OT completing application to nursing home

[Kingfisher]

My wife has alzheimers and is declining quite rapidly. Already in a daycare program a few days per week but for future I need to get her on the list for assisted living facility.

The application looks pretty straightforward..assets, liabilities, etc.

Has anyone done this and is there anything I need to be wary of completing this thing?

Thanks much

[CNY rider]

There are definitely pitfalls and potholes you need to watch for.
Don't know where you live but if your county has an office of the aging, get in touch with them and sit down with a social worker or case manager before you submit anything.

[robin3mj]

Will this be private-pay or some kind of government funding?

If private pay, they are merely trying to ascertain ability to pay. Most operators will want to see enough assets (minus liabilities) to fund a couple years' worth of the resident's costs. The ability to discharge non-paying residents varies by locality but it can be extremely difficult, and you'd be dismayed by the number of folks with dementia who get abandoned (for lack of better word) at memory care facilities.

If gov't funded, some programs' qualifications are based on assets, and some on income, so there are nuances there.

Feel free to PM me if I can be of help.

[drewellison]

I'm sorry to hear your news.

My experience is not the same as yours at all. My mother had that nasty disease (and it's familial so my sisters and I look at each other and wonder, who's next?). She went to an assisted living place which had a very nice memory care unit - she started in assisted living and then moved into memory care at the appropriate time.

I was not involved in the initial application process, so I cannot comment on that particular process.

However, the facility did regular evaluations and reported on level of service needed, I think at least quarterly if not monthly. If they noticed a particular decline or change in behavior which needed a different type or level of service, they'd do an evaluation and inform the family.

I can say that my mother never knew she had the disease. That part was a blessing. In fact, she was never more happy than when she was in the care facility. Every day was a new day and she loved being around the people and staff there. She literally thought she was on vacation some of the time.

As I watched my mom go down this road, what I found helpful and what I think my father could have benefited from significantly is to get in a support group and/or read lots about it and learn how to continue to be in a healthy relationship with those suffering. Those in close relationships with people with Alzheimer's need support, too. There are tough times and it's good to know how to react and to know that it's the effect of the disease you may be seeing, not the person herself. She will continue to have the same internal qualities you've known all these years, but the disease sometimes is in control.

Bless you and your wife on this journey.

Drew

[TBLS]

Sorry to hear; went through this with my father and in process with my 93 year old mother. My Mom had tremendous guilt when we had to act on my Father; only comment I have is focus on spending quality time vs caregiving time if you go this route

Additional advice is to secure a review of all legal docs, poa's, etc and consider who can act if you can't

I'm 58 with most friends same age are working thru similar challenges so you are far from alone.

[Ralph]

Don't know all the details but.....If I were you, would buy an hour's time of a Elder Law lawyer.

Don't know how much assets you have to burn thru....but assisted care soon turns to skilled care.....and my mother in law went thru about $9000 per month in skilled care (about $200,000....her life's savings as a nurse) until she was broke, then Medicaid program took over.

So unless you have hundred's of thousands of dollars of financial assets you won't need in your later years, you need to find how to hang on to a portion of your assets for your future needs, and see what state/fed programs she can qualify for....after you spend some amount. I've done all the paper work for my mother in law, and got a good education on just how important these programs are. The subject is too complicated for a bike forum. For your sake...see an attorney who specializes in this. Your future is at stake also. They will take all your money until you are broke, unless you do some planning. IMHO no American should be forced to go broke over a spouse's healthcare.

[Ralph]

Having just gone thru this with my mother in law...who is still living.....feel so strongly about this subject.

Briefly....don't know what state you live in.....but in Florida.....When a spouse has to put the other spouse into nursing care.....you are required to spend down your assets.....no free ride.
However.....the remaining spouse is allowed to keep the home and one vehicle from the asset test calculation. You can then split your financial assets into halves, (a penalty if you didn't do it 5 years earlier....they can claw some back), so then you spend down her assets until she has less than $2000, then state takes over. You get to keep your part of the money, your house, and a car. The state may require your estate to sell your home after you die to pay back the state, maybe not. So lots to plan for. See a elder law specialist. it's your future at stake now.

[thwart]

Originally Posted by CNY rider

There are definitely pitfalls and potholes you need to watch for.
Don't know where you live but if your county has an office of the aging, get in touch with them and sit down with a social worker or case manager before you submit anything.

Originally Posted by Ralph

Having just gone thru this with my mother in law...who is still living.....feel so strongly about this subject.

Briefly....don't know what state you live in.....but in Florida.....When a spouse has to put the other spouse into nursing care.....you are required to spend down your assets.....no free ride.
However.....the remaining spouse is allowed to keep the home and one vehicle from the asset test calculation. You can then split your financial assets into halves, (a penalty if you didn't do it 5 years earlier....they can claw some back), so then you spend down her assets until she has less than $2000, then state takes over. You get to keep your part of the money, your house, and a car. The state may require your estate to sell your home after you die to pay back the state, maybe not. So lots to plan for. See a elder law specialist. it's your future at stake now.

Sorry to hear it. Hope time on the bike makes the caregiving process a little easier.

You've got some very good advice above.

[carpediemracing]

I forget some of the details I learned when I was looking for something for my dad. I ended up caring for him myself. Not pure dementia but close enough that it doesn't matter.

There's "clawback" where they go back 5 years to determine your ability to pay (so if you gifted money away to reduce assets they can go "reclaim" those gifts from the people that received the gifts). Basically you need to start planning for nursing home stuff 5 years in advance.

