sister end of life

I'm guessing the office at the nursing home will facilitate the sister getting on Medicaid as sounds like she'll need assistance from day one.

Close friend works in nursing home head office and deals with the county SS on stuff like this all the time. The hospital knows she has almost nothing and has steered her to place that take Medicaid.

I found out when looking that the statement place that takes Medicaid has many meanings,


  1. There are places that will take folks with zero assets who are already on Medicaid.
  2. There are places that will take folks with assets and apply for Medicaid and keep the person there once Medicaid starts (some put them in a "Medicaid" room)
  3. Some places take person with assets and kick them out once they run out of money (Officially they say they will help them transition to a Medicaid accepting place).
I also found the nursing homes were very willing to help a person apply for Medicaid, as it's complex, and they want to ensure there will be money for when the person runs out of money.
 
I found out when looking that the statement place that takes Medicaid has many meanings,


  1. There are places that will take folks with zero assets who are already on Medicaid.
  2. There are places that will take folks with assets and apply for Medicaid and keep the person there once Medicaid starts (some put them in a "Medicaid" room)
  3. Some places take person with assets and kick them out once they run out of money (Officially they say they will help them transition to a Medicaid accepting place).
I also found the nursing homes were very willing to help a person apply for Medicaid, as it's complex, and they want to ensure there will be money for when the person runs out of money.


That's why I mentioned the hospital who know she basically has nothing steered her towards a certain nursing home. It's complex and if you haven't had a family member deal with this what you don't know can hurt you.
 
What does it mean that you’ve given the deed to the house to the nursing home? Is there something written about what they will do with that?

Just to show them that my sister owns the house free and clear. The nursing home isn't getting the house. They need it for the medicaid application.
 
Bigdawg-
So sorry you, your sister and her family are going through this tough time.
Take care of yourself. You are doing the best you can for her.
 
1) Check what the requirements are for probate in the state. If the estate is worth less than a certain amount, it might not need to go through probate.

2) If the real estate agent thought the house would be worth over $100,000, why would it be condemned? What would be the value of getting the house condemned at this point?

3) In some states, the title to the car can have a beneficiary put onto the title, which could avoid probate.

4) Talk with your niece and nephew about how to get your expenses reimbursed.

5) If the SS check goes into a financial account, the account can be set up with beneficiary designations that would bypass probate. Your sister might have already designated the beneficiaries. If so, there’s no need for the Social Security to go into a trust. However, the money might still be clawbacked to pay for Medicaid.

6) Remember to document all of your expenses well. Social Security might not clawback well-documented expenses reasonably made on your sister’s behalf.

7) Setting up a trust at this late point will not protect any assets, including the car, from the Medicaid clawback. All gifts or transfers made within a few years of applying for Medicaid can be clawbacked if there isn’t enough available to reimburse the Medicaid system.

"How Do You Avoid Probate in Arkansas?
The best way to avoid having an estate go to probate after the owner dies is by putting all the assets into a living trust. When the person dies, they won’t show any assets in their name. All assets belong to the trust. Another option is by having assets that automatically transfer to another person or the beneficiary. For example, this would include life insurance policies, retirement plans and bank accounts with a pay-on-death beneficiary."

Her house would be worth aprox $150k in good condition. Her house is trash. No heat, no A/C, propane company came and took the tank a few years ago. Origional walls and carpet from the 70's. Mold, fleas (I bugged bombed it twice now), no water (pipes broke in January with record breaking cold spell), 30 years of smoking in the house, deck is not up to code, origional and falling apart, soffits and fascia are rotting. My father and I painted the exterior 25 years ago. House would be a gut job/tear down. Would take 60-80K to gut and rehab. If I do the trust (leaning toward no), I wouldn't sell the house. It would be in the trust until after she passes.
 
"How Do You Avoid Probate in Arkansas?
The best way to avoid having an estate go to probate after the owner dies is by putting all the assets into a living trust. When the person dies, they won’t show any assets in their name. All assets belong to the trust. Another option is by having assets that automatically transfer to another person or the beneficiary. For example, this would include life insurance policies, retirement plans and bank accounts with a pay-on-death beneficiary."

