Family caregiver payment and Medicaid. What do you all think about this?

Based on experiences in my lifetime, do NOT trust anyone, no matter who, until they CAN PROVE BEYOND A SHADOW OF A DOUBT THEY CAN BE TRUSTED. This does not sound good to me - I have seen too much. Find an attorney who is highly skilled in eldercare and seek advice. Protect yourself and the elder - you won't be able to do this one alone - and be careful in the meantime. And I have a question - at age 91 with dementia, why is someone taking this person into their home - it will be hell on earth with behavior and personal needs. What is the true reason? I feel this person should be placed where they can be properly cared for. Something is not right. I feel this.

Your idea of how to proceed with caregiving make sense. Her ideas do not. I’d hold off on bringing her in and look elsewhere.

bluebell19: Imho, for lack of a better word, your SIL is very naive.

The fact the SIL wants control of everything and has had very little input to date is concerning, at the least. Insist on the meeting with the lawyer, since a caregiver contract appears to be in order. It also might be wise to have mom's groceries, h mom's supplies and mom's medications delivered to the home - you will control those expenses.

Since you are seeing red flags now, please consider allowing SIL to take mom in on a trial basis - maybe 2 weeks. Visit frequently to see how mom is doing. If you have any qualms, please bring her back home.

Please consider alternative options. You might also consider placing your mom into an adult day program - weekdays during usual business hours in a nursing home of personal care home. You might also be able to secure a home health aide for a shift or 2 - at least 4 hours per shift - so you have time off on the weekends. If mom has reached the point of keeping everybody up at night (sorry, it happens), then she might be best served in a residential facility that will take her social security, Medicare, and/or Medicaid as payment.

Your MIL should be with someone who actually cares. Not SIL. I would put her in a memory care nursing home before SIL. My impression is SIL just cares about the money.

I work for a Certified Elder Law Attorney and what you suspect is true, you need to meet with an ELDER law attorney and draw up a Caregiver's Contract. If you don't have a caregiver's contract, you won't be able to count all the payments toward Medicaid; it would be labeled a "Transfer of Assets," and she would be penalized for that! Once done anything you pay, your SIL will count toward the spendown for Medicaid when she's ready.

Find an elder law attorney who does a free consultation for new clients, the certified elder law attorney I work for does this. They can go into much more detail about why you must have a caregiver contract.

Also, talk to the elder law attorney about why you should have a secondary agent on the POA for MIL safe. You have a secondary for the protection of your MIL.

This whole scheme sounds bad...It sounds REALLY REALLY BAD!!

Please, for the sake of your MIL, seek help from a qualified Medicaid lawyer. It will be worth every penny! Your SIL is wrong about spending the money freely, even if it is for her care. It will greatly hurt your MIL in the long run when she needs more care and is out of money. If her money isn't spent right, Medicaid will penalize her and withhold care and services when she needs it the most. Then what? It also does not sound like your SIL has the best intentions and thinks this will be an easy way to generate more income for herself. I agree with others that it would be best to keep her near you in a facility that can give her the care she needs. I would also keep the current POA in place.

The main thing I have learned about Medicaid is that the applicant has to be near financially destitute. In your case, RUN to a lawyer as others suggested. Your MIL would be better cared for in a facility equipped for her condition. Your SIL would burn out (and resent) in weeks from the requirements of basically round the clock care. Once approved for Medicaid in a nursing facility, they will attach her social security check except for pocket change. Is that behind your SIL motivation? Its going to be a sensitive situation but the best interests of the MIL must be priority. NEVER have a dual POA and if you have a person in place, leave it unless they have misused the authority. Wish you the best outcome.

Don't take our opinions. Speak to an attorney who is well versed in Medicaid and elder law and get the FACTS before this power struggle drives a chasm between your families. It's important that MIL has all her legal and financial affairs in order before you make any decisions. Always keep MIL's wishes and well being in the forefront. Finally, present all the facts, workarounds, and potential agreements in a non- confrontational manner with the intention of a final agreement that works for everyone.

Save the attorney fees this is a no way Jose deal. Keep hubs poa, place her close to you. B&B is prob losing money, don’t fall for it.

Perhaps SIL hasn't got a clue and is imagining her mother will be no more work than any of her B&B guests 🤣.
Unless she is one of the lucky ones who dies peacefully in her sleep she will need increasing levels of care (as you well know) and she may need a memory care or nursing home at some point. Explain to SIL that the care contract is really for her own protection because without it your MIL will have nowhere to go when that time comes, SIL will either have to take on her care or pay back the money. I wouldn't allow her to be sole POA either, she could be primary with your husband as secondary or you can word the document as "jointly and severally" (either or) - but if MIL is far enough along in her dementia creating a new document may not be possible at all and the point is moot.

