Does a resident family member (with POA) have to pay nursing home, when resident can't?

I'd like to add some very recent advice to all as this is what happened to us. Although a little out of the ordinary here's the story..

My husband and I purchased my parent's house on a Land Contract three years ago. Never missed a payment.

Being that my dad's savings were beginning to become depleted, we followed Medicaid guidelines and spent down all life insurance policies, annuites, etc. ALL for his care as any funds spent on any one elses behalf would be considered a divestment.

After Medicare decided to stop paying for my dad's stay at the nursing facility, we have paid out of pocket for well over a year. Recently applied for Medicaid since Dad is spent down.

Here's the kicker. Since we bought my parent's property on a 10 year Land Contract and being three years into it..Medicaid denied my dad benefits. Their reasoning was that the Land Contract won't be paid in his lifetime according to their "statistics", and thus, they're considering two years a divestment.

They are giving us two options: Get a loan and pay off the property (which we are in the process of doing); AND in addition, claim a hardship, meaning that the nursing home my dad is currently in start eviction processes; in addition to giving him alternate places to live, including Assisted Living, etc. These places don't count on Medicaid for their payments, but on County Insurance, which would take my dad BACK to Assisted Living where many of the staff isn't even qualified by the State to give care. My dad has BEEN there and there is no staff even qualified to take care of the elderly.

Of couse this will never be the route we'll take for my dad as we'll simply take out a loan, pay the house off, and will use it for Dad's care until he's below the $2000 Medicaid point. However, the way they want us to go about it regarding claiming a hardship with the nursing facility starting eviction while giving us lousy options for my dad's care including Assisted Living and County Insurance while not getting to choose his providers is absolutely ludacrist!!

I have an insurance background and have done much of my homework regarding all of this. As a family we cashed out all of my dad's life insurance policies, annuties, etc. We did as we were told. However, knowing what I know now..we could have done it differently while keeping some of my dad's assets.

Nobody but nobody would tell me any of this, although I did my homework. We had to purchase a Funeral Trust, etc., which we did. We paid full value for the house regarding the Land Contract, in addition to a 3% interest. We paid down all my dad's assets for his care and didn't spend any of it on anything but dad's care.

So all of a sudden Medicaid came along and denied my dad benefits because of a loophole they found that "Statistics say that he won't live long enough to collect the full payment of the house.." and thus, that is a divestment.

Just a few month ago I read over and over again that if family made an error regarding making a divestment, it would be taken out of the estate. We would have been happy to pay Uncle Sam two more years of Land Contract payments if that's what they wanted, but now..we'll just get a loan and pay all dad's bills off.

Badda Bing..Badda Boom!! Ya gotcher money!!

The Social Worker that I worked with was soo very nice until Dad was denied. Then she became very cold to all my questions finally being answered as she rattled everyone off. It was like the Holy Grail to her.

My question was, "Why did I have to search underneath every single rock on the face of this earth to get answers on what I can and can't do regarding all the rules..and then once my dad gets denied..you can rattle them off like the Holy Grail??"

Good Lord, it still makes me angry when she told me, "Well, Medicaid isn't for everybody."

Of course not..especially for those that have worked and saved all their lives and thanfully for the ones who love them; outlive their savings. What makes me the angriest is that just becuse my dad sold the hosue to me, his daugter..you know the rest..he gets penalized.

What's Title 19?

where was the post about 6 mos.?

Retain an elder law attorney.

I think people are confused about the difference in Medicare and Medicaid.

I am still so surprised that many persons believe that because an individual paid taxes in the past, the state should pay for their nursing home care. That would be a nice world I agree, but the laws are not this way. Government only kicks in at poverty levels...and I mean POVERTY (Your last $2000 in assets or so).

careinhome, what would be the appropriate agency? just read on here somewhere I thought nursing home had to give at least 6 mos. before they started pressing for sale of resident's home; just stopped by a neighbors - never dreamed get involved in yet another situation - she was placed in nursing home, last fall, hasn't been 6 mos. - fell, broke hip, rehab, then long-term, had dementia already - nh telling them they at least have to list house whether sells or not - which then that makes me think and son, who's living in the house, had moved home - when his unemployment, from quitting, other issues won't go into yet - to take care of her, may have said they're saying they're being told that - by Medicaid? - but already is the point, when hasn't even been 6 mos.

