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No doubt it is ridiculously expensive. Watch for the large "for profit" conglomerates who seem to be buying up the independent AL/Memory Care facilities. Those prices do go sky high after they pull a bait and switch to get your LO moved in and then comes the first re-assessment. The bill just went from $8,050 to $10,950, at least in California. LTC Medi-Cal in CA only reviews income not assets and assess the health and mobility of the resident as SNFs only take on those needing continual medical care. It is a labyrinth and it is best to retain the services of an Elder Law attorney. If there is an issue with the Medicaid application, it's back to the drawing board and that available bed in a facility that you thought was just perfect has now been given to someone who got it right the first time around.
Who ever thought when we were growing up that our lives would end up under the "care" of those who warehouse the elderly for profit only. There are exceptions but they are in short supply.
Get some help and posting on the blog is a good first step.
You don't actually have to pay for it. If you're placing your spouse and unless you're extremely wealthy Medicaid will be paying for most of the care costs unless you have a very good LTC insurance policy.
Medicaid is not unreasonable to deal with. They are not going to put a spouse in the street because the other has to go into care. You will be allowed to remain in your home and they don't take all of your income.
If you have assets your wife's care is not going to be free. No one's is when they have assets unless they have been Medicaid exempt. The nursing home and Medicaid can only collect upon half of any marital assets. If there are things like real estate or bank accounts that are not shared assets (also in your wife's name) they can't touch them.
So if you have to put your wife in care, do it. You'll be all right.
So yes - the amount is astronomical - but with the ability to utilize the concept of community spouse and apply for Medicaid after spend down- it is honestly more feasible when you get to the point of needing 24 hour care than the other options - which are typically trying to schedule and split a family member's care between loved ones (if you have them available and willing) - all of whom likely already have a lot on their own plates from full time jobs to children to their own health problems - and juggling scheduling 24 hour care between untrained family members - I can promise you from experience - can be enough to drive even the most dedicated and loving family members crazy. And the other option is having 24/7 paid caregivers come into the home - and if you think nursing homes are expensive - the price tag on in home round the clock care is enough to make you cry.. When we priced it out for my FIL - it would have run between $480 - $720 a day (so @$175,000 - 263,000 a year) and that was just ONE caregiver per 8 hour shift - he would have needed TWO - given his size and needs - so double that.
When we did THAT math - and given that we could no longer PHYSICALLY provide the level of care that he needed at home - and the funds were not there to provide his care at home - we literally only had one option - as expensive as it may have been.
As far as no accountability or knowledge of what goes on inside of the facility - I disagree - but that's a rabbit hole for another day.
Who leaves their loved one in a nursing home, or any managed care facility for that matter, w/o frequent visits to make CERTAIN "what's going on" and that they're being cared for properly?? All nursing homes are accountable to the state who monitors them for compliance with regulations.
How does this work (or does it work at all?) in a “community-property” state? Is there still a way to divide a wife’s income from the husband’s for Medicaid purposes?
Where I live an “average” nursing home costs $18,000/month. A really nice one, well over $20,000/month. When I see posts like this I wonder where people are from.
OldDad, what you do is find a CELA level of elder law atty to go over options for wife’s eligibility for precisely however your State runs its LTC Medicaid program, then follow their advice and let them shepherd your wife’s application to become a custodial care resident in a NH and eligible for LTC Medicaid after she (not you but her) does any legit spenddown needed to get to the asset level for LTC Medicaid & for you to become a CS “community spouse” continuing to live in your home and - if applicable- able to have some of wf monthly income be waived to go to you instead of almost all hers being paid to the NH as LTC Medicaid required SOC share of cost. You have to be all in on this with providing details on every bit of assets, old legal done, income, etc.
For couples, imho, when 1 Nh & other is not, is attorney work. It is NOT - again not - ever a DIY. There are just too too many nuances to how LTC Medicaid runs to attempt this on your own. You are doing caregiving so yourself are overwhelmed and you will cock it up and make mistakes that will cost you for both right now and over time even into past your or your wfs passing. If CELA atty in yiur region tell you it’s 8K or 10K upfront retainer, it is what it is.
