Medicaid lookback, etc

[CleverNickname 1308]

At some point my mom is going to need to transition to assisted living, and eventually probably to memory care. So I'm fully expecting that to be $120-150k per year if she outlives her brain. I'm going to meet with a will and estates attorney about a medicaid trust. 

Would an alternate strategy to divest a good chunk of assets now, and then pay for elder care out of remaining savings (on the theory that gifts prior to 60 months are kosher)? Probably not the maximum savings method, but that would work in part? I don't need the money, but maybe the grandkids 529s ought to get stuffed more aggressively now.

Edited March 27 by CleverNickname
Clarity

[royiv 9236]

You must really hate your mother if your plan is to put her in a facility that accepts Medicaid.

[CleverNickname 1308]

If memory care is $11k a month, at some point it don't matter how much I love her.

[bborange 10038]

1 hour ago, CleverNickname said:

At some point my mom is going to need to transition to assisted living, and eventually probably to memory care. So I'm fully expecting that to be $120-150k per year if she outlives her brain. I'm going to meet with a will and estates attorney about a medicaid trust. 

Would an alternate strategy to divest a good chunk of assets now, and then pay for elder care out of remaining savings (on the theory that gifts prior to 60 months are kosher)? Probably not the maximum savings method, but that would work in part? I don't need the money, but maybe the grandkids 529s ought to get stuffed more aggressively now.

 

I would divest while she can to preserve as much as possible.   Medicare will take almost everything based on what i read a few years ago. 

[TwiceHorn 31429]

51 minutes ago, CleverNickname said:

If memory care is $11k a month, at some point it don't matter how much I love her.

Texas Medicaid covers only skilled nursing, not assisted living or memory care. 

About the only thing one can do with Medicaid beyond skilled nursing is jimmy up a home health care plan that probably won't cover 24/7,but would give family caretakers the ability to work and have some breaks. 

[EastHorn 281]

If I'm too old and/or demented to watch Texas football and and not know if Texas is playing, I want a shot of morphine and not bankrupting my family.  

[CleverNickname 1308]

51 minutes ago, EastHorn said:

If I'm too old and/or demented to watch Texas football and and not know if Texas is playing, I want a shot of morphine and not bankrupting my family.  

I hear ya, but this ain't for me. 

[Captainant 27617]

14 hours ago, royiv said:

You must really hate your mother if your plan is to put her in a facility that accepts Medicaid.

Tell me you've never dealt with elder care without telling me. Shit is outrageously expensive, and even when your family does shell out for a place that's "nice" you still have to fuckin hound them constantly just do do the bare minimum 

 

On topic edit: when my family ran out of money and my dad needed a higher level of care than we were able to provide him we used an estate attorney to guide us through the process and help us get our ducks in a row. 

It's a scary thing because going Medicaid is a one-way street

Edited March 28 by Captainant

[royiv 9236]

1 hour ago, Captainant said:

Tell me you've never dealt with elder care without telling me. Shit is outrageously expensive, and even when your family does shell out for a place that's "nice" you still have to fuckin hound them constantly just do do the bare minimum 

 

On topic edit: when my family ran out of money and my dad needed a higher level of care than we were able to provide him we used an estate attorney to guide us through the process and help us get our ducks in a row. 

It's a scary thing because going Medicaid is a one-way street

I’ve dealt with it, asshole. 

[Captainant 27617]

12 minutes ago, royiv said:

I’ve dealt with it, asshole. 

Well it just seemed like a calloused fucking thing to say "you don't love your mom if you're not rich enough to pay for the best facilities", so I wouldn't have guessed that you had to deal with it before.

My b, dawg.

[royiv 9236]

15 minutes ago, Captainant said:

Well it just seemed like a calloused fucking thing to say "you don't love your mom if you're not rich enough to pay for the best facilities", so I wouldn't have guessed that you had to deal with it before.

My b, dawg.

The fact that I’ve dealt with it directly informs my opinion that you would never subject a loved one to a facility that accepts Medicaid. I prefer that my loved ones not be subjected to abuse.

