Assisted Living After the Money Runs Out?

[NoiseBoy]

My parents are both 94. They are currently living in an apartment without any assistance other than what my sister and I provide. However, Mom has experienced a number of health issues this year that she has not been able to fully recover from, so we are starting to look at moving them to an assisted living facility.

We've taken one tour (with Mom) and I've done some research online, so I have a ballpark idea of the costs for moderate care, assisted living in our area (downstate Illinois.) After going over my parent's finances, I estimate that they have enough savings and monthly income to last for about 4 years until their savings would be exhausted. And that estimate doesn't account for any significant health issues or perhaps the need for skilled nursing care for either parent.

There is no family history of heart disease, and neither one is diabetic or even has high blood pressure, so I think it's very likely that one or both of my parents will make it to one hundred. My question for this forum is, what happens to them when their money runs out (in Illinois?) The administrator at the facility we toured mentioned applying for state aid; did she mean Medicaid? I'd like to read any general advice about making this kind of move from this group.

 

[Bir48die]

The best scenario unless you want to continue to spent a ton of your own money is to exhaust their resources and put them on Medicaid. They do allow a small sum of personal money but their assets need to be liquidated for the most part. You need to do some research on what the qualifications that need to be met to be on Medicaid so if it's not now, it's when time comes for the conversion. There are income levels & restrictions so do your homework and each state has different thresholds. Also, staying with a facility that would take Medicaid would alleviate the need to move them after a few years.

 

[Likes_to_Lurk]

It's important to get state-specific information. Try contacting your state's agency that deals with aging.

If your father was a veteran, he may be eligible for VA benefits. If so, you mother would be able to use survivor benefits if he passes before she does.

It's good to start looking into this as soon as you feasible.

Good luck. Take care of yourself. This can be very stressful.

 

[AllDone]

A huge portion of Medicaid spending is nursing home care. You probably should check with an eldercare attorney. Not all assisted living choices are covered which I'm sure varies from state to state. Also, if there are certain assets like a house, Medicaid may be able to claw back its payments from the estate after the second member of the couple dies.

 

[FIRE'd@51]

Generally speaking, one will be able to get into a better nursing home if one is paying the full freight. If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid. On the other hand, getting into a good nursing home when already on Medicaid is much less likely, if not impossible.

 

[NoiseBoy]

Generally speaking, one will be able to get into a better nursing home if one is paying the full freight. If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid. On the other hand, getting into a good nursing home when already on Medicaid is much less likely, if not impossible.

Ah, this makes sense to me. The facility we toured did not accept state aid, but they have a sister facility that does, so we've learned that that is a question we need to ask. Also, my father is a veteran, so I'm am getting the papers together so I can meet with the VA to see about any possible benefits. I'll have to call the state because the website wants you to fill out an application, but otherwise doesn't give much useful information on nursing home benefits.

 

[Likes_to_Lurk]

You can get help with the VA application. When my mother became eligible, a VA specialist at her nursing home put the application together. He was associated with the American Legion, but worked for the facility. The VFW also has people trained to do this. This helped me at lot.

Also, have you had your parents professionally evaluated to determine what type of facility each needs? It's important to know if they need assisted living, nursing home, etc. I wasted a lot of time with my mother looking at places that were not equipped to deal with her. An evaluation can be done by a nurse or social worker. Their needs will likely change, but you have to start somewhere. Nursing homes and some assisted living places will require some type of assessment of needs.

 

[Likes_to_Lurk]

Generally speaking, one will be able to get into a better nursing home if one is paying the full freight. If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid. On the other hand, getting into a good nursing home when already on Medicaid is much less likely, if not impossible.

I found this to be the case with my mother in Pa. Most places were looking for 1 year of private payment before going on Medicaid. She had about that amount when she went in and was there for an additional 2 + years.

 

[The Rodent]

The application for Medicaid benefits is quite lengthy, at least in New York. I did it for my stepfather. His care facility recommended a local company that helped me gather all the necessary information, prepared/submitted the application,and represented me when the Dept of Health Services reviewed the application. It was well worth the cost (SF paid for it anyway)

When your speaking with various care facilities, inquire about the type of service I mentioned above. What looked like a complicated and difficult process became a very quick almost turn-key event.

Don't drain down your own money to cover costs if they can qualify for Medicaid benefits. It may be emotional but rational business-like decisions are needed. Do you have power of attorney to represent them if needed for financial and health matters?

 

[youbet]

We're in NE Illinois. Three+ yrs ago, We went through the ordeal of getting DW's mother into a quality NH with the circumstances that she could private pay for about two years and after that would have only SS income. We succeeded, at least so far. She's been on Medicaid for about a year, has stayed in the same home and same room with the same amenities and level of care as when she was private pay. It's a pretty nice place (we toured a ton of them) and the percentage of Medicaid clients is small.

