Retirement and your chidren's part

[Deleted]

I know there was a previous thread about this, but with two boards, I couldn't find it. This, however, isn't really hearsay.

My cousin has a 99-year-old mother who she has now living with her. My cousin had found a nursing home for when she couldn't do her mother's care. That is when she moved her seveal states away into her town.

Now she has discovered that her mother earns $8000 a year too much to pay for the nusing home. These are her pensions, her husband's annuity, SS, and a small pension benefit from her husband. She said she would have to pay $3000 a month to pay for her mother to live that.

How can they make her pay that much? She doesn't have the $$$, by the way. Her mother has no ASSETS . . . no house, no car, no furniture, nothing. She just has the income streams listed above.

So what is her daughter to DO? Right now her niinety-nine-year-old mother is living with her and is in Hospice. It may end up being a moot point.

But I kept telling my cousin, maybe erroneously, "If you can get her in there, they probably can't kick her out." I was urging my cousin to set herself a small salary and a small amount of rent and to subtract that from her mother's income, if possible. I would be saving to move her into the nursing home.

I know the old model was for the daughters to take care of their parents. But what is the new model. You guys are pretty straight-forward about how you won't be taking care of your parents.

But if $8000 can put you over the cut-off income wise, what are your parents going to do?

[Deleted]

Do you mean her income is $8,000/over the threshold where the government would pick up the tab?
Did she try to see a social worker?
Did she try another nursing home?

Maybe I am wrong, I thought it was they take all your income to cover the nursing home and whatever you cannot pay the government pick up that tab... am I wrong?
I thought the government would be happy she has so much income, less for them to pay out of pocket compared to someone that has no income and no assets.

[Works4me]

What state is your cousin in?
What is the total cost per month?
What is the mother's income per month?
What type of facility are you talking about?

Prices range depending on the level of care and type of assistance.
FYI long term care medicaid is different from regular medicaid.
All of the mother's income is expected to go to pay for her care needs.
I have been a medical social worker for 25 years and it is an extremely confusing issue.

[Deleted]

Your statement that they can't kick her out once she's there is in error. You need to get correct eldercare advice for the state she resides in. I'm not sure what you read to lead you to that conclusion but there are a number of books you can check out from the library on the topic to help you out. Wrong advice can be extremely detrimental in this situation, so make sure you have verified accurate facts.

There are a lot of places where you can pay them full rate for a set amount of time & then if you fall to medicare/medicaid after that, they agree not to kick you out (this is in the contract, not just a verbal assurance).

How much monthly income does she receive? Is it less than the monthly cost of care? What is it disqualifying her from? Maybe use some of her current income to pay for an elder care advisor or attorney to get correct information if she isn't able to figure it out.

Yes, your cousin should be charging care/rent as compensation for her services, which she can chose to use to pay for some comforts for her mom later.

[Deleted]

I don't have a lot of first-hand information. My aunt broke her wrist maybe ten years ago, and I had to help her write checks. So she has probably $3000 a month in income coming in. I think they now live in SC (the now is because my aunt moved there at the end of December.)

I will say that my cousin is the kind of consumer that banks love. When her mother's house went into foreclosure, she actually spent her own money doing repairs on it. She wanted it to be in as good of shape as possible because they let her mother live in it for two years without paying. (The daughter couldn't afford to catch her mother up.) Now that they have foreclosed, she is paying last year's taxes . . . because her mother lived in it last year.

I will suggest legal counsel, but the truth is that my cousin won't do it. I tried to explain why she shouldn't do repairs, why she shouldn't pay the taxes for a house her mother really lost two years ago when they started the foreclosure process, etc.

Somehow they will muddle on. My aunt is now 99-and-a-half. She is on hospice. I doubt if she will make it to her birthday (Dec. 31, ironically).

I was mostly pointing out that it is possible to earn too little to pay for nursing home care and too much to pay for it yourself. I am guessing without my cousin stepping in, DHR (social services in Alabama) would have stepped in and placed her somewhere, using her available resources.

[Works4me]

Well, unfortunately the fact that the house is in foreclosure and her daughter has been paying taxes, etc can really mix everything up. The fact that hospice is involved will help - their social worker can work with your cousin to see that her mother is placed in an appropriate situation. Hopefully she will cooperate and listen.

What will happen is all of your aunt's income will go to pay for her care minus about $50 for her personal needs. That is most likely where the $3000 monthly payment mentioned in your first post came from - ie all of your aunt's income. Many people fail to understand that Medicaid is entirely need based and for a single adult, all of one's income/assets are to be used for their care prior to Medicaid providing coverage. DOes that make sense?

[Deleted]

The house was foreclosed upon several years ago. But once the financial crisis hit, the bank wasn't in a hurry to put a 97 year-old, now 98 year-old, now 99 year-old teacher of a heck of a lot of important people on the sidewalk. She wouldn't vacate, and they wouldn't put her out. My cousin actually asked the bank to write a final stern letter to get her mother to move in with her. She could no longer handle commuting from SC to AL.

