Geriatric financial management & asset allocations

[Free To Canoe]

This is a good thread for me since I am starting down this dementia care road. I finally talked Mom into putting me on the checking account jointly with her. At least this way I can keep tabs on what is happening with her finances. I am not 100% that this is the best path but it will allow me to fix things and pay bills if she becomes unable to.

A little background: My Mother is a widow of modest means but she does own her paid for house. She has always been independent. The oldest of 3 children (sons) lives nearby but doesn't want to have anything to do with her (or me). I am the middle. The youngest lives in the Midwest.

A will has been completed and I am the executor. Cannot pursuade her to do living will or any other documents so far. Getting on the checking account is a first step.

I live a couple of hours away. I am going down to see her on Monday.
Your input is appreciated.

[Huston55]

Wow! This is a tremendously informative and useful thread. I'm going thru this now with my mom, who has dementia, and the uncertainty of not knowing everything to do is quite stressful. Lots of useful info in here for me to study.

She did have the foresight to do a will, living will and POA, and to put my sister on her accounts and home title, and that has made a World of difference. For us, the POA is like a magic key - it has worked for everything we've had to do thus far. Her assets are simple though. Our discussions with a geriatric lawyer were well worth the $700 we paid. We know we're on the right path document-wise and known the ropes to qualify for Medicaid when the time comes. If you are in this situation and want to explore vehicles to retain some of your relatives assets, a good geriatric lawyer can explain vehicles that will overcome the 5 year look-back provision with Medicaid; I expect this varies from state to state.

For all those who are going thru this, you have my empathy; pls keep sharing, so we can all benefit from one another.

[Nords]

Quote:

Originally Posted by Free To Canoe A little background: My Mother is a widow of modest means but she does own her paid for house. A will has been completed and I am the executor. Cannot pursuade her to do living will or any other documents so far. Getting on the checking account is a first step. Your input is appreciated.

We've been lucky that Dad just had a two-bedroom apartment. When Mom died in 1987 he downsized (ironically via an estate sale) from a 3500 sq ft 4BR three-story home. Glad we didn't have to deal with that. Three rooms of furniture & a few antiques was painful enough.

I believe that at some point you're going to need a special/limited POA for selling real estate. By the time you get to that point, your mom will be considered incompetent to sign a POA for selling real estate. The trick appears to be convincing her to sign one and have it notarized, then lock it away in her files until it's needed, and execute a new one every year or so. It also might depend on whether the house is part of a revocable living trust or titled in some other manner.

Otherwise the only way I know of to deal with selling real estate would be conservatorship. I don't think a general POA can cut it.

Another potentially sticky situation is Dad's 1999 Ford Explorer. His personal property insurer is the same company as his vehicle insurance, and when I canceled the personal-property policy (over the Internet) the insurance agent got all needy about wanting to "review other insurance options" with Dad. The company might be reluctant to renew the SUV policy if they had access to Dad's medical records. As far as I can tell, though, it's none of their business.

Dad knows that the SUV stays at my brother's house "in case Dad needs it". Lately Dad has said that he doesn't want to have to "take care of it" anymore. I've been nudging my brother to buy the SUV for $1 (which is probably its resale value anyhow), have Dad sign over the title, re-register it at the DMV in his own name, and have Dad pay the registration/insurance fees. My brother doesn't own a car (yet) and this will ensure that the SUV is ready to drive Dad to appointments or outings in a familiar conveyance.

Even more horrifically ironically, my father is still licensed to operate a motor vehicle. I'm not sure there's any process to cancel his license (maybe the guardianship petition?), although of course Dad doesn't have any keys and we'll let his license expire.

Last month Dad even got a notice for jury duty in the state district court. (I obtained a medical excuse for him.) I wonder if he's eligible to vote in the 2012 election...

[chinaco]

Quote:

Originally Posted by Free To Canoe This is a good thread for me since I am starting down this dementia care road. I finally talked Mom into putting me on the checking account jointly with her. ... I live a couple of hours away. I am going down to see her on Monday. Your input is appreciated.

Describe to her the problems that will be encountered if she does not make "Her Wishes" known in those legal documents. Otherwise, you kids will be trying to figure out what to do in a crisis.

She can hang on to the POA docs at her home. Just let you guys know where they are if you need to get them. Make sure you have a key to her home.

If your mother is reluctant, an attorney can be the "expert" that might be able to help counsel your mother. You can take her to an attorney to review her Will to make sure it is still in proper order. In that review session the attorney can explain about the need for those documents and the problems that occur if it has not been dealt with.... Sometimes, an "experts" opinion carries a lot of weight with elderly people.