My mother was moved from I NH in Mass ton another in NY, I cannot get a
Decent answer. By brother is/was POA, he refuses to let me get a copy of her med records.
She died a week after she was moved.she had a fall a month before the. Move.
Her hea;lath was bad, weak-wasn't in good condition when she arrived at new my. Brother has cut me off,even thought I was her caregiver in my for 13 yrs.
How can I find out about the move- why-the financial situation etc.she was private pay and that ran out,she was at the 1st NH for 2 yrs, but they claim she wasn't a resident. They also said it had something to do with property and assets in nyc. Non one will tell me about this.
I feel something was not right in the whole situation. Can u help?is it impossible form me her daughter, to find outs about her situation up in mass?why am I not allowed to see her medical records?i want to know what happened, I love/loved her and feel like I am being denied info because my brother may have not done everything according to legal standards,please help me-I will wait for your reply.

Other issues that may arise are gifting and look backs. As long as you are in compliance with those state/federal regulations, POA is not financially responsible. Sounds like the NH is just trying to bully someone for payment. If so, the NH should be reported to the appropriate agency. NHs take payments from the state via funds residents have paid in taxes to the state during their working years. Resident is not getting a 'free ride.'

Filial responsibility laws. Enter term in search box and articles will come up.

Does anyone know what states have those laws, and what such a law is called?
Or how to find out if they pertain to your particular family?

If you live in one of the states where the state can come after you for the care of one or both parents, then you can be found responsible for their bills, even out of your own assets. I wouldn't just "volunteer" to to be responsible though, and a nursing home can't make you. Even in such a state, they'd still have to go after you under through a lawsuit. It's an unpopular law in most places and I understand legislation is pending to change it in many states.

Whatever you do, don't commit in writing to be responsible for your mom's costs. If you have already done so, then you really should see an elder attorney to see if anything can be done.

pam, think I did see where you had mentioned that, as also thought I saw where you're one our resident experts - do understand where you're coming from, I think, I guess, depending on when it was done? - I'm still wondering about life estates - but especially signing as responsible party - but I was just addressing this post's issue but especially what I felt was a misunderstanding regarding the spend-down funds

debdaughter, in other posts lamama reveals that the house was put in other names. Bad move #1. She also signed as responsible party when mom was admitted. Bad move #2. So she is stuck between a rock and a hard place.

I thought she meant the money from the sale of the house would have to be spent down and I thought she said it had a mortgage, still not sure any of that's accurate; a friend just put her mom in and she was able to apply for Medicaid and her house had a mortgage, question I have if it has a mortgage, who's paying it?

There are so many conflicting comments on this thread it is a bit confusing. When someone goes from hospital to skilled nursing facility medicare will pay if they have stayed inpatient in hospital for 3 midnights or days. The amount of days they cover is as follows day 1-20 covered 100% day 21-100 covered with copay of 161.00 per day. Day 100 and over not covered. A person must be in need of skilled nursing care or rehab and must be showing progress for coverage to apply. If a person has medicare supplement policy they may cover the 161.00 per day copay as my mothers ins did. Now that being said of a person goes to a nursing home without a qualifying hospital stay medicare pay nothing. It is either private pay or medicaid in that case. We just went through this twice last year with mom so I know the journey all to well.

Just to set the record straight, POA is never responsible to pay any debt or bill of the person they are serving as POA for. I think my message might have been misunderstood; sorry about that.

Families are often overwhelmed by numerous nursing home admissions documents. Rest assured that family members cannot be required to sign as a “Responsible Party” for payment, 42 USC §1396r(c)(5)(A)(ii), although some facilities have asked family members to “volunteer” to act as a responsible party. The federal law says: “a nursing facility must (ii) not require a third party guarantee of payment to the facility as a condition of admission (or expedited admission) to, or continued stay in, the facility.”

Why do you think that: “Resident can't apply for Medicaid, until house is sold (it has a mortgage) and money is spent down.”? Who provided you with this misinformation?