Even if your SIL doesn't want to go to a lawyer, you should. And you should see a MEDICAID ATTORNEY, not an estate planning attorney or elder law attorney, but someone who is a bona fide MEDICAID ATTORNEY. That way you are in the know and you understand the circumstances that will play out with respect to finances.

Trust your gut.

I think your MIL would happiest in a
good AL or care home !!!
this is exactly situation we would not want for ourselves ..!!! siblings fighting over $$, POA ‘s, and whose responsible for care.
we wouldn’t want feel like a huge burden. Hands off her money … use it all for her care … sell her house whatever to make her comfortable and independent! She’ll enjoy being cared for , help when she needs it, activities good meals and lots of people around !!
much better than being isolated in someone’s house with resentful bickering kids around…. And don’t expect any $$ left over !!!

Excellent advice, my2cents! Either you have "been there, done that," or you're a professional Medicaid planner! My brother and SiL have been taking care of Mom in their house since 2018, but recently my SiL had to start looking after her own mother, leaving my brother with 24-hr care of Mom (I live 300 miles away, and am looking after my husband). Brother "thought" he understood what was/was not allowed under Medicaid's 5-yr look-back period, but he was wrong. An informal loan agreement; receipts for expenditures not fully documented; other mistakes.....and now when he needs Medicaid he learns that Mom will have a 14-month penalty period. He deeply regrets not consulting a Medicaid Planner to help him structure the transactions in accordance with Medicaid's strict requirements.

So, Bluebell, don't give in to your SiL's demands!

I would place her. If she has money, a nice AL. If not then Medicaid and her SS goes towards her care.

I agree what SIL is suggesting sounds fishy. First thing I thought was she will take over and you will be cut off.

Thank you! That's what I thought. My 24 year old son is living with her but is moving out but starting back to college an hour drive away next week and will commute until his apartment is available, hopefully in October. We moved him in in June when she wandered to the neighbors that she doesn't know but is obsessed with and fell along the way. So him moving out means we have to do something, but no there has not been a 'complaint' per se. We would like for her to live in a facility close to us, but that is her daughter and well, if she wants to step up and care for her, then we will oblige her even if it means we won't be seeing her much. SIL says she is also taking in her husband's mother and that they have looked into everything and do not need to account for any moneys spent, just as we have been paying all of MIL's bills at her home thru POA, SIL says she will just be paying the bills there in the same fashion.
The house (we are in a neighbor state as yours with low house values - so less than 100K) has been in the children's names for over 30 years, and we offered to sell that if she needed an infusion of cash, but also cautioned that capital gains taxes will cut into that quite a bit, depending on her other income.
They are already in quite a bit of back tax trouble so I'm not very confident in their financial literacy. Bottom line is DH was somewhat relieved when sister offered to take her in, but has been blindsided by her other requests. We have stayed close to MIL despite other opportunities and desires to move out of this god forsaken state and have taken care of most of her needs since her husband died over 25 years ago, including a bout of rectal cancer when she was 70 and we had small children. So while we would love a break from this, we also don't want it to ruin our chances for moving and retiring from the corporate world in a few years to pursue other things, and to help our adult children who seem to be flailing in this pandemic.
And for the record, I don't want her to live with us. We have an 'adult' child still living with us, work and I have an elderly father we visit often without notice due to crisis of the day. I also have significant health issues. My husband has to drive me due to vision loss so it would just be a nightmare. Let's not even mention the relationship is quite strained already due to MIL's stubbornness and lack of planning for her care throughout the last 2 decades.
Thank you for responding!

No, no and no. If SIL wants all the SS money - you need a caregiver contract and an atty can help set that up. Will advise how to file tax forms etc. In Texas you have to explain all monies paid out of a bank acct in excess of $200. Failure to use money appropriately WILL create penalties if she needs to apply for medicaid bed later on when her own money runs out.

The basic rule of government assistance (like Medicaid) is if you don't want the government to nose into your finances, don't ask for their help. They do have the right to look at how the assets were spent and they WILL ask. Should you allow SIL to do as she pleases now, one of you is going to end up trying to pay for the nursing home until penalty completed or the patient is going to need a place to live when the level of care becomes much harder than it is now.

Sounds sketchy to me on one hand, but on the other - have you complained about needing her help and now she has stepped up to the plate to oblige? If she takes mom to the BnB, mom's money can be paid directly to caregivers to help out when guests are present. No loss of income for the business and she would have receipts to show mom's medical needs paid for. Caregivers w/an agency not a big paperwork problem, but private care will definitely need employer/employee type contract, especially for the 5 years prior to needing Medicaid - meaning payroll gets reported to irs appropriately.