 

ETA: OP mentioned grandkids 529s getting stuffed aggressively with mom’s assets so I don’t think we’re talking about someone that’s destitute. 

Edited March 28 by royiv

[Nice Guy Eddie 13506]

My view is that parents money is there for their care. When/if it’s runs out, switch to Medicaid care.

But if the parent doesn’t care about their care, then give it all away years before they need it.

[CleverNickname 1308]

My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

[fattyflattie 4639]

3 hours ago, CleverNickname said:

My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

Sorry you are going thru this.  Been thru it once, and about to make a second go it seems. 

[Blotto 23484]

When my old man passed about 14 years ago, my mom of her own volition decided to purchase long term care insurance. Her insurer was Mutual of Omaha, and they were a bitch to deal with when it was time to start collecting(Alzheimers/memory care). There is no way my mom would be able to navigate the hurdles thrown up by her insurer to resist the start of payments, as her mental faculties were too diminished by the time she qualified. Luckily my sister stayed on their ass like a rabid  banshee so they did begin payout. We exhausted the entirety of her lifetime maximum  benefit ($350K) in a little  over 2 years, but she was in a nice place on the east coast. She had some savings which we were just starting to tap into when she passed. Realizing exactly how much it costs to receive the standard of care that she did (and it was top  notch) was horrifying.

As an aside, the long term care insurance market must be a horrible business. I forget the exact details, but I know she paid in much less than  she received (maybe 30%). Which probably  explains the difficulty in getting the payments started. These companies are losing their ass with the spike in costs as evidenced by the number of insurers offering long term care insurance falling from 100+ to about a dozen. I'm not sure if its even worth  looking into these days as premiums to enroll have skyrocketed, but it proved to a valuable financial tool in my  mom's case. But she also had an advocate in my sister to manage the claims process which was not trivial.

And to clarify, I don't believe she qualified for benefits while she was merely in assisted living. So she paid for assisted living (around $60-$70K/yr) and only when she entered memory care did she get the benefits  of her policy. But fuck those were exhausted quickly. 

[Wally Fairway 5539]

On 3/28/2024 at 9:08 PM, CleverNickname said:

My mom has 7 figs saved and I legit am not sure that's enough. But if TX medicaid won't pay for memory care, I don't know if it matters too much. I may have to see if another state has different options. Anyway, I have an appointment with a specialist. 

I had to deal with this with both my parents, they had a decent amount of savings but it was not effectively invested. It took several years before my Dad was willing to change their investments. They decided to move to senior living in 2017, by 2019 they were in assisted living - thankfully they did have long-term (separate) LTC insurances that paid for most of their LTC costs. Dad passed in 2020 (due to medical complications) and Mom moved to a higher level of care later that year. In 2022 she was moved to the mental care (dementia/alzheimers)  wing of the facility, and the LTC policy was covering 90% of that cost. She passed in August of 2023, which was a blessing as she hadn't been able to speak for over 6 months and was not responsive.  Thankfully, money was not an issue because there savings was able to cover the insurance shortfall, but we were looking at how long that could be maintained as her LTC policy would have reached full payout by October. 
Talking with specialist is a great option, there could be things you can do that someone dealing with families making these transitions are not aware of . Also I would advise looking into hospice care, there is long-term hospice care that may be covered by Medicare. We only found this out a few weeks before my Mom passed, and only because a new medical director at her facility was pro-active in getting this started. In all honesty, no one in my family thought about it, and she could have had those services for probably the last 8-12 months. 
Good luck with this journey, it is a difficult road - stay in touch with family and close friends who are aware of what is going on. This is not a path that you need to travel alone.

And ignore the assholes who throw out hateful comments - that is a bit much, even for the assholes on this site.
 

[troph 24781]

Following.

My mom has LTC insurance, she’s pushing 80. She’s been paying for more than 2 decades I bet. I’m also wondering if we should get it, 53/48. We will have enough to pay for shit but not unlimited and I’d like to have something left for my kids without having to chose to rot in a substandard facility. Strongly prefer to die of a heart attack while doing something I love at the opportune time but we can’t fully control that outcome. 

