What can we do if mom won’t apply for Medicaid and she has no money to pay for her care?

Good to hear all the progress youve made, Optimist!

Just spoke with Geriatric Care Manager this morning. She indicates that if mom is competent and accepts the risk of being at home where she cannot get up, even if left for 10 hours, then she can be dismissed from nursing home. APS would make a visit but probably would not file report unless she was vulnerable, being mistreated, in very bad conditions, etc. APS probably has many very difficult cases which are their priority. Bottom line-individual has right to return home if they are competent and accept the risks of returning home. Might be eligible for Aid and Attendance from Veterans services (my dad was veteran, passed away 10 years ago), but would need to find home health care agency who accepts A&A and then you must pay them up front and VA needs to then reimburse mom, sometimes that can take weeks. But this is good news for those who want to stay in home. Maybe a little tricky to find out all the various rules involved (you know, typical with the military). And mom would likely benefit from home health services; encouraged to call local Senior Services office; they will often come to home, assess situation, and determine what individual could benefit from. Sometimes these evals are offered for free.

Also informed that family cannot be liable for nursing home bill unless they have signed a document when family member admitted to nursing home (fine print might say you are financially responsible), so be careful what you are signing! NH can be pushy to encourage you to sign (they are running a business, after all), just make sure you review, perhaps with lawyer, or do not sign anything like this as family member.

This provides some clarity and I am thankful for the resources out there. Now looking for some financial clarity on the situation about LTC, Medicaid, etc. Will keep you posted about sis's meeting with Elder Law Attorney today.

So if mom is not eligible for Medicaid currently because has helped sis out financially and she cannot afford to self-pay full balance in nursing home, what are the options? If she gets pensions, can she use these to partially pay and wait out the penalty period until she is eligible for Medicaid? I bet it is complicated (and varies with each individual) regarding the penalty period for Medicaid. And in this situation, would it make sense to sell her house up front to allow those assets to go towards self-pay until she is eligible? I am just wondering about other options and I'm beginning to think there are none. She almost definitely would not qualify for assisted living as she cannot do anything for herself except eat if the food is put in front of her. Am I understanding this correctly? Sis cannot take her back in as she needs to work and is gone 10 hours a day. Are there other benefits she is eligible for as a spouse of a veteran (I think she might be eligible for Aid and Attendance but likely difficult to get her back into home given its condition, I'm thinking.)

Optimist, There's a whole body of research on adults who have been given "economic outpatient care" = subsidized living. I'm at the point where I wonder how much/long is reasonable to allow my recent college graduate while he looks for his first career entry job. I understand your mom's struggle.

I also have experience with hoarding and the secret keeping in families beyond hoarding. My therapist said the psychology of it is very much like that of alcoholics', and my children of hoarders group also feels hoarding is an addiction problem. When people buy, there is some kind of chemical release in the brain that is addictive, just like drugs and porn produce. Odd, yes, but when you look at it that way, you understand better why they are trying to hide it. That can also give you insight into how hard it would be to cause any change in 42 until she hits rock bottom.

Hoarders, as you have seen, don't change even with a perfectly clean house in front of them. Your sister42 is not the right place for mom because even if mom had a perfectly functioning home, 42 would fill it right back up. Mom needs more care, and if 42 loses the house, so be it. Fine, not your drama, but it might push 42 towards rock bottom/recovery.