Watch out for the lookback period, Bigdawg. If you transfer the house and other assets into a trust and she passes within the look-back period (5 years in most states, 30 months in a couple) the the assets are considered to be recoverable.

"Irrevocable Trusts (also called Medicaid Qualifying Trusts) – One might assume that these type of trusts are exempt from Medicaid’s look-back period, but this is not always true. The term, Medicaid Qualifying Trust, can create confusion, as the name suggests it is used to qualify for Medicaid. Unfortunately, if the trust is created during the look-back period, it is considered a gift, and therefore, is in violation of the look-back period." (from
https://www.medicaidplanningassistance.org/medicaid-look-back-period/ )
 
When we looked for Dad, there were very few nursing homes that accepted folks who had no assets and there was a waiting list for them.

My relative who placed her Dad , had visited 25 nursing homes, and she told me in her opinion there was a quality difference, and the pure medicaid ones generally were the worst.
She put her Dad into a nursing home, where he exhausted his assets in a few months, the nursing home helped him get onto medicaid and he stayed in his same room and level of service.
 
BigDawg, if your sister is able to sign bank forms putting your name on her account as a joint owner, when she passes the bank will not freeze her account. It will just pass to you as joint owner immediately upon her death. Greatly simplifies dealing with expenses after her death, as long as you keep receipts and clearly document all withdrawals.

I feel for you and now this is a hard process. So sad to see a sibling lose their life in this way, and sad to see how she was living. Addiction is a terrible thing.
 
BigDawg, if your sister is able to sign bank forms putting your name on her account as a joint owner, when she passes the bank will not freeze her account. It will just pass to you as joint owner immediately upon her death. Greatly simplifies dealing with expenses after her death, as long as you keep receipts and clearly document all withdrawals.

I feel for you and now this is a hard process. So sad to see a sibling lose their life in this way, and sad to see how she was living. Addiction is a terrible thing.

She doesn't even have a bank account. She lost her last job about a year ago. Was getting unemployment. Her job and all other money's (unemployment, stimulas, etc...) were deposited onto a reloadable visa debit card. I can't understand how someone can live that way. Trying to off load the cat today. Sister has dialysis again today. Hopefully moving to nursing home tomorrow or Monday.
 
I wouldn't do a trust if probate is not a bear in the OP's state (i.e. not California)

Sell the house for whatever it brings & expect Medicaid will try to recover from wherever the OP puts those funds.
 
She doesn't even have a bank account. She lost her last job about a year ago. Was getting unemployment. Her job and all other money's (unemployment, stimulas, etc...) were deposited onto a reloadable visa debit card. I can't understand how someone can live that way. Trying to off load the cat today. Sister has dialysis again today. Hopefully moving to nursing home tomorrow or Monday.

No advice being offered here, just some good will karma being thrown your way. Helping out aging/dying family isn't easy in the first place, but to have to deal with the situation that you in for someone that has done this to themselves; I feel for you. I am pretty sure you are destined for sainthood.
 
The cost of Dialysis is probably 10X cheaper in Mexico or other Latin American countries, and even cheaper in some Asian countries. You might spend $100,000 in the US for several weeks. In the Philippines, it cost $100-$150/week. So the cost of travel ($1000 for a plane ticket) will offset it.

59 yr old sister is in the hospital. 40+yr smoker and alcoholic. 10% kidney function. Liver just as bad. My nephew(36) and niece(33) are there with her. They want a decision on dialysis now. She wants to wait until I arrive on Thursday. No insurance, no job. Has paid for house (basically falling down) and a paid for car worth maybe 5k. I don't have the funds to finance the mutiple hundreds of thousands of dollars that would be needed for transplants, dialysis and ongoing care. I live 1300 miles away. They next few days/weeks will be interesting. Thoughts?, Ideas?, things I should think about?
 
The cost of Dialysis is probably 10X cheaper in Mexico or other Latin American countries, and even cheaper in some Asian countries. You might spend $100,000 in the US for several weeks. In the Philippines, it cost $100-$150/week. So the cost of travel ($1000 for a plane ticket) will offset it.

Doesn't sound like his sis is in any condition to travel. Good thing Medicaid will cover the cost of dialysis.
 
