elder law

beaglebuddyMarch 8, 2006

My mother is in a nursing home and my father is still at home w/ an aid. I understand there is a way to seperate their finances so medicaid (california) will pick up the nursing home fees that do not get paid by their long term insurance and we won't have to reimburse the state after she passes. Anyone familiar w/ all this ?

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I would encourage you to seek out the professional services of a lawyer who SPECIALIZES in elder law. Do you have medical and durable power of attorney for your parents? Be sure to bring bank statements, deeds, wills, all legal documents with you when you go. Do this immediately!

I don't want to sound discouraging, but by the time most families realize what the cost of care will be and the value of parents' assets it is too late to isolate them legally, and preserve them for the next of kin. There are time frames ("look back" periods) that must be met before the new legal documents become viable. This is to prevent wholesale, last minute, "hiding" or protective transfers of valuable real estate holdings. Often these "look backs" vary from state to state.

My parents were incredibly stupid in their own "planning", meaning they did little if anything! Mum had a stroke in '04 and it was then that my brother and I sprang into action. We established a trust, have long since met the "look back" and her real estate is now shielded from government seizure to pay for her long term care... . On our attorney's advice Mum has been legally gifting liquid assets to us, and valuable and sentimental family heirlooms have been distributed. She has money to pay for adult day care, "the bath lady", and many other things, but the "cream" of her holdings is now safely isolated.

I am routinely shocked at the number of young people who have children, sizeable assets, and NO WILL, let alone medical and durable powers of attorney. We update our own routinely, and following the establishment of the trust both my brother and I carefully re-examined them.

Good luck with this; I know well how stressful it can be to have a failing parent and have to deal with all their affairs because they're no longer capable! Have you checked out the Caregiver's forum? I posted there for some time, but it got "stale" for my own circumstance and I've not been there in good while. There are many good, knowledgeable folk over there, good resource.

    Bookmark   March 8, 2006 at 3:24PM
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Medicaid changed their laws years ago so that one spouse could still live in the home and the spouse needing nursing home care could qualify. Check with you state Madicaid agency to see what the rules are.

Start with your local Area Agency on Aging. Should be in the gov. section of the phone book. If not there, then check in with a social worker/discharge planner at a large hospital to give you some contacts.


    Bookmark   March 10, 2006 at 2:33AM
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I see people in nursing homes to provide mental health care, so I think a lot about these issues. What I can't understand is why people believe the government is supposed to pay for nursing home care when the person in the nursing home has assets that can pay for that care. At least here in Michigan, the state cannot kick a spouse out of the home. After the death of the person living in the home, the state can take half of the value of the house to pay for the care that the person in the nursing home recieved. I can fully understand about wanting to preserve family heirlooms, but why "protect" assets in general? Why should the citizens of the state pay for nursing home care when the person in the nursing home has money that could be used for that purpose?

When my mother died two years ago, I was pleasantly surprised to learn that her life insurance was not "hers," but belonged to the beneficiaries. That meant that it did not have to be used to pay her bills. My sister got the lion's share and it paid off the mobile home she had shared with Mom. We still felt a bit guilty not paying her credit card bill (Discover card was used to pay for her meds) and her final hospital bill. We paid for her cremation by dividing the costs in thirds and each of us children paid our share. What little she had in her savings and checking paid her bills until there was no money left - which was reached a few days after she died.

I guess that learning that the insurance money was really a gift from her to us, and not part of her assets was enough of a windfall that I cannot comprehend why most people also see a person's assets as something that "should" be passed on to the next generation - instead of being used to pay for the care they receive while alive. Chelone, I respect you and have always benefitted from your well-thought-out opinions, so this is not meant as a slap at you. Help me understand the whole thing. Is it just because one "can" legally shield assets that people do this? After all, the surviving spouse retains their half of all assets and is not made to leave their home.

    Bookmark   March 12, 2006 at 12:14AM
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I understand how you feel, nancy louise. For a long time I felt the same way. And then, one day (as I heard the helicopters pass my home on their way to Walker's Point) I asked myself why it's considered smart planning when the very wealthy do it but sort of "sleazy" when the minions start to "wise up" and do the same thing?

I follow the news. I know damn right well that Social Security and Medicare are going to take a tremendous hit in the coming years. While we've been careful, studied, and diligent in our planning and saving for our old age there will be a greatly reduced "safety net". All that will follow the single, largest transfer of real assets this country has ever seen. And I don't feel the least bit bad about shielding assets to add a dimension of safety to my own life considering what will be eroded in a few short years.

