Who's Responsible for Nursing Home Payment?

[PatrickA5]

I have a developing situation occurring with FIL and his wife.

FIL is currently in the hospital and it's looking like he won't be able to go home. His condition will most likely result in a hospice stay in a long-term care facility.

His wife of two years is also in poor health and may require a nursing home stay, but probably not soon, but not sure.

With the exception of a joint checking account that pays their monthly bills, I believe all of their assets are individually owned (with their respective kids as beneficiaries).

Obviously, he's responsible for paying his own nursing home bills. What about if his wife also has to go to a nursing home? Can the nursing home look to his assets to pay her bills? At this point, I have no idea exactly what assets she has. I've heard some stories about one of her kids always after her money and have some concerns they'll look to pay for her nursing home care with his money. They have both been pretty clear that they want things to remain separate financially as it pertains to retirement accounts, etc. Any ideas?

 

[Sunset]

Interested to know as well, since I seem to have read that a married couple are financially responsible for each other's healthcare as far as medicaid is concerned.

 

[bizlady]

Contacting an attorney might be best.
There is this, but have no idea if it applies :https://www.agingcare.com/Articles/...egardless of how long they have been married!

 

[PatrickA5]

Interested to know as well, since I seem to have read that a married couple are financially responsible for each other's healthcare as far as medicaid is concerned.

I'm not sure of her assets, but think she has enough that Medicaid won't be in the picture for awhile.

FIL has a decent amount of assets, so he'll have no problem paying his long-term care needs. DW and I are just concerned about his wife having a lengthy nursing home stay and spending down his assets.

 

[PatrickA5]

Contacting an attorney might be best.
There is this, but have no idea if it applies :https://www.agingcare.com/Articles/...egardless of how long they have been married!

Yes, we'll probably contact our attorney at some point.

We've talked to him about his finances. He's pretty secretive. I have a decent idea, what he has since I do his (their) taxes.

His POA is the worthless type (springing). He has to be shown incompetent by two doctors. He's not incompetent, just very sick. I remember many years ago telling him that a Springing POA is pretty much worthless and won't help when the time comes, but he had a buddy that kids stole from him using POA, so.....

 

[Teacher Terry]

It won’t help in this situation but this is a great example of why it’s a bad idea to get married in your senior years. At this age living together is the best option.

 

[PatrickA5]

It won’t help in this situation but this is a great example of why it’s a bad idea to get married in your senior years. At this age living together is the best option.

We tried to gently push him to stay single legally, but she put some pressure on him as she wasn't comfortable living together.

I should mention that she has been wonderful for him and we're glad he found her for his last few years.

 

[Murf2]

I'm not sure of her assets, but think she has enough that Medicaid won't be in the picture for awhile.

FIL has a decent amount of assets, so he'll have no problem paying his long-term care needs. DW and I are just concerned about his wife having a lengthy nursing home stay and spending down his assets.

Do you have some other plans for his assets?

 

[aja8888]

It won’t help in this situation but this is a great example of why it’s a bad idea to get married in your senior years. At this age living together is the best option.

Absolutely! a HUGE number of seniors in my 55+ community are living as "Partners".

 

[Mark1]

For what it worth, I had a similar questions a few years ago with Step-FIL and DM. The attachment shows how the state of Iowa would handle the situation (at least a couple of years ago). I'm sure all state Medicaid programs are different, but I would be surprised if it was dramatically different. I would suspect that once her money is gone the state would require your FIL money be used up to some level prior to her going on Medicaid. The state doesn't care if they were only married a few years, or if the assets were going to different sets of kids, etc.

 

[PatrickA5]

Do you have some other plans for his assets?

No, not while he's alive. We have no problem with his assets being used for his (and hers) long-term care needs.

He (supposedly) has his kids as beneficiaries on his assets, but we don't know for sure. Aside from the one joint bank account, we're hopeful that his assets are distributed according to beneficiary/will assignments.

