If I take division of assets, will Medicaid come to our aid without moving husband from his present in-home care?

Joy, the first thing I'm going to ask, is what does HE want? Did he have any advance directives about end of life care? Did he want things to be prolonged? Being bedfast is no picnic, how did he view that years ago?
As for Medicaid vs. Hospice, Hospice is fully covered by Medicare and would not bring MERP (Medicaid Estate Recovery Program) into the picture. Plus farms are an exempted property under MO Medicaid. Never give them the gross income from the farm, but the net amount after expenses. Your house, however is not fully protected, just exempted while he is alive. I think you would be better off to call in that loan and use the proceeds for his care, and avoid Medicaid all together. If he was a wartime vet, I would see if he can get VA Aid & Attendance instead of Medicaid, because they won't go after his estate. Neither Medicaid nor Medicare nor the VA would force him to go anywhere, he can stay at home as long as you are able to care for him.
My father had congestive heart failure, and summers were very hard on him. He died in early August, during the hottest dog days of summer, even with medical intervention and no Hospice. My gut feeling is that you are facing a very similar scenario. Hospice or no Hospice, he may not survive the summer heat and humidity. With time being so short, I would not put myself through the hassle of hiring a lawyer to sort out and divide the assets, then hassle with Medicaid, because he could pass on before you get a decision. I would keep the Hospice number on the fridge in case I needed it. My thoughts and prayers for angels to guide you.

Unfortunately, I think the VA's Aid and Attendance program is the only program which offers home health aides for veterans in their homes which is provided free. Given your limited income, I would investigate his eligibility for this program if he was in the armed services. This agency can make it possible for people to receive long term care at home.

I did not use Hospice for the same restrictions. Hospice is fine for people with end stage cancer and other like illnesses who wish not to continue their suffering. However, if someone is elderly and experiencing the normal aging process often they do not qualify nor should they. I also was not willing (nor was my father) to give up medical care for ever changing medical needs that arise with old age.

Having said all of this, as the primary caregiver with very limited income you are not eligible for long term care for your loved one under Medicare. Medicare does not provide it. If he has a recent hospitalization and needs rehab to return home the Medicare program can give the elder up to 90 days of rehab.

Good luck hopefully some day America will assist those families who want to care for their elderly in the elder's home and not just institutional care like nursing homes. We are not there as a nation yet. Perhaps 79 million aging Baby boomers can make it a routine option for aging folks. We will see in the next quarter century. We really do not have enough nursing home beds for the boomers of the future.

We had the same situation with my Dad, as far as hospice. We could put him A Hospice place for Pain Management, but it Medicare only paid for so many days, the it went to $250.00 a day.

By "division of assets" do you mean you are thinking of selling the land? I believe that if you sold any type of property, your husband would be subject to a Medicaid penalty which is basically the property value divided by the nursing home divisor in your State. For example: say $100,000 sale divided by $10,000 month nursing home care would mean he is ineligible for 10 months and you would have to self pay. (just an example). Under new rules, Medicaid penalties do not start until the person is actually in the nursing home so you can't wait out the penalty period at home. I strongly advise against selling any property until you have consulted with at least 2 Elderlaw attorneys. Do you homework online and try to schedule a free phone consultation to make sure the lawyers you have in mind are personable and pleasant instead of pompous. (Trust me, I've spoken to many pompous stuffed shirts but there are nice ones out there too). Also it depends on how the piece of land is held. If its held jointly, Medicaid can't force the sale and your husband may qualify for Medicaid but they may lien the property after he passes unless you are able to do some kind of crisis estate planning (hence a good lawyer). One more idea to consider.... income property is an exempt asset for Medicaid purposes. So if you were to sell the land and then buy an income property with the proceeds. The net rent would go to the nursing home but the income property would be exempt. It is important to consult an Elderlaw attorney who is experienced in income property and asset protection though. Good luck to you and your husband.