My neighbor is a realtor, and her hubs recently passed. Just for info, she called one of those buy your home places. They offered to pay off her mortgage.. no more no less. She asked them,, then where do I live? No response! They want your house are bare minimum,, OK if it's paid off maybe... but your not going to see much. Better to call a reputable realtor.

surprise-mom was trying to do the right thing by helping out 'Sissy42', only to have caused herself a heap of trouble, potentially. She is of the old-school thinking that as long as it's in the family, she can gift what she wants but unfortunately Medicaid might not see it like that. 'Sissy42's issues are a whole separate issue I could talk about but won't right here (anymore). But mom has probably enabled some of her poor choices (but again I want to say she has been solely responsible for keeping mom in her home for as long as she has--for better or worse). She's not really 'livin' the dream' but could be in a better place financially if she had made some better choices. We could probably all start a new site of 'poor choices our sibs have made' and how it has affected us and our parents, right? I have been trying to encourage Sissy42 to meet with a lawyer to settle her own finances (offered three times and she never took me up on the offer to pay for that consultation!). In denial to her problems and doesn't want to be proactive to fix them, even if that means losing more money. Aggravating!

igloo572, yes middle sis going to atty meeting. No, I haven't shared with her the questions I have. I am hoping that the two of them can sort it out themselves although I am sure I will have plenty more questions. I am trying to keep out of it as if I am on the call, they might think I am trying to control things. I expect to hear the outcome but would just like to wait and see what comes of this. You're right, I should conference call atty after the meeting just to get his side of the story and recommendations.

Middle sis ('princess sissy') lives in her own protected world and is coming only because it is no inconvenience for her. She truly loves my mom, I do believe, but her actions have been very planned to do only what benefits her. As a family we all were notorious for avoiding confrontation (which meant walking away from any difficult conversation and sweeping sh** under the rug and not addressing it). Hence, this is why we are in the problem we are in, because no one wants to have the difficult conversation about finances, planning for the future, what to do when you cannot care for yourself.

Opti - well it’s beyond fabulous that Sissy42 will meet with elder law atty. it kinda sounds like mom & 42 have been commingling funds. This is a big not allowed by SSA and in my experience downstreams into a Medicaid eligibility issue as looks like gifting. Really the atty needs to look at just what the clusterF is in all this AND the atty shepherds mom’s Medicaid LTC application.

I have a suggestion for 42’s living situation..... as moms house- assuming it has no mortgage - can remain an exempt asset for her lifetime by Medicaid, so 42 can stay there rent free till there’s an “issue”. By issue well that could be that mom gets whacked with gifting of $$ transfer penalty a few months from now when unearthed by Medicaid or even later on when it hits the tax sale due to no property taxes paid (this route maybe 3 years). Sissy42 needs to save every penny to get her own place & she uses this period of time to save, save, save or to pay towards the penalty. 

So PrincessSissy is going to attys meeting? But you’ve given the Sissy’s both a list of ?s, right? You may want to schedule a conference call with atty after both Sissy’s report back to you. Just to clearly be on the same page as to what atty gives as option(s). If I had to venture a guess PrincessSissy looks at everything from how do I benefit viewpoint.... sigh. Stuff like this makes me oh so glad to have been an only child although I had 2 tried to interfere if they smelled opportunity older cousins. 

So Opti did you have to wade through the “common application” for universities? You get glitzy good mom stars on your holiday tiara if you did!!

Igloo has the answer for you in a nutshell. Basically, you keep your boundaries - you don't sign anything, you don't pay anything. The sister living in mom's house sounds like she's been living the life. Mom does not know how little she has. You have done the work of setting up the atty appointment. Now step back and let what happens, happen. Fault lies with the middle sister, which is why you refuse to sign anything. You have no fault here. Step back and love your college bound child while they are at home!

gladimhere-oh dear, who knew this potentially be a problem? I'll keep you posted so we can all learn from other's mistakes.

Qualifying? How much has mom helped sis in the last five years? That will tally the penalty for Medicaid, dollar for dollar when self pay will be required until penalty is repaid. That may be why mom says she will not quAlify.

If sis remains in the home free of rent that will be additional penalty, as a gift from mom.

Find an elder law attorney to assist with the Medicaid qualification.

igloo572, you have covered a lot in your post! Regarding the CC debt, I know my mom has given her credit card to my sister and she also pays the utility bills, etc online. My mom has probably not written a check in ages. Sissy 'manages' mom's finances. I know mom had been giving her money for rent in the past as well as Sissy's own bills so that is probably the tricky part.

