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My mother (87) fractured her pelvis in August. After 2 weeks in the hospital, she was in rehab for 8 weeks and currently home in a hospital bed for nearly 6 weeks. She was not cleared to put any weight on her left leg until a few weeks ago, so any PT has been very slow and painful. My dad has been caring for her, using a combo of paid-for VNA services and private care (8 hours/wk).


She apparently had two "episodes" of talking nonsense. Not garbled, more of a word salad which appears to be consistent with dementia. That freaked him out, but it has not happened since 11/23/23. (I understand this can be a symptom of a UTI).


I think the likelihood of her being able to get in and out of wheelchair, unassisted, with her level of strength is zero. She was very weak to begin with, and had a fall earlier this year (legs just give out) and now bedridden for 4 months. I am beyond greatful for VNA support, but that won't last much longer.


My dad expressed concern about how to pay for her care outside of their home. He is under the assumption that going to AL/NH means "they take all your money". My parents have about $40K in liquid accounts, and then the biggest asset is their house.


One of the issues is that my father does not want to go to AL with my mother, although she probably needs a NH now. He is also reluctant to sell the house, because of the work involved. I hope the attorney steers him in that direction... it does not involve "spending down their money", frees up money for mom's care, and a condo or apt. for him.


I can't attend the meeting next week, and would appreciate your advice. FYI, they live in MA, which apparently is HIGH on the scale for NH costs.

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As far as work involved in selling the house, find out what he thinks the work actually is. If he thinks he has to paint and refurbish, he doesn't. He can sell as is or hire someone to do the work. If he thinks he has to sell it himself, he doesn't. Real estate people could set his mind at ease and do all the work of selling for him. If he dreads cleaning out the house and moving, there are companies that do that. It costs money, and he may not like that, but it's what we have to do when we're sitting between a rock and a hard place.

Dad needs to be reassured that selling the house can be accomplished without killing himself in the process. BUT - I'm sure he's attached to the place and you'll meet with resistance all the way.

As for assisted living taking all his money, who knows. Someone needs to take care of his wife. He needs to step up and take responsibility for finding a place where professional caregivers can do that. He also needs to be realistic about his own situation. Clearly mom will never be able to take care of him. If he doesn't go to AL and gets sick, who will? He'd better start understanding that!

Good luck, I hope it goes well.
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Logan1964 Dec 15, 2023
Thank you for your answer. He wants to sell the house as a tear-down. However, it will still need to be emptied, etc. I live out of state.

He is kind of "stepping up", just very reluctantly. He can't force my mother into AL or NH (that's what he tells me).

For years he has been saying "we'll cross that bridge when we come to it" and avoid any kind of discussion or planning which has created so much stress and worry for me. I worry about them both, and I am also very frustrated.
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Someone should really be there with them. At 87 it maybe very confusing for him to understand it all. 40k my last them 4 to 6 months in an AL. Assets can be split between them. 20k may get Mom 2 months in a NH. Then Medicaid can be applied for, which I think it will need to be how it goes. Then Dad can stay in their home.
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I would maybe tell your Dad to wait unil your Mom is a little further along in her PT before concluding she is a candidate for AL. Please consider that your Mom may not walk unassisted again and that she will in fact require LTC, which is what Medicaid pays for in most states (and not AL). In which case he should meet with a Medicaid Planner for his state of residence. Also do have her checked for a UTI. Medicaid does not impoverish the spouse. Do you think your Dad can live by himself truly independently? If not, please don't encourage him to live alone in a condo or apartment. A senior community may be a better option.
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Logan1964 Dec 15, 2023
Thank you for your answer. My dad is actually far more optimistic than me (or in denial) regarding my mother's mobility. I have not heard of a Medicaid planner, thank you. I do think he'd like a senior community TBH, however, mentally he is not quite ready for that (meaning, afraid of a perceived loss of independence). They live in a ranch house with a pool, yard and snow. They have help with landscaping, etc. and I know my dad would prefer to move to a smaller place but I think he is getting anxious thinking about it. FYI, he'd like to sell the house as a tear-down. One around the corner sold in June as a tear-down.
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I agree with JoAnn that you need to BE THERE. This is a big deal. If you cannot be there physically there will be a way to be there online by ZOOM or another method and this has to happen. You need to be in the loop.

I sure wish you luck and hope you will update us on what you learn. You are likely correct that Mom will require some placement, and that division of assets is crucial now to save what can be saved here. With this much in assets the money will go very very quickly once any care is needed. The home came of course be saved until both have passed, even if Medicaid care is needed eventually for both. There will be Medicaid recovery on the home after its sale.l

Best to you. Call that atttorney today.
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Have the conversation taped. If you canine there, have it taped. Really truly am the atty to hire a court reporter (they have one they use) to do this and send you it via email. Way way too much oppfor folks, esp dad to hear what they want to hear.

With facilities costing at a minimum 4K a mo for AL on the lowest of the low side to 20K for private pay for a SNF, paying for a CR to do a transcript for you will be worthwhile. And they may charge you less as it’s not legal for a trial or a deposition.
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At his age everything is massively overwhelming, so to expect him to pull off a move, selling the house, etc. is unrealistic.

Frankly, the better idea might be to help him find a place with independent, AL, and skilled nursing all in one place, get them both moved in, then deal with the house.

Most larger real estate companies now have programs where they'll font the money for repairs to the house, they get repaid out of the proceeds. That way you get the most possible for the house within the scope of a fairly quick "lipstick on a pig" fix-up. Hire an estate sale company, and they'll hold the sale, then they'll bring in someone to haul off the rest.