Edited April 2 by troph

[Nice Guy Eddie 13506]

My mom had LTC insurance that was a blessing in allowing her to stay in assisted living near me (central.) If she didn't have the LTC, she would have had to stay in a place that was further (suburbs) from me. I found that Genworth Ins was awesome with my mom's LTC. They didn't have a problem qualifying her. They were inconsistent in payment dates so I made sure my mom's bank account wasn't dependent on the payment being received on the exact same date each month. I padded her account by a month's expenses.

As for getting LTC for us younger folks, I would love to but I worry about the benefit time coverage and the uncertainty of rising premiums while waiting to someday use the benefit. 

On note of utilizing hospice care, the answer is 100% yes assuming that the person is effectively done with curative care. And even with that, you can opt out of hospice whenever you want, and re-apply.

[Nice Guy Eddie 13506]

One more piece of advice that I recommend for anyone dealing with parent who is entering assisted living, hospice, dementia care, etc: talk to a consultant. There are people who can answer almost any question you have. In my experience they get paid from the living facilities/services that they recommend. Obviously keep that in mind.

In Houston, I found that Lori at the following was invaluable teaching me about everything senior care/living related. http://www.seniorlivingspecialistshouston.com/

I never asked her about the Medicaid lookback but I would assume that consultants understand that very well.

[CleverNickname 1308]

Oh, that's interesting! If anyone finds an Austin based consultant, let me know.

[Sawbonz 27522]

On 3/27/2024 at 8:13 PM, CleverNickname said:

I hear ya, but this ain't for me. 

If she is still with it talk to her now about what she wants to do. In home hospice may be an option. That’s what we did with my mom and it was a tremendous blessing. Got to keep her dignity and my dad (technically step but better than any biological I could ask for) got to stay by her side literally until the end. 

[BottleRocket 644]

On 4/2/2024 at 9:09 PM, CleverNickname said:

Oh, that's interesting! If anyone finds an Austin based consultant, let me know.

 

Me too.  Both of my parents are currently in assisted living in Austin.  My mother's mental health is rapidly declining due to dementia.  My father thinks that, based on the rate of her decline, she will need to be moved to the memory care unit this summer.  I'd like to think that I'm a fairly intelligent person, but I'll be damned if I know what to do next.  I don't understand any of these insurance policies and feel helpless and stupid when it comes to my parents medical and financial needs.  Thank God my wife went through something similar with her mother and has become a pit bull with these insurance and medical providers.  

[Nice Guy Eddie 13506]

On 4/16/2024 at 5:39 PM, BottleRocket said:

 

Me too.  Both of my parents are currently in assisted living in Austin.  My mother's mental health is rapidly declining due to dementia.  My father thinks that, based on the rate of her decline, she will need to be moved to the memory care unit this summer.  I'd like to think that I'm a fairly intelligent person, but I'll be damned if I know what to do next.  I don't understand any of these insurance policies and feel helpless and stupid when it comes to my parents medical and financial needs.  Thank God my wife went through something similar with her mother and has become a pit bull with these insurance and medical providers.  

If I can offer any advice from the other side, look to get your mom in a place sooner than later. I understand wanting to hold off as long as possible but you also want her in a situation where she can thrive. The same for your dad in that I bet most of his day is caring for her.

My mom and I held off in her moving into assisted living for too long. By the time she got there, she was basically too far gone to want to participate in the social activities.

as for dementia, there are sone medications that can provides short term benefits for some patients.  Aricept is one that really helped my mom. Not to mention that it was cheap.

[BottleRocket 644]

8 minutes ago, Nice Guy Eddie said:

If I can offer any advice from the other side, look to get your mom in a place sooner than later. I understand wanting to hold off as long as possible but you also want her in a situation where she can thrive. The same for your dad in that I bet most of his day is caring for her.

My mom and I held off in her moving into assisted living for too long. By the time she got there, she was basically too far gone to want to participate in the social activities.

as for dementia, there are sone medications that can provides short term benefits for some patients.  Aricept is one that really helped my mom. Not to mention that it was cheap.