And regarding my middle sister who seemingly has washed her hands of any of the difficult part of this, honestly, this is just the way she is and has been since we were kids. Oh sure, she gets upset when she and her hubby came and painted mom's bathroom, cleaned the kitchen and one week later it is a total disaster. But she has always been one to keep up appearances. Once upon a time she offered, 'Mom, if you ever need a home to stay in, our home is yours' but once it came closer to being a reality, she denies ever having said that and wanted to change the subject. I myself am a planner; I want Plan A, Plan B, Plan C as options. She tells me 'Life is not a flow chart' and just goes with the flow, pretending everything is perfect, and it is for her. Sure, she's got it good with older hubby with no kids, hubby a great saver of money, neat and tidy with his house and he wants to do all the chores. She is living the life as a queen, lounging around reading, drawing, taking long walks while my younger sister is busting her a** caring for mom. Then she can only muster once a week visits on her own terms.

Anyway, today I spent a good part of the day (while working) trying to arrange for my sister to have a meeting with an Elder Care Attorney. I arranged everything, made the initial call, gave my sister his phone number, typed up a document with questions I had, emailed it to her and implored her again and again to contact him and arrange a meeting. Finally she did it and thankfully middle sis is actually going to the meeting. I am going to consider that I spent enough time worrying about this for today and am going to take a break.

Regarding the selling of the house, I think what is most important might be getting some money for the house to be put towards mom's NH bill and doing this in as timely a fashion as possible, if the choice is made that selling the house is the right thing to do.

Sis does work (and more than one job at times) but I imagine would find difficulty in keeping up with utilities, taxes, etc. of mom's home especially given there are so many issues to potentially deal with. I just wonder if she would be able to find an affordable apartment for herself (and a dog and a cat) that is between her work and mom (she currently works one hour away from my mom's home).

I will keep you posted. igloo572, I really appreciate your insight and advice. Hopefully it won't come down to mom being a ward of the state and hopefully my sister will get some good practical information that she can bring back to the nursing home during a care conference next week. I feel that some progress has been made, even if part of it is that I am doing something to get my sister to move in the right direction.

Igloo, you are such a treasure!

Opti, let us know how you're doing!

Opti - also regarding the “we buy ugly” sales, my experience is that they offer the land value of the home to maybe 20/30% above land value. If you look at the tax assessor bill (well at least ours are this way) it’s made up of a figure that’s the land value AND the improvements value added together for assessed value. Improvements means the house & outbuildings. The “uglies” tend to heavily discount improvements value.

If this property has all sorts of issues it may not be the assessed value as those are based on recent sales of comparable houses of same sq foot and type (like 2 bedroom 2 baths under 1800 sq ft). Mom’s house could be way way less value. If neighborhood has all sorts of Reno’s or tear downs it’s going to be off. But you’d have to get it appraised to have it legally (good enough for court) at less value. If lots of issues you may want to get it inspected first and then the inspector report is given to appraiser to use within their report. For my moms house I also got a residential engineering report as foundation & watershed issues - this was kinda hard to get as not many do lower value residential, took months to schedule in. Her home came in significantly under assessor value & entered in probate as such, judge signed off so it’s legally the appraised value & not the tax assessor value.

Give some though if there could be any issues, liens, etc that could be lurking about as title company will find it. The uglies seem to want you to use the title company they select. To me there’s a whiff of collusion about this approach. I’m of the use a Realtor with a local MLS type of firm school of thought on buying/selling a house as it’s not simple; paperwork has to be done & recorded correctly. Buyer & seller split the 6% Realtor commission unless the house is in an hot market area where theres really no inventory (this is what it’s like in parts of New Orleans where I am) so the seller can pretty well make the buyer pay all costs including commission. 

For those on this thread, please try to read Opti’s post from last month, it’s enlightening especially the answers from Doriannne (her “home is the representation of self” analogy is beautifully written).

