sister end of life
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ivinsfan
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Such a tragic outcome for everyone. You might think you are good, but realistically how could you be good? You are getting all the feels from every direction. Take care of yourself and God Bless you and your sister.
Sunset
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Glad you are pushing for pallative care / hospice AND letting them know you live FAR away.
She needs to be in a nursing home / hospice facility if not the hospital.
Take care of yourself, you have already done a lot.
daylatedollarshort
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It sounds like you are doing more than enough already without providing full-time hospice care, too. In another forum I am on, the hospital tried to get one of the members to accept release of her father and have her pay for in home therapy, and the hospital said they would rent her a hospital bed, wheel chair and a hoyser lift. The man couldn't even get out of bed on his own and they wanted the family presumably to quit their jobs to provide 24 X 7 skilled nursing care, and cover all the medical costs they were in no way legally required to pay for since he was a visiting relative from outside the country and not any dependent of theirs.
So even if they push for you to provide 24 X 7 hospice care, if it were me I would refuse to accept the release. Be emotionally prepared that it is possible they may try to make an unreasonable demands on you and make you feel guilty for not solving their Medicaid care patient problem for them.
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ugeauxgirl
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You are doing a great job with an awful situation. Prayers for you and your family.
street
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What a tough time for you. I send my blessing to everyone involved and all will work out, just one day at a time.
Stay strong.
Stay strong.
EastWest Gal
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You are being a very good brother to help do what you can for your sister, niece, and nephew at this time. It is difficult for all of you, and the doctors too. What your sister has leaves few options.
It puzzles me is that there are the kidney and liver specialists, and a palliative care physician, but who in the hospital is coordinating her care? Who is considered her primary physician team in the hospital? I'm assuming there is a general medical team that has called in the specialists. Have you spoken with them? Acute care physicians can get distant when they feel there is nothing they can do.
Meet with the palliative care physician, specialists if you can, and talk with primary team. The palliative care physician will probably provide you with the best information and support. The focus of palliative care is overall quality of life, physical, emotional, spiritual. If she has hepatorenal syndrome due to cirrhosis, she is unfortunately unlikely to survive. Most pain medications have to be used with caution with kidney and liver failure. There is no easy solution to any of this, but focus on her comfort and pain management.
Neither you nor her children are responsible for her medical bills. Do not worry about estate recovery at this time. That occurs if she is on Medicaid, and several months after she is gone. That is a discussion for a much later date. Depending on her state, there may be none, or only for skilled nursing outside the hospital. Most states only go after the estate for skilled nursing care; only about 10 states try to recover all medical expenses, and they are last in line after all other bills are paid. If she makes it to discharge, and gets skilled nursing somewhere, that is what the state will most likely go after. Getting her on Medicaid can be financially helpful to your niece and nephew, as there may be something left of her estate. Otherwise, the hospital will claim a lot of it.
Focus on your sister, and what you all can or cannot do to help her now. Be there for her and your niece and nephew when you can. My thoughts are with you and your family today. I'm glad you are working out; taking care of yourself through all this is a high priority.
wdwwildbill
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Prayers to your family ...
I'm good because I have an incredible DW at home. Totally independent and has my back. $ situation is good for me and DW. Sister did this to herself. I have survived mutiple combat tours so this is a piece of cake. Today I had to tell my 89 yr old mother that her daughter does not want to see her. Trust me, I DON'T want to deal with this. Basically the only person in the family that CAN deal with it. My contract ended the end of June. I'm on 5 weeks leave and 13 weeks serverance. Baseball (umpiring) just ended and volleyball picks up in a few weeks. Perfect timing for my sister to be in this situation. Care facility contacted me today. Not sure when she is moving there but it will be in the next few days. Couldn't see lawyer today. Have appointment for tomorrow morning. Might have to sell house and car, put in an escrow account to pay for sister's incidentals. Will have to give any extra (at the end) to the facility or medicaid. I am verifying all of this with the lawyer. Dialysis again in the morning. Betting she will be gassed tomorrow afternoon. I don't want her to give up, but she probably should. The writing is on the wall in large bold letters. Thank you all for the comments and suggestions. I'm good.
Well, I'm 6'6", 250 combat vet. I was a bouncer for many years. My favorite word is "NO". Sometimes I proceed that word with "HE!!". I will literally walk away and block my phone and email. Then if the hospital/facility pushes her on the street I'll sue. In all seriousness, it looks like things are proceeding down the expected path. Facilty reached out to me today. The admissions lady and I seem to be on the same sheet of music. They know that she has nothing(not even a bank account) except the house and car.
ivinsfan
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Bigdawg you have tremendous clarity which will help you through this ordeal. God Bless
daylatedollarshort
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I'm glad things are working out as best they can under the circumstances. If the facility reached out to you today then it seems like the hospice care issue is being covered.
Gremlin
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You are an inspiration.
I have no doubt I shall be going through something somewhat similar in my future. I shall channel my inner Bigdawg. All my best!
I have no doubt I shall be going through something somewhat similar in my future. I shall channel my inner Bigdawg. All my best!
ohyes
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Hey Bigdawg,
Been following along and wondering if your sister is near me (Fayetteville, AR).
Hospice will be good because they will take care of the pain...and provide services such as chaplain visits if your sister is so inclined. I knew a patient once for whom the hospice provided a boom box and CDs of her favorite classical musicians because she had no family to help with things like that. They work to make the patient as comfortable as possible.
You have a lot of folks thinking and praying right now. Your sister is lucky to have you step up. The Roatan trip will be just what you need. Glad you have it to look forward to.
