How do you find a place for your mother who has dementia and has no assets at all?

This doesn't apply to original question but does follow the thread about a pitch for the sale of financial instruments....look into Long Term Care Insurance, LTCI. There is an excellent booklet called A Shopper's Guide to Long-Term Care Insurance put out by the National Association of Insurance Commissioners. It clearly defined terms, explains the long term care coverage provided by Medicare, how to compare policies, how to determine if you even should consider purchasing this type of insurance, and who is not likely to qualify medically for the insurance. The NAIC is an association of state government officials. By the way, for the federal employees and annuitants, order a LTC package of info from OPM. I looked mine over and realized that relatives such as a spouse and adult children could also qualify for their own policy. Also something to think about, if someone could qualify for LTCI medically but might need help to cover the high premiums, would the adult children kick in for the insurance payments? Might be a great way to insure that the need to provide care won't derail their own career and finan cial future down the road when an elderly parent does need care.

It's always good to talk to a elder care lawyer when dancing with these questions. There are people with plenty of money that think they can get free government assistance but it doesn't work that way. A spenddown is required but certain restrictions apply (and your records can be checked). If it is appropriate for a person to remain at home then spending money on home help/products/whatever for the best possible "quality of life" is what I would suggest. Once a person is spent down (usually to a $2000 asset limit) they can apply for Medicaid- however at that point they have little money/control over what happens next. "Spending money" is a hard concept for many seniors that have saved all their lives- but if that is required for them to remain safe, at home, and have "quality of life" as long as possible then "spending money" would be in their best interest vs. seeing everything disappear quickly with out of pocket nursing home costs and then applying for Medicaid assistance.

If your mom has extra money in the bank, she will need to spend it down before qualifying for Medicaid. You can still get her into a facility, but she will need to use the extra money to pay for her care until it's gone. This is sad but true, but this is how it is

Thank you igloo. Very interesting. Do you know if an irrevocable trust is considered by Medicaid for assets?

Igloo572 --

Your explanation about annuities is thorough and enlightening.

Señorita - IL is independent living...like they live in an smallish apt that is within campus that provides for some meals at the cafeteria and activities and daily check-in. My mom was in IL in a tiered facility...there was IL, AL & NH and a hospice wing all on the same campus. IL is always private pay; AL is usually private pay and some states do Medicaid waivers for AL. Often tiered facilities are CCRC - continuing care retirement communities & these usually have a "buy-in". The buy-in types are expensive 200-300k. My aunt - who I was executor for - moved into a CCRC less than 2ms before she died & the contract was totally written for the benefit of the CCRC. Personally I'd bet that a lot of the older & establshed CCrCs are going to have problems providing the things in the contracts in the near future.

There are also subsidized senior apts. but those usually don't have daily cafeteria type hot meals and activities. My late MIL was in one.

About the "dinner" card.....well those are more than likely from a "senior financial advisor" who probably is an agent with an insurance license who is selling annuities. They might be called all sorts of things at the seminar but are annuities. Annuities usually pay pretty significant commission structure for the agent for the life of the policy which could be locked in past whatever is actuarial tables for your age. Personally I find most annuities to be a pox on the scared & gullible financially unsophisticated elderly.

Annuities by & large are never Medicaid compliant, so if you need to get Medicaid to pay for NH, you are going to have to surrender the policy and it will be very VERY very costly. If you go to the dinner ask what the commission is in real number $; ask if it can be written to be Medicaid (Medicaid not Medicare) compliant without penalty; and what the surrender value & charges & fees will be at 5 years, 10 years, etc.; ask what $/% of early withdrawal can be done & what the penalty & fees are for doing this. Ask if they hold a Series 7 license. Ask for their insurance licenses registration with your state and for what types of insurance product - sometimes the ones doing the dinner are not a license agent but a salesperson working for an agent. Ask for the name & contact info of the compliance officer (for consumer or policy holder issues) for them & or their district. If they give you hard looks, tell them a fib...that your nephew is an investigator with DOT (US dept of treasury) or IRS and he told you, his beloved Auntie, that these were important things to ask about. Usually the more high end the restaurant, the more affluent the audience pitched to. if you go -hey its a free meal & outing! - and they start uncomfortably pressing on you...tell them all your $ is in an irrevocable trust with the catholic church as the beneficiary of the trust, that will stop them in their tracks.

Senorita --

I suggest that if you attend the seminar, listen carefully, take notes, and don't sign anything. If it sounds too good to be true, that may be the case. If you can, bring a friend with you so the two of you can discuss the information that is presented. I feel uneasy about their statements, "you don't have to spend down your money" and "receive benefits even if you have significant assets". I have been the sole caregiver of my late mother and my late husband, and don't regret having spent on consulting legal professionals.

Igloo572 what is IL? Also, I received a card in the mail about attending a seminar about paying for NH and it said things like "you don't have to spend down your money" and "receive benefits even if you have significant assets". Anyone know about that? This is in California.

Someone else mentioned exactly what I was thinking:

Get your mom on Medicaid. Medicaid is a needs-based program that covers people who have no money or assets

This is just from my experience; I'm not a financial expert. When my husband became ill, but still knew what he was signing, we changed from joint checking to individual accounts. Medicaid took both incomes into account, but the separate accounts made things easier to work out.

