What to do if there is no money and only a house to sell? (parent, father)
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My mother-in-law is 90 and living alone. She recently suffered a UTI and had a hospital stay followed by rehab stay. She has had some memory issues for about a year, but the UTI made this worse and it really has not improved back to her baseline. She also gets extremely dizzy, which has been looked into extensively and has not been able to be cured.
During the hospital and rehab stay, we asked them to look into her mental state. They both said she was sharp and that her confusion had cleared up, which is obviously not the case if you spend any length of time with her. So, she has no diagnosis of dementia despite signs of it such as asking the same question multiple times a day, not being able to properly take her meds, and confusion over many things. We have an appointment with a neurologist, but it isn't for 2 months, and she is currently staying with us as we figure out the next step.
We have been looking at assisted living, and they all seem to think it would be a good fit for her. They cost around $4000/month here. However, she has no money aside from social security and a house to sell, which would likely clear no more than $50,000. Based on this, she will run out of money for assisted living in about 18 months, coupled with her SS income. Every assisted living facility we've spoken with says she would have to leave when her money runs out--she doesn't qualify for veteran benefits, and the Medicaid waiver for assisted living in our state pays only a few hundred dollars, so not even close to the $4000 monthly bill.
We are concerned that she will go to assisted living, run out of money in less than 18 months, and then we have to pick a nursing home with her having zero money. She has no other health issues other than the confusion and dizziness and some urinary incontinence from not getting to the bathroom on time, and really expect she could live several more years. She normally is a very social person, she does want to go to some kind of facility, but she thinks we are talking assisted living, not "nursing home" type of care.
Any advice on this? Should we skip assisted living, knowing she won't be able to stay there long? Can you go into a skilled nursing facility if you don't need skilled care, or does dementia (assuming she is diagnosed with such) count for that? Or just start with AL and move when she must?
I love her dearly, but living with us long-term isn't an option. Any advice is appreciated. Thank you.
Every assisted living facility accepts (and sets aside) some space for Medicaid patients. They also will help her (you) apply for Medicaid once her savings/house profits run out. If she is applying for Medicaid and they have the space, they will not relocate her in the interim while waiting for Medicaid. If the assisted living facility did not explain this to you, then choose another facility. Most of them are very helpful in this regard. Most facilities also have skilled nursing facilities so that elderly clients can transition from assisted living to skilled nursing without moving to a different facility.
Lastly, as a learning moment, when everyone reaches her age, what are your plans and means to effect those plans? Social Security was never intended to be the total retirement solution. I hope everyone is doing some planning.
actually I've never heard that medicaid paid anything for assisted living, it does however pay for SNF (nursing home) once the patient is qualified/accepted.
I suppose - since medicaid is run by individual states - that some states may actually allow medicaid to be paid towards assisted living, but you'd really want to make sure you check that before you'd move her.
I think your first step (no matter what living situation you choose) is to get her applied/qualified for medicaid. At least start the paperwork.
Medicaid does have some "aide at home" programs (the government is trying to shift programs in that direction, rather than institutionalization), so depending on if they're availble in her/your area - it might end up that she'd be able to stay in her home, but with assistace (provided by medicaid).
Every assisted living we have talked to, and we have talked to at least 20, has said the only Medicaid they offer/accept is a state Medicaid waiver, which in their experience, would be no more than $500/month. One did tell us they would try to keep her there on the Medicaid waiver and her SS income, but they would expect us to make up the difference, which they estimated would run about $1800/month--they would offer a slight discount in the monthly fee. I don't want to do that for an indefinite time period that could potentially last 5+ years, and my husband and I are the only family she has who can pay at all. All other facilities have clearly said, and I'm not misunderstanding, that she will have to leave or we will have to pay for it on top of this Medicaid waiver. Moving to the skilled area of the same campus is a possibility at a few we spoke with, but they have waiting lists, which we have put her on, and no hope for her to get in in the near future.
I am well aware that SS is not meant to cover all retirement living expenses. We don't know what happened to her savings; my father-in-law made a nice living but there is nothing left.
My husband and I are covered for our own retirement, but that plan doesn't include paying for her retirement as well, unfortunately. Maybe it should, but I'm not willing to spend that kind of money when I have my own future to consider.
These places may say they offer Medicaid, but a $500 waiver out of $4000 just doesn't help in her situation.
1) You say she's staying with you so I presume you're residents of the same state. (as opposed to her living in another state until now)
Know the rules and programs in your state..... some states have less help/fewer programs, than others. I'd call around NOW so you have info that can help you plan. It seems you're tight for time...but you're not in ABSOLUTE CRISIS -- yet.
2) IF all she has is what you've stated, she will likely have to sell the house and use proceeds from that. There ARE one or two moves you all could make as a family to try to preserve some assets, but you'd need to see and pay a lawyer to do that. And I don't know that you'd what to spend any money on that now. a) because at this late stage it's even more vital that any asset protection be done absolutely correctly, and b) at this stage you may just decide the moves are just to complicated, just sell the house and use the proceeds for her, and when that's done she'll be on medicaid and that's it.