Medicaid regulations allow eligibility if the applicant is taking steps toward selling the real estate. When the property is sold, the proceeds can be immediately deposited into a pooled trust account that will benefit the nursing home resident, or into a trust that benefits another disabled person. You may miss out on many options if you decide to try to go it alone through this difficult time of transition. An elder law attorney in your state can give you good advice and services that protect you and the nursing home resident.

To read the nursing home law:

https://www.law.cornell.edu/uscode/text/42/1396r

Scroll down to §1396r(c)(5)(A)(ii)

A nursing facility must have identical policies and practices for transfer, discharge, and services, regardless of source of payment. 42 U.S.C. §1396(c)(4). In my state (Massachusetts) state law prohibits nursing homes from discriminating based on a person’s source of anticipated payment. 940 CMR 4.03(1).

Medicaid reimbursements to the nursing home will probably be lower than if you privately pay, but the nursing home cannot require a resident to waive their right to Medicaid benefits.

A nursing home may be motivated to give preference to people who can pay privately, but they are not permitted to require a resident to give up the right to Medicaid benefits by requiring private payment for a time before the resident applies for Medicaid.

http://www.mass.gov/ago/docs/regulations/940-cmr-4-00.pdf

freqflyer you are correct, rehab stays are different than the 100 days that Medicare pays for ongoing Nursing Home Care. My Dad used the VA for medical so he didn't have any supplemental insurance. During his 100 days he paid out of pocket for the not covered portion of his stay.
He was no longer living in his apartment or needing his cell phone or other expenses so I just canceled everything and paid the Nursing Home with his money. Luckily his income was high enough that there wasn't a large amount he couldn't cover. He lived in GA and it took me years to get him on Medicaid because there was one bank account there that did not have a POA assigned. I froze the account because some young people had his debit card and were taking his SS $ as soon as it was deposited every month. The Nursing home was able to get the SS check transferred to them but I couldn't get the bank to send a statement or close the account. Finally when the NH was threatening to throw him out on the street I got a Bank Executive on the phone and said if they didn't fax the statement to my Dad at the Nursing Home or to the Medicaid Worker I was going to have the NH deliver my Dad to his office and he could figure out what to do with him.
What do you know the bank finally sent the required records to the Medicaid office!!
What a headache!!!!!!!!!

Lamama, you said in November that you signed for her unpaid bills when she was admitted. There is also some question about the house being put in the childrens' names. I think you know that is why Medicaid will not pay and why you are stuck with her bill. At this point you need a really good attorney or else you take mom home with you.

I am seeing some rather incorrect statements here. I think its important for people to avoid writing things that they don't know for sure to be true. Good sources consistently are pamstegma and freqflyer for the record. The poster suggests there is private money which has to be spent down in this case (in addition to the home) before Mom gets down to the Medicaid qualifying amount...so yes POA is supposed to be paying the nursing home for those bills from the patient's money...although not from her own assets. Make sense?

agency on aging / county senior services for information. Stay away from lawyers.

Unless Medicare made a huge change in how long they will pay for rehab/nursing home, my Mom was only allowed 21 days under Medicare at 100% last year. A few years ago my Dad had the same 21 days.

Then after the 21 days it depends if the patient is improving with rehab or not. If the patient isn't improving and needs to stay in the nursing home, then it becomes either self-pay or Medicaid. If the patient is improving, then Medicare will pay a certain percentage of the care, with the secondary insurance kicking in to help for a limited certain amount.... for a certain set number of days.

Good advice above. Lots of it.
BUT...the NH already accepted the person into their care.
While I totally respect they want to be paid for services rendered, they HAVE taken on that person.
So, they will also need to help find a place where the person can be transferred to, if they opt to move them out. They cannot simply dump the person on the sidewalk out front--that is "patient abandonment".
And, they cannot tell the POA to take the elder home with them, either.
They can bill the estate.
The assets up for sale, could be legally liened, I think. Need proper legal advice on how to do that. IF that can be arranged, the NH might be satisfied to wait for the completion of the sale.
Some people in the past, used to sign over their ownership of a house, for instance, directly to the NH, and the NH would then sell it off, and take what is due them. That gives the NH control of the asset, so they might feel more secure about being paid from the money, once it's sold.
Would this place do that?
Also, talk with DSHS and Social Services.
IS there some special arrangement, which would allow assistance for the NH care, while the asset is being sold?
Like, maybe, signing some papers to show that the money gained from the sale of the asset, will go to the NH to pay for care, and anything beyond that would go to the State, to repay Aid? Then after that, IF there is anything left, the residual left over would go to family?