Checking accounts: Would you know if the services available look at only my husbands income or being I am still working do they include my income when applying for services needed in the future for a dementia patient. Should I have my own checking account with my earnings, instead of our now joint account?

Hi Deb,
I was just in your situation last year.
For Medicaid (in California, it's called Medi-Cal), you can only have $2000. in assets. My mother, however, had about $15,000. in the bank but had no home or car. We were told by social workers connected to her health insurance that she would have to "spend down" her money to $2000. I thought I could just transfer it over to my account but they actually check on the money in the account and want receipts for her care. I thought the process would be very disruptive for her, finding a place where she's comfortable, while using up her money, then applying for Medicaid and having to take her out of the facility and move her into one they'll pay for.
I was told that a "Board and Care" home (a home residence where people needing care live with caregivers), is the cheapest way to go and also less "institutional" than a Nursing Home. Board and Care homes can be just for living assistance and/or also for memory care. Unfortunately, because she has dementia, she would need the dementia care and the cost in our area (Southern San Diego, California) is about $3300. a month. She would blow through her money in less than 5 months.
For Medicare (seniors' health insurance) to pay, the senior has to have a "skilled" need, (some type of treatment that only a medical person could do). She did not have that need, so Medicare was not an option.
Her deceased husband was not a veteran, so that wasn't an opinion either.
I am an only child and the breadwinner of our family. I have to keep working and could not take care of my mom. My mother has been pampered all her life and wasn't about to share a small room with anyone either. Iwas really up the creek without a paddle. I was calling anyone and everyone I could think of, as it was imperative I move her soon, due to her increasing confusion.
Since I live in Tijuana, Mexico and commute across the border to work, a social worker suggested looking in Mexico. We got 3 leads from her and we checked out 2, Both nice places with good staff that spoke English. One was an American company and the other a Mexican company that follows the American standards of elder care. We picked the place the next town down from us and on the whole, I've been pleased with it. Mom has settled in and seems as adjusted as a person with Alzheimer's can be. The price is $1300. (U.S. Dollars) a month for a private bedroom and shared bath with one other lady.
I really didn't know what else we could have done. I'm NOT saying this is an option for everyone, but thankfully it worked for us.
I took my mom to an elder attorney for Durable Power of Attorney BEFORE she got too bad because I knew this day would come. IF you don't have DPOA, technically, you aren't allowed to make any decisions for her. Going for custody of your parent, I'm told, can take months or years wrapped up in the court system. I made sure to have the 2 doctors that examined my mom write out a letter so I'd have it to transport her back and forth across the border.
It's so sad that the well meaning family of the dementia patient have to jump through so many hoops and hit the wall to just get some help for their loved one.
Good luck and keep asking for help. Hopefully you'll get an answer that works.

I suggest reading all the answers here and then copying the ones that seem useful and pasting them in a document to reread. I wish I had done that when my husband's social worker said he needed to be placed in a nursing home. It would have helped familiarize myself with terms like "nursing home Medicaid and given me a source to start my research. I was fearful of signing the nursing home's contract for Medicaid Pending, but it all worked out well.

Dcoach - about the route of getting admitted from being in a hospital. Why this works is because of Medicare. Medicare NOT Medicaid.

Medicare will pay as a full 100% benefit for rehab for 21 days upon a hospitalization discharge if rehab orders are done. And then Medicare will pay 80% for up to 100 days. Almost all discharges get rehab orders. Almost all NH are skilled nursing & rehab facilities. It's something like 70% - 80% of residents enter a NH coming in as a post hospitalization Medicare paid rehab resident. The NH loves, loves, loves this as Medicare pays lots, lots more than medicaid. And they want them to stay as long as possible on rehab due to this with the 20% is either private pay or coming from a big insurers (like BCBS).

Also by being in the hospital & then into NH for rehab, it creates the big fat medical chart to clear show the elder is "at need" so will qualify immediately for the medical at need review for Medicaid to stay in NH once rehab ends.

Having them move into NH from either living at home or IL can be done. My mom was in IL and totally bypassed the AL stage and went from IL to NH with no hospitalization. But family is going to have to become real proactive with the elders medical chart & MD to go this route. For my mom, it took about 6 mos of every 3 -5 week vists to her gerontologist. The visit mom had a 10% weight loss, a bad H&H lab report & a couple of other issues, her doc wrote orders for skilled nursing needed. Got mom moved from IL to NH about 4 weeks later.

Deb - mom is still living at home, right? If so you kinda have to have 2 different plans going: to get mom eligible both MEDiCALLY & FINANCIALLY for Medicaid. There is the tendency for articles & posts to make Medicaid all about $$$, but they have to be "at need" for both. Medicaid is an at need entitlement.

For medical, mom will need to have a medical chart & orders from her MD that skilled nursing care is needed & documentation within her chart to show that. Just being old, incontinent, forgetful, needs help on ADLs won't cut it. Does she have current written orders for skilled from her doc? If not, please post that.