Financially it is only your Wf that has to be impoverished for LTC Medicaid, not you as you are a CS and still need your own income and assets to be able to stay in your home. But doing this correctly in a way that passes a caseworker view of documents required by State is not a DIY. If this was a POA son that is very involved in their widowed Dads life, even if Dad has a home & a car or even two, yeah that can be a DIY if they are organized and Dad isn’t fighting them on decision making. But couples is way waaaaay complicated. Not DIY.
I live in a low cost of living area and I was just quoted $361 per day plus supplies to place my wife in a skilled nursing facility for 6 weeks. This was a religious nonprofit facility. No local Medicaid beds are available.
At least our health system in Canada is better in that aspect, otherwise US is much more efficient. If a spouse goes to LTC there is no splitting assets, spouse living in community retains control of all assets, house, investments. Average cost of LTC $2700. AL is different story, just paid close to $ 3000 for ten days of respite stay for my husband. Average $4000 per month, good one close to $8000-10000 per month. Statistically, people live in AL 3-5 years, it used to be 2-3 years but of course people live longer or remain healthier longer until they go to LTC. So how much money is needed? Assuming paying $100,000 per year adding taxable income would put one in 40% tax bracket which would reduce cost significantly. For 5 years my quick estimate will be $300,000. Of course it will be more as increases are more likely to occur.
You need to see an elder lawyer. He can have your assets split. Your wife's split going to her care. About 3 months before her split runs out, you apply for Medicaid. Once she is on Medicaid, you become the Cummunity spouse remaining in the home, have a car and enough or all your monthly income to live on.
My mother lived four years in nursing home care, in the best place in the city. She went through a long term care policy to private pay to Medicaid in about a year. Please know that upon using Medicaid her SS went to the nursing home, but dad kept all of his SS, all of his monthly pension from being a teacher, their home, all the money in their checking and savings, and only had to sell one car and keep one car. His lifestyle changed none. Mom’s care remained the same, competent and compassionate, throughout no matter how it was paid. She stayed in the same room, with same caregivers. Nursing home care doesn’t have to break you. Get some good advice from someone well versed in Medicaid applications
NH care is super expensive. Look into medicaid with an elder care attorney if you can. Once assets are gone, the government can step in and help. Take assets out of your LO's name. I am paying $15,000 for each of my parents in NY and it goes higher when you add in meds and therapy. Some months the cost is over $17,000 for just one of them.
It makes sense to save your money but they will most likely use all of their assets before they pass.
Prices do vary from state to state. I would make an appointment with an elder law attorney and have them help you best figure out how to still protect some of your monies and assets while applying for Medicaid for your wife's care when needed.
Having all your legal ducks in a row right now is critical: assigned PoA for yourself (and wife, if she's legally able), Advance Healthcare Directive, Last Will/Executor, etc.
Also, consider talking to a Medicaid Planner for your home state to know what is required to qualify and when, and what the look-back period is. Or and estate planner.
You can research facilities local to you by joining Nextdoor.com and asking for recommendations -- you'll get lots of up-to-date and honest opinions from your actual neighbors in your community. You can give your preferences to your PoA so that if you are unable to make this decision yourself, you've already approved your final residence.
My MIL is 3 miles from our house in an excellent non-profit facility owned and operated by the Presbyterian church. She was never a Presbyterian. It is affordable and run like a mission, not a business. It's where I want to eventually go. My friend's parents (multi millionaires) could have gone "anyplace" but they chose there because it's so well run and established (35+ years in that location, on a large metro lake). Places like these do exist but you have to search for them and get others' opinions. I wish you much clarity and wisdom in your planning.
Yes, and lucky at that price, for in the bay area MC can run to 20,000 a month. And yes, the money goes very very quickly. That is why the government provides assistance to so many who outlive their funds. We speak of this all the time on Forum, as you will see if you stick around with us. Glad to have you here and hope you'll stay.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Who ever thought when we were growing up that our lives would end up under the "care" of those who warehouse the elderly for profit only. There are exceptions but they are in short supply.
Get some help and posting on the blog is a good first step.
If something is beyond your reach, seek counsel on how to achieve your goal.
Best of luck to you.