I've just been through the applying for Medicaid process. My husband and I although separated for 15 years are still legally married. He lived in the home we own together and I live in a coop that is mine alone. Medicaid has what they call a 5 year look back window. You must give them 5 years of filed taxes, all of your banking information. It is a complicated draining process. I was luckly somehow the nursing home accepted him from the hospital before the Medicaid process was done. Now in an effort for them to get themselves paid theirMedicaid Specialist has walked me through the process. Online there is a legal website called AVVO. You can asked questions(make them precise and to the point) and you will get answers(limited) and it directs you to lawyers in your area who can offer assistance. There are also reviews on lawyers. My first lawyer(before I knew about the site), charged me $250 for an hours consultation.She made me feel rushed and gave me incorrect information. There are plenty of lawyers (a great deal of them young ones) who do consultations for free. My experience was they are eager to help, always available to answer questions and aren't looking at their watches. I found my lawyer on this site. You are a consumer if you don't like one get a second opinion. I'm sure glad I did. The medicaid system is quite complex, I strongly advise you speak with an Elder Care Attorney. One mistake could be a disaster. Hope this helps!

Thank you all above... for valuable info....I am presently doing as suggested above... do your homework online... especially in the Aging-Care site ... I will definitely check AVVO [did not know about that] ... and find out what that abbreviation stands for... so it won't get my GOAT... hehehe ... before talking to an "Elder"-Attorney,... I also did not know about Medicare rule changes... Guess reading their rule updates is a good thing too. ....
I went thru Hospice-care with both parents. Hospice literally had to discontinue care altogether, when I took my Pop to the ER several times... oh, did they fuss !!! Yet I never heard my father say "I want to die" ... he therefore had the right to proper medical protocol for his medical problems even if it required ER and labs and IV-drips to control his Lung cancer SYMPTOMS, not his cancer.... Funny thing is... that each time I brought him home feeling 100% better... Hospice took him back...they did not want to loose an account... Since I worked in Hospitals, etc for 20 years, I ran my mother's and father's care ... often displeasing Hospice..., however not the Nurses who came to the house, but their bosses in the office...
It is a difficult situation for Medicare to be in, caring for the severely ill, with rules that dis-allow extreme life-saving measures... which Medicare rules tell Hospice to avoid, and yet they do not want to say "just let him die"...no more care....
So as long as the ER measures are to ease pain and suffering of the condition... Hospice did justify to Medicare -taking him back - ... Hospice walks a tightrope there ! They are also used to have the household follow their rules... again I did not allow that.. i.e. the paper on the fridge which says "NO resuscitation" ... They got very fussy, when I did CPR on my mother. When I saw her not breathing I quickly felt her pulse...she had a rapid one... checked her mouth cavity which showed froth- not breathing ... meaning she needed suctioning... fast... which still did not revive her, and at that point I did CPR, which did the job after only 3 compressions... In other words there was a difference between my mother dying of her illnesses, and her chocking to death from accumulated saliva in her mouth.... and I had in my opinion every right to do CPR.... OR- I would have stood there letting my mother choke to death , knowing she had a pulse, knowing that I knew how to do CPR, in my opinion that would have made me a murderer !!!..... This still upsets me... It was MY mother !
The Hospice rules on the Fridge not only required me to not use CPR, but also required me to report emergency situations to them Hospice...which I did. They sent a Physicians Assistant to check Mom out... who stood on the opposite side of Mom's bed from me, with Mom looking at him, and proceeded to tell me that I had no right to do CPR... etc.... and I had to motion the fool to the hallway and remind him - like I learned in NSG school, he most likely was told also in all his training, that Medical personnel is NEVER to discuss such delicate subjects in front of a dying patient... as one never knows how acute their hearing + comprehension actually is.... !!!!!!!!!!!!!
It is just plain tactless...
It took him awhile to understand the difference between a choking attack and dying of the terminal condition... and I asked for him not to return ever.
Well, we all make mistakes and even Hospice care is only as good as the persons they employ! One certainly has the right to refuse caregivers who are not up to par !!!
I agree with the earlier statement, that rule-changes are necessary to have Medicare extend their HOME-CARE HELP... which most patients prefer over NSG-home care...
Home Care would have to be awful before 90% of elderly patients would "prefer" NSG-home care.
... It is already acknowledged that home care assistance is a lot cheaper for Medicare than NSG-Homes.... and this is why Hospice came about... yet it is not far-reaching enough in my humble opinion... especially since I have seen this care aspect in , England, Canada, and Germany...
I cared for my aunt there and a terminal brain-cancer patient... both had in-house daily visits from Nurses for simple bandage changes for leg-ulcer-care, and Aides for personal care, provided by their health-insurances.... The Docs even come to the house there....for any sick person.
.... yes... I know... different places... different cases !
Yet there is a County Service here, which also came to my aid when I cared for a late-stage Parkinson's, almost blind Mom , with severe osteoporosis, heart- and other problems, and later for Dementia+cancer -riddled father who forgot his 2nd [English] language, but could still swear in German, when things hurt.
This service is called ESP - Elderly Service Program -
I am quoting directly from their pamphlet next to me:
" What is ESP? "
ESP is a support service system for Butler County, Ohio residents, age 60 + older. helping them to remain in their homes.. Funded by a property tax levy, ESP provides both short + long-term care.
No charge for initial call for case management services.
You may be required to pay for a portion of the cost for in-home services, based on your income, minus your medical expenses. However, all services are provided at no cost to qualified low income elderly.... includes:
Companion Service, Emergency Response System, Home delivered Meals, Homemaking, Independent Living Assistance , Minor Home Modifications, Medical Transportation, Medical Equipment, Personal Care, Adult Day Services, Pest Control, Respite Care.
So the age limit is a determining factor as well here.
This service provided me with a care giver who became a friend, and came as she could squeeze her visits into her own family affairs... Her presence allowed me the shopping/personal time needed, and assisted with the 2-person job of getting Pop into the whirlpool bathtub....which greatly improves blood-circulation.
I sincerely hope every County in the States has such a program set-up...!!!
I also wish everyone best result-outcomes from all our searches here... Wishing you well ! DHilBe ... author of " Abbreviations are getting my GOAT!" which seem to have taken on a life of it's own here ... hahaha !!!