We found that the NH's evaluate each potential client's circumstances (health, finance, special needs, etc) specifically and carefully before committing to take them on with a guarantee they can stay on when they run out of money.

Your circumstances are different that ours because you're dealing with a couple and each has different care requirements. And you're talking about assisted living where my MIL was ready to go directly to full NH.

You mentioned your parents have some ongoing income and this can be a critical factor. If their ongoing income would pay for a significant percentage of the ongoing costs, that's a big help. A NH might look and see that their ongoing income will cover one third, vet benefits another one third and that they'd be chasing Illinois Medicaid (hard folks to actually get any money from even after they approve your application!) for only one third. That would make your parents more desireable than clients whose ongoing income might pay for only 10% and there are no vet benefits.

There's a lot to it and you'll need to both educate yourself and shop around a lot. If I had it to do over again, I'd likely hire some pro help to assist me.

 

[EastWest Gal]

It is my understanding that living is NOT a nursing home. Assisted living is not paid for by Medicaid, directly. However, Medicaid may pay for assisted living in some states and some circumstances.

http://www.aplaceformom.com/senior-care-resources/articles/directory-state-medicaid-websites

 

[MRG]

A great point being made is how much elder care financial assistance can vary by state. When my parents were in FL DM could, at least then, sign off her ownership on joint assets. Basically leaving her indigent and eligible for Medicaid. Instead they moved to PA, that angle didn't work, she passed shortly so that didn't matter. A few years later DF was in assisted living and needed a memory unit we learned about filial laws and the possibility of paying the difference between Medicaid and rack rate.

Get an elder care attorney. It's the cheapest and best way to go.

 

[youbet]

If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid.

Because he is in Illinois, I would advise OP that this would be a dicey assumption to make. Illinois is a slow/no pay proposition even after the Medicaid application is approved and NH's realize that Medicaid clients are really charity cases on their part. If you plan ahead and have your loved one in a "Medicaid bed" at the time they run out of money, the NH is mandated to keep them. However, without planning ahead and perhaps having your loved one in a home where there are no Medicaid beds, or in a "non-Medicaid bed" in a NH with a percentage of Medicaid beds, they're history when the money runs out.

I have a close friend in neighboring Indiana who recently had to move his mother when she ran out money. She had been private pay for over 7 years in an upscale facility close to his home, but it was a private pay only facility. Because of his mother's health and age at the time of entry, it seemed like a sure bet she'd pass long before the money ran out. But, not so. He said it was a really tough job finding a decent place, reasonably located, that would accept her on Indiana Medicaid from the get-go. It's a circumstance I'd work hard to avoid.

 

[youbet]

A few years later DF was in assisted living and needed a memory unit we learned about filial laws and the possibility of paying the difference between Medicaid and rack rate.

MRG...... Could you expand on this a bit please? I'm not quite sure what you mean. Who "paid the difference between Medicaid and rack rate?" Are you saying that in your state, the caregivers might be able to come after you for the difference between Medicaid and the rack rate?

Thanks.

 

[travelover]

My experience with FIL was that when he had to leave the nursing home temporarily to go to the hospital, he was out unless we paid for his bed while he was in the hospital. Once he was released from the hospital, we were back to square one in trying to find a nursing home with an open bed.

He passed before he actually had to go on Medicaid, but it made me question whether the nursing homes that took him on Medicare / private pay would have accepted him on Medicaid.

 

[Walt34]

Get an elder care attorney. It's the cheapest and best way to go.

I second that. The elder care attorney was invaluable in dealing with FIL's issues a few years ago, and well worth the fees. There are so many "gotcha's" in this that you will appreciate the expertise the elder care attorney brings to the table.

As to whether the assisted living facility will keep your parents or kick them to the curb when resources are exhausted, that depends on the facility's policy, not state law. The better ones of course will let them stay and accept what Medicaid pays but of course you're going to pay more up front to pay for the ones that run out of money. Normally these want to see assets that are enough to pay for at least one year of full nursing care (not just assisted living) and usually two years.

 

[MRG]

MRG...... Could you expand on this a bit please? I'm not quite sure what you mean. Who "paid the difference between Medicaid and rack rate?" Are you saying that in your state, the caregivers might be able to come after you for the difference between Medicaid and the rack rate?

Thanks.

That's how I remember it. That state, PA, had filial laws permitting homes to come after the clients kids assets. I don't believe IL has them, it's really the notion of how different each state is.

Here's a link to one article:

http://www.post-gazette.com/busines...sibility-in-Pennsylvania/stories/201410260034

 

[Teacher Terry]

I became the guardian for a good friend of mine when her husband died because she has Alzheimer's. I put her in a home that would take Medicaid when she needed more care and the price increased. She had to be put in the locked portion after a year and the cost doubled. I told the home to apply for Medicaid since they moved her without asking or telling me. They did and we have been assigned a social worker to assist.