[chinaco]

Quote:

Originally Posted by Nords ... Another potentially sticky situation is Dad's 1999 Ford Explorer. His personal property insurer is the same company as his vehicle insurance, and when I canceled the personal-property policy (over the Internet) the insurance agent got all needy about wanting to "review other insurance options" with Dad. The company might be reluctant to renew the SUV policy if they had access to Dad's medical records. As far as I can tell, though, it's none of their business. Dad knows that the SUV stays at my brother's house "in case Dad needs it". Lately Dad has said that he doesn't want to have to "take care of it" anymore. I've been nudging my brother to buy the SUV for $1 (which is probably its resale value anyhow), have Dad sign over the title, re-register it at the DMV in his own name, and have Dad pay the registration/insurance fees. My brother doesn't own a car (yet) and this will ensure that the SUV is ready to drive Dad to appointments or outings in a familiar conveyance. .....

Your brother will wind up eating a lot of out of pocket transportation expenses if he doesn't watch it. If he had his own vehicle, because he needed one for his personal use... he could just charge back the IRS mileage rate for transportation (including visit to the NH to look in on your father). He would need to keep a log of trips and miles traveled!!

However, owning a vehicle outright is an expense.. older vehicles often incur costly maint... certain parts just give way. Plus for reliability... he does not want to wind up on the side of an interstate with your father in the car!!! A mileage based reimbursement would work fine as long as there are not huge repair bills (e.g., transmission). For that matter... now days fairly minor repairs (that must be done to keep it running) can cost $1k. That would blow up a mileage based model.


I think you are headed down the reasonable path... But you might consider discussing it with your father's attorney (courtesy email so he is aware of the issue)... just in case there are large expenses filed to fix your brother's future car... Make sure you keep records.

Unfortunately... nothing about this will be simple.

[Huston55]

Regarding use of POA, our atty says it's adequate for all actions we'll have to take. But, my sister is co-title holder on mom's house so, we're covered there in any case.

Also wanted to note for those just starting down the path of caring for an elderly parent, that your state's agency on aging (Area Agency on Aging in TN; may be different name in your state) is a great place to start; knowledgeable and helpful people with lots of educational material and references for who's (facilities, docs, lawyers, etc) good and who's not.

[Free To Canoe]

Quote:

Originally Posted by Nords I believe that at some point you're going to need a special/limited POA for selling real estate. By the time you get to that point, your mom will be considered incompetent to sign a POA for selling real estate. The trick appears to be convincing her to sign one and have it notarized, then lock it away in her files until it's needed, and execute a new one every year or so. It also might depend on whether the house is part of a revocable living trust or titled in some other manner. Otherwise the only way I know of to deal with selling real estate would be conservatorship. I don't think a general POA can cut it.

I am thinking hoping that if care is needed, then they will "take" the house as payment since there is not much else in assets besides the house. Then a POA is not needed. Or is it: no sale = no care?

[Huston55]

Yes, if your parent goes the Medicaid route and the house is the only asset left, the state will implement "estate recovery" (read: you sell the house and pay them back with proceeds, then you get anything left). But, that doesn't mean you want to give up control. So, IMO, you need POA and/or other vehicles to have control; and to get thru the estate and probate process (very burdensome in some states). Also, as I said in an earlier post, a good elder atty can show you vehicles to protect some of you parent's estate from "estate recovery."

Hope this helps. I know a little since I'm going thru this now but, I'm still learning and seeking a lot of help.

[Nords]

Quote:

Originally Posted by Free To Canoe I am thinking hoping that if care is needed, then they will "take" the house as payment since there is not much else in assets besides the house. Then a POA is not needed. Or is it: no sale = no care?

I think you're a very trusting person to hope that the care facility's business manager, the state, and Medicaid will make it all work out in your parent's best interests...

I'm doing the best I can to keep the care facility happy to have Dad there. If he develops a tendency to "wander" or "bolt" (as some Alzheimers' patients do) or if he ends up having to go to the hospital for a medical emergency or some other procedure, then I want them to still feel as if they should keep a space open for him. I don't want repeat the process of hiring care managers to "dial for care facilities".

[chinaco]

Quote:

Originally Posted by Nords I think you're a very trusting person to hope that the care facility's business manager, the state, and Medicaid will make it all work out in your parent's best interests... I'm doing the best I can to keep the care facility happy to have Dad there. If he develops a tendency to "wander" or "bolt" (as some Alzheimers' patients do) or if he ends up having to go to the hospital for a medical emergency or some other procedure, then I want them to still feel as if they should keep a space open for him. I don't want repeat the process of hiring care managers to "dial for care facilities".

Back when were going through it, I was told nursing homes will hold beds but not for long periods of absence... especially if they have waiting list.

