My mother is 90 and still lives in her home, with my unemployed adult brother living with her. Without going into too many details, I'll just say that for financial reasons my brother has been trying to keep her at home for as long as possible. She's had a few stints in a rehab after being hospitalized for illnesses (pneumonia) and they've been nice places, with good food and activities and even visiting entertainers. Each time I've gently suggested that she might be able to stay there one day, but she would start crying and getting upset, saying she has her own home and doesn't EVER want to go in a NH. I think she remembers the awful places my grandmother and great-grandmother were in the 1960s and 70s. She is a very stubborn woman and I've been dreading this NH issue for many years. It certainly hasn't helped having my brother side with her - it's been two against one. I am her DPOA, but do not have a medical POA; stupid, I know.
It's been a rough road the past few years and both my mother and brother, for their own personal reasons, have fought her going in a NH. It's now becoming apparent that we're nearing the end of the road for her staying at home and she will need to go in a NH soon. She is on a cocktail of meds that are keeping her fairly healthy for her age, but she has mild to middling dementia and worsening arthritis in her knees. There was an awful flareup of pain last week and an ambulance took her to the ER. They were unable to do much else but give her a painkiller injection and a lidocaine shot, along with a cortisone shot which didn't work. We didn't think she'd be able to get around the house too well when she got home (get on and off the toilet, etc) so we pretty much begged her doc to admit her, which he refused to do for an arthritic knee. We brought her home (with difficulty, after that painkiller), and she's been in pain but stable ever since. We have an appt with an orthopedic this week.
The helplessness we felt that night in the ER when told they us they wouldn't admit her was just awful. It was really obvious my brother wouldn't be able to handle taking care of her and I work and have my own family to care for. I asked to speak to a social worker about moving her to a NH that very night but was told since it was a Sunday night, there weren't any available. I think that night, coupled with my mother's increasing hygiene problems and dementia, has shown my brother that our mother can no longer live at home. I spoke to an elder lawyer a while back and the house will probably be transferred to my brother, as a "caretaker child". From that moment on, he'll own the house and be responsible for all the bills, which is the reason he's been fighting putting my mother in a NH for so long. Hiring an in-home caretaker is out of the question due to the cluttered condition of the home and other problems which I won't go into. We now have a home health aide coming in twice a week to bathe my mother and, while I'm thrilled that she's finally getting clean, it's been causing it's own kind of problems having someone come into the house.
I always thought my mother would move into a NH after another stint in the hospital and then rehab. I had hoped that it would be a natural progression. But it's obvious to me now that she'll probably need to go in one not due to illness but because of my and my brother's inability to care for her ourselves. My question to the message board is: how do I get her into a NH directly from her home? I can't imagine just loading her up into my car and driving her there; she would most likely throw herself out of the car. Is there a procedure? (I've already picked the NH). Also, does anyone have any advice on what we should do if (more like when) we're back in the ER with our mother and they won't admit her and there's no way she should be going home that night because we can't care for her? We're in NJ, by the way.
Thank you in advance for any advice or stories about your own experiences when moving a parent to NH directly from their home and how you got through it. I really appreciate your support.
Thank you,
Sue
can you repost your question in the "ask a new question"
Your post comes up in a ? from back in 2011 so a lot of folks will just ignore it.OK.
MedicAID rules determined by each state & are state specific even though it is a federal & state program. Medicaid is needs-based. You are expected to spend your assets first and foremost before the state will pay. There are things you can do to reduce assets but these need to be done by someone qualified to do this that will pass your state's review. An certified elder law attorney is best.
For NH Medicaid eligibility, an individual must show that:
1) are 65+ (can be younger if qualified disability),
2) medical condition requires skilled level of nursing care,
3) monthly income at or below their states max (about 2K),
This is the “income test”– how much $ do you make. TX is $2,094.
4) all countable assets are at or below 2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.
If you do, could be a “transfer penalty” when items are gifted. Penalty different for each state as it’s based on each state’s daily NH reimbursement rate. For Texas, it is $ 142.92 a day rate (2011).
Max look-back is 5 yrs. Most states require 3 – 6 mo. of financials with initial Medicaid application. Can require more financials if something pique’s interest. Financials are bank statements, social security and retirement statements, insurance policies, etc.
INCOME: If it is that every month they are over the states income limit BUT not enough to pay in full for the NH and qualifies for NH in every other way, then they can see an elder care attorney to do a "Miller Trust" or a "Qualified Income Trust". Say mom gets 1K from SS & 1,500K from retirement every mo. Income=$2,500. Basically $ 500 over ceiling for monthly income. No matter what is always is $500 over. So this excess $ 500 is what funds the trust and therefore mom’s income is now 2K and within the states income ceiling. The beneficiary of the trust is state's Medicaid program and upon death reverts to the state. Miller really has to be done by an attorney who does elder law as it needs to be flexible/adaptable and meet the criteria of each state's law on probate (death laws) & Medicaid rules.