 

We're moving my mother to the memory care unit of assisted living next week.  She doesn't know anything about the plans but we feel that telling her in advance will only make her unnecessarily anxious.  You are right about my father.  He is mentally and physically exhausted from taking care of my mother.   So next week will be full of milestones.  Some sad, some happy.   End the end, there doesn't seem to be any other good options.  We'll look into the Aricept suggestion.   Thank you.

[Nice Guy Eddie 13506]

1 minute ago, BottleRocket said:

 

We're moving my mother to the memory care unit of assisted living next week.  She doesn't know anything about the plans but we feel that telling her in advance will only make her unnecessarily anxious.  You are right about my father.  He is mentally and physically exhausted from taking care of my mother.   So next week will be full of milestones.  Some sad, some happy.   End the end, there doesn't seem to be any other good options.  We'll look into the Aricept suggestion.   Thank you.

Good luck. It’s tough with the emotions you mention including bouts of guilt in that you’re abandoning your mom. You’re not but I felt that from time to time. Dementia is difficult for all involved.

[Blotto 23484]

On 5/25/2024 at 9:51 AM, BottleRocket said:

 

We're moving my mother to the memory care unit of assisted living next week.  She doesn't know anything about the plans but we feel that telling her in advance will only make her unnecessarily anxious.  You are right about my father.  He is mentally and physically exhausted from taking care of my mother.   So next week will be full of milestones.  Some sad, some happy.   End the end, there doesn't seem to be any other good options.  We'll look into the Aricept suggestion.   Thank you.

Its an emotional ride for sure, and we wondered whether we were premature in placing my mom in memory care, but the type of care my mom required when she transitioned to memory care spiked quickly and it was evident that those nurses knew their shit. You're folks are lucky you're around and involved in the process. 

[tbone_ 14105]

Subscribed

[Nice Guy Eddie 13506]

On 5/25/2024 at 9:51 AM, BottleRocket said:

 

We're moving my mother to the memory care unit of assisted living next week.  She doesn't know anything about the plans but we feel that telling her in advance will only make her unnecessarily anxious.  You are right about my father.  He is mentally and physically exhausted from taking care of my mother.   So next week will be full of milestones.  Some sad, some happy.   End the end, there doesn't seem to be any other good options.  We'll look into the Aricept suggestion.   Thank you.

How was the move?

[BottleRocket 644]

9 minutes ago, Nice Guy Eddie said:

How was the move?

First, thanks for asking.  It was emotional and draining for everyone involved - especially my mother.  She was (and still is) a mixed bag of angry, sad, and confused.  She's been in her new place since Monday.  At the advice of the staff, we involved her in the moving process in the days leading up to her move date.  She helped the best she could in picking out pictures, or particular pieces of furniture, etc. to take with her.  My wife did a great job in making the new space reflect her personality and filled it with items that she cared about the most.  On the surface my mother loved her room.  She's most confused about the "why".  "Why are you doing this to me?"  We had come up with a story to tell her about how the assisted living unit was going to be under construction soon and it was going to be too noisy and disruptive for her to stay.  Logically she asked why my father was staying and we just laughed it off and said that he can sleep through anything.  She doesn't believe any of it.  It's the best we could do.

My father visits her an hour in the morning and an hour after lunch.  He's purposefully not spending too much time with her in the hopes that she will participate in some of the activities going on and get to know the staff and other residents.  This is the worst part.  Most of the other residents on her floor are really out of it.  Non-communicative.  In that respect, my mother doesn't belong.  She is unable to complete a coherent sentence, but if you know her you understand what she's trying to say.  She calls the lobby "downtown" and "yellow" might mean vegetables.  It's mostly gibberish but you can tell that she's still putting together pretty complex thoughts and has deep emotions.  It's really sad to see her eating lunch with people that cant lift their heads and she KNOWS she's not like THEM.  It's as if there should be a place that is 'somewhere in between'.  I feel guilty.  My father feels guilty.  My wife feels guilty.  My mother feels angry and betrayed.  It sucks.  But all-in-all everything went about as well as we could have hoped.  How about them apples?