For the financial, find NH or two that you are comfortable with & that can provide the level of care that mom needs & that will accept mom as a " Medicaid Pending" resident. Medicaid Pending is crucial in all this. The NH Medicaid process in most states is that they need to apply for Medicaid in tandem with moving into the NH. The application is done at the NH. So that their medicaid application along with the facilities bill to the state go together to the caseworker for processing. When you visit places, they should give you a list of items they require to determine if ok for pending & the state requires for Medicaid. It will vary by facility & state but in general their current "awards letters" (like SS, pension), their insurance as if those have cash value it needs to be spent down, property ownership past 5 years, and banking (this lil gem can be 6 mos to 5years). If you see a problem with items required, you need to get it worked out before they will ever be eligible. It could mean needing an elder aw atty or coukd be stuff you just have to request (like life insurance info) as moms DPOA.

Someone posted about them putting $ up & getting it back (once on medicaid), that cannot happen. Medicaid rules on assets are fixed, almost all states have assets set at 2K. Getting any funds that take them over 2k into the next month means they will become ineligible. Medicaid does renewals in which a review is done, the $ will show up. Medicaid means they are impoverished and stay impoverished.

When touring NH, see if what the NH does fits mom, like if your mom is the type to like arts & crafts (mine was) then does this NH have an activities director that is crafty? Of yours likes to sing, does this NH do sing a longs? Do the residents look like your moms friends? Look at the rooms with residents when your walking down a hallway to see an empty room.... do they look lived in, are some of the doors personalized (like wreathes or decor) or is the whole place kinda military and austere? personally I've found visiting around 10/11AM is best as residents are dressed and moving about...yiu can tell of there are groups going on, & socialization happening. If you can stay for lunch, do that to see how staff interacts with residents. A fancy with fountain in the front arched driveway tower NH may not be as good as the old X or V building layout 2 story NH with less beds. Also residents tend to sit & mill around the nurses station as its their daily "theatre", see if the residents seem comfortable.

Expect NH to ask what moms awards letters total to. My mom had an mo income of $ 1800 a mo & the places I visited were positively giddy about this.

Do you know about the co-pay or SOC requirement set by Medicaid?
Do you know about the personal needs allowance & it's NH trust fund?
Does mom have assets over 2K? Assets not income....

Yeah its alot to deal with. Really buy a couple of binders & start to get organized, visit places, speak with her doc. It can get overwhelming so take time for you too.

and no matter where you place your loved one, make sure you find out IF they accept Medicaid.....some places do not.

You also may want to consider placing your mom in a personal care home. They are much more affordable, provide a small intimate environment, more personalized attention, and care. Of course you have to be very selective in choosing one. Like nursing homes, they don't have the best reputation, but there are certainly good ones--hopefully in your community too. Make sure it's licensed and do your homework! The state licensing office can provide you with a list of them.

contact local office of aging, contact elder attorney (which I found out thru here) and have them help your parent apply for Medicaid, it might take several months but most NH will (and especially if you have an attorney involved), will allow your parent to be admitted and wait for the payment from Medicaid. wishing you luck.......its a lot to deal with but the attorney can help.

You will need to apply for nursing home Medicaid, if you are planning on placing start looking now and get on the waiting list. I know here there is a great need for Long Term care but no beds. If she is able get the power of attorney signed asap you will need that.

Is your mom the Veteran or was that your dad? If she was the vet, then recieving aid and attendance shouldn't be a problem. Spouse privledges, however, may be different. You need to check with the local Veteran Hospital or online at the Veteran Association's website. If Aid and Attendence is not available then the VA might be able to help get you linked up to your State Medicaid's office. If she's eligible for A&A and it's not enough, then you and the VA should be able to work together with medicaid to cover the difference needed to get her placed somewhere. If you're mother is not in full dementia, you should try now to get her to sign you as her Power of Attorney, if she's not done it yet.

There's a lot of hoops to jump through, so the sooner you start jumping, the better off you and your mom will be. If you don't have Power of Attorney and mom's not completely impared, you need to try to get her to sign over POA to you. It will be very helpful when it comes to getting her help. Without it, if she tries to fight you (as well she might as she get's worse), you might have to go to court to have her declaired imcompetent, a painful and expensive process you should try to avoid.

May goodness and mercy be on you and your mother's side in this very hard situation.

Medicaid is the insurance plan provided for those with few/no assets. Most people pay into the plan through taxes during their working years. If a person has few assets (varies by state - for example in Florida it is $2000 plus a house and a car) they can apply for Medicaid and, once approved, it should cover the cost of the care needed. You may find an Elder Law attorney helpful in the application process but most facilities can help you with that as well. They may require one month of payment up front while the person is Medicaid-pending but then they refund that. You may find a facility or person in your community who will help you with the application (it is online) at no cost. You would still need to find a facility which was appropriate for your mother and which accepts Medicaid patients/residents. They may be a challenge but there is at least one in most communities. You may need to be on a waiting list until there is an opening. It is often quicker to get admitted if the person has to be hospitalized for a few days. If that happens the hospital social worker can assist you.

Contact a social worker at the her hospital or your local county agency. Apply for Medicaid.