And nope, a POA is not themselves financially responsible to pay the elder's bills out of their own pocket.
The elder, and/or the elder's estate, and/or sale of assets, and retirement funds, SSI, etc., are what is used.
Beyond that, State Aid can help.
A combination of SSI/MediCaid, are commonly used to pay for NH care. There are loads of elders who get stuck in this kind of limbo though, trying to sell off assets, and there being a gap between needing NH care and getting assets sold.
There surely must be ways to resolve it.

lamama, If you refuse to apply for Medicaid, they (NH) want private pay. So apply for Medicaid. If you previously applied and were assessed a penalty, selling the house will not remove the penalty.
As POA, if you moved money or assets out of her name, you could be liable for nursing home costs, as in HCR v. Pittas in Pennsylvania.
Work with a benefits counselor. Most NH facilities can refer you to one at no cost.

To Christine73
POA is not responsible for bills incurred by the person. Apply for Medicaid and list the house. Some states only allow you to keep the house for a certain number of months.
You cannot apply for Community Medicaid if you are already in a Nursing Home, it has to be Institutional Medicaid.
Call your local Medicaid office and ask if she can apply while her house is on the market and Medicaid will place a lien on the property. They will take back the money that they have paid out before the resident gets any money. The remaining funds will have to be spent on her Nursing Home Bills until she gets below $2000. Then she will be eligible for Medicaid again.
Medicare is not an option Christine73 unless she is coming directly from an INpatient Hospital stay of 3 or more days.
Please don't give inaccurate advice about public programs, it just confuses people.
If a person comes to a nursing home after inpatient hospital stay of 3 or more days MEDCARE ONLY PAYS 100 DAYS. not 200 or 365.

contact an Elder attorney asap. when my dad was pending Medicaid, it was 6 or 7 months before they got their money. but with the help of the elder attorney we got things situated so that things worked out. good luck

As POA, you must help resident pay out of her own funds. They have no claim on your assets. I will echo what everyone else says; it's worth it to consult an attorney and the sooner the better. He/she may even tell you that mom can keep the house or somehow shelter it. They have many options to get medicaid and preserve as much of the estate as possible.

I know Medicare pays for x number or days (200 or 365) at 100%. They may consider keeping her as Medicaid Pending status, but for that, medicaid needs to be pending. There is also community medicaid, which is a lot easier to get and takes less time. Once you're on community medicaid, you can be converted to institutional medicaid in the facility. Good luck, and please note, nursing homes are required by law to give 30 days written notice of intent to discharge. You are allowed to appeal that discharge. Worst case scenario, that will buy you some time.

Yes. You are not responsible as POA for mom unless you personally assured payment Being a POA means you "stand in the shoes" of your mom to deal with the business-side of her life. Always be sure to sign anything, For example, "Mary Smith, POA for Amanda Jones." That makes it clear you are signing on mom's behalf.

I agree with the others here, 1) you shouldn't have to sell her house to apply for Medicaid and 2) the nursing home is a business and has a reasonable expectation to get paid. However, before paying for an attorney, you coud start with your local area agency on aging / county senior services for information. They can direct you to free advuce regarding Medicaid etc. Hope this helps.

Yup, Elder attorney is the way to go, no doubt. You can't blame the NH for wanting to be paid. If not Medicare, then it has to come from somewhere. They are not a charity, and have bills to meet just as we do. They are not obligated to keep your mom without pay. But, along the same lines, as Jeannie says, if you did not sign anything, then they can't hold you responsible for the bills. If you did sign something when you put your mom into the NH, perhaps as a backup if you're mom can't pay, then you could be held responsible for the bills. So best to talk to an Elder Care attorney on behalf of your mom as her POA. The fee might be able to, ultimately, come from the proceeds of the sale of the house, since attaining the services of an attorney for your mom can be counted as being used for her benefit.