ASSETS: All assets are counted, unless the assets fall within the short list of "noncountable" assets:
- personal possessions,
- a vehicle (some states have a limit on the value)
- their principal residence, provided it is in the same state in which the individual is applying & the house may be kept with no equity limit if the "community spouse" lives there; otherwise equity limit is 500K (750K in some). House does NOT need to be sold, is a "non countable" asset but elder will have no $ to pay for anything for house as all $ less a small personal allowance has to go to NH each mo.
- prepaid funeral(irrevocable, NCV, usually 10K max)
- small amount of life insurance (usually $1,500 & NCV)
All other assets (savings, stocks, whole life, rental property) are counted.Must “spend down” to get to their states max to qualify.
The financials are what most folks focus on. But remember that they also need to medically qualify for the need for skilled care for Medicaid.
It sounds like her income is like $ 3,500 a month? If so she will need to get at Miller Trust done even after you spend down to the 2K asset situation. You will need an attorney to do this - they are simple and done all the time but have to be done by an attorney familiar with Medicaid regulations & probate laws for your state.
This site has articles on Medicaid Medicare and how they are different. Also if you go back on this post to the beginning there are posts from myself & others with our experience in going thru the NH & Medicaid.
What you need to realize is MedicAID is a needs based program. So in order for your parent or anyone to participate and benefit from MedicAID you must be at-need. "At Need" basically mean they have +/- $2K each in assets and monthly income in order to qualify. But can have a home and a car (which are exempt assets). At-Need basically means they are poor and at poverty level. All their assets and income for 5 years prior to admission to a NH must have been used for them or their care (like private duty nurses or home health care agency) or their wholly owned property (like their home). If everybody could go and empty out our parents bank accounts and transfer all their property for zero to others today, and then apply for Medicaid tomorrow, the system could not pay for it and there would be no Medicaid program for anyone to be able to use.
If any assets or monthly income are transferred to you or others, then the state can impose a transfer penalty against the elder via their representative (this would be you as her DPOA) for the amount of funds based on the state's NH Medicaid reimbursement rate. The transfer penalty is a total cluster to deal with as it usually happens after the elder has been in the NH - perhaps for a few months - and then the state in it's require due diligence has found that mom transferred a car worth 20K and cashed in a 10K Treasury bill before she went into the NH. 30K transfer penalty. What will happen is that the state will send whomever is the residents family contact and the NH a letter that the elder is out of compliance with Medicaid and the $ amount and length of time. NH will require you come up with the $ and sign off a promissory note &/or hefty deposit or you get the dreaded 30 day notice (that they have to move and believe me no other NH will take them except by private pay contract with a deposit upfront). This is a total panic situation to be in and a terrible situation to place you parents in.
So in Texas, whose transfer penalty is about $ 145 a day, a 30K transfer would mean someone would have to private pay for 210 NH days. Each state's transfer rate is different. TX is a a low Medicaid reinbursment rate state.
Remember if and when you apply for Medicaid, you, as DPOA, basically sign off on an all-access pass to all your parents financial and legal. You have to provide for 3 - 12 months of their financial and asset and income information with Medicaid application. Which the NH usually vetts before they will even accept a resident as "Medicaid Pending". Many NH which have multiple homes have a regional admissions person who reviews whatever you provide before it even gets sent by the NH to the state program along with the NH's bill.
Property records are recorded by the local assessor and then folded into the state's data base, so moving property ownership will come out. Interest paid on savings or investments are available via IRS or state, etc. All their info is just keystrokes away and eventually it will be found out. If your state uses HMS for compliance, they will be able to find out to the penny every cent spent as HMS has a extremely good system via algorithms for compliance and recognizing patterns of fraud. HMS does compliance for Medicare (via CMS) & federal insurers.
For my mom, she was in IL before the NH, so her 6 months of bank statements (sent with Medicaid application) clearly showed where all her $ was going (to pay for IL) and showed a steady decrease in assets with nothing different or unusual. Even then, I had to go to her bank and have a bank officer do a detailed letter of all accounts, CD's etc. closed and where the assets went for 3 years prior. Fortunatly all closed went into her single checking account, so this was simple but took about 3 hours at the bank and I went prepared with my legal and all her account info. This letter was submitted with her initial application which ran over 100 pages of required documentation. Is it a total PIA? Yes, but every day I am grateful that the Medicare and Medicaid program exists as there is no way she or I could pay or provide the level of care that her NH provides for my mom, who has Lewy Body Dementia. Imho, if they live long enough (my mom is mid 90's) they will eventually run out of $$ and the caregiver will run out of ability (and humor) and thank goodness there is Medicaid for them available.
Most NH admissions come from a hospital discharge. If an individual covered by MediCARE is discharge from a hospital to a nursing home for continued care (rehabilitation) after an inpatient stay of at least 3 days, Medicare will cover 100% of the first 20 days and MAY pay up to 100 days, subject to a co-payment by the patient of $141.50 per day for days 21 to 100 (for 2011). Medicare does not pay for the many months/years that some people reside in a NH for long-term custodial care. In general, Medicare is limited to short-term acute care.But this MediCARE paid period of time in the NH is when you need to get the documents together to apply for MedicAID. This is the easiest way to get them into the NH.
