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Let me just say I am not using Medi-Cal (Medicaid) nor do I hope that I ever have to apply for it for my mother but I recently had a physician tell me to put my mother in a nursing home. I personally have no money to pay for one, nor does she have insurance for long term care, she does have Medicare and a secondary insurance which pays part of the 20% leftover.

The only way my mother could ever go into a nursing home would be if she went on Medi-Cal as all her savings would be gone in a flash. I am hoping to be able to care for her at home the remainder of her life but what if she gets worse or develops something worse that I am unable to care for at home?

Therefore my question, when we begin caring for an ill parent, should we look at their financial situation and just automatically think...."my parent will be applying for Medi-Cal at sometime in the future" and should we base their financial spending and income or receipt of money on what would be best, down the road, when or if Medi-Cal is needed?

I have paid my mother $57,600 in rent for myself and my child for the years I have been in her home. I have also paid for groceries, my own personal expenses and helped (paid) with projects around her home. I am her UNPAID 24/7 caregiver. We paid rent because it seemed the right thing to do, but it also allowed Mom to keep her savings in tact. Why are we doing this??? It does not make sense to pay her rent to keep her savings in tact, when she may very well need Medi-Cal in the future, and they will require that she then spend every cent she has in her savings, which part of it is the $57,600 I paid to her, but she is getting her care for free from me.

Am I wrong or is there something wrong with allowing this for so long? It seems like if nothing else the rent I paid her should have never gone into her personal bank account but I never saw this coming. Did anyone have better foresight than I?

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It could help the check with an elder law attorney. You usually cannot just move money from her personal account to a different account in order to make her medicaid eligible. There is typically a "look back" period to make sure that someone really is Medicaid eligible and did not hide or transfer their assets in some way. Perhaps you could shift to not paying rent since you are providing care. She could probably use some of her assets to pre-arrange her final services and expenses. Medicaid is insurance of last resort which is paid for by the rest of the people in the country so it is understandable that recipient would need to use up their own financial resources first.

People with dementia and or other long-term medical conditions with relatively clear expected outcomes face a lot of expenses. Most people simply do not have the financial resources to cover the hundreds of thousands of dollars (or more) of anticipated expenses. It seems that a large percentage of them will end up on Medicaid of some form. Planning ahead makes sense. An elder law attorney and perhaps a financial planner could be of assistance - even late in the process.
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dcoach is correct - However, my parents were & mom's on Medicaid for nursing home care. I have a "medicaid person" I have known for many years & she saved us from personal bankruptcy. Also, HolyCow, there is NO shame in putting your parent on Medicaid - NONE whatsoever! Just realized my maternal grandmother NEVER would accept "welfare" & I respect her 100% for that (she passed in 1962), & Richard (hubby) NEVER went on welfare/medicaid, whatever you want to call it back in 1989 when he almost died, was working two jobs AND going through a divorce. BUT, when Dad had his stroke, the FIRST person I called when the dust settled was Maureen (Medicaid lady). She literally saved our financial lives & once again, there is absolutely NO shame in that - @Dcoach - you are correct, You can't just start moving money around to "make her" Medicaid eligible. Richard's a CPA but he doesn't know the Medicaid rules & besides yoiu then have to deal w/ Medicaid - which I do NOT intend to do - I have enough issues w/n.h. mom's in to deal w/Medicaid too! As for your question of whether you shouild think about Medi-Cal WHILE your parents are having health problems MY answer is YES - like I said there's NO shame in in whatsoever!!! But do contact an elder care attornery ASAP.
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I would suggest that you visit your local Alzheimers Association office for a list of people & places that offer "low cost" or "no cost" information. I was able to gather a wealth of information from my local associations contacts.
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I say Yes, plan for Medicaid to be needed. Given the current five-year lookback period, you might secure many of her assets, depending on the amount, in an irrevocable trust to have the clock start. Don't transfer the assets into your name, for example, because they would count against you if you needed Medicaid in the next five years, and your mother's care could require those assets be given back for her care.

Seek advice from a reputable, competent, ethical eldercare attorney.
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Plan for the worse and hope for the best. Assume that your mom will need Medicaid to pay for the nursing home and get started on the paperwork. As everyone said, an attorney should be very helpful. I've read posts on other threads giving good advice on spending down money wisely. I also read somewhere that if you've lived in the house to be your mother's caretaker, thus keeping her out of a nursing home, you can stay in the house once your mom is in a facility.

I've been working for the past six months to get my mom on the Elderly Waiver. It is paid for by Medicaid and will provide services to my mom in her home, and then in any facility she will need in the future. It also provides nutrition assistance and the Lifeline service. The main idea of the Waiver is to help people stay in their homes as long as possible, which is cheaper (for taxpayers) than having them in a nursing home. My dad is still living, which changed the financial situation somewhat.