My mother is nearly 80. She has lived with me for nearly 3 years now. I see that she goes to the dentist, audiologist, doctor, hairdresser, shopping, visits friends, etc., etc.. I manage and change her urostomy twice weekly. I do all of that on my days off, often rescheduling my work to accomodate required appointments. I get a month off every few months when she goes to my stay with my brother. She lacks for nothing, but it comes at a very high price for me and my helpmeet, you lose your privacy when you tend to a "high maintenance" declining parent. Until you have cared for someone 24/7 you have no clue how difficult it can be... I provide more care, devotion, and attention to detail than any nursing home will provide (and I've seen the inside of several rehabs.), ditto my brother. We do it for "free"... no tax exclusion to make it easier. Would a nursing home be content with 11K/year? Why should her home NOT be protected as delayed compensation for devoted, conscientious, and loving care for as long as we're able to keep her with us? Why should we not use her resources wisely as more services are required to ensure greater quality of life? What do we all hope for? a massive coronary in the middle of the night... . It only sounds grim and cruel until you've watched someone you love evaporate before your eyes. Surely, you understand that, given your work.

My brother and I pay a lot in taxes to provide the services she gets... services that will NOT be there for us. My parents wanted us to have the proceeds of their years of hard work, and said so repeatedly. Sadly, they were too trusting that that would be the case; they never bothered to see a lawyer to give their wishes "teeth". I don't feel bad about the way we've protected things, my deceased father would be very proud of the way we moved to secure their assets before it was too late. My brother and I have "paid" for it in blood, sweat, and tears many times over in the past few years.

So that's how I feel and that was the reasoning behind our decision to isolate and protect family assets. Unquestionably, our country is in for a very serious "reality check" in the next few years.

    Bookmark   March 13, 2006 at 6:57PM
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Sorry about your name, nancy in mich.! There are a variety of "nancys" and I foolishly typed in the wrong name.


    Bookmark   March 13, 2006 at 6:59PM
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It is my job to exploit the tax laws as much as I can, not to try and be fair.

    Bookmark   March 13, 2006 at 10:02PM
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Thanks, Chelone, I figured it was something logical, knowing you. I fully agree that the parent's assets should be used to pay for the care they need in their, or your, home. I know that my sister worked very hard to cope with the moods of our mom as she declined, to provide for her care - and keep her tongue when all Mom wanted to eat was salty soups, pretzels, cheese or other high sodium foods as her kidneys were failing, her legs were swelling, and death was drawing near. Then there were all those years of crankiness before she became really ill! I helped, but Sue lived it all the time. My brother and I had no problem at all that the majority of the insurance went to Sue. Full care is far more than what we ever had to provide for her, though. The lost hours of work are never made up for, nor the loss hours of having time for yourself or family. And as long as the parent has income that pays half of their needs, you cannot even use their presence in your home as a tax deduction. Those years of giving care are priceless for the elder, but very costly for the family.

Fortunately, we have not had to provide full care. DH's dad is living with us but is doing well for 89.75! He helps US out by letting the dogs in and out.

Last week our office did a report on a young woman who is in the nursing home. She had a stomach problem at 17 and was hospitalized. She had a cardiac arrest in her room's bathroom and was not found in time to provent massive brain damage. Now it is four or five years later and she is starting to come out of the coma and our agency now has to do an assessment to make sure her mental health and developmental needs are met in the nursing home. All the nursing home staff went on and on to our assessors about how her family was so rich from the settlement with the hospital that they have built multiple houses and drive an Escalade. Now, the mom (who visits her daughter once a week) wants to take her home. The county offered her 6 hours a day of assistance in the home, and the mom wants 16 hours and is going to fight for it. The staff at the nursing home are afraid that the young woman will develop bedsores or decompensate in other ways if she goes home with untrained or inadequate care. So far, only the aides closest to her think they can understand communication from the young lady, who tells them things with looks and blinks.

Guess who is paying the nursing home bill? Medicaid.

Now the Escalade and the homes are all just rumor, but the lawsuit made the news and the "responsible party" (ie: bill payer) is clearly marked on a chart and the assessors say this lady is a Medicaid client. I just don't understand how someone can win a settlement for her injuries, then not use it to pay the nursing home bill. The hospital where the injury occurred was not a county-owned or state-owned, so it is not like the nursing home costs were part of a settlement deal. The world works in strange ways.

    Bookmark   March 13, 2006 at 10:08PM
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The injury and probably the resulting medical bills and attorney fees happened when she was a minor (17) right? But isn't she now 22 years old? As an adult with no income and bills acquired over 5-6 years that need to be paid, shouldn't Medicaid come in to play? Isn't that what it's there for? Who's to say where the settlement money has gone and it's really nobody's business. For all anyone could know, the parents may have set it aside for her future. Lord knows she's probably going need it and I'm sure that family has been through enough. As for what kind of car her parents drive or what they do with THEIR money and THEIR daughter it's no one's business but theirs! Sorry, it just totally rubs me wrong to hear about professionals gossiping about a family in that manner.