Opti - well quite a bit has happened in the past month, hasn’t it! Well at least you didn’t get APS involved as mom got hospitalized...... I totally understand how conflicted you are right now as when our son was a hs senior (a jr in college now) I was dealing with my moms NH, Medicaid, home plus college visits and applications (omg frickin’ “Common application”), FAFSA, plus you have a girl so it’s more time & $$ especially if she’s wanting to go Greek and at a school like Ole Miss that is very socially & dorm decor competitive. Please try to make your family - your hubs & kids - your priority OR at least try to make it seem that way, lol.

That being said, here’s my thoughts: considering that mom is bedfast, diabetic with early dementia, & was living in a hoarding level house with decades of non maintenance, realistically she needs to stay in the NH. Your sister - the 42 yr old who has been living with mom - needs be told by you that if Sissy moves mom out of the NH & back home it will be very very difficult to get mom back into a NH again as Mom will be viewed as non-compliant for care & facilities will find a way to not accept her as a resident. If sissy moves her back, it’s Sissy & mom at the house forever & you cannot fund their codependency. If mom refuses to file for Medicaid and Dpoa Sissy won’t do it as they are oh so dysfunctional codependent, what can happen is that the facility will contact APS and APS will ask the court for mom to be made a temporary ward of the state. Court appoints an outside guardian from a list of vetted local guardians. It’s not ideal but if Sissy just won’t deal that what’s likely needed to have mom stay in the Nh to get the level of care she needs. I’d speak with the SW at the NH to let them know you’ve heard this is an option and you’d be ok with it. Although you could yourself file for guardianship I’d be concerned that as your not local & also not in state that the judge would not appoint you as they tend to want guardian within their purview; also guardianship filing has cost, seems to run 7k-10k as you need an atty & all this is your cost to do & pay for whether or not you are successful in getting guardianship. Honey that’s college application, visits & tuition & dorm $$. FAFSA in how they calculate “parental contribution” doesn’t give an ants butt or factor in your spending on mom/sissy/mom’s house. Mom is not your legal dependent and on last years IRS 1040. Fafsa is all about your 1040. There’s going to be major drama at home if you find daughter is short on college costs, your fafsa has you as totally able to afford the tuition and you & hubs have to get a private loan for her college costs. Parental loans for thier kids college isn’t low interest unless your low income yourselves, plus it’s new debt on you. Daughter can get a Stafford but unless she’s living at home and going the JC route, the Stafford won’t cut it alone. Freshman year Stafford $4500. Even if she’s scholarship, there’s still all sorts of costs. I have a dear friend who’s daughter is a Terry scholar (TX) and Terry supposedly covers all costs..... well so far this freshman Fall they needed an additional 5k for costs, fees, stuff that just isn’t covered.

What does NH do when non-payment happens? My experience was that the NH sends both to the resident and whomever in family who they have on file as contact a “30 Day Notice”. The Notice basically states that within 30 days resident or family must sign off on a legally binding private pay contract or the NH will seek redress. The Notice is cc’d to local APS and whomever is Ombudsmen for NH, if they’ve filed for Medicaid the state Medicaid program is cc’d as well. If nothing happens then APS is asked to review the situation and usually APS files for emergency guardianship hearing.

Guardian takes over & they can place mom’s house up for sale so that mom will have a way to pay for the NH and spend down till poor at which time guardian files for Medicaid. Sissy will have to move as she doesn’t own the home. Sissy needs to let it sink in that if state takes over mom’s situation & if that happens sissy need to live at the house isn’t the guardians or the states problem. 
BUT If she as mom dpoa files for Medicaid for mom, she will keep some degree of control on what happens with the house. Even if it means she stops paying taxes, insurance and house falls into disrepair even worse, Sissy can still live there as Medicaid views it as an exempt asset of mom’s till mom dies. Now mom will have no $ to pay property costs as Medicaid requires a copay or SOC (share of costs) of moms SS $ and all other monthly income to the NH. So sissy on her own to pay house costs. If you feel the need to help, you could pay some of the utilities directly for Sissy so she doesn’t freeze & has running water. Sissy’s 42, she in theory can get a job as no more in home caregiver for mom. 