 

 

[Wally Fairway 5539]

19 minutes ago, BottleRocket said:

First, thanks for asking.  It was emotional and draining for everyone involved - especially my mother.  She was (and still is) a mixed bag of angry, sad, and confused.  She's been in her new place since Monday.  At the advice of the staff, we involved her in the moving process in the days leading up to her move date.  She helped the best she could in picking out pictures, or particular pieces of furniture, etc. to take with her.  My wife did a great job in making the new space reflect her personality and filled it with items that she cared about the most.  On the surface my mother loved her room.  She's most confused about the "why".  "Why are you doing this to me?"  We had come up with a story to tell her about how the assisted living unit was going to be under construction soon and it was going to be too noisy and disruptive for her to stay.  Logically she asked why my father was staying and we just laughed it off and said that he can sleep through anything.  She doesn't believe any of it.  It's the best we could do.

My father visits her an hour in the morning and an hour after lunch.  He's purposefully not spending too much time with her in the hopes that she will participate in some of the activities going on and get to know the staff and other residents.  This is the worst part.  Most of the other residents on her floor are really out of it.  Non-communicative.  In that respect, my mother doesn't belong.  She is unable to complete a coherent sentence, but if you know her you understand what she's trying to say.  She calls the lobby "downtown" and "yellow" might mean vegetables.  It's mostly gibberish but you can tell that she's still putting together pretty complex thoughts and has deep emotions.  It's really sad to see her eating lunch with people that cant lift their heads and she KNOWS she's not like THEM.  It's as if there should be a place that is 'somewhere in between'.  I feel guilty.  My father feels guilty.  My wife feels guilty.  My mother feels angry and betrayed.  It sucks.  But all-in-all everything went about as well as we could have hoped.  How about them apples?

It is a tough journey, I teared up reading your story and the memories it brought up of moving my parents. All I can do is tell you that there is no one right answer, and it is good that you are interactive with the facility staff as they deal with this on a daily basis. I would tell you to cherish any and all of the good moments along the way, and to tell your parents that you love them and give them a gently hug  (this that is as good for you as it is for them). 

[Nice Guy Eddie 13506]

On 6/7/2024 at 10:04 AM, BottleRocket said:

First, thanks for asking.  It was emotional and draining for everyone involved - especially my mother.  She was (and still is) a mixed bag of angry, sad, and confused.  She's been in her new place since Monday.  At the advice of the staff, we involved her in the moving process in the days leading up to her move date.  She helped the best she could in picking out pictures, or particular pieces of furniture, etc. to take with her.  My wife did a great job in making the new space reflect her personality and filled it with items that she cared about the most.  On the surface my mother loved her room.  She's most confused about the "why".  "Why are you doing this to me?"  We had come up with a story to tell her about how the assisted living unit was going to be under construction soon and it was going to be too noisy and disruptive for her to stay.  Logically she asked why my father was staying and we just laughed it off and said that he can sleep through anything.  She doesn't believe any of it.  It's the best we could do.

My father visits her an hour in the morning and an hour after lunch.  He's purposefully not spending too much time with her in the hopes that she will participate in some of the activities going on and get to know the staff and other residents.  This is the worst part.  Most of the other residents on her floor are really out of it.  Non-communicative.  In that respect, my mother doesn't belong.  She is unable to complete a coherent sentence, but if you know her you understand what she's trying to say.  She calls the lobby "downtown" and "yellow" might mean vegetables.  It's mostly gibberish but you can tell that she's still putting together pretty complex thoughts and has deep emotions.  It's really sad to see her eating lunch with people that cant lift their heads and she KNOWS she's not like THEM.  It's as if there should be a place that is 'somewhere in between'.  I feel guilty.  My father feels guilty.  My wife feels guilty.  My mother feels angry and betrayed.  It sucks.  But all-in-all everything went about as well as we could have hoped.  How about them apples?

