and our caregiver's days off too. If both of you are working and you only have paid help during the day, lots still will fall on your shoulders. Just telling you what I went through, but I don't  regret keeping both my parents home.  But it was not easy even with paid help. Hopefully, someone has the answer you need.  Peace always Veronica 

Abuela
Posted: Sunday, January 26, 2020 4:46 PM
Joined: 6/24/2012
Posts: 576


One more suggestion... Usually, these places have to offer 'affordable' units.  There is always a waiting list for them.  Remember that these prices are based on 'real estate' values as well as the care end of things so ask about that at some places near you.  Several of my friends have their parents in 'affordable' units now that they have spent down quite a bit.  

Just a suggestion.  Good luck.