I'm reading some of the others' posts in a couple of threads about finances and medicaid and exhausting assets and then... where does mom go if ALF won't take medicaid, etc.

Here's my question, and it's legal, not moral or ethical -- if the elder runs out of money and the ALF evicts them, and if they've nowhere to go, what does happen then? What if there was no family to step up and make arrangements? Would the elder be put out on the street, or would a social services agency step in and find medicaid housing? So why won't an agency find medicaid housing for elders who do have family? What if the family just said to the ALF (and this is the legal, not moral or ethical part) "sorry, we can't take her - you figure out what happens next."

Really, can they FORCE the family to take Mom back home with them? To pay cash for rent?

And, this waitlist game when medicaid beds are involved is so ridiculous. When MIL was first to be moved to an ALF, we looked at one that had a SNF on the same grounds. When I made the initial appointment, they told me there was a waiting list, but we should come and see the facility even though. So husband and SIL went, and when the person giving the tour asked, "Where does mom live now?" and learned that MIL owned a 4-bedroom home in a nice town, SUDDENLY there was no waiting list, because they knew that the house could be sold and she'd be a cash paying resident.

I hear you Nina. It's amazing how much financial information these places want and how the waiting lists seem to disappear for private pay people. This is why I now need to find a nursing home for my mother since nursing homes can't kick you out. Need to find a good one while we're still private pay.

I hate to sound selfish here but I worry about myself. I have no children. What is going to happen to me? I never thought about this prior to my mother getting dementia. LTC insurance only covers so much. I'm in my 40's. I'm supposed to be enjoying my life right now, not worrying so pathetically about my future and funds to pay for my care.

Nina
There are NH's that have a contract with the state that have all Medicaid beds. The homeless, the family-less, the impoverished are always accepted.

they're not always horrible. My aunt was in a secure alzheimer's unit in one that had a wonderful director and staff. We picked over a very fancy home that had many private pay but felt less attuned to patient care.

However, when my aunt had to move to the more advanced ward, there were mentally ill patients mixed with the alzheimer's and we had to move her to another NH--she was still too aware of the chaos around her.

My understanding is that a NH would find a place that takes Medicaid with no private pay wati period. They are supposed to give your 30 days notice.

I'm not sure about assisted living facilities. Look at the paperwork you signed and see if there is anything there. Does your state's Medicaid cover that? Call the place and ask them -- or have someone else call if you don't wish for them to know you are running out of funds, etc.

Google your own state and the rules and you may find good information on the way it works where you are.

Something else to keep in mind....a lot of places assisted living, nursing homes, etc. want 2 months up front...the first and last month just like when you rent an apartment. They want to make sure they have their money when you run out. It's another way to screen out those who have zero funds.

My own take is that the "system" for AD/chronic disease care is a farce.

In my case, my father will have to be completely impoverished before Medicaid kicks in for his NH care. If he'd been fantastically wealthy, there'd be money left over, but he wasn't, so there won't be.

Putting all that aside - you might want to take a second look at the high-end facilities in your area. In mine, one of the effects of the recession is that the most expensive facilities have empty beds, and are beginning to accept Medicaid right at the start, with no private-pay period required. This doens't do my father any good because we'll have to wait out a penalty period for asset transfers. But if that wasn't the case, and if he was Medicaid-qualified immediately, they'd have room for him.

It surprised me, but something like this might work to your advantage. Worth a look, at least.


Best,
Alan

Not all NHs accept Medicaid. Those that do have a certain number of beds for Medicaid patients. I know at the NH where my mom is over 60% of the patients are on Medicaid. Therefore they will no longer accept Medicaid patients and want at least 12 months of private pay.
When and if the Medicaid population is reduced they will probably admit Medicaid patients again but that may never happen since many of the patients admitted as Private pay will run out of money and will then qualify for Medicaid.

They have about 20 people on the waiting list for Medicaid but we got a bed within a week since she had money to pay for at least a year. It also helps if they qualify for VA aid and attendance since that is additional money.

In this state there are county homes that take care of older people with no place to go that cannot take care of themselves. There are also state mental hospitals that will take people who cannot care for themselves. So when there is no family and no money I suspect most people end up in one of these facilities.

Alan, since you transferred assets, can't you use them for his care? Or I guess that's what you are doing since he doesn't qualify for Medicaid.

Always Learning -

Right - the asset transfer was intended to qualify him for Medicaid. But in each of the two states in question (New York and Maryland), there's a five-year lookback period (meaning Medicaid still counts the assets as his for five years after the transfer) and a transfer penalty (a certain amount of time you have to pay out of pocket for each dollar you transfer). It's designed to keep people from transferring assets in order to hide them, then claiming Medicaid eligibility on day one. So basically you're required to use the transferred assets to pay for care. In our case that means that the last private dollar will be spent out just as Medicaid kicks in - if we're lucky. If not, I'll have to close the gap somehow (not sure how).

It'd be vastly better if long-term care was covered by a Medicare-like system, but I think Alzheimer's will have to be a much bigger crisis before anything like that happens. Figure ten or 15 years from now...


Best,
Alan

Alan, I'm in the same boat you are. My mother's apartment and annuities left to her by my father will make it impossible for her to get Medicaid until we spend down EVERYTHING for her care. We thought we would have enough provided she was able to stay in assisted living because we have long term care insurance. Because circumstances have changed with my mother, we need to place her in a VERY expensive behavioral place ($475 a day!). The money will run out. Being in New York, there is the five year look back period. We can at least get her into a place and be private pay for quite awhile, but the money WILL run out. I still have to figure out how to get my hands on her annuities to pay for her care if we don't sell her apartment before we run out of money.

For YEARS my mother's financial adviser was telling her to start giving her money to me and my sister and nephew, to set up funds for us. She would never listen. I know that sounds greedy, it's not meant to be. All the money saved for generations, all that my mother's parents worked for and all that my father worked for and saved is going to end up going because of this stupid disease and then the taxpayers will have to pick up the bill for the rest. My sister and I would have much rather had my mother run out of money and we could have helped with her care. My sister and I don't need her money, but it would have been nice to have a nice big college fund for my nephew. After all, he's the one who's going to have to take care of both of his parents and his loving aunt!

quote:

Originally posted by Marjk:
I hate to sound selfish here but I worry about myself. I have no children. What is going to happen to me? I never thought about this prior to my mother getting dementia. LTC insurance only covers so much. I'm in my 40's. I'm supposed to be enjoying my life right now, not worrying so pathetically about my future and funds to pay for my care.

I understand where you're coming from, as my only child has autism, and there is unlikely to be anyone else to "step up."