How do I determine if my 77 year old dad who is in a nursing home should go on Medicaid?

Depending on the circumstances Medicare will get the house. Sister may be allowed to remain living there till she dies before Medicaid takes it to pay any unpaid bills.
Can sister afford the expenses of the house or would she do better in subsidized housing.
You are correct in thinking that the nursing home is trying to ensure that they get paid. Hospice is free to the patient as long as the patient meet admission requirements. Hospice will pay a daily fee which no where near covers the cost of care. they will also cover the cost of medications related to the admitting diagnosis. For example if he is admitted with heart faure but also has diabetes they will only pay for the heart meds.
As far as Medicaid is concerned he will have to spend down his cash before he can receive benefits. That will include the money he gave you and possibly the value of the house if they don't allow sister to stay.
Medicaid typically takes several months to be approved which is why the need to apply now is important. As long as the nursing home accepts Medicaid he can remain.
I am not familiar with all the details so talk to the social worker, an eldercare attorney and the local hospice. you can't make a decision till you know the facts.

How about selling the house, putting the cash in a dedicated account, and your sister renting a home of her own?

Admission to hospice means a maximum life expectancy of six months, as you know. But seriously you do not want to be sitting by your father's bedside when you get to three and a half months from today and thinking about the money.

It isn't that I don't sympathise with your sister but the plan for her to stay in the house must leave your hearts in your mouths, both of you. Won't she feel a huge sense of relief if she can make herself independent of the situation? Can't you help her make a different plan?

Oh, I get it now...it's only if your dad outlives the 4 months' worth of money to private pay the NH that your sister will lose the house to Medicaid.

If he signs up for Medicaid now they would take it. It seems to me that we should wait to sign up for Medicaid and pay for his NH until that money runs out. If he should pass before that time then my sister will be able to keep the house. Granted, if he does live longer than that then she will lose the house anyway.

Why wouldn't Medicaid still take the house from your sister?

It would be paid from the $15000 he gave me and the $8000 he has in his account. That would cover about 4 months and if he is still with us at that point I would sign him up for Medicaid. I hate to look at it that way but it seems easier than signing him up now and Medicaid taking the house from my sister.

How are you going to pay for his nursing home care if he is not going on Medicaid?

I will have to look into PC. But I’m also confused about hospice because the NH administrator said it would be free regardless if he is on Medicaid or Medicare. I did speak with an elder care attorney who basically said that Medicaid would go after the house due to the fact that it was transferrred in the last 5 years regardless of the fact she has lived there and helped with care. She said it would have been better if he had simply kept it in his name. Currently it is difficult to have a conversation with him due to breathing problems and not being all there, I assume due to the medications he is on. Previously he didn’t really want to be in a NH at all. Unfortunately I’m unable to take off work to care for him and my sister can’t due to her current medical issues. Yes it does get tricky and very confusing!

My sister has lived there 3 years and has helped take care of him as well as my mother before she passed a year ago. I asked an elder law attorney about that and she stated that Medicaid would go after the house. I haven’t spoken with the doctor but I did directly ask his nurse and the social worker at the NH what his prognosis was since they felt he needed hospice and neither would give me a direct answer. They both stated that hospice is being suggested to make him more comfortable and he could live for a long time. From what I have read for someone to have hospice care they would need to determine that they were terminal and likely have less than 6 months left. I feel like the NH is pushing for Medicaid to make sure they get paid. At this point I feel like I should not try to get him on Medicaid because I really don’t know how much longer he has and the situation with my sister.

Since he's already immobile and can't walk, and therefore presumably can't rehab, it looks as if some type of 24/7 care will be necessary. But unless someone has specifically discussed end of life issues, I'm wondering about Palliative Care? It's not as comprehensive as Hospice Care (PC doesn't reimburse for medications).

But I think the quality of life is the important issue at this point. PC might be able to provide some assistance, not as much as Medicaid, but I think that issue is also complicated by the need for a place for your sister. Medicaid is not an area on which I know much, so I'm wondering if you might need some counseling or advice from a Medicaid knowledgeable attorney, especially b/c of the transfer of the home and the need for your sister to have somewhere to live.

Gets tricky and complicated very quickly, doesn't it?

How is your father feeling about this? Is he comfortable with going into a hospice program?

It sounds like your dad has no other options but to go on Medicaid. If he gave you the $15,000 within the last 5 years, medicaid is going to want that back to help pay for your dad's care. The nursing home can do an application called "Medicaid Pending" in which they will ask Medicaid for back pay to when the application was made. That is normal procedure. The house being signed over to your sister a year ago may be a problem unless she was living there and caring for him earlier. I'm not sure about that one. I wish there was a way for you to become durable and medical POA for normally that takes place at a lawyer's office.

Since they are talking about bringing hospice in, then he must not have long to live. What does his doctor say?