That's the reason for the question as to whether her nursing home could somehow use his assets - even after his death.

To muddy the waters even more, she has a life estate in his house. DW and her sister are on the deed (with FIL). His wife has a legal right to live there as long as she wants, but not sure what happens if she goes to assisted living somewhere.

 

[OldShooter]

Be very careful who signs what during the admission process. The facility, understandably enough, will try to hook FIL, his wife, and probably you and DW also as guarantors. This will be by using official-looking preprinted forms.

Best case is to take all the forms for your own lawyer's review, then refusing at least some of the requests and crossing out and initialing the changes. Finally, all parties on your side should initial each page of the agreement(s) even if no changes. This makes later substitution of pages more difficult.

 

[marinauser]

Much may also depend on to what extent the two seniors have commingled their assets after marriage. If they have been diligent about keeping them separate and distinct, that should make it easier to establish with medicaid, if necessary, that one spouse and his assets are not responsible for the bills of the other spouse.

 

[PatrickA5]

Be very careful who signs what during the admission process. The facility, understandably enough, will try to hook FIL, his wife, and probably you and DW also as guarantors. This will be by using official-looking preprinted forms.

Best case is to take all the forms for your own lawyer's review, then refusing at least some of the requests and crossing out and initialing the changes. Finally, all parties on your side should initial each page of the agreement(s) even if no changes. This makes later substitution of pages more difficult.

Thanks. Went through that with my dad. The nursing home made me sign as responsible party before taking my dad - even though Medicare was to pay for a short period. Knowing he only had a few weeks to live at most, I signed it. He lasted two days. Sure enough, a couple of months later they sent me a bill for $800. I told them to pound sand and get it from Medicare. Never heard from them again.

FIL has plenty of assets to pay for his nursing home needs. Now, how we're going to get to those assets (mutual funds, etc) is another problem entirely due to his worthless POA.

 

[Sunset]

Much may also depend on to what extent the two seniors have commingled their assets after marriage. If they have been diligent about keeping them separate and distinct, that should make it easier to establish with medicaid, if necessary, that one spouse and his assets are not responsible for the bills of the other spouse.

I don't think that is how Medicaid works, it overrides all that separate ownership stuff and says married assets are for each as needed, leaving about $123K plus few other things, to the non-medicaid spouse.

 

[rodi]

MediCAID limits for the spouse vary by state. You will need to look up how much of the joint assets need to be spent down and how much is set aside for the spouse.

One tip - if your FIL goes straight from the hospital to the nursing home/hospice/rehab then mediCARE will pay some of the first 100 days. I think it's 100% for the first X days, then 80% for 100-X days. Again, double check.

BUT - if he goes home, *then* goes to a nursing home, you lose that benefit. My FIL went home, because MIL thought she could care for him (she couldn't)... and it was an expensive decision.

 

[jim584672]

Minimum and Maximum Resource Allowance Amounts

While the exact amount of assets that can be retained by the non-applicant spouse as the Community Spouse Resource Allowance varies based on the state, the federal government sets a minimum and maximum “resource standard”. In 2023, the minimum CSRA is $29,724 and the maximum CSRA is $148,620. It is within these federally set standards that states are permitted to set their own standards.

https://www.medicaidplanningassistance.org/community-spouse-resource-allowance/

 

[marko]

You need a lawyer. Asap. Rules vary state to state.

 

[marko]

One tip - if your FIL goes straight from the hospital to the nursing home/hospice/rehab then mediCARE will pay some of the first 100 days. I think it's 100% for the first X days, then 80% for 100-X days. Again, double check.

BUT - if he goes home, *then* goes to a nursing home, you lose that benefit. My FIL went home, because MIL thought she could care for him (she couldn't)... and it was an expensive decision.

This is true.

 

[COcheesehead]

It won’t help in this situation but this is a great example of why it’s a bad idea to get married in your senior years. At this age living together is the best option.