Ooohhhh - I wanna move to Butler County, Ohio!!!! Sounds great!

As the "Baby Boomers " have started to age out, these ptoblems are going to magnify ten doles. I do not want my children to go through with me what i went through with my parents. They had figured that they had done their job in providing for themselves by doing whatwas expected, IRA's, pensions etc. Never expecting that if they weren't either extremely rich or extremely poor their entire life savings that gave them comfort in knowing they were leaving something behind for their fsmilies just wouldn't be there. It is up to.our generation, I'm 57 to figure this out so it doesn't fall on our beloved children! It makes me so angry.Assisted Living is foe the wealthy @$5,00 a month to start. Who can afford that? These politicians need to get up and take a stand to help those whose backs this country was builtbon!

I agree with beechgirl and empathize with joylee's challenge. Butler County Ohio rocks. I live in California which is supposed to be so advanced, yet we have nothing like that here for homecare. My 93yr old Dad in southeast Louisiana certainly doesn't and is in dire straits trying to remain in his home now on fixed income. While I wouldn't discourage anyone from filing Aid and Attendance please know it takes soooo long ; Dad runs out of money next month and I am sweating bullets waiting for the snail's pace of Aid and Attendance to pay the pension he is fully qualified to receive. I even have a Congressional Inquiry about it in to the local Congressman who specializes in VA claims but they haven't gotten back to me in weeks. It is excruciating waiting on VA, so if you do file, please know it could be many months before you see anything. By the way, they routinely send out denial letters early on in the process, so be sure you ignore these and don't take NO for an answer, if you are certain your parent VET qualifies.