 

 

Unfortunately those guilt feelings may never go fully away. I found that as my mom’s dementia became worse, I did understand that her need for 24/7 care exceeded my ability and honesty my patience. This helped me accept the guilt. It never left though.

Other tips that I learned with my mom, dementia and assisted living. Your mileage may vary.

• more visits and shorter stays was best as time went on
• a large digital clock with day and date. I hung it right beside her tv.
• flowers. She previously wasn’t a flower person but she became one. I think she liked to show them off to the care givers.
• Wherever her memory might be better, focus on that. My mom had decent long term but horrible short term. I asked questions about her childhood and parents. I never knew my grandfather so I learned a few new things.

many other people are going thru similar situations. You may find it useful to talk to them. Co workers, friends, etc. 

[Bozo_Casanova 26429]

On 6/7/2024 at 10:04 AM, BottleRocket said:

First, thanks for asking.  It was emotional and draining for everyone involved - especially my mother.  She was (and still is) a mixed bag of angry, sad, and confused.  She's been in her new place since Monday.  At the advice of the staff, we involved her in the moving process in the days leading up to her move date.  She helped the best she could in picking out pictures, or particular pieces of furniture, etc. to take with her.  My wife did a great job in making the new space reflect her personality and filled it with items that she cared about the most.  On the surface my mother loved her room.  She's most confused about the "why".  "Why are you doing this to me?"  We had come up with a story to tell her about how the assisted living unit was going to be under construction soon and it was going to be too noisy and disruptive for her to stay.  Logically she asked why my father was staying and we just laughed it off and said that he can sleep through anything.  She doesn't believe any of it.  It's the best we could do.

My father visits her an hour in the morning and an hour after lunch.  He's purposefully not spending too much time with her in the hopes that she will participate in some of the activities going on and get to know the staff and other residents.  This is the worst part.  Most of the other residents on her floor are really out of it.  Non-communicative.  In that respect, my mother doesn't belong.  She is unable to complete a coherent sentence, but if you know her you understand what she's trying to say.  She calls the lobby "downtown" and "yellow" might mean vegetables.  It's mostly gibberish but you can tell that she's still putting together pretty complex thoughts and has deep emotions.  It's really sad to see her eating lunch with people that cant lift their heads and she KNOWS she's not like THEM.  It's as if there should be a place that is 'somewhere in between'.  I feel guilty.  My father feels guilty.  My wife feels guilty.  My mother feels angry and betrayed.  It sucks.  But all-in-all everything went about as well as we could have hoped.  How about them apples?

 

 

You’re doing the right thing. It’s not fun or easy. 

[Armybrat 40814]

On 6/7/2024 at 10:32 AM, Wally Fairway said:

It is a tough journey, I teared up reading your story and the memories it brought up of moving my parents. All I can do is tell you that there is no one right answer, and it is good that you are interactive with the facility staff as they deal with this on a daily basis. I would tell you to cherish any and all of the good moments along the way, and to tell your parents that you love them and give them a gently hug  (this that is as good for you as it is for them). 

Always interact with the facility staff, that’s what my brother did almost every day (he lived 5 minutes from Dad’s nursing home). 
He even brought fresh baked cookies & cakes in for theirbreak room on his floor. 
Schmoozed with the administrators at least weekly didn’t hurt either.

[CleverNickname 1308]

fwiw... Taking my mom for a cognitive assessment this week. Probably end her driving. Looking at independent living and assisted living options. She loves one place (awesome, amd a huge milestone for her ro be willing to give up loving in her house), 1 bedroom with private balcony. But I worry they just want our initial fee and will push her to assisted living (studio). Doesn't need help with ADLs, but memory is shot.

She didn't like the place here thay had all 3 of independent living, assisted living, and memory care. Her memory sucks, but she's not one to just take a runner or wander. We shall see. 

[Nice Guy Eddie 13506]

15 hours ago, CleverNickname said:

fwiw... Taking my mom for a cognitive assessment this week. Probably end her driving. Looking at independent living and assisted living options. She loves one place (awesome, amd a huge milestone for her ro be willing to give up loving in her house), 1 bedroom with private balcony. But I worry they just want our initial fee and will push her to assisted living (studio). Doesn't need help with ADLs, but memory is shot.

