We're seeking guidance in securing financial assistance for current home care & future memory care.
When we became aware of our mother's decline with dementia along with congestive heart disease, we helped our parents sell their home in northern Minnesota (which happened in just three days!) & move to our sister's home in St. Paul. A mother-in-law addition is underway, but the weather has caused a standstill forcing them to occupy a guest room since September. Dad (age 80) is an army veteran (no active duty) & also worked several years for the US postal service. Their cash asset total is very low, most of which is in a revocable family trust. Their monthly SSI combined is around $2000, & Dad gets an additional monthly retirement check of approximately $500. Last month, Mom (age 76) was hospitalized for a week due to her heart condition; they drained 1.5 liters of fluid from one lung but couldn't do anything more because of her frail condition & the risk of accelerating the Alzheimer's disease. She also has diabetes. Dad's physical & emotional health is also suffering. My sister & her family are becoming overwhelmed as caregivers; she is facing the possibility of having to quit her job in order to keep up with doctor appointments, dietary monitoring, safety at home, etc. I live out of state & fly up as much as possible to help. Our other sister is mostly confined to her home with M.S., & our brother works in construction. We've done some research about Medicaid assistance, including articles here by Attorney Heiser about the life estate & gifts protected from probate, & my sister will be consulting an attorney as well as her tax expert regarding necessary steps to qualify our parents for financial assistance before the health assessment is made on Mom in a few weeks. She has also considered the possibility of becoming a paid caregiver & is seeking related info. We would be grateful for guidance in making sure we have every possible point covered legally so their limited cash assets can be reserved for their home build & they can benefit from programs available to them. Our desire is to care for them at home as long as possible, until it becomes absolutely necessary to seek a nursing/memory care facility.
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I'm contacting three different elder law firms this afternoon, so all of your input is extremely helpful.
As I said, the addition is already underway -- exterior is virtually completed except for siding. Plumbing is roughed in. All of us siblings are still in agreement that we have made a commitment to the addition, and there is no disagreement whatsoever with the life estate being purchased from our sister. This arrangement was pretty much the only way we finally convinced our parents to move from their little piece of heaven in northern Minnesota -- about 3-4 hours from the nearest sibling, so too far away when the extent of Mom's health issues became known. Sister and BIL are amazing! We all are truly grateful for the way they have put themselves, their home, and their family on the front lines to do the day-to-day things the rest of us are unable to do. We are united in coming alongside them in various ways -- research, visits, extended stays to give them relief, help with appointments when necessary, explaining certain information to Dad, etc. In short, we are doing our best to follow what God asks of children...to honor our parents. It's our responsibility and our privilege.
That being said, we must protect the little bit of cash they got from the sale of their mobile home in order to finish the addition. Sister and BIL even refinanced to get additional funds and partner with our parents for the build. None of us have much money, so we're doing all we can to qualify our parents for available assistance with care.
My son is a licensed CPA/auditor in Atlanta and has been incredibly valuable in helping to explain things to Dad. He also stressed the importance of securing an attorney who knows Medicaid and tax laws.
BobbiJanke, thank you - I will definitely look into those two programs!
Since her hospital stay, Mom has had weekly visits from a nurse and PT. OT came to do an assessment of her ability to function and to make recommendations for equipment in the home...mostly in the bathroom. PT released her from their part today, and it is my understanding that there will be another assessment by the nurse or hospital social worker in a couple weeks. I'm wondering if this would trump any assessment we try to line up with one of these state programs?
Mom is able to walk, preferably with a walker, but she is VERY unsteady. She doesn't like to do her exercises and fights us on it. But the biggest concern we have besides her heart condition is her dementia. She absolutely can not be left alone. We're fearful that the medical professionals will simply come and talk with her, not us (even though my sister makes a point of being there for every visit), and draw their conclusions based on what she tells them. Mom usually doesn't even know what month it is. She sometimes complains that she hasn't eaten all day...this can happen 10 minutes after she has had lunch or dinner!
Thank you all for taking time to respond!
First, we do really want to care for them in the home as long as possible. That was our whole premise in convincing them to sell their house & make the move. Basically, nothing has gone according to plan since then, so we hesitate to add that huge change into the mix so soon while Mom still makes it her mission to be aware of what's going on at all times. She would not do well being away from Dad, & they do not want to live in a facility.