There is a certain amount of admin overhead and cost to admitting a brand new patient... the admissions office will take the route of least resistance (for themselves).

You might check your father's LTC policy. Some policies will pay a benefit to hold a bed... but the amount of benefit is limited and there would be a cap.

[JakeBrake]

I put my mother into an assisted care facility. After a few days the facility manager called and said she needed to be in their lockdown alzheimer's unit. I could not argue because my mother was in great physical condition and could wander away and go for miles, but her mind was about gone. the facility furnished a 24/7 sitter at no charge for a few days until there was a vacancy in the lockdown alzheimer's unit.

Although I had a notarized POA, there was no way I could sell her house until I obtained a conservatorship in the appropriate chancery court.

My mother's assets were too large for Medicaid to be a consideration.

[Brat]

Maybe it's just me but I have an issue with potential heirs sheltering assets from Medicaid recovery. In the 'good old days' the kids were responsible for the care of their aging parents, period! They took them in if that was necessary. I can understand when the relatively healthy spouse needs resources to maintain themselves but for heaven's sake if a single person needs care sell their assets and pay for the care. The rest of us tax payers should not bear the burden of preserving your inheritance.

Off my soap box.

[Nords]

Quote:

Originally Posted by JakeBrake I put my mother into an assisted care facility. After a few days the facility manager called and said she needed to be in their lockdown alzheimer's unit.

My Dad's pretty proud of the "special ID bracelet" that the staff gave him to identify him to the other residents as a "senior resident". He practices "managing by walking around" every day, and occasionally he's mistaken for a member of the staff. It's not until the third or fourth day that most of the new residents notice that he's asking them the same "How's it going? How are they treating you?" questions every day. Then they recognize that the bracelet means "resident", not "staff".

Dad also doesn't realize that the RFID chip in his bracelet triggers the exit alarms.

For now he says he doesn't want to leave the building because he's afraid he won't remember how to get back to it. As his cognition continues to decline, I hope this is ingrained behavior.

[Huston55]

Quote:

Originally Posted by Brat Maybe it's just me but I have an issue with potential heirs sheltering assets from Medicaid recovery. In the 'good old days' the kids were responsible for the care of their aging parents, period! They took them in if that was necessary. I can understand when the relatively healthy spouse needs resources to maintain themselves but for heaven's sake if a single person needs care sell their assets and pay for the care. The rest of us tax payers should not bear the burden of preserving your inheritance. Off my soap box.

I understand why you might feel that way but, it's a little too narrow a view for me. We all pay into "the system" and then benefit to varying degrees. The fact is that we all subsidize one another in various ways: progressive income taxes, property taxes for schools that people without children pay, etc. In the 'good old days', before SS, most elderly widows lived and died in poverty; not a place we want to return to.

Regarding estate recovery, the state will still get paid at least some amount in all cases where there are assets remaining, which will be the case for my mom and most who have any assets. But, at some point, everyone (including those on this on this forum after enough time) runs out of assets and relies on the state; not always perfectly balanced ($ in = $ out) but, equitable and certainly better than ' the good old days.'

[brewer12345]

In addition to bringing in the lawyer, don't be shy about sic'ingthe state insurance department on the insurer. Most state insurance departments would be positively thrilled to hit a insurer with a big, fat consumer issue fine.

[Nords]

Quote:

Originally Posted by brewer12345 In addition to bringing in the lawyer, don't be shy about sic'ingthe state insurance department on the insurer. Most state insurance departments would be positively thrilled to hit a insurer with a big, fat consumer issue fine.

Good to know. I'll add that to the lawyer's list.

I'm just hoping that we end up shaking hands next to the big pile of ammunition that I'm stockpiling.

[Free To Canoe]

Just got back from Moms. I am joint on the checking. We cleared up most of the mysteries surrounding the banking (balancing the checkbook comes later). Mom now seems OK with Living Will and POA in theory. I think she is feeling better about things. I know I am.

[Nords]

Quote:

Originally Posted by Free To Canoe Just got back from Moms. I am joint on the checking.

Whew.

Hopefully she's a fan of online banking and web-based billpay, too...

[Free To Canoe]

Quote:

Originally Posted by Nords Whew. Hopefully she's a fan of online banking and web-based billpay, too...

No but I am and I will now be able to check online. Woo Hoo!
She gets checks direct deposited. I need to make that the rule for all. I am currently wondering where the "Rent rebate" check is. I should have known better. When I worked for VITA, it was the law.

[Huston55]

Free-

Congrats on convincing your mom to put the necessary documents in place; that will pay dividends.

My sister and I are still investigating assisted living facilities, while mom gets home help. And, we're formally applying to be enrolled in the Medicaid system.