Been following along and wondering if your sister is near me (Fayetteville, AR).
Hospice will be good because they will take care of the pain...and provide services such as chaplain visits if your sister is so inclined. I knew a patient once for whom the hospice provided a boom box and CDs of her favorite classical musicians because she had no family to help with things like that. They work to make the patient as comfortable as possible.
You have a lot of folks thinking and praying right now. Your sister is lucky to have you step up. The Roatan trip will be just what you need. Glad you have it to look forward to.
teejayevans
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Just went through this, hospital hospice would only take them for 1 week, if still alive they go to a nursing home. If you do in home care, they’ll provide a nurse to stop by during the day and 24 hotline. The nurse then will make the decision to transfer them to the hospital.
Yup, Just up the road in Rogers.
Sister had dialysis again today. Cleaned blood but no water removal. She seemed very upbeat and energetic this afternoon. She looked better. What does that mean? IDK. I met the lawyer today and we will attempt to sign trust paperwork on Friday. Started to plant that seed with my sister. Real estate agent and I are looking at the house tomorrow. He is thinking 135K. Shockingly high in my opinion. We'll see. All will go into the trust. Pushed my stay out until 4 August. Need to get back to some of my stuff. Might have to come back out on August 8th for a week. We'll see. I will ask tomorrow about when she will move to nursing home facility. Hopefully soon. I want that done before I depart next week. Hard for me to explain to her that she will never be going back to that house.
Yesterday I dropped off paperwork at the nursing home they want her to go to. The deed to the house and the personal property tax statement. We were suppose to meet with the lawyer today at the hospital. I put it on hold. #1. Nursing home told me not to do a trust. It might hold up admission and/or medicaid application. I think (so does lawyer) that is b.s. but I want/need my sister out of the hospital and into that facility before I leave town on Wednesday. #2. Not really seeing the upside to the trust. She only has the house (needs to be condemned) and a car worth maybe 7k. Maybe her SS disabilty checks would go into the trust also. Not sure. Setting up trust would cost me $1800. I would control it and would be able to extract my expenses. Is it worth it? I'm really not seeing it. A big hassle I think. If no trust then house and car will go into probate when she passes. My nephew is local. He can deal with that.
She did well again yesterday on dialysis. What does that mean? IDK. Still has shot liver and kydneys. Quality of life will suck for her. Cannot imagine her ever being a candidate for transplant. I will see palliative care doctor today hopefully and get a clearer picture. #1 priority is to get her out of that hospital and into the nursing home. Looks like I found a home for the cat.
She did well again yesterday on dialysis. What does that mean? IDK. Still has shot liver and kydneys. Quality of life will suck for her. Cannot imagine her ever being a candidate for transplant. I will see palliative care doctor today hopefully and get a clearer picture. #1 priority is to get her out of that hospital and into the nursing home. Looks like I found a home for the cat.
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.
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.
ivinsfan
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BD you're an intelligent man go with your gut and make an informed decision.
Some of the items LL listed might possibility be done but they can take time which you don't have a lot of right now.
For example on number 5 the nursing home office will notify the bank if she passes and the bank account will be frozen. So that's a non issue.
I'm with you on the trust don't think it's needed. Unless your lawyer works nights and weekends I assume the time statement the nurse talked was simply the lag between starting a trust going, getting all the paperwork done and getting it to the nursing home
Hope your sister gets settled in soon.
Some of the items LL listed might possibility be done but they can take time which you don't have a lot of right now.
For example on number 5 the nursing home office will notify the bank if she passes and the bank account will be frozen. So that's a non issue.
I'm with you on the trust don't think it's needed. Unless your lawyer works nights and weekends I assume the time statement the nurse talked was simply the lag between starting a trust going, getting all the paperwork done and getting it to the nursing home
Hope your sister gets settled in soon.
Oh, Bigdawg, I'm so sorry for all you and your sister and family are going through. Just went through a lot of this with my dad...it's not easy...sigh...
Medicaid came though (after a lot of hard work on my part!) wonderfully for my dad...I hope it comes through for your sister.
Keeping you all in my thoughts and prayers - stay tough!
Medicaid came though (after a lot of hard work on my part!) wonderfully for my dad...I hope it comes through for your sister.
Keeping you all in my thoughts and prayers - stay tough!
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?
Sunset
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I'm thinking it means the nursing home wants proof, the sister has assets as the cost of the nursing home is a lot , my experience is ~100K -> 140K for "reasonable" place per yr.
A lot of nursing homes won't take a person in who has zero assets.
Places I looked at wanted a minimum of $300K or 3 yrs worth of assets, they will also take nearly all SS except for ~$100/month towards the payment.
ivinsfan
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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.
EastWest Gal
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Some states have not expanded the the Medicaid estate recovery beyond recovery for long term care expenses. And the states are paid last, after other expenses are paid. Maryland and California are two states which aggressively pursue estate recovery. Most states just go after long term care expenses.
The reason for putting a house in a trust is to avoid probate. Since the estate is small, it may not be subject to probate anyway. This varies from state to state. You can look up her state here. An appraisal of the house should be done by a property appraiser, not a real estate agent. This may put the value of the estate under the state's limit.
https://www.nolo.com/legal-encyclopedia/free-books/avoid-probate-book/chapter8-2.html
The state does a 5 year look back for property transfers within 5 years of the application for Medicaid. It seems that move may disqualify her for Medicaid. There does not seem to be an upside to a trust, and there could be a huge downside. The nursing home may be correct in this case.
