We have been caring for mom and dad for 3 years in our home. Long story short, Dad passed in January. Mom is 82 and needs full time care. She has ALZ and severe vascular dementia, no strokes. Not sure what it is from. She is heavy and we are unable to lift her. If she gets to where she has to be lifted to do anything, we will need help. She does not like being helped with anything and is confrontational about almost everything. We don't want to put her in a home, but we know there is going to come the time when we can no longer care for her at home. Their home is in a different state than where we live, will that matter when trying to figure out the financials? Thank you in advance for your help.
82 yr old Mom’s house is across the country?
& you are the only family member to deal with her & her home?
Moms home is older than 20 years?
Have you & hubs been paying out of your own pocket for any costs on moms home?
Is moms monthly income only social security or perhaps SS and something else guaranteed income but it’s under $2,200/3K all in?
Does mom have under 250K in liquid / available total assets?
imho if you answered Yes to these, mom realistically financially does not have ability to continue to own an older home in far away state.
At 82, mom already past 80.5 life expectancy for women in the US, so it’s a crap shoot as to how much longer she’ll be around. But should she go into a skilled nursing care facility, average stay is 2.5 years. At 10K a mo private pay, that’s 300K. Plus her costs to keep her old home safe, secure, maintained. Plus her costs for her incidentals like clothing, toiletries, dental, health care copays, etc. She does not have enough $ to private pay for care and afford the property. Unless you are able to pay for all costs above what she can and do so for sure positively till beyond her death. I know it sounds harsh, but that eventuality is harsh.
On Medicaid, you may heard elder can keep their home. In theory that is true as LTC Medicaid views home as exempt asset for elders lifetime if it is their homestead. BUT….
- Medicaid will require the now in a NH elder to do a copay of basically almost all their mo income as a copay to the facility. Realistically no $ to pay property costs. So family have to or things go delinquent. May b feasible depending on your wallet & make sense if u have reasonable chance of exemption/ exclusions to MERP (estate recovery)
HOWEVER, you have another issue:
- Your moms home in another state cannot be her homestead for your states LTC Medicaid program. Will be a nonexempt asset with a value dependent on tax assessor value. What happens depends on how your state’s Medicaid runs eligibility. Some states Medicaid realizes elders move and what seems to happen is that she / you will file a waiver that allows for home to be suspended as nonexempt for a period of time (like 6 mos) while it is under a MLS Realtor listing. Once it sells, she is off LTC Medicaid and Medicaid is reimbursed; then she does a spend down / private pay till once again impoverished & does a new LTC application. Other states flat find them ineligible if property owed in another state. You as her POA need to speak with an elder law attorney experienced in Medicaid regulations for your state.
also please keep in mind that as mom owns her home, should it sell then all the $ from the Act of Sale is hers. And it’s recorded to the penny at the courthouse. Should mom give you, hubs, son $ from the sale it looks like “gifting”. Gifting NOT allowed at all by Medicaid and will place a transfer penalty which is a period of ineligiblity by # of days. Say 50K gifted in state with $175 LTC Medicaid room&board rate = 285 days ineligiblity.
If she is reimbursing for expenses paid, please speak with the atty as to how to possibly structure an agreement for payment so that it can be done to removed any future issues with Medicaid. Medicaid ime tends to take the view that what we do for our folks we do out of a sense of familial responsibility and without expectation of compensation. It may be that all $ paid b4 an agreement done, cannot be repaid. It’s very much a legal issue for an attorney to give you insight on. Good luck and try not to get too too overwhelmed if possible.
Last year we finalized a trust an it was 90 pages long. In it we provided funds for our Trustee to pay an attorney to help manage or answer questions. If you are the Trustee, your travel and time spent working on Trust issues will hopefully be covered by your parent's Trust assets.
Trusts can be very complicated and laws regarding them can differ by state. We are not attorneys so please be very careful about following any advice given on this forum.
Also, if you know "there is going to come a time when we can no longer care for her at home" then why not start working on solving that now rather than during a crisis? If she is heavy, it is very ill advised that anyone is lifting her without 2 people every time or a mechanical aid. Just ask the countless retired nurses who permanently wrecked their backs trying to turn and move heavy people without the proper assistance in the hospitals and nursing homes.
Just curious, why hasn't the house already been sold. Is it a rental? I just can't see paying for a house that sits empty. If a rental, that is considered her income and will be counted towards eligibility for assistance.
Any changes in assets during the look back period, 2.5 to 5 years depending on the state, will cause red flags and potential penalty periods. Meaning no help for a determined period of time. Just a heads up.
I would see a certified elder law attorney to do whatever you are thinking about. www.nelf.org is where you will find one.
The state does matter in terms of what it might provide as well as take, such as whether or not it has an income tax and what support it might provide for the elderly.
The facilities that might be available for an elderly person would also come into play.
As to care and end of life documentation, that's a good issue to address, with your attorney, or a reputable firm that focuses on elder planning and care, and/or a similar practice area in a larger law firm with a variety of subpractices within the elder care practice area. (Last good law firm I worked for had this, with attorneys who specialized not only in the overall category of estate law and planning, but probate litigation, specialty trusts, etc. They also provided estate planning seminars for clients, especially corporate clients. And of course they were active in State and local bar activities.)
You can sometimes opt for legal services for a general package of estate documents or specialty documents, such as care for a disabled person. You also can decide whether or not you need a trust (not everyone does), and should explore this in detail with the attorney before selecting one. Trusts seem to have become more popular as solo practice attorneys held "seminars" to draw in clients. I think people were persuaded to consider trusts even though they didn't need one.
If there are stocks available to be transferred into the asset portfolio, you'll be subject to different levels of tax than if they were not transferred into a trust. This could be a major issue in terms of addressing financials.
Estate planning attorneys can also address planning for care. There's a trust arrangement which allows for pooled financing, but I don't remember the details.
Good attorneys have questionnaire type forms for clients to complete, which helps them guide clients into the best estate planning options.
You mention a Trust. There are all sort of trusts, some irrevocable and some revocable. When assets are moved into a Trust they are the property of the Trust, not of the individual and other law applies. But an individuals assets stand to provide for their care.
Because all of this is quite complicated, and I am assuming you are POA, your Mom's Trust and Estate pay for the cost of your attorney to get answers, and that's what I suggest you use. Take lists of all assets, how held (Trust or individually) with you. Find an elder law attorney who understands they will be answering some few questions for you, and who are paid by the hour.
I am uncertain whether you are POA as you don't mention that, but do know that POA don't act with regard to Trusts; only the Trustee acts for the Trust, so if you are to manage that asset for Mom's care in future you would need to be Trustee of Trust as well as POA for things not held in trust.
Always get the advice of professionals when dealing with these important issues. MD for medical, Accountant for financial, Attorney for legal, and etc. Forum is just a bunch of folks out here with caregiving experiences. Some few of us have real expertise (Hoping Igloo is around to answer some questions here; I will refer this question to her) but you really need a professional in your area for some questions.
Good luck.