There is a rule of law known as a common law marriage which may still view you legally as a married couple even if you are not.

 

[Walt34]

Be very careful who signs what during the admission process. The facility, understandably enough, will try to hook FIL, his wife, and probably you and DW also as guarantors. This will be by using official-looking preprinted forms.

What he said.

We ran into this when FIL went to a recovery place after some surgery. He was to be there for maybe three weeks or so and they tried to get DW to sign forms accepting financial responsibility if his assets ran out. I told the wench what to do with her forms. DW was a tad upset about that but I knew what she was trying to pull on us. They still admitted him.

 

[GravitySucks]

Be very careful who signs what during the admission process. The facility, understandably enough, will try to hook FIL, his wife, and probably you and DW also as guarantors. This will be by using official-looking preprinted forms.

Best case is to take all the forms for your own lawyer's review, then refusing at least some of the requests and crossing out and initialing the changes. Finally, all parties on your side should initial each page of the agreement(s) even if no changes. This makes later substitution of pages more difficult.

Thanks. DM was transferred to a nursing home today and I have to go into the business office to sign the papers for insurance reimbursement to the facility tomorrow. I’ll read the documents carefully with this advice in mind.

 

[Pluperfect]

There is a rule of law known as a common law marriage which may still view you legally as a married couple even if you are not.

Only a handful of states still recognize common law marriage, and there are elements in addition to cohabitation that must be established. (Contrary to popular belief, a common law marriage is never imposed solely because a couple lives together, regardless of how long they live together.)

For a common law marriage to exist, a couple has to agree to be married, and they have to hold themselves out as being married. An agreement can be inferred from the holding out, so it's the holding out that's important. (And there might be additional requirements, depending on the state.)

The one that trips people up a lot is filing a joint income tax return. It's hard to argue you're not married when you file an income tax return as spouses.

If you live in a state that recognizes common law marriage, you can live together forever without being declared common law married. It's a case-by-case basis, but if you keep your own names, never check a box that says "married," never refer to your boyfriend/girlfriend as "husband" or "wife," keep your finances separate, etc., it will be very very difficult for anyone to argue/claim that you're married.

 

[youbet]

I don't think that is how Medicaid works, it overrides all that separate ownership stuff and says married assets are for each as needed, leaving about $123K plus few other things, to the non-medicaid spouse.

Yes.

 

[pb4uski]

No, not while he's alive. We have no problem with his assets being used for his (and hers) long-term care needs.

He (supposedly) has his kids as beneficiaries on his assets, but we don't know for sure. Aside from the one joint bank account, we're hopeful that his assets are distributed according to beneficiary/will assignments.

That's the reason for the question as to whether her nursing home could somehow use his assets - even after his death.

To muddy the waters even more, she has a life estate in his house. DW and her sister are on the deed (with FIL). His wife has a legal right to live there as long as she wants, but not sure what happens if she goes to assisted living somewhere.

Be very careful who signs what during the admission process. The facility, understandably enough, will try to hook FIL, his wife, and probably you and DW also as guarantors. This will be by using official-looking preprinted forms.

Best case is to take all the forms for your own lawyer's review, then refusing at least some of the requests and crossing out and initialing the changes. Finally, all parties on your side should initial each page of the agreement(s) even if no changes. This makes later substitution of pages more difficult.

My understanding is that the way it should work is that as long as they are married that all their assets are in play, even if separately titled. Once one of them dies, their separately titled assets are distributed as called for by beneficiary designations and/or the will and from that point on that those assets are no longer in play. YMMV and as others have advised, see a lawyer... I'm not a lawyer but I did stay at a Holiday Inn Express last night.

Can you have him now sign a new POA?

+1 on OldShooter's post... be very careful when signing such documents. Have DFIL sign is he is competent to do so, but if you or someone else signs make it clear that they are signing only as his POA and are not assuming any personal responsibility... and of course have