Many people fail to understand that Medicaid is entirely need based and for a single adult, all of one's income/assets are to be used for their care prior to Medicaid providing coverage. DOes that make sense?

That makes "sense," but it isn't what is happening (according to my cousin). Her mother's total income is $8,000 over the limits for Medicaid, but it $3000 a month too little to pay the nursing home bill. So Medicaid is not willing to use all of her income/assets to pay for her care. They don't want to pay for any of it.

That leaves only my cousin. As I said, she isn't necessarily doing what might be best for her (and maybe her mom) financially. She is very worried about the ethical part. But she doesn't have $3000 a month to spend for her mother's care in addition to her mother's monthly income. It is coincidence that the numbers are practically identical. Apparently, it would cost $72,000 a year for this nursing home. Remember that my aunt is at the end stage of life.

I only hear bits and pieces. I do appreciate the advice that the nursing home doesn't have to keep her. I will pass that along.

[Deleted]

Message deleted by southernsusana. I quoted myself accidentally while correcting a spelling error.

[Works4me]

"That makes "sense," but it isn't what is happening (according to my cousin). Her mother's total income is $8,000 over the limits for Medicaid, but it $3000 a month too little to pay the nursing home bill. So Medicaid is not willing to use all of her income/assets to pay for her care. They don't want to pay for any of it."

This is true if it is not a skilled nursing facility. There are lower levels of care that are not covered by Medicaid - assisted living, board and care, etc. Medicaid only pays for SNF level care. Lower levels of care require private payment unless the person is below poverty line. FYI - help with ADL's (activities of daily living) such as dressing, hygeine, etc are provided at these places and alone do not qualify a personfor SNF. While any facility can remove a resident when they run out of money, they cannot just "street" the person. The key is that there must be somewhere safe for that person to go - ie back home with daughter.

I recommend that she work with the Hospice Social Work team as they know the specifics of that area and they deal with this every day. Most likely your cousin is confused somewhere or other. Another possibility is that their finances are intermingled or that there is maybe even other assets. The system has difficulty with issues such as foreclosure, etc. Also the fact that she is on service with Hospice can allow some Medicare coverage but further complicates matters.

Bottom line is that all of these situations are unique and individual - part of the reason I love medical social work is because no two days/cases are ever the same. I am taking care of my father at home right now and really miss work sometimes but this is where I need to be for now. Boring for me but he deserves it -lucky that my father is just a nice decent man and the worst thing I can say is that he is a retired engineer - lol.

Googled a bit and here is what the SC Medicaid web site says about Medicaid for LTC:
"*If the individual is eligible for Medicaid except that his gross monthly income is greater than the Medicaid Cap, he/she may establish an income trust to become eligible for Medicaid. The individual should contact the Department of Health and Human Services to obtain more information about the income trust provisions."

Source: www.scdhhs.gov/openpublic/InsideDHHS/bureaus/bureauofeligibilityprocessing/nursinghome.asp


ETA - Aother issue is some SNFs only accept private pay, all have to balance private with Medicaid, and Medicaid beds are always hard to find meaning she can't ne a picky about where the facility is.

Another issue could be recent move to SC - again do not know the regulations is SC so she really needs to work with the Hospice team.

[Deleted]

Thanks for the info. I came up with the same link and am sending it to my cousin. It IS very complicated, particularly with the fact that she probably hasn't even filed a state income tax form with SC, applied to a driver's license, or become a voter. So I have no idea if SC would consider her eligible or not.

Removing her from the state may have created its own set of complications, but what is an adult child do? There is really no other family here except me, and I refused to even be the medical back-up to make decisions for a multiplicity of reasons.

[973beachbum]

Susanna you said that your aunt makes $8000 over in income with her approx $3000 a month in income from pensions and SS.
Is is possilbe that your cousin is confused with which numbers she is supposed to be looking for or asking for?

I ask this because the medicaid financial elegibility for medicaid is only $2094 a month which puts her over the limit by $12000. There is a provision though that might help.

*If the individual is eligible for Medicaid except that his gross monthly income is greater than the Medicaid Cap, he/she may establish an income trust to become eligible for Medicaid. The individual should contact the Department of Health and Human Services to obtain more information about the income trust provisions"

Good luck with your Aunt and cousin. I hope she gets the care she needs.

[qofcc]

I think there are probably ways your cousin could get your aunt into a nursing home with the trust, etc. but honestly, if her income is that high, why would she want to? Then your cousin would be stuck going to the nursing home all the time and your aunt would probably not be happy. For that kind of money she should be able to hire plenty of at home care so your cousin doesn't have to do anything but keep her mom company. DH's grandma had a lovely woman with home health skills come to stay with her and provide end of life care. She charged $400/week plus room and board. If your aunt is living with your cousin, she probably doesn't need someone there 24 hours, just someone to do the heavy work and maybe the housework.

[Deleted]

You are partially right, Qofcc, but elderly people who have moved into senility can be somewhat toxic at times. They have used the resources to hire help, but it's not necessarily going to always be enough. They have to use a lift to physically move my aunt and that sort of thing. Sometimes my aunt isn't in the mood to be moved. You get the idea.