Opti, a ? for you, in your thread last month, you mentioned mom’s hefty credit card debt. If the CC spending was for Sissy and Medicaid discovers this, it could trigger a transfer penalty inquiry by Medicaid. Perchance has mom been writing checks to Sissy to give Sissy spending money as well?? There’s no personal care contract between them, so if mom’s been doing this, it too will trigger a transfer penalty inquiry. Medicaid can do a 5 yr look back on mom’s finances. If there’s been gifting going on, or you suspect that it has, please please do NOT ever sign off by your own signature on any mom related documents/ paperwork cause if you do and mom is deemed ineligible for Medicaid, the Nh and whatever vendors who were expecting to be paid by medicaid will bill you instead. NH at 5k -15k a mo..... that’s like a full semesters dorm costs. Please make sure your funds are first & foremost for your own nuclear family. Mom & Sissy must be secondary imho.

I’d bet your other sister- who has washed her hands on the situation- has herself gone through all this with mom in the past and had to totally remove herself from them for her own sanity. Help as you can but don’t put yourself at risk. It will be hard but you can do it and start 2018 afresh.

Optimist, I was told to apply for Medicaid when Dad is within $20k on assets, bc the process can be lengthy, so I would think she needs to apply now. Otherwise, you'll have to go to a facility that allows Medicaid pending. Secondly, though it would all depend on the value of the house and how long it would take to sell it, and probably if you could assist financially until then (thru a well-documented loan), AL or MC could still work. Dad was immobile when he entered MC. The only thing he could do was feed himself.

State Medicaid regulations and procedures can vary, and exactly how a POA becomes activated or whether that needs to happen depends on how it is written. One of the things that could help you both tremendously to take over for Mom is an eldercare attorney consultation. Find one who knows Medicaid - you may be able to tell from their website. If you need a spend-down or a Miller trust in case her assets beyond the home and one car exceed Medicaid limits, this step is critical.

In my case, just a few years ago, Mom's POA was activated for all purposes including selling her home by getting a couple of incapacity letters from two of her doctors. And Medicaid had some claim on the house and car because of my Dad's care, but they would not exercise those rights until she passed on because she was the "community spouse" and she still expressed an intention to return to living there, however unrealistic that actually was. When we finally sold, the proceeds went into a special account where it all went for her care and she ended up never needing Medicaid for herself, and we actually did not have assets left for Medicaid to claim when all was said and done. We found out from our eldercare attorney that if she had needed Medicaid, we would have had a penalty period because of spending some money retrofitting a vehicle for wheelchair use that she did not actually own (oops, but not really a mistake, and no regrets - it was a huge factor in her quality of life once she was not able to do a car transfer.)

So, it's complicated. You can use Mom's money to cover attorney fees if you need to and she can afford it better than you can. Ours did a solid consultation for only abut $300.00 and it was so helpful.

My dear, this is the time to hang tough. You do NOT throw money at this problem; unless you are generationally wealthy, Medicaid is going to come into play at some point.

My mom was able to private pay at NH for nearly 4 years due to a good pension that dad left and carefully managed CD and 401K funds (my SIL is an MBA....thanks be to G-d!).

Are you in touch with the SW at the rehab? Is she understanding that your poor sister in kind of in la-la land?

CTTN55-yes, the clock is ticking and I am the only one hearing it! I make good money but have a daughter soon to put through college and we are providing for ourselves and also saving so we won't be a burden for our daughter when we cannot care for ourselves. I could contribute but why should I do that when my mom and sister haven't heeded my warnings to plan for the future? I feel a little selfish in not contributing but have also given my mom money gifts in the past and now it is all gone! Not going to throw away my hard-earned savings when I know I won't get any of it back.