Bigdawg, I don't have any particular wisdom for you, just best wishes for your health & sanity as you go through this, and a release from suffering for your sister. Peace.
 
thanks for all of the advice, comments and support. Got the cat to a good home today. Changed the lock on the house. Sister didn't know where the key was. She doesn't was her son/my nephew to have a key. She kicked him out 20 years ago. Strange relationships. But, he is the only one here. I am heading back east on Wednesday. He has really stepped up. There is hope for him. Apparently the doctors where in today. I didn't think they would be (sunday). I will be in there all day tomorrow and put some pressure on them. Sister didn't look good today. She was chipper last night after morning dialysis. Not so much today (with no dialysis). Tomorrow they need to move her to the nursning home. I will elevate my concern to the appropriate level (no yelling-not yet anyway). Still reading so much about this topic on the internet. If I had to put $100 on it I would say she is gone before 1 September. House (maybe 70K) and car (maybe 10k) will stay where they are. Nephew is getting his ducks in a row to by pass probate (estates under 100k). He has the most to gain. He did say he would throw me a couple k to cover my current costs being here. Thanks Nephew. Plus I'll cover cremation out of my pocket. Looks like $700 here in NW Arkansas. Nephew will be charged with sprucing up my sisters room at the nursing home. I'm guessing spartan setting. Probably just a bed. He is ready to bring her a TV, blankets, a chair, etc... to make it homey.
This afternoon he told me he will be upping his 401k contributions. Like I said, maybe hope for my nephew.
 
thanks for all of the advice, comments and support. Got the cat to a good home today. Changed the lock on the house. Sister didn't know where the key was. She doesn't was her son/my nephew to have a key. She kicked him out 20 years ago. Strange relationships. But, he is the only one here. I am heading back east on Wednesday. He has really stepped up. There is hope for him. Apparently the doctors where in today. I didn't think they would be (sunday). I will be in there all day tomorrow and put some pressure on them. Sister didn't look good today. She was chipper last night after morning dialysis. Not so much today (with no dialysis). Tomorrow they need to move her to the nursning home. I will elevate my concern to the appropriate level (no yelling-not yet anyway). Still reading so much about this topic on the internet. If I had to put $100 on it I would say she is gone before 1 September. House (maybe 70K) and car (maybe 10k) will stay where they are. Nephew is getting his ducks in a row to by pass probate (estates under 100k). He has the most to gain. He did say he would throw me a couple k to cover my current costs being here. Thanks Nephew. Plus I'll cover cremation out of my pocket. Looks like $700 here in NW Arkansas. Nephew will be charged with sprucing up my sisters room at the nursing home. I'm guessing spartan setting. Probably just a bed. He is ready to bring her a TV, blankets, a chair, etc... to make it homey.

This afternoon he told me he will be upping his 401k contributions. Like I said, maybe hope for my nephew.



Take care of yourself and sorry you’re going through this. Glad her son is stepping up a bit.
 
Big Dawg; I just read through this and have no advice, but wanted to chime in with positive thoughts for you and your sister. It appears you've stepped into the breach. I hope your sister gets through the Looking Glass soon and you can take a breath.
 
Zero progress today other than I got the water pipes fixed. No luck at the hospital. Doctors are nowhere to be found. Sister was talking nosense and having issues with her 10 yr old laptop. I'm not going there. Will not be pulled further into the abyss. Waving the white flag. Heading home on Wednesday and I'll let "the system" work. Think of a broken vase, soaking in an oil pan, behind a locked glass bullet proof door in a building that is about to be torn down. Every proverbial door I open in her life is a pit of quick sand surrounded by scorpions. Such a mess. Worst part is she is a good person. I can't let this drag me down. Her son is local and I have prepped him for what he needs to do. I will help him and guide him through that but I need to get back to my life and responsibilities. Thank you all for the support, understanding, suggestions, thoughts and prayers. Flying back to the east coast on Wednesday. After Wednesday morning I will most likely never see my sister alive. Hope her final days/weeks/months are somewhat comfortable and without too much pain. Just signed up to umpire the Junior Legion state baseball tournament this weekend. That will be a nice distraction.
 