My parents have worked hard all of their lives, but we were never rich in earthly goods. We looked into private pay to have a public health nurse come into their home to help with blood pressure checks, blood sugar checks, and medication management, but it would have cost around $400 a month. They just don't have that money to spend. When/If my dad needs a facility in the future, I guess we'll sell the house.

For myself, I have long-term care insurance and hope to have enough pension and social security money to keep me off Medicaid, but who knows?
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@stevensmom - THAT's the term I was looking for Medicaid Diversion program or something like that
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I would consult with a good elder law attorney. The planning is generally a good idea, but often people who give you advice really don't understand the correct things to do for eligibility for Medicaid if needed in the future. There is a five year look back period, so I would get the advice sooner rather than later. Good luck, I know with caregiving duties we really don't have time to mess around with the legal/financial planning but it has to be done for your mother's benefit.
Good luck, it would be nice to live in a country which provided NH care without such considerations, it is an additional burden when you surely don't need it.
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All the advice above is really helpful! I hadn't thought about pre-planning for five years down the road for my mother, but I'm going to get on it right away before she starts to need more care and while she has the money to pay for an elder law attorney.
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Also, agingdaughter, I would stop paying the rent, as that would be reasonable compensation for the care and assistance you're giving your Mom. I realize you wouldn't ask for compensation for being there and caring for her, but think about the peace of mind that you being there gives your Mom, and the good fortune she has to have a daughter like you who cares enough to give of yourself in the way you have so that she doesn't have to (right now, anyway) go into a nursing home. I care for my 88 year old Mom in my home, and I am hoping to be able to do it to the end, as well, but I worry about what may be ahead, and if I am going to be able to handle it. I am planning to look into options ahead of time....just in case the worst scenario rears its ugly head. It definitely is best to be prepared. :(
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Yes, plan NOW. I wish we had 5 years ago when husband was diagnosed with Alzheimers. I consulted an Elder Care Attorney, did not hire them yet. But they want so much personal information, I am scared to give it to them. They want to look at what we have...and what to do now and possibly later when he goes into a home. I dont understand why they have to have soc Security card, medicare card, birth certificate, deed to house, titles to cars, wills, taxes, .... and I haven't decided if I want to use this lawyer. I could understand having some of this IF I decided to hire them but why now?
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Thank you for bringing this up because my situation is very much like yours. I, too, live with my mom and care for her full time. I have had to reduce my working hours to be with her and keep her safe and care for her. I do not pay rent and I also pay for food and a few household expenses as well as care for the entire household care and upkeep. I feel my not paying rent is compensated by the care she is getting from me in lieu of the fact that it would cost her equal or more to have someone do what I do. My mother is also not on Medi-cal and has only her Medicare and secondary insurance. She receives only Social Security and a small pension to get her by. If her mental and physical health does get worse (and it is slowly), she "might be" eligible for Medi-cal but would only be able to get an assisted living program in an area 50 miles away from me. There is no available facility that takes Medi-cal nearby. You may want to check that out. I don't know what will happen. I am just trying to keep her in her own home for as long as possible. Also, as I get older (62 yrs) jobs will be hard for me to find to support myself when she is in other care.
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Medi-Cal planning is not for the week willed nor faint of heart! My company has been doing advanced Medi-Cal Pre-planning for 23 years now and completed more than 4,000 cases. We have successfully salvaged untold assest and resources while preserving a legacy for the families of the elderly. We conslutant feebased for this service and explain exactly what needs to be done before any fees are paid. Knowledge should be free and not be 'held hostage' with retainers or advance payments of fees.

Don't forget what generation is the primary user of Custodial Nursing Home Care. It's our "Greatest Generation"; that amazing generation of young men and women who fought for you country during WWII & Korea. They're a proud, frugal, feisty and private generation that hates being a burden to family or community. The youngest WWII survivor just turned 88 and the oldest is 107 and still drives the ladies to church every Sunday in West Texas.

This Greatest Generation has two primary goals in life: 1.) Trying not to outlive their money, 2.) They don't want to be a burden to their family and would like to leave a financial legacy to the next generation.

We have to honor those lofty goals even though our generation (Aging Baby Boomers) couldn't care less about inheritening their money and assets under most circumstances. We're doing just fine thank you and, more often that not, don't need their assets and resources to survive.

I agree, get some advice from an Elder Law Attorney or Medi-Cal Advocate licensed to give financial advice. Be very careful here, there are many organizations looking to profit off the elderly by selling annuities and other insurance related products that you probably don't need.

At my firm, we call our team of Medicaid specialists (Called Medi-Cal in CA)a "Strategic Alliance". It's made up of an Elder Law Attorney, a Investment Advisor Representative speicalizing in 'Catastrophic Planning" and a CPA specializing in generational asset transfers.

Be sure to do your own 'due diligence' by checking out their credentials and reputation. Some websites inclued: www.bbb.org (Better Business Bureau), www.naela.org (Elder Law Attorneys), www.FINRA.gov (Securities licensed Advisors) and www.NAIFA.org (National Association of Insurance and Financial Advisors) to name a few.