Regarding the division of assets question that was kindly and helpfully answered by numerous helpful people, I will add a bit here. The land thing that I, joylee is involved with my sister on, is a small acreage t o use only, for income. However I must pay taxes on it while using it, furnish seed, chemicals and harvesting expense to put crop in and out, plus extra insurance expense on farm buildings, and grain bins, paying the full amount of insurance rather than splitting with my sister, due to their wishes they get some return back because we reside in the house, which we had done for over thirty years, due to circumstances of farming the place and then our son farming the place, which was customary years ago. Hard feelings were always harbored in family due to fact it was difficult to accept that my parents felt it best to have our son take over the farming which he struggled with and worked hard to make it work for years and is still doing. I applied once before to social services, only to find out there was a mistake of ignorance on my part about the 5 year thing, after you inherit any holdings from your parents due to their death. I contacted one of the lawyers, like was mentioned, paid her $250 dollars only to be nearly mocked due to my lack of knowledge of the 5 year matter. So it looked like to her that I had purposefully helped our children and grandchildren with paying bills and giving them money gifts, for at that time, we were not sick and our kids needed money to care for their families, so we shared. I was told maybe you better just go home and let your kids help you! Well, I guess you would say that is being stuck between a rock and a hard spot. So at present, we are still hoping that I can pay back the loan that was necessary for the seed, chemicals and harvesting of the small portion of useable income only while I am alive. The farm cannot be sold, only used while my sister and I am alive. When one dies off, the control of it goes to the remaining girl. When both of us are gone, it goes to our children. My sister has two children who will get half of the farm, and my four children will need to divide the other half of farm. My parents thought they were doing us a favor to have some kind of income. The small acreage that was on a warranty deed, was sold, because my sister did not wish to keep it and use it. That income was where I had money to share with our children and grand children, which now the social services say we do not qualify for help of any kind since it was handled that way. Well, the money was used, our kids are poor, so there is nothing to do in that department. So it is very difficult to keep our heads above water, and we are nearly ready to sink with no where to go. I just keep praying and hoping that we can hang on just awhile longer. Social services mentioned that spin down could be considered. You pay so much a month or pay it back in future the way I understand that, but it appears you must enter individual into a nursing home to receive even an option of that nature. As to my husbands feelings on the matter, he was told that he was not surgery material, so has to live with his condition without surgery. He was told he had an 80% chance of dying on the table if surgery was performed. He replied to doctor, " I would like to live as long as possible." Yes, he prefers to live here at home as long as possible. He is a person that could be taken advantage of, due to his kind and quiet ways. Children in this day and age have their own big problems of survival, so it is not expected or anticipated that any help could come from them to any big extent. Even though they love their dad, it is not practical. So it may be possible to use the spin down thing if all other avenues close, but we do not wish to do that. Your life is not your own once you go that route. So we will continue to try to keep him here in the home, which is expensive, due to the money needed for personal care. Pads, bandages, lotions, salves, medication for heart and diabetes which we pay for most of his medication except the insulin has a part of it paid through plan D of Medicare. Not to mention food to live. I guess you would say, I am just looking for varied avenues to continue to care for him and not shove him out of here to a care center. Our doctor indicates he may make it for a year but does not wish to be held to that, which I understand. It is hard every time that I wash his face and hands before breakfast to think that one never knows if that will be the last morning my loved one will make it through the night. Any one of the health issues that he has could take him. The only positive thing about that is that to go peacefully in his own home would be to his liking. Once he made the comment, if I gotta go, I wish I could just fall over and be gone. Well, we do not have those kind of choices as you all know, but facts are, many people are having that happen to them in this day and age at a seemingly younger age. My poor old mom made it to 98, but her last 8 years of life had no real good quality of life. My husband's parents lived to 90 years old, each one of them. Their health finally weakened enough that they needed help in their home for a short time, but neither of them suffered with pain before they died. One went into a diabetic comma, of which I was not aware she even had diabetes, the other one ended up in hospital for few days and passed away. His older son said he might have had cancer or like, unknown to us. But what ever the case, they passed off the scene in basically a peaceful manner. When one is young strong and healthy, we do not think about these times nearly as seriously, until it really faces us personally. I wish to thank everyone that offered some ideas regarding the question of division of assets , medicaid, and in home care. Should anyone out there know of any way to keep their loved one in their own home as long as possible, when on limited means, please feel free to share your thoughts in that regard. Thanks again for your kind writings on the subject. Joylee

Joylee, as hard as it is to accept, now is the time for Hospice. Find a way to accept the care, accept the help, and give your husband permission to go free. It's not easy. My daughter died peacefully, so hard to let her go, but keeping her alive bedfast and weak was like keeping her in prison.