There's something about future bills, meaning they can come after your assets once insurance runs out. This is where a parent may try to do stuff to protect assets, but, again, you have to do that 5+ years before you commit to a home, else whatever you do is vulnerable to "claw back".

One place flat out asked how much money was available, figuring on $10k/month as an average cost. It was literally "I'm interested in finding out about your program for my dad." "Does he have money?" Literally the start of the conversation.

Talking to someone who knows about this stuff (lawyer) would be the first step.

[carpediemracing]

Also, if end of life seems near, "hospice care" is a bit different versus normal care. They aren't concerned with keeping the patient alive as long as possible. They are interested in providing quality of life.

My dad fell while in my care, toppling over onto the floor. He cut his eye. We took him to a walk in, then the hospital, x-rays, CAT scan, etc. The hospice nurse said they'd have just dressed his wound at home and made him comfortable. Any other injuries or whatever they'd have just worked on comfort level, not doing things like surgery for a hernia or cataracts or whatever might pop up.

I forget how hospice care costs worked for my dad but he only had one visit from the nurse before he passed so we never stress tested the system. I think Medicare covered it.

[Ralph]

If a Medicare eligible person spends 3 days in a hospital....Medicare will then cover 21 days in a rehab facility, which can be mostly skilled nursing with some PT. That's all....up to 21 days. Rest is on you, spending down your assets, until you qualify for Medicaid. Without getting political.....some states accepted more Fed money for their Medicaid program for mostly old folks. Some states didn't, or wouldn't.

For you folks on Medicare who have a secondary policy to pick up the 20% of Doctor bills Medicare doesn't pay.....double check to see if your secondary will also pick up an additional 100 days of nursing care, after the 21 days of Medicare nursing home coverage ends. Better policies will do this. Lots of secondary policies were scrapped because they did not meet the requirements of Obama Care, and adding the 100 days of extra nursing home care was added to most secondary policies with Obama Care. Check yours to be sure. Mine does. So after 3 days in a hospital, Medicare will pay for up to 21 days in a nursing home, and better secondary policies will pay an additional 100 days. Then you pay. Until you go broke, then Medicaid pays.

[Corso]

Originally Posted by carpediemracing

There's "clawback" where they go back 5 years to determine your ability to pay (so if you gifted money away to reduce assets they can go "reclaim" those gifts from the people that received the gifts). Basically you need to start planning for nursing home stuff 5 years in advance.

Talking to someone who knows about this stuff (lawyer) would be the first step.

The 5 year “reclaim” is true. It’s a shame, but an assisted care facility will eventually go after all assets once the cash runs out. Most folks think Medicaid will cover them in their twilight years…but Medicaid only pays a percentage of what a facility needs to stay in business.

Facilites used to take a percentage of Gov-pay people,(as private pay could “cover” the gap- but the tipping point is hitting, so...

...more and more Care homes are going private pay only (taking residence who have enough money to pay them), as they can’t lose money with what the gov pays. And the Gov doesn’t own the facilities, (well, very few of them--anymore.)

It’s like insurance companies pulling out of states due to losing money (Obama-care). Some states don’t have more than one or two providers now.

Our gov can make rules, decide what to pay (or what they deem is fair) to private companies, but they can’t order those companies to stay in business.

My 2cents: Visit a variety of facilities, and go with your gut. It’s hard. but there are still elder care professionals who are there to do the right thing.

I feel for you and your family.

[AngryScientist]

kingfisher - i'm vaguely familiar with the system, but my experience is based on getting my dad into assisted living in NJ. totally different than what i'd expect to go through with my wife.

i have no advice per the topic, but just wanted to offer my support. i can not imagine what you must be going through, in total. stay strong, it must be a long and challenging road.

wishing the best for you.

[Ken Robb]

Originally Posted by Ralph

If a Medicare eligible person spends 3 days in a hospital....Medicare will then cover 21 days in a rehab facility, which can be mostly skilled nursing with some PT. That's all....up to 21 days. Rest is on you, spending down your assets, until you qualify for Medicaid. Without getting political.....some states accepted more Fed money for their Medicaid program for mostly old folks. Some states didn't, or wouldn't.

For you folks on Medicare who have a secondary policy to pick up the 20% of Doctor bills Medicare doesn't pay.....double check to see if your secondary will also pick up an additional 100 days of nursing care, after the 21 days of Medicare nursing home coverage ends. Better policies will do this. Lots of secondary policies were scrapped because they did not meet the requirements of Obama Care, and adding the 100 days of extra nursing home care was added to most secondary policies with Obama Care. Check yours to be sure. Mine does. So after 3 days in a hospital, Medicare will pay for up to 21 days in a nursing home, and better secondary policies will pay an additional 100 days. Then you pay. Until you go broke, then Medicaid pays.

Ralph is a sharp cookie and offers valuable insights on a wide range of topics. Thanks Ralph.

[oldpotatoe]

Originally Posted by Kingfisher

My wife has alzheimers and is declining quite rapidly. Already in a daycare program a few days per week but for future I need to get her on the list for assisted living facility.

The application looks pretty straightforward..assets, liabilities, etc.

Has anyone done this and is there anything I need to be wary of completing this thing?

Thanks much

So sorry...my mother in law has Alzheimer's, is now in a 20 bed memory care center. The system with her is to drain her savings(at about $7500 per month), apply for medicad(just completed with the an attorney's assistance)..and nothing changes..just be sure the place she goes has a 'no discharge' policy. 'Some' places, if the patient is either somewhat violent or in the Alzheimer's 'end game', will discharge to a local hospital.

BUT get an attorney who specializes in this sort of thing, visit as many care centers as you can and my thoughts out to you for your very difficult situation..