Don't forget about Veterans Aid & Attendance benefits for those vets and widows who are "medically needy" due to non-service connected disability. Unfortunately, there is no easy website to navigate the 'maze of VA benefits', but there are firms out there that can help you understand the process. Remember, watch out for annuity scams....it's against the law to charge vets and their families for this service.
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Planning at least 5 years in advance is certainly the most ideal, since then you can take advantage of many more options. After five years, you won't have to worry about a penalty for transfers (say, to an irrevocable trust), since the lookback period will have expired. You may wish to review the long-term planning chapters of my book on Medicaid planning, here: www.MedicaidSecrets.com
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I bit of personal history from my Mom's situation in Mississippi. First, she would never had consented to lose control of her assets in her last years. You many find this a tougher nut than you expect. If she agrees, create a special account for the allowed funeral expenses (actual costs ran $8K). Retain the small amount of cash she is allowed in a personal account. All large assets such as nice cars, houses, land etc. must be transferred to the trust or the state Medicare agency will require sale to settle claims after death. In MS, if the property value is within the Homestead Exemption amount (approx $65k), our Medicaid Dept. could not file a lien on the property and final amounts were written off. (That may unique to MS). Have money aside for dental--Medicaid only pulls teeth as I recall. The probate lawyer cost about $6K of her small estate. My Mother's expenses in a nursing home came to over $24k in about a year including pharmacy. A private room payment ($250/mo) comes from outside since she can't have enough assets to pay for this. I recall $50/mo is the limit of assets she can retain. SS and other amounts are directed into the Medicaid/Nursing Home account. If you have more cash than allowed, rest assured the $6K to $10K monthly bill will eat it up pretty fast. The good news, her treatment as a Medicaid patient was identical to everyone else s. In our case, we did not have an attorney (since a trust was not set up)--but I did make friends of the Medicaid agent and nursing home coordinator to follow the rules exactly. My words may seem dispassionate, it was far from that at the time. It was the most emotionally painful experience I've had. If money had been available, I still could not have gotten her into a better facility in her small town--she did not want to move. As for guilt about Medicaid, she was a war widow and had earned the price of admission to my thinking. It will be a difficult time -- good luck to you and your family.
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AS for the older generation & pride - Daddy would NEVER want his only child/daughter to go into personal bankruptcy because of him OR mom - my parents basically gave me the idyllic childhood & Daddy worried about me even as he took his last breath. So I KNOW my parents would be ok w/this. As long as me & Richard know what we are doing w/Maureen Rulison, they're OK with Medicaid long-term diversion program.
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It should be interesting, I have heard a rumor they may move it to a 10 year look back but it will take a couple of years to enact the law if the government decides to do it.
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Very good that you are thinking of this and thinking the way you are... it's so complicated and something we will all have to do at some time in our lives, if we live well and live long. Thank you for asking a GREAT question.
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Why don't you start paying yourself for caring for your mother (which you paid in rent before she got so ill). There is nothing wrong with that. Just document every cent you take, and you can probably spend down that $57K before she really needs to go into a nursing home. Or, she might die, so make sure she has a revocable trust, will, and appoints you POA. If you need help, go see an elder attorney.
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I tried caring for my mom in my home. She insisted she wanted to live alone and went back to her apartment. She was only gone from me for 24hours before she fell and fractured her pelvis. Since then she had in-home care for 7 hours a day 5 days a week. Found out that when they were not there to monitor her she did not eat, take her meds, etc. and continued to fall based on her bruises which she would not admit to. She was already receiving Medicaid. The last time she was in the hospital they told her she could no longer live alone. She is now in a nursing home and I'm pleased. She is being well taken care of and takes her meds on time, eats 3 meals a day and is now socially engaged. The old stigma about nursing homes was they were not good places to be but I disagree. They do provide a level of care that most cannot.They are scrutinized more carefully than family and friends who try to provide care have to submit to background checks before hire.

She had no assets for us to worry about and Medicaid is truly taking care of her. I looked into assisted living they want over $4,000 per month. Homes provide skilled nursing care from doctors, RN's, LPN's, etc. and you can visit anytime you wish. Take her out etc without stressing your life.

I suggest like everyone else you contact an Elder Attorney or Alzheimers Associated for guidance. Good Luck!
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yes
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After all of what's going on with my 93yo mom I have been thinking getting LTC insurance would be wise--- but it's SO expensive, since my hubby and I are
60 now, I don't know that we can afford to.
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No, what you are thinking is fine. Talk to a eldercare attorney to see if you can get reimbursed for the rent. If she had ample funds to pay the rent, probably should have had her pay it. At least you will get some money back and if you take care of her as long as you can that will help. You could even talk to the eldercare attorney about caregiver reimbursement if you cannot get your rent paid back. Just a thought..
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