BUT if If they are living at home or in IL, like your mom is and my mom was, AND they need to move to a NH, you will need to work with their MD to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, or forget stuff, etc. is not enough. They have to have documented need for skilled nursing. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. Sometimes the MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med to one that needs to be compounded daily which you can’t do at home. Understand? Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH and often are denied because they don’t have enough “critical” conditions because there is no history when living@ home (unlike coming from a hospitalization). You will have to work with NH and your parents MD’s to get whatever done to establish the need for NH if they are coming from being at home or IL. There is a whole Medicaid medical appeals process in each state for this and separate from the financial appeals.
For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is really good as they will know how to create & write up the overall health history chart so that it passes Medicaid medical review to get them into the NH they are medical director of. It may not be the NH that is your first choice but once they are in and on Medicaid, it is easy to get them moved to another NH. My mom is now in her 2nd and much better NH.
Now this isn't very kum-ba-ya, but if she should have another fall that provides for a 3 or more day hospitalization (3 day minimum needed for rehab orders to be done), then social services at the hospital can expedite finding a NH for her.
Good luck and keep a sense of humor.
Here it goes.
Mom-85
Has mobility issues due to a disease called Arteritis -Inflamation of the small arteries in her brain, which creates a lot of havoc in her body. Lots of pain. Has good days and bad. Compounded issue with her bad back and now walking issues.
Her mind is in tact. No dementia. Just plain Narcissistic Personality. Hell on wheels. Those who have one of those, know what I mean.
Still handles her check book. I was finally able to convince her to let me open it. on line . Now I can see her accounts, but she still insists to write her own checks.
She owns a Condo. It's in a Trust, with my name on it. In fact I just paid the yearly fee.
She is very guarded about her assets. She stated lately she has Cash in the House. Car is in both of our names. I'
I'm an only child. She lets me in on some things but still holds control and I have a hard time discussing as to what will happen to her if she can't take care of herself. I will not move in with her nor will I take her in. The nastiness of her personality I believe would be detrimental to my health. I'm not willing to sacrifice my mental and physical health for a woman who has been horrible to me all my life, but I do have a soft spot for her because she is my mother and I'm nothing like her, so I want to be able to handle the situation when it will come.
My mother does not want the Government to get a nickle. To a point that she keeps her cash at home.
Her total income including her SS is about $1400.00 per month. Condo paid for. She only pays the Taxes and Association. Supplemental Health Ins.. Car is all paid for. She is frugal and manages her money well.
The question is: If she becomes in capable of caring for herself and needs to be in a NH, will she have to surrender her Condo even though it's in a Trust? It's been in a Trust for over 25 years. Half of it is mine.
This sounds bad but I have to ask. Will I loose half the Condo Trust or be financially responsible for her in any way?
Any advice or input is greatly appreciated.
not mind paying what we can..but want to stay in our home.explain how they will divide our savings ?
Home Health Care service is the best option for your mom,With home care services patient can live independently and happy and you can get almost any type of help you want in your home.
I totally understand what you are going through and I am going to have to push for my mum to go into a home.
I live here with her but want to move on I cannot handle her abuse etc.. but apart from her illness I dont want to live in this area and need to move and have some sort of a life?
My mums house is a pigstye and she cannot see it! I am drained from her hygiene and clutter issues and like you have a problem with getting cleaners as they do not understand and lets be honest they do not want to come back??
I do everything have a USELESS brother down the road who comes up and does the lawn has a quick cup of tea with mum then leaves.
My dr has told me to find a solution or walk away the stress of all this has made me ill with chronic back pain. I know myself that either she goes into a home or I will have to leave and let my family sort it out as the stress of worrying about her is just too much and making me ill.
If your brother cannot take care of her I dont think you have any choice like us my family live abroad and they have NO IDEA what the stress is like.
You are doing the right thing as I know I will have to look at nusing homes soon but like most parents on here my mum is so stubborn and will refuse to go to a NH and this is what I have nightmares about that she may be forced against her will for her own safety??
Nobody wants to put thier loved one in a home but sometimes their safety takes over all emotions and its usually the best for everyone. My mum is going into respite next week for the first time and i know this will be very hard for me I just pray she has a great time as this would be the home I would choose for her permanently as my friends mum went here and was very well looked after with Alsz.
Above the input box to answer a question and right below the words "Answer this Question", the AgingCare folks have written, "Please stay on topic or ask a new question".
You WERE on topic however this thread started in 2011 and pretty much concluded in 2012 except for some extraneous Q&A that tripled in after that. I believe DogGrrrl's mom has passed on because I saw a follow up question from her about how to file taxes for a deceased person.
Your post was long and descriptive but it's probably not going to get much attention under someone else's gold heading. Lt's got some very good information in it and it would be too bad for it to get lost. Why don't you repost it as a new question or a new discussion under a new heading of your own.