Yes, it is so true that needs will increase! We have already said that God was watching out for us with slowing the build...we wouldn't know everything we know now if they were living out there already!
Mom is doing better as long as she cooperates with low sugar/sodium diet & the simple exercises assigned by PT. Right now, however, she is homebound except for doctor appointments & church. We are dealing with constant paranoia & temper. Although she sometimes seems to be "herself," Dad needs to fully adjust to the fact that Mom is not the same person she has been for 57 years together. He makes their breakfast faithfully every morning & is very devoted. My sister helps him organize Mom's meds each week, & he puts them out at the proper meal times. He has been in good health for the most part & doing a remarkable job for his age & the daily challenges Mom presents. He is currently recovering from a bladder infection & also has surgery coming up to finally address blockage from an enlarged prostate that has been pretty frustrating for quite some time.
The status of the addition is that the outside is almost completely done. Windows are in; roof/shingles done; just needs siding & exterior door. Plumbing is roughed in, & we're waiting for warmer weather to thaw the ground so it can be completed. Thus, we have committed to it. The plan is for Dad/Mom to partner with sister/BIL in that investment.
We were focusing mostly on the life estate option -- parents would purchase life estate from sister & BIL. Their home value without the addition is $255k, so the table I found online would calculate the life estate allowance at $111,330.45. According to advice from CPA & the "Medicaid Secrets" planning checklist, that would be exempt/tangible personal property (no lookback) & also protected from probate later. Cash assets are just a bit over the allowance amount, but they could pay off what they owe on their car. There seem to be several other techniques on the checklist including gift to a disabled child, home improvements, personal services contract (maybe this could be an example of what @jeannegibbs mentioned)...are we on the right track?
LinkAge Line is a great starting point, but it is not a substitute for seeing an Elder Law attorney. Lots of lawyers can give you tax advice, but may not be aware of all the ins and outs of Medicaid. And that is crucial! You can see from Igloo's advice how complicated it can be. Get things set up correctly from the start.
I hope your sister can avoid giving up her job. Can she take family leave, with the intention of returning? It sounds like the original intention was that her caregiving role is intended to be temporary. She won't get paid while she is on leave, but she can set up a caregiving contract and get paid by your parents, this would be a way for them to spend down there assets for Medicaid. Talk to the Elder Law attorney about this.
Your parents' needs will not decrease if/when they move into the in-law apartment. In fact, with dementia in the picture they will definitely increase, the only question is will it be slowly or quickly. Your family made plans based on one set of circumstances, but circumstances can change drastically in health and needs of elders.
Call the LinkAge Line. Talk to an ELDER LAW attorney. Have a needs assessment done.
Let us know how this goes, we learn from each other (and we care!)
What may be better is for them to do a personal care contract to Sissy & BIL that pays them every month for caregiving and living costs. And sis uses the $ to fund renovation. Contract needs to be all above board and with taxes, fica....
The info on the house sale upstate will be known by Medicaid to the penny. Has any of the $ already changed hands? Really gather all folks finances and act of sale document and whatever existing on the renovation and get them to an atty ASAP.
The other concern to me, is that their medical needs, especially your mom’s sound pretty intense. The heart/fluid situation is it likely to be chronic? Is her diabetes under control? The needs assessment may be that mom flat needs skilled nursing care 24/7 oversight and that means in a facility or huge sums paid for home health services & equipment. Medicaids in the community programs will have limits on the # of hours of in home care allowed. Seems to be in the 20-25-maybe 28 hrs a week range. If mom needs over 30 hrs it’s means she needs care in a facility.
Sissy cannot do this on her own for mom. Plus there’s dad...... if they had to be apart could he adjust?
Ask assessment team if for mom, hospice is a possibility. It doesn’t mean your giving up. My mom was on hospice 18 months. Hospice can bring in equipment & care assistance esp bathing care within days of qualifying. Plus it’s all MediCARE, which they have.
Revocable trusts usually have no protection from Medicaid. It’s viewed as an asset subject to spend down. Irrevocable trusts though can be.
There is a poster on this site from MN who has been through Medicaid for both her husband, living at home, and also with her mom who lived with her sister for a bit and then the mom moved into a NH. I’m sure Jeanne will post some insight on Medicaid in MN for you.