Medicaid is not unreasonable to deal with. They are not going to put a spouse in the street because the other has to go into care. You will be allowed to remain in your home and they don't take all of your income.
If you have assets your wife's care is not going to be free. No one's is when they have assets unless they have been Medicaid exempt. The nursing home and Medicaid can only collect upon half of any marital assets. If there are things like real estate or bank accounts that are not shared assets (also in your wife's name) they can't touch them.
So if you have to put your wife in care, do it. You'll be all right.
Because their worth it.
When we priced it out for my FIL - it would have run between $480 - $720 a day (so @$175,000 - 263,000 a year) and that was just ONE caregiver per 8 hour shift - he would have needed TWO - given his size and needs - so double that.
When we did THAT math - and given that we could no longer PHYSICALLY provide the level of care that he needed at home - and the funds were not there to provide his care at home - we literally only had one option - as expensive as it may have been.
As far as no accountability or knowledge of what goes on inside of the facility - I disagree - but that's a rabbit hole for another day.
OldDad, what you do is find a CELA level of elder law atty to go over options for wife’s eligibility for precisely however your State runs its LTC Medicaid program, then follow their advice and let them shepherd your wife’s application to become a custodial care resident in a NH and eligible for LTC Medicaid after she (not you but her) does any legit spenddown needed to get to the asset level for LTC Medicaid & for you to become a CS “community spouse” continuing to live in your home and - if applicable- able to have some of wf monthly income be waived to go to you instead of almost all hers being paid to the NH as LTC Medicaid required SOC share of cost. You have to be all in on this with providing details on every bit of assets, old legal done, income, etc.
For couples, imho, when 1 Nh & other is not, is attorney work.
It is NOT - again not - ever a DIY. There are just too too many nuances to how LTC Medicaid runs to attempt this on your own. You are doing caregiving so yourself are overwhelmed and you will cock it up and make mistakes that will cost you for both right now and over time even into past your or your wfs passing. If CELA atty in yiur region tell you it’s 8K or 10K upfront retainer, it is what it is.
Financially it is only your Wf that has to be impoverished for LTC Medicaid, not you as you are a CS and still need your own income and assets to be able to stay in your home. But doing this correctly in a way that passes a caseworker view of documents required by State is not a DIY. If this was a POA son that is very involved in their widowed Dads life, even if Dad has a home & a car or even two, yeah that can be a DIY if they are organized and Dad isn’t fighting them on decision making. But couples is way waaaaay complicated. Not DIY.
If a spouse goes to LTC there is no splitting assets, spouse living in community retains control of all assets, house, investments.
Average cost of LTC $2700.
AL is different story, just paid close to $ 3000 for ten days of respite stay for my husband.
Average $4000 per month, good one close to $8000-10000 per month.
Statistically, people live in AL 3-5 years, it used to be 2-3 years but of course people live longer or remain healthier longer until they go to LTC.
So how much money is needed?
Assuming paying $100,000 per year adding taxable income would put one in 40% tax bracket which would reduce cost significantly. For 5 years my quick estimate will be $300,000. Of course it will be more as increases are more likely to occur.
It makes sense to save your money but they will most likely use all of their assets before they pass.
Also, consider talking to a Medicaid Planner for your home state to know what is required to qualify and when, and what the look-back period is. Or and estate planner.
You can research facilities local to you by joining Nextdoor.com and asking for recommendations -- you'll get lots of up-to-date and honest opinions from your actual neighbors in your community. You can give your preferences to your PoA so that if you are unable to make this decision yourself, you've already approved your final residence.
My MIL is 3 miles from our house in an excellent non-profit facility owned and operated by the Presbyterian church. She was never a Presbyterian. It is affordable and run like a mission, not a business. It's where I want to eventually go. My friend's parents (multi millionaires) could have gone "anyplace" but they chose there because it's so well run and established (35+ years in that location, on a large metro lake). Places like these do exist but you have to search for them and get others' opinions. I wish you much clarity and wisdom in your planning.
And yes, the money goes very very quickly.
That is why the government provides assistance to so many who outlive their funds.
We speak of this all the time on Forum, as you will see if you stick around with us. Glad to have you here and hope you'll stay.