She didn't like the place here thay had all 3 of independent living, assisted living, and memory care. Her memory sucks, but she's not one to just take a runner or wander. We shall see. 

Good luck. You will find that over time, it's natural for dementia patients to move into a smaller living space. Sadly their world gets smaller and smaller. Having her live in a place she likes is great, especially if she can make friends. You want her to have to desire to get up and move everyday.

[ChiTownDoc 21135]

On 3/28/2024 at 3:57 PM, royiv said:

The fact that I’ve dealt with it directly informs my opinion that you would never subject a loved one to a facility that accepts Medicaid. I prefer that my loved ones not be subjected to abuse.

 

ETA: OP mentioned grandkids 529s getting stuffed aggressively with mom’s assets so I don’t think we’re talking about someone that’s destitute. 

This is my gig.  We are in 150ish hospitals.  1300 skilled nursing facilities with 1500ish providers.  There are definitely very nice Medicaid facilities.  Many of these take primarily short term residents but have a limited number of long term care beds that are Medicaid.  It’s not easy to find these and get in but they’re out there and I cringe seeing how certain people end up in a shithole with Medicaid (majority) and others are in a place with Starbucks that’s brand new and offers great care / rehab / nursing ratios etc.  

[ChiTownDoc 21135]

On 8/12/2024 at 11:57 PM, CleverNickname said:

fwiw... Taking my mom for a cognitive assessment this week. Probably end her driving. Looking at independent living and assisted living options. She loves one place (awesome, amd a huge milestone for her ro be willing to give up loving in her house), 1 bedroom with private balcony. But I worry they just want our initial fee and will push her to assisted living (studio). Doesn't need help with ADLs, but memory is shot.

She didn't like the place here thay had all 3 of independent living, assisted living, and memory care. Her memory sucks, but she's not one to just take a runner or wander. We shall see. 

Before AL you should have option for IL ‘with services’ and they always struggle to get people to go from IL to AL so hold your ground the best you can but ‘usually’ they really are recommending what’s safest but it’s expensive and sucks.  Have sat in on thousands of care plans with families having these convos and they never get easier…

[Nice Guy Eddie 13506]

Isn’t it most likely that if you go the Medicaid pay route, you’re most likely sharing a room with another Medicaid recipient? I would also question if a dual pay facility (Medicaid and private/insurance) really offers the exact same care for both. While the care level may be the same on paper but the facility definitely has an incentive to keep the private payment residents happier.  The Medicaid resident is going to receive acceptable or adequate care.

if a family is out of money, I’m not suggesting that everyone gets a second or third job to pay for mom’s private room but I do question placing inheritance above her care.

[CleverNickname 1308]

Yeah, still haven't opened a trust, but I may do it once I get mom moved. I did confirm that I could make a trust with the durable POA we got, so that's good. I have gone to 2 of her banks and dropped off the POA and can now move money should I need to. Seems like every week has been a doc visit or a assisted living tour. To be honest, she's really enjoyed going out. I think that being mostly alone at home was way too unstimulating. 

We have picked a place, paid the fee, and are gathering stuff to move. The big day will be in a week or two. Have ordered new bed, mattress, linens, etc. Took her to Target for some stuff today. It's a lot like packing of a kid to move into a dorms, and I think to her similarly exciting/scary. I'm not totally sure she is able to fully pack for herself, so that might be a day or two itself. But I keep telling her (amnd myself) that we will keep the hiuse for a but, so we can go back and forth and get stuff as she realizes what would be nice to have on hand.

Hopefully all goes well with the move. I'm pretty sure she will enjoy having people around. And I'll feel better she is getting better nutrition and getting checked up on. Lots of things didn't surprise me about the cognitive assessment, but one thing that did was that she could not recall how to call fire/ems/police. I mean... if she can't call 911, she needs to be somewhere.

I also wonder about a medicaid facility being crap, but I think part of the calculation (self delusion?) is that by the time a dementia patient is on 24/7 nursing, they are just a shell. The spark is largely gone.