Also, if you do the math, my cousin isn't exactly young herself. Her mother did have her at age 30, so she is 68 herself. It's not a healthy 68. People have forgotten about polio as a disease with long-term effects. Also, my cousin's husband, who is older than she is, has late-stage cancer.

So the time may come fairly quickly that my cousin can't do it all even with at home care. She is trying to come up with a back-up plan. I actually applaud that.

[Deleted]

My step-dad has alzheimers or the like but it is not bad enough to qualify for medicaid and my mother can't afford an assisted living situation for him. It's very hard to take care of someone like that when you have your own issues to deal with. I hope your cousin is able to find a solution.

[Works4me]

Susana - Good plan to send the link and I also commend you for caring. Caring for our elderly is hard to do. All of the issues discussed above can further complicate the situation. Sending her the link above is a great idea. But she also needs to talk with someone who specializes in this - hospice can be a great place to start.

I have been trying to figure out how to say this nicely on these boards - no can do - here is the nasty truth of elder care: many facilities manipulate the family and/or the elderly in order to maximize profit. If they can convince you to take your relative home their problem of only being able to discharge to a safe environment is solved. If they can make someone feel responsible for paying the bills privately they make more money than with Medicaid and receive faster payment. Kind of like any other business except for the fact that these are people's lives that are being dealt with.

[happyhoix]

May 28, 2012 10:41:20 GMT -5 Works4me said:

Susana - Good plan to send the link and I also commend you for caring. Caring for our elderly is hard to do. All of the issues discussed above can further complicate the situation. Sending her the link above is a great idea. But she also needs to talk with someone who specializes in this - hospice can be a great place to start.

I have been trying to figure out how to say this nicely on these boards - no can do - here is the nasty truth of elder care: many facilities manipulate the family and/or the elderly in order to maximize profit. If they can convince you to take your relative home their problem of only being able to discharge to a safe environment is solved. If they can make someone feel responsible for paying the bills privately they make more money than with Medicaid and receive faster payment. Kind of like any other business except for the fact that these are people's lives that are being dealt with.

I ran into this when trying to find a facility for our mom. An elder care lawyer told us that most facilities take medicare patients but won't admit that they will. Sometimes you have to apply legal pressure to get them to admit they will accept a medicare patient.
If you look at it from a business perspectivel, why would they accept a medicare patient when they can find a private care patient that can afford to pay thousands more a month to stay there?

Right now mom has the savings she got when she sold her house, but if she outlives that, we'll be in trouble.

[Phoenix84]

"Maybe I am wrong, I thought it was they take all your income to cover the nursing home and whatever you cannot pay the government pick up that tab... am I wrong?
I thought the government would be happy she has so much income, less for them to pay out of pocket compared to someone that has no income and no assets."

It's my understanding it's a hard line. Either you have less than the medicare/medicade limits and you pay nothing or you have over and they don't pay anything. This is one of the things I've thought about for my retirement. Since I (should) be getting a government pension, if I ever need nursing home care and spend down all my assets, I could run into a similar situation. You make too much income to qualify for government asistance but not enough to cover it out of pocket. And it's not like you can "spend down" a pension.

[cronewitch]

My mom might hit the same issue someday. She says she can afford 12 years care but then she would be out of money with income of 40K or so. Hopefully she won't need nursing care or at least not 12 years worth. She just needs to keep herself clean to stay where she is at my brother's house. They refuse to provide personal care but have a housekeeper and do the cooking and laundry for her. When she needs help bathing or dressing they will find paid help to do it but hopefully by then she will be 95 or more since she is fine now at 85. She is considering becoming a caregiver again since her sister needs help and she isn't doing anything anyhow.

[Deleted]

Happyhoix... Please understand MediCARE does not pay for nursing homes OR assisted living facilities. The only time MediCARE pays is if it a skilled nursing facility that is providing rehab, perhaps from a broken hip or stroke. Even then, Medicare has very strict limits on the length of the stay for that care.

MediCAID is what is used to cover semi-indigent people who need an advance level of care, i. nursing home. In Nebraska, there is something called a MediCAID waiver, this is what my 92 y/o Mom has. It allows her to live in assisted living and the state pays the bill. She has all but $60/mo taken from her SS check, the rest is taken by Medicaid to help cover her monthly costs.

Further, my Mom went into assisted living by being able to be "self pay" for a few months. She was able to bypass the waiting list that that way.

[Deleted]

--------------------------------------------------------------------------------
The mother's assets can be spent down until she meets Medicaid criteria, then she can be put onto Medicaid.

There are NO assets. She doesn't even own a stick of furniture.

What is "too much" is the total of her pension, annuity, SS, and her husband's pension . . . by $8,000 a year. I only helped her with her checkbook. Maybe when I said she got $3000 a month, I was counting support from her daughter or something.

Anyway, the SC website suggests settting up a trust to handle the income. So that is what I will tell my cousin to look into.

[Peace77]

Perhaps respite care would be helpful. Your aunt could go into a nursing home for a short time to give your cousin a break from constant care.

It would also give them time to set up the trust and to check out the nursing home more thoroughly.