Wow, you've already done amazing things for her!

Can you get the kids to push for Hospice?

With a failing liver I don't see the point in continuing dialysis unless it contributes to her comfort...as you've said, she's not a transplant candidate, so might as well make her as comfortable as possible.

Part A covers most Hospice services.
 
You're a good man.
 
Zero progress today other than I got the water pipes fixed. No luck at the hospital. Doctors are nowhere to be found. Sister was talking nosense and having issues with her 10 yr old laptop. I'm not going there. Will not be pulled further into the abyss. Waving the white flag. Heading home on Wednesday and I'll let "the system" work. Think of a broken vase, soaking in an oil pan, behind a locked glass bullet proof door in a building that is about to be torn down. Every proverbial door I open in her life is a pit of quick sand surrounded by scorpions. Such a mess. Worst part is she is a good person. I can't let this drag me down. Her son is local and I have prepped him for what he needs to do. I will help him and guide him through that but I need to get back to my life and responsibilities. Thank you all for the support, understanding, suggestions, thoughts and prayers. Flying back to the east coast on Wednesday. After Wednesday morning I will most likely never see my sister alive. Hope her final days/weeks/months are somewhat comfortable and without too much pain. Just signed up to umpire the Junior Legion state baseball tournament this weekend. That will be a nice distraction.



So glad you are going to head back to your own life. You’ve done more than most people would have and her son needs to take the reins from here. Great that you will guide him through it. So sorry, I know how difficult this is having been through losing my sister to alcoholism.
 
WOW! I just read through the whole post and your sister and her children are so lucky to have you in their lives. It also gave me a whole new perspective and I am grateful that my brother will never have to go through this because I got sober. I am praying that she passes with no pain, surrounded by people who love her.
 
BigDawg,

Hang tough friend. This has been a lot of grim work. Hopefully the nephew will continue to step up. Hope everything goes as well as it can and you get a much needed break.

Monte
 
Think of a broken vase, soaking in an oil pan, behind a locked glass bullet proof door in a building that is about to be torn down. Every proverbial door I open in her life is a pit of quick sand surrounded by scorpions. Such a mess.

Wow...that is a really well-written description...I can just see and feel what you are going through.

You've tried so hard to help, and done so much for her...take care of yourself, too, OK?
 
Most likely the last update until she passes.

Caught the red eye home. Walked in the door at 0330 as to not wake DW before she rises for her pre work morning work out. Up a few hours later to go to the MVA(DMV) to renew drivers license. Sign of the apocalypse-24 hour diner that I usually stop at is now open 0700-2200. I know, right?

Said goodbye to sister yesterday. I guess she thought I was going to stop by one more time later yesterday but I was already heading to the airport. She is starting to get confused. I'm guessing toxins moving to the brain. Doctors said that would happen. Still in hospital. Not privy to staff internal meetings but I guess she is deteriorating fast enough that maybe she will just stay where she is and pass. Maybe they are leaning hospice instead of nursing home. Hospital has implimented the one visitor per day rule (COVID uptick). My nephew will stop in and see her each day. He is prepared to deal with estate of less tha 100K. House and car basically. I have the cremation covered when that happens. Our soon to be 90 year old mother is slipping mentally and physically. No funeral or memorial service. My oldest cousin and I are slowly collecting the family urns and will be having our own little memorial service some day up north. We all grew up on or near Lake Superior. Sister is comfortable or at least pain free. They give her any med she wants. They have her on a nicotine patch to satisfy the cravings. I'm sure she would love a bottle of vodka or tequila. Addictions are tough. Love her because she is my sister. Had a few good conversations with her over the past two weeks. Very different perspectives on almost everything but I was cordial and understanding. Feel like I did everything I could do within reason. Will not blow our stash on a dying addict, family or not. Had one last conversation with a doctor yesterday before I left. He is thinking 2-3 weeks at best. He and I are actually hoping for a few days.

Thank you all so much for your support, understanding and suggestions. I will give one more update when she passes because you all deserve that. I have learned so much about estate planning, health care and end of life processes over the last three weeks. Best of luck to you all as you deal with your loved ones.
 
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