 

[CleverNickname 1308]

On 4/2/2024 at 9:09 PM, CleverNickname said:

Oh, that's interesting! If anyone finds an Austin based consultant, let me know.

fwiw there is "A Place for Mom" and Oasis Consultants. I guess us dudes just don't live long enough. APfM seems a but like an apartment rental service, they get a kickback if you rent. But they also know all the places and their strengths & weaknesses.

[Nice Guy Eddie 13506]

On 9/2/2024 at 3:39 PM, CleverNickname said:

Yeah, still haven't opened a trust, but I may do it once I get mom moved. I did confirm that I could make a trust with the durable POA we got, so that's good. I have gone to 2 of her banks and dropped off the POA and can now move money should I need to. Seems like every week has been a doc visit or a assisted living tour. To be honest, she's really enjoyed going out. I think that being mostly alone at home was way too unstimulating. 

We have picked a place, paid the fee, and are gathering stuff to move. The big day will be in a week or two. Have ordered new bed, mattress, linens, etc. Took her to Target for some stuff today. It's a lot like packing of a kid to move into a dorms, and I think to her similarly exciting/scary. I'm not totally sure she is able to fully pack for herself, so that might be a day or two itself. But I keep telling her (amnd myself) that we will keep the hiuse for a but, so we can go back and forth and get stuff as she realizes what would be nice to have on hand.

Hopefully all goes well with the move. I'm pretty sure she will enjoy having people around. And I'll feel better she is getting better nutrition and getting checked up on. Lots of things didn't surprise me about the cognitive assessment, but one thing that did was that she could not recall how to call fire/ems/police. I mean... if she can't call 911, she needs to be somewhere.

I also wonder about a medicaid facility being crap, but I think part of the calculation (self delusion?) is that by the time a dementia patient is on 24/7 nursing, they are just a shell. The spark is largely gone.

 

If your mom is open to it, have her put you on the bank accounts as a joint-owner opposed to a POA. The funds will also be yours so you have an easier method to abide by her wishes, now and later.

[davidg 4035]

If your mom is open to it, have her put you on the bank accounts as a joint-owner opposed to a POA. The funds will also be yours so you have an easier method to abide by her wishes, now and later.

We did this with dad’s accounts when mom passed. The POA terminates upon death and you will have to wait until you get a death certificate and letter of testamentary before you can do anything with the accounts. Also, fill out transfer on death/ beneficiary forms for any accounts (banking, investment, etc) that can pass outside of her estate unless moving to the trust takes care of this.

[Nice Guy Eddie 13506]

1 hour ago, davidg said:

We did this with dad’s accounts when mom passed. The POA terminates upon death and you will have to wait until you get a death certificate and letter of testamentary before you can do anything with the accounts. Also, fill out transfer on death/ beneficiary forms for any accounts (banking, investment, etc) that can pass outside of her estate unless moving to the trust takes care of this.

I've only had experience as an account joint owner. I would hate to wait on the letter of testamentary to act. In my limited experience that could take months.

Obviously without joint ownership but if you have the account login or debit PIN, you can functionally pay for items/services out of the bank account. However it sounds like it's questionable of whether you should be doing that if you only have a POA. Perhaps it's illegal to do so. Don't know.

When my mom passed and I informed the bank, they just said that the funds were mine to do what I wanted since I was the joint owner. Also being a joint owner, I had my own debit card and login. I could have had my own checks. Another benefit of joint ownership is that, the setup paperwork at the bank was simple. I still think that having a POA and MPOA is important for other reasons too. 

[CleverNickname 1308]

fwiw moved my mom to an assisted living last week. I think it's going OK, although I'm still anxious. I check on her every day. She has had some senior confusion... put trash in wrong container (a lot of new furniture and such). But she is going to all meals and likes to eat with others. I think she's double feeding the cat, but he isn't complaining. I worry she might need elope-y at some point. If she needs memory care, I might move her to a different place. This one is a good deal for AL but the MC is painful.