For example, MAYBE a lawyer would say she should KEEP the house, go on Medicaid still owning the house. I don't know whether she'd sign the house over, or Medicaid makes her sell the house, and though those monetary assets.
THAT is the kind of advice I'd rather get from an eldercare/estate planning attorney (who knows MEDICAID eligibility) -- RATHER than a social worker.
3) DEFINITELY call the county office of aging, or 'senior living" -- or "elder care" -- or whatever they call it, and consult with a case manager or social worker. Do state and county research online. You should call the state too. They'll help with some info, but also likely refer you back to the county, which administers the state programs. But if helps to get TWO sources of info.
4) Get ready for lots of phone calls and research. Be organized. Always have a pad at the ready to get more names and numbers. You'll get so much contact info it's crazy.
5) Do you have her POA, will, directives, etc in place? Have you been, before now, involved in her care...or you're sort of just getting involved and up to speed?
6) Use the next two months while she stays with you as your research time. Make phone calls, Observe her. TAKE NOTES, so when you see the doctors ....you go in with as much info as you can.
7) As I'm sure you'll here -- and I have learned from others -- stay on top of any urinary infection...big time. And preventing them is vital.
8) You're doing a wonderful thing for her! Be blessed.
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Based on your post ^^ I'd say call the state and county directly, get some info from THEM. Facilities have a vested interest in getting as much money as they can. Ask about in home assistance (domiciliary care) My state has a program where an elder can stay with a sort of "foster care" situation in the home of a family or couple who will care for them, at less cost than a facility....cost is on a sliding scale income basis. ((Usually a person needs to be "independent enough to NOT need 24/7 care, NOR can they be permanently incontinent. So for example a mid-stage alzheimer's person likely wouldn't qualify, and an EARLY stage person might.))
Also ask if they have a "LIFE" - Living independently for Elders, or PACE (Program of All-inclusive Care for the Elderly) Look for something like that, perhaps.
My mom had mid-stage Alzheimers (and assets) so didn't qualify for any programs. But key is finding out for sure and with confidence (from the right sources) WHAT she'll qualify for an what she won't.....or when she MIGHT qualify in the future should her asset or medical condition change.
HOW MUCH ARE YOU ALL actually willing to take care of her. That would definitely stretch her money. The more you all assume they less you'd have to pay someone else to do. I know you said you're not interested in long term, but what if???
To your basic question - yes, skip assisted living as it will bankrupt you/her.
Pursue either SNF (including seeing if she has a diagnosis that would qualify) and getting her approved on medicaid to either pay for SNF or at home-assistance in lieu of a SNF.
As rdflk points out, the more you assist, the more pressure that takes off the system, however if its not practical/possible in the long run don't beat yourself up about it.
Our lawyer's medica person said apply for Medicaid about 3 months ahead.
But first you have to know what programs she qualifies for.
And the purpose of you all doing what you could -- would be to stretch her money for HER to have more/better care options. Not necessarily 'taking pressure off the system." The longer you stretch her money, the longer you have time to really scout out and research your options. A big question is the house...do you sell it now, or can she qualify for medicaid owning the house, and you 'sign it over', or deed it. or whatever. that's where perhaps a free medicaid attorney consult might help. -- IF you can find one.
Our attorney for example doesn't do FREE consults. There's are hourly rate, but if you go KNOWING what you want to get out of the meeting...if COULD be worth a few hundred dollars. Don't just let the attorney rattle on about what he does. You be going to GET ANSWERS to questions, not waste time, and leave with no action plan. Be clear before you make the appointment, that your coming with info, and you want answers and guidance, not hot air.
I would try to get her qualified for Medicaid, which as has been stated would have to be in a SNF. At 90, she is probably going to have some dementia/memory issues sooner than later.
I am going through this now with my dad. He had a UTI which was discovered during his 3-day hospital stay. He has dementia and Parkinson's and we decided to give him the type of care and safety he needed to transfer him into a SNF. My sister and I then have started the process with a legal team into applying for Medicaid. Mom still lives at home and I live here with her and take care of her.
This happened so quickly that we didn't have a chance to apply for Medicaid several months ahead, like someone mentioned. My dad had a Doctor's appointment and the Doctor immediately admitted him to the hospital, so we had to scramble to make a decision. Luckily, my parents also have had a LTC policy for 18 years, which is going to help us with a portion of the costs.
To the OP, you may know this, but Medicare pays for the first 20 days in a SNF, after a 3 night stay in a hospital and a signed release from a Physician. I would say ask your attorney about the house and if it is possible to put the house in a trust to protect it from being sold to pay the expenses of the SNF. (It never hurts to ask.)
My heart goes out to the OP. I know her situation with her MIL is different than my situation with my dad. But do find out what you can about a Nursing Home (SNF). And as someone mentioned, I would confer with an Elder Care attorney who will specialize in these type of matters. We did, and it has been very helpful.
'ville, I just realized you clarified something important, the mother in law would be on Medicare, NOT Medicaid. OP, big difference.
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