Can a doctor prevent me from bringing my parents home to live?
Can a doctor prevent me from bringing my parents home to live! Both my parents recently withing the last 6 months have declined to the point they required intubation, than were put on a ventilator with the weaning process being done in an LTAC hospital.. however no weaning occurred ... the pulmonologist is now fighting my efforts to go back to a LTAC after a lot of fluid was removed from one of my parents lungs (1300 CC) and now she is weaning... He is insisting she go back to a SNF ! where she was downgraded to after her first bout with an LTAC hospital.... I admitted there for "short term" care at the faciliity! Can he refuse to sign off on our wishes to bring her home ( with appropriate care services in place)! Does his medical opinion if opposite our wishes to bring her home tie the "outside agency" I want to hire and who will go there to do the as sessment at the SNF to determine if they can provide her care in the home?.... .........Now if in fact I bring her home and find it is not working and have to bring her back to the SNF for ventilator care they will require an application for long term care be filled out(financials assets etc )...I need to know the following! My parents have rental properties which are not earning any income for the most part due to not being well enough to manage them. Should I find someone to manage these 3 properties I could possibly earn them up to 3300.00 a month if all are rented. My question is ....Can the real estate assets come under the control of the long term facility once I fill out the paperwork for long term care? So specifically in the case of their living in a long term care facility once my parents cash in the bank is used up to pay for their room and board... can a the facility demand the rental properties be sold to pay the balance immediately? Second, Can I negotiate the terms of paying the balance due facility in payments ...ex: say they owe 100K... pay the balance over a longer term...so I can keep the income properties to keep income coming in....while they are still alive... Lastly if the rental properties are my parents, if I hoped to keep renting the properties for income after they pass, can the long term facility force me to sell to get a lump payment or could I negotiate paying it off over time?
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First -- who is the medical proxy for your parents? If your parents are competent, they can decide what they want to do. If they are not competent, their medical proxy can decide. Of course, all life support services need to be in place before they are moved. A big question is why you want to move them home. Is it to save money? It may be very difficult on them to go home, than to transfer to a SNF if that doesn't work out. If you have the medical proxy, you should be able to move them, but it would be AMA (against medical advice). Find out what the implications of that would be.
Now for the property questions -- if the houses are bringing in income, they will be considered as part of your parents' income and the money can be used to help with the cost of their care if they have to go to a facility. This can be a two-edged sword if it raises their income over the amount that they can qualify for Medicaid if needed. There are ways to spend down and trusts available, but that is beyond my knowledge. I hope someone else will chime in on it. If they do go on Medicaid, then the properties will most likely have a lien put on them and be subject to recovery when your parents pass.
If they are not bringing in money, then it would probably be better to sell them unless the heirs are considering them for future income. Only the primary residence is exempt from counting when applying for Medicaid. Rental properties that are a source of income are also allowed if I understand correctly.
The fact that their specialist doc is fighting you on doing this is probably noted in both their health charts & in detail. If you remove & take them home and they need ER care or readmit to a hospital, their charts are going to show AMA and the you were fully aware of the issue. You should expect to get APS involved and worst case scenario parents being made emergency wards of the state....you will be shut out of anything regarding your folks if this happens. It is a contentious situation and totally avoidable by you. Your not going to get much sympathy from APS or a court on "I know better".
About the properties, they have value, the fact that they aren't getting market rates rent or haven't been repaired to rent, etc.....doesn't matter. If need be they can be sold with $$$ used to pay for care. Care facilities or home health agencies aren't in the real estate biz, or want your parents home or rental property, BUT they expect to be paid as per terms of the private pay contract that you or your folks will have to sign off on. Home health care involving intubation & ventilators has got to be speciality care and expensive I would imagine....where I live (New Orleans) won't take these as the liability& difficulty if they have to be transported during hurricane season is too much to be worth doing.
It sounds like your folks have some degree of $$, this is fortunate as it provides for a window of time to get their property sold with proceeds of sale use to pay for care. They are at the point of imminent & complex need, the time for doing creative elder estate planning has passed....not to sound harsh but that is the reality imo based on what you have written.
They have non-exempt assets, so they cannot be eligible for medicaid till they become impoverished. It could well be that they will eventually outlive their $, so ask the facilities you look at if they take Medicaid.