How would you like it if someone made assumptions about your mother's insurance money and how it was spent?

    Bookmark   March 13, 2006 at 10:54PM
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This is a subject so terribly fraught with spectres of greed, avarice, controversy that it's often difficult to be really honest when discussing it. I tip my hat to Nancy in Mich. for stepping up to the mike and asking me WHY my brother and I arrived at the decision we did. It's important that those questions be asked and that they be answered.

I worry a lot about this. I worry that Mum will deteriorate to such an extent that she cannot remain with me or my brother, in a setting that is familiar to her, surrounded with things and pets that she "remembers". I have seen the interior of nursing homes and "rehabilitation" facilities 3 times.

Only one of the 3 was "acceptable", the other two were so pathetically inadequate I wouldn't send a hated enemy there. And it wasn't for lack of funding... (heaven knows Mum was a "cash cow"! spry, pleasant, and cooperative)it was for lack of QUALIFIED staffing. Those workers "in the trenches", were largely immigrant, working for minimum wage (probably without any benefit package, too), and barely able, with their broken English, to communicate with wards barely able to comprehend the spoken word, let alone that spoken with a thick accent, no matter how affectionately! THEY were the real treasures! they were attentive, affectionate, and virtually ignored by more "educated" staff. The most PATHETIC employees were the vaunted RNs, PTs... no kidding! I have, NEVER, in my life met a more arrogant, selfish, unwilling cadre of "caregivers". I was embarrassed for THEM; they were nearly universally unwilling to do ANYTHING that remotely required "hands on" work. "I'll call an aid"; "I have other duties to attend to...". "Could you call me later?" (needless to say they didn't "do" e-mail). Oh, I've heard it all. And that's why Mum is with me and my brother and NOT in one of those hell-holes. $60-80K/yr. for THAT? I rather think not. But families willing to do the work to keep them at home can't be compensated? HUH?! Welcome to life, corporate America runs this country, make no mistake about it.

But consider this: you wouldn't have wanted to be the RN on "duty" (eating her doughnut behind the counter at "reception"!) when my brother arrived at 11:30 AM on Saturday morning, the day after Mum was transferred. She was lying in bed, soaked in urine (failed urostomy appliance), unfed. He coolly told the RN to get her ass in the room and take care of it. He went next to the administrator's office. From that day on, he and I went to visit Mum EVERY SINGLE DAY for 5 weeks to "check up" on her care. I HAD TO TEACH THOSE RNs HOW TO CHANGE AN UROSTOMY APPLIANCE. (Wingate)

There is one level of employee I hold in greater contempt, though. And that's the SOCIAL WORKER. Never, in my life, have I seen a greater waste of payroll than they. I have had the (dis)pleasure to deal with 7 in the past 3 years. ONLY ONE of them was helpful in any meaningful way. Frankly, the other 6 could have been nicely replaced with a WEBSITE. The one that was helpful is someone with whom I still maintain contact. She has remained a tried, true, and good friend. When you find a good one, stick with them!

Am I angry? You bet. Why? because the whole system is set up to milk families of their assets even as they "tell" families they can't possibly "take adequate care" of much loved elders. The entire system is stacked against those of us who are willing to care for our families. Mark my words, this is the coming battleground and I'll be well finished with it in a few short years. Me? I've joined the Hemlock Society!

    Bookmark   March 14, 2006 at 6:14PM
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Kimba, I do agree with your opinion of the gossip, but if there is money somewhere in the name of a nursing home resident, I would rather that money was spent on the care before the taxpayers are tapped to pay the bill.

Oh Chelone! The Hemlock Society! Actually, one of my people in the NH would love for them to visit. I know how frustrating it is to visit someone and find that they have gotten poor care. It is so exasperating. Visiting every day got her better care, even when you and your brother weren't there, you can be sure. At the NH I visit, the social workers are the worst of them all, too. They are controlling and judgemental. Today I was at a meeting where I had to tell the social worker how to praise when the resident did the desired behavivor, to ignore the (non-dangerous) undesired behavior, and reward, reward, reward to help her meet her weight loss goals! The SWer wanted to make her eat in her room so that she could not ask others for food off their trays.

Thank goodness the home I visit is not as bad as the one your mom unfortunately visited. I agree that the lack of remuneration for families is a big mistake. Couldn't you just pay yourselves for the caregiving out of her funds and transfer the "wealth" that way?

    Bookmark   March 14, 2006 at 10:06PM
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nancy in mich,

Who do you think paid the debt owed on your mother's Discover card and the hospital?