My mom could self-pay for about 15 days and then she will have only $2000 left and would be eligible for Medicaid (IF she would apply and IF my sister would talk to a social worker about the alternatives or what to do when mom is out of money and cannot pay rehab bill). Yes, I make daily contact with my sister but she is so overwhelmed, I know she is sick of talking to me about it. She wants to still keep mom happy so won't make her do anything she doesn't want to (mom doesn't want to get up out of bed, refuses to see a psychiatrist). It is more co-dependency. I have tried to put her in touch with Geriatric Care Manager and encouraged her to talk to social worker; not sure if she is doing either. She is helpless, depressed, and discouraged. Do they need to threaten to kick her out of long-term care when she isn't able to pay before my sister will do anything about this? And forget my middle sister who won't even respond to my text when I ask her to help my sister fill out Medicaid application. She's ridiculous.

The clock is really ticking now, with the self-pay starting today! How long can your mother self-pay?

Your sister has no money, you are not going to be able to contribute, and the other sister isn't involved. So until your mother gets over her "Medicaid is for poor people" attitude, things are tenuous.

Are you in daily contact with the sister who is living in Mom's house?

Thank you talkey for sharing your experience. I'm sure she can't do assisted living. She is immobile, cannot get up on her own, completely dependent on others for her bathing, washing hair. Has difficulty eating on her own but can still do that if she tries. And rehab facilities take patients into postacute care and if you are not making progress, it is their responsibility to contact Medicare and indicate that you are no longer making progress or have no potential to make progress. The problem is this problem has been going on for a long time so she is deconditioned, has contractures in the knees, is afraid of falling, and unwilling to do the hard work with pain. She's officially discharged today but will stay in longterm care self pay until my sister can figure out what to do (and that is going slow, mom is pushing back on everything). She won't apply for Medicaid as she doesn't think she'll qualify and indicates she 'will find someone to take her'. Frankly, I'm beginning to think she is not thinking clearly. I think she needs psychiatry to see her, determine if she needs increased antidepressant medication but she refuses to see psychiatrist. I am encouraging my sister to have her seen anyway. If she throws a fit and gets angry in front of the psychiatrist, perhaps that is diagnostic of something he can treat. She is just hurting her case by acting like this but I understand she might not be able to control it. So sad, she was never an angry mom.

It's a shame you're so close to discharge date. But I think the facility social worker can and should help. Don't discount selling the house (if you have time). Dad's needed some repair, but sold in 5 days. It's a great market this year. And I've no doubt your mother isn't safe at home unless someone can be there 24/7, if she's completely immobile on her own. Depending on her other needs, she may qualify for Assisted Living, which can cost so much less than Skilled Nursing Facilities. With Dad, I considered his condition and did the math. If he could maintain the physical standards and he had enough money (proceeds from house, car & other assets included), he could live X number of years in MC (memory care). Then if he needed a SNF, we would spend down and apply for Medicaid. Continuing Care facilities are optimal, I think, but can be much more costly. Maybe you could get her into AL, using current savings and income, then sell the house and continue AL until the money is gone.

This is all such good advice. BarbBrooklyn, you are right, I think my sister is depressed and she is definitely running on fumes, but also overspends beyond her means. We have cleaned part of the house before, only to have her clutter it up within days. She claims it is just not her style to be able to keep a neat home... No doubt she is overwhelmed; she has done everything possible to keep mom in her home and happy. Problem is I think mom is getting a bit of early dementia (perhaps) and can sometimes say some things that are very hurtful to my sister. I tell her that although we love mom dearly, we need to stay away from being super-emotional about these changes. These are part of life and we should plan for them.