 

[marko]

Generally speaking, one will be able to get into a better nursing home if one is paying the full freight. If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid. On the other hand, getting into a good nursing home when already on Medicaid is much less likely, if not impossible.

This might be a state by state issue.

In Mass, you can be paying full freight and sharing a room with someone who is on Medicaid. 70% of all NH cases in Mass are paid by Medicaid and is the preferred method of payment by the NHs.

Back in the day, my grandfather wanted to pay his own way and they were stumped as to how to bill him; they never had anyone pay their own way.

 

[Teacher Terry]

In NV if your monthly income is over 2100/month you can't qualify for Medicaid. Also you can't have more then $2500.00 in assets. Not sure what you do if you need care that costs more then that and you don't have the $.

 

[youbet]

That's how I remember it. That state, PA, had filial laws permitting homes to come after the clients kids assets. I don't believe IL has them, it's really the notion of how different each state is.

Here's a link to one article:

Elder Law: A new twist on filial responsibility in Pennsylvania | Pittsburgh Post-Gazette

Oh yeah, thanks. I remember that one now. It's interesting that there do not seem to be a flock of similar cases cropping up in Pa. If this case opened a big precedent, there don't seem to be many (any) taking advantage of it.

In this case, Medicaid (at the time of the article) had paid nothing. The NH was suing for the full amount. I wonder if perhaps in cases where Medicaid does make the normal payment and the NH accepts that payment, if the NH must consider that payment in full? This would be similar to Medicare where providers that accept Medicare must accept the Medicare negotiated allowable charge as payment in full. They can't go after you for the difference between the Medicare allowable max charge and the provider's rack rate.

The expense of LTC is interesting stuff. Sorry OP if I took this off your topic too far........

 

[LauAnn]

My dad was in an assisted living home. The place was not a nursing home but provided personal care and dispensed medicine, including insulin shots. Since they were not designated a nursing home, Medicaid would never have been a viable form of payment. We were still paying with Dad's own assets when he passed at age 87. If Dad had lived longer and run out of money, the assisted living home would have garnered Dad's social security (about $15,000 a year) which only would have covered 4 months expenses at the home. They would have let him stay the remaining 8 months rent free. And would have continued this cycle until he passed. This arrangement would have kicked in after the home having received about 4-5 years of full payment. If at some point he needed skilled nursing, he would have to move and then would have blown through his assets much quicker in a nursing home and then Medicaid would have kicked in.

 

[braumeister]

This is probably very state-specific, but a friend of mine had to deal with his mother's late life problems, and was really in a bind regarding the 5 year look back provision.

He found an attorney who specialized in elder law and learned that there was a loophole. If the mother received in-home care rather than an assisted living establishment, and if he and his family committed to providing half the care (in other words, 12 hours a day, seven days a week), then they would also halve the look back period to 2 ½ years.

That's what they did, and it worked out in the end. But having to be at his mom's bedside 12 hours every day for years took a terrible toll on him, his wife, and their kids. Basically, they put their lives on hold for years until his mom finally died. Incidentally, she died at 103.

 

[NoiseBoy]

The expense of LTC is interesting stuff. Sorry OP if I took this off your topic too far........

No worries, Youbet, it's all interesting and thank you for the Illinois specific information. An eldercare attorney is starting to sound like the way to go. Mom has a Prudential life insurance policy that I'm all but sure is a stupid waste of money, but just try telling her that! However, my parents are from the generation that if a doctor or attorney tells them something, then they believe them. That was how we got Dad to stop driving at 91; his doctor said he shouldn't drive anymore.

And thanks for the tip that assisted living care may not qualify for Medicaid. That is a wrinkle I had not heard of yet. I'd say that their monthly income is equal to about 40% of the assisted living rates that I've seen, and we may pick up something from the VA. Dad turns 95 in January and uses a wheel chair to get around the apartment. He is amazingly self-sufficient for his age and mobility. But it feels like the time is right to negotiate our way into a good facility before a significant illness drains their savings.

 

[COcheesehead]

Generally speaking, one will be able to get into a better nursing home if one is paying the full freight. If you then run out of money while in the nursing home, it is unlikely that they will put you out if you have to go on Medicaid. On the other hand, getting into a good nursing home when already on Medicaid is much less likely, if not impossible.

Be careful with this. I am not an expert by any means, but I had a friend who was an elder care attorney and he was fighting a case where the elderly person on Medicare was put in the hospital for an ailment and the nursing home would not allow them back claiming they were beyond their care. So there are ways of getting around this.