    Bookmark   March 14, 2006 at 10:24PM
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I believe you are the kind of son that parents everywhere wish for. I pray for your mum, and for your family. I'm essentially in the same boat with my father in law. It makes my blood boil to listen to so called "professionals" who want to bleed a family dry and then to add salt to the wound by dragging guilt into the equation because you've tried to protect your loved one and the families assets to boot, ALL WITHIN THE LAW!

I'm totally with you on the Hemlock Society too. I know you weren't kidding.

    Bookmark   March 14, 2006 at 11:22PM
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I'm sorry I ranted on so. You can see what a "hot button" issue this is for me. And changing the system is like stopping or changing the course of a supertanker on the ocean... it requires MILES to get it done.

Given our experience, my brother and I have determined that we will drain every blessed cent in Mum's retirement account before committing her to one of those places. I KNOW there are good nursing homes with attentive, professional staff, but my experience has been the opposite. Mum had cancer surgery and the deal with hospitalizations is that patients are discharged ASAP and those requiring a longer recovery period are routinely sent to "rehabilitation" centres (I'm cool with that, it seems a more practical way to divy up healthcare dollars, for the most part). Naively, my brother and I both believed Mum would receive instruction on the "care and feeding" of her new urostomy appliance, as well as routine PT and OT. The latter two were taken care of pretty effectively, but the former? how could that be addressed when the staff was INCAPABLE of doing it properly? (I taught myself to do it in about 10 minutes with the help of a fabulous Ostomy website). My point is, they didn't care enough to learn how and do that for one of their wards. But weren't they just SO concerned when my brother and I both expressed disatisfaction with lack of results and asked for discharge before the 4 week (Medicare paid!) time frame... ? It was EXACTLY the same scenario following Mum's stroke and her transfer out of a WONDERFUL facility (where they taught her to walk again) and into another "rehabilitation" centre/nursing home.

I have a couple of dear friends who are RNs (one in dialysis, the other a Nurse Practioner/midwife) and they confirmed my suspicions about keeping Mum as long as possible because she was "profitable". The lovely Social Worker I referenced above grudginly admitted that that is how the system works... .

The SW at Wingate was too pathetic for words, and I'm glad to learn Nancy's encountered more of the same ilk in her visits. She and I locked horns about week one of Mum's incarceration. I challenged her "authority" and it scared the daylights out of her. I have no patience for incompetence and when someone wraps themselves in a cloak of smugness and presumed authority you'd best believe I'll go for the jugular. I did precisely that with her. I showed up every single day (an hour there and hour home). I took PICTURES, have some lovely shots of the creeping skin condition on Mum's back... showed them to the "head" nurse and asked embarrassingly frank questions. As soon as Mum's bathroom was rehabbed for her new physical limitations I had her released. Visiting nurses from our local hospital, PT and OTs came to the house for over a month. In 2 weeks at home, my mother made more progress than she'd made in 4 weeks there. I'm not kidding. But the pressure put on my brother and I to leave her in that pit was incredible.

Did any of you hear the story about the 102 year old woman who cares for her younger brother and sister that aired on NPR's Morning Edition today?! See if you can catch it on their website, it was inspiring and SOBERING.

Thanks for letting me vent... didn't realize how much I needed it. ;)

    Bookmark   March 16, 2006 at 4:14PM
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kimba00, we share a birthday! How coincidental is that?

    Bookmark   March 16, 2006 at 4:29PM
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Well then. Happy belated birthday to you, Chelone!

    Bookmark   March 16, 2006 at 5:35PM
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Valid point, Kimba. You should use the laws to your best advantage, too. It is when the law is bent that it irks me.

Chelone - I, too, heard that piece. Wow, that lady is something. Not only does she provide most of the care herself, but she is up several times in the night to turn and change her siblings' diapers. Neither of them have any bedsores. That is quite the accomplishment.

I am not surprised that your mom did better at home. The dynamics there would be much more conducive to healing. I think the staff at nursing homes are put in a difficult position. Every place is always understaffed. The minimums required by law are unreasonably low. If you try to staff above the minimum staffing levels, you find you can't make money because your competition has fewer wages to pay. Therefore, the homes are always understaffed. If some staffers manage to be cheerful all day, do their work thoroughly and promptly, they feel like they are doing more than "their share" in comparison to coworkers. They will be asked by the residents for assistance more often because it is easier to deal with them. Then they will be running from task to task, get burned out, resent the other staff, and want to leave. The other staffers, who appear to us to be "lazy," learned that lesson long ago, and insist on getting their breaks and doing things at a slower pace because there is no advantage to working faster, the work is never caught up. Even good-hearted people need to get their breaks and lunch times - and setting those limits to protect one's self will always result in a resident not getting attention they need. It is a vicious cycle of dysfunction. Not a good atmosphere to get well and heal in!

    Bookmark   March 17, 2006 at 11:43PM
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