Mom probably doesn't think she qualifies because she might look at Medicaid as for 'poor people' (just my thought, she hasn't actually verbalized it). She has always been private about her finances but she used to be good at saving but I think has incurred much credit card debt and has helped my sister out quite a bit, thus the savings are dwindling. Again, I was always forbidden to speak of Medicaid or planning for the future, as if speaking about it would magically transport her to a nursing home forever.

jjariz, an elder care attorney is a great idea. I have spoken to one already last year (and he posts on this site!). I need to reconnect, even if no one else wants to do that.

freqflyer, you make a good point about asking about which 'home' she wants to go to. I know she has sadness for the things that are lost; she has good memory and realization that she will never do those things again.

My dad was a veteran so I believe my mom is eligible for Aid and Assistance but don't know how many hours this covers. She would certainly need someone for at least 8 hours, or part of that. However, if there were ever a fire in the home, she could not get out on her own, thus is very vulnerable. I don't want to assume anything and that is why I want to consult someone who can provide all of the options to mom, in an objective way, so they can be informed and come to their own conclusions. Otherwise it's just me being bossy again (and I admit I am not an expert and might have my own misinformation which might not be appropriate. I don't want that responsibility of making things worse).

And regarding selling the house, I have been trying to think of the easiest way to do that. Not to be silly but has anyone used 'We Buy Ugly Houses' in this situation? Because my sister works and I am across the country, we need a fast way to sell this house and I think we can cut our losses. I think the house is more of a burden and liability right now than an asset and any amount of cash would be reasonable. Too overwhelming for my sister and I to go through the house and prep for selling. This would be a nightmare. Can anyone comment on how to sell house quickly? Thank you all again.

optimist1, when your Mom mentions that she wants to go home, you need to figure out if Mom means the current house that she owns, or if she means her own childhood home. It is not unusual for an elder to say they want to go home to their childhood home where life was simpler and fun.

I am curious about the "home health aide" that will come in to take care of your Mom. Is that something that Medicaid said they would do? If yes, that is great that your Mom's State would have that program as many States do not. As for a visiting nurse, they usually stay 15 minutes or so, just long enough to check vitals.

Am I reading this right, the sister who takes care of Mom also has a full time job? Oh my gosh, no wonder she drags her feet on getting things done around the house. She is running on fumes, being physically and emotionally drained. I vote that Mom does not come home, but reside in a continuing care facility using Medicaid for her care.

As for the house, if Mom is accepted by Medicaid, sell the house ASAP. As others had mentioned someone would need to pay for the mortgage, home owners insurance, the utilities, etc. out of their own pocket. If the house is sold when Mom finally goes into a nursing home, then there is a relief not worrying about the house... but all the equity in the house must go for Mom's care.

Let us know what is decided. Keep us up-to-date.

Since there is so much uncertainty, perhaps a visit to an Elder Care Attorney (who helps plan the spend-down before Medicaid) would be appropriate. His/her fees is part of the spend-down. With an appropriate plan, you can make sure that there are no regrets later.

If there was ever a time to be "the bossy older sister", this is it, Optimist!

Your sister sounds overwhelmed and possibly depressed.

Somewhere around 40% of all caregivers die before the folks they are caring for do. It sounds like you love your sister and would hate to see her dug further into this hole that mom is insisting on digging.

There comes a point in our lives where we have to not care about not being popular any more. It happened to me twice; once when I told mom I could no longer respond on a daily basis to her "emergencies" and leave work and family to "rescue" her and that she needed facility care; and once, at the end of mom's life when my brother and SIL were resisting hospice care for my actively dying in pain mother. I'm a VERY conflict averse person, but in both cases, I saw that damage was being done to my mother and needed to be set right and how anyone else felt about me be d@mned.

This sounds to me like one of those times.

Go to the SW at the rehab and say "sending my mother home will be an unsafe discharge. Her home is a wreck; someone, maybe APS needs to go look at it and tell me that you don't consider the lack of (fill in the blanks) to be a health hazard to my mother in her present condition. I don't think mom will survive the 24-48 hours that it will take to send out home health, so please get someone out there to inspect it BEFORE she gets sent home."

Emphasize "unsafe discharge". Say you are notifying your lawyer and that you want it in writing on facility letterhead that they have seen the home that they are sending your mother back to. For good measure, you might call the hospital that your mom was discharged from; there are Medicare penalties when patients are readmitted for the same diagnosis within 30 days. The HOSPITAL has a vested interest in mom NOT coming back to them so soon.

Mom should no longer be "driving the bus". If sis can't stand up to her and say "nonsense mom, of course you have to apply for Medicaid; do you have $25. per hour to pay for home health?", then she's not doing your mother any favors.

Why does mom think she doesn't qualify?

Veronica91, I didn’t think Medicaid would take the house until the passing of my mother? But as others have pointed out, it is probably unrealistic to have my sister stay there and keep the house since she will need to pay utilities, taxes.

The problem is that mom doesn’t think she qualifies and therefore doesn’t want to apply. Sister (POA) says she cannot force mom to do anything she doesn’t want to do but just thinks that she can ‘self-pay’ although doesn’t have that kind of money. Eventually nursing home will figure this out and I don’t know what the next step will be. Sister seems happy just sitting back and waiting for something to happen, which is the story for the past 15 months. I can speak to a social worker but really, it’s my youngest sister who has been caring for her and my mom has the greatest trust in that needs the info from the social worker. If I look into all this and give them info, it makes me look again like the bossy older sister all over again. I’m always the one that wants to be proactive and then am the one that worries a lot about their future, maybe even more than they are willing to admit. They are paralyzed by the situation and this is becoming a recurring theme. Has anyone else been in this situation? How did it come to resolve itself? I appreciate the wisdom of this group very much.

Just lost my post and hate rewriting.
Briefly Mom should stay where she is on Medicaid. Talk to the social Worker and contact Adult protective services. Sis may have been painting a rosy picture on her caregiving capabilities.
Your sister will not be permitted to continue living in the house once medicaid is involved.
Do not start paying for anything, the state of the house no longer matters to medicaid it will just be sold off as a fixer.

BarbBrooklyn-thank you all. Sister says she 'needs help' getting the house in order for someone to come look at it to see if it is safe and appropriate for home health aide but really doesn't think mom will be good back at home. I have tried for years to have her move the clutter, repair the hole in the kitchen sink pipe, etc., all to no avail; was hoping to avoid a time like this when sister is embarrassed at the mess in the house but doesn't have the forethought or skill to keep the home reasonably cleaned all these months. I don't think I would suggest my sister waste a moment trying to do anything to the house in preparation of that visit; it would take her a long time to do anything meaningful and I'm sure the experts can observe through the clutter what needs to be done.  She's embarrassed but as I have been reminded of on this site before, the experts have seen EVERYTHING so just invite them in to get the ball rolling as to next step.  Otherwise, increasing inability to do anything substantial and meaningful for mom.

Mom thinks I'm poking my nose where it doesn't belong when I told her (and offered to pay) to fix a broken window in the basement. There is so much delayed maintenance of the house, it is heartbreaking to me. I grew up in that house. Part of me wants to sit back and watch out how this will play out as I am getting pushback from both my mom and my sister, and my middle sister is so self-absorbed with her own life (she is on third marriage with no children) that she can't bear to lift her finger to help when my sister is so overwhelmed. Someone once said, 'Failing to plan is planning to fail'. Oh so true.

I would not "take her home".

I would insist that the facility send someone NOW to evaluate her home. When my mom was in rehab, they were going to send an OT out to evaluate her residence for safety.

Ask the facility how to get mom's competence to make these decisions assessed.

Ask the facility if they accept Medicaid after a certain period of private private pay, and how long that is.

I'm sorry you're dealing with this, and that your sisters don't see the danger in sending mom home.

JoAnn29-my sister does have POA but I believe despite this, she still needs mom's OK to apply for Medicaid and right now she is refusing that, saying she does not qualify.