Many Realtors these days specialize in estates and handle everything from the sale, the clean-out, and the repairs for a small cut of the proceeds. That'd be the ideal person to use, especially if you're out of the area and Mom and Dad are out of the house.

Start with the attorney visit first, then go from there. He'll likely have contacts for those types of Realtors, too
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If she cannot help with transfer or requires a 2 or 3 person lift, then you might be right about NH instead of AL. AL is mostly private pay at 5 to 8 k per month. NH is more than 10 K but she may qualify for Medicaid. Legal decisions will help him with how to split assets before the application depending on the state. He might be able to keep the savings because that is far below the spousal benefit. If she gets social security, then that check will go for her care. At leat the lawyer will explain a plan of action. He can stay in his home and only a lein will be placed for a clawback. The unfortunate part of selling a house as a teardown, it still must sell at fair market value. A home in poor condition may take a while in this market. So mom might stay at home for several more months.
While there is still time, talk to your father about including you in a zoom call or a conference call
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The attorney should be able to advise on how your father can preserve his assets. Your father should also make sure that all of the paperwork for him and your mother is in order: setting up Powers of Attorney (POA) for both of them for medical (health care proxy) and financial matters (durable power of attorney), living wills with their advance medical directives, and both of them should have wills. Good luck to you all.
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Logan1964 Jan 3, 2024
You are exactly right, she seemed to know what's legal and how to preserve his/their assets. She is the attorney who amended their wills after the first attorney retired.

I often asked my father these types of questions (e.g. bank accounts) and his response was always "the attorney has that information" I sent her a long email asking to prioritize what information she needs. I think she needs to change their wills, etc. I also asked her what information she has. I eagerly wait for her response.

If my father suddenly passed away, I would not know where to start! Now my father has to gather documents such as social security statements, brokerage account statements, etc. This has somewhat given me some peace of mind that it is being collected.

I realize that many people don't have their financial affairs in order, which makes it a huge burden on their children. This is so unfortunate. Yes, it's a lot of work to do it... but? I think there should be a class called "getting your financial affairs in order". I think some have accountants and financial planners, but most do not.

Going through this, it's really hard. We're fortunate that we can afford the attorney fees, but it's still so much work and stress.

Thank you for your concern and comments.
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Logan,
Can you update us on how this meeting went with your Dad and attorney, and if he was helped? Were you able to attend by zoom or speak with the attorney and your Dad?
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Logan1964 Jan 3, 2024
The call went well. I was on the phone with them. Please see the answer to Llamalover. I am grateful for the Attorney's help!
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You are on the right track of consulting with an elder law attorney. Try to convince your father to go with an open mind to the consult. Let your father know that if your mother is going into the facility through Medicaid that Medicaid will never leave him destitute. Your father will still be able to live in his house while your mother is in the facility.

Best wishes.
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Logan1964 Jan 3, 2024
Thank you. Please see my response to Llamalover (great handle!). There is a TON of paperwork to gather, it's nearly overwhelming. I sent a follow up email to the lawyer regarding how to prioritize, etc.
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Logan1964: I hope that you WERE able to attend the meeting with the attorney either in person or virtually.
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Logan1964 Jan 3, 2024
I did join the meeting over the phone, thank you. I learned a lot. We have a lot of paperwork to gather for apply for MASSHEALTH but my dad hired the lawyer to use her services ($$$, but worth it). Apparently my father can transfer the deed to the house to his name, as well as liquidate joint accounts. I just sent her a long email asking follow up questions, because I thought Medicaid has a "look back" process to see what you have done with your assets. I also want her help prioritizing what information she needs first. This is really hard. Thank you for asking!
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Before my dad’s death I was in the process of applying for Medicaid to help pay for his home care. The rules here in Ohio, each state may be different, is that one spouse can be considered “destitute” and the other spouse can retain the home and a set mount of cash and assets to support him/her.

To qualify Dad we transferred the title of their home to Mom, and since their assets were in shared accounts and totaled less than the allowed amount Dad did qualify for Medicaid. If Dad had been moved to a facility Medicaid would have paid the fees less his share of Social Security.

Mom would have been able to continue to live in the house. If she died or moved out and the home sold Medicaid would have been repaid out of half of the proceeds of that sale, the rest going to Mom. If Mom had outlived her share of the sale and assets then we would have applied for Medicaid for her.

The important thing here is the government shouldn’t have to pay for senior care if that person holds assets that can be used instead. Medicaid will not “take the house”, there are rules to follow on both sides. You would be wise to consult the Medicaid office in your area. It took me 6 weeks and LOTS of paperwork to get things filed for Dad.
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I would get an evaluation done by Hospice.
Hospice does not ALWAYS mean 6 months or fewer. After my Husband fractured his hip he was on Hospice for almost 3 years. (He also had dementia)
But with Hospice I got a Nurse that would come in and check on him weekly.
I got a CNA 2 to 3 times a week.
I got all the supplies I needed to care for him (incontinent supplies, gloves, creams, ointments, medications)
I got the equipment that I needed to care for him (Hospital bed with an alternating pressure mattress, wheelchair then later a Broda Chair, Sit-To-Stand, then a Hoyer Lift all delivered to the house and set up.)
And if I needed anything I could call 24/7.
What I could not do was call 911 for transport to the hospital. (I did call 911 for Lift Assist)
All that was covered by Medicare (Hospice is also covered by Medicaid and most other insurance)
Let Hospice be an option to help with some things. (If she is not progressing with PT It will not be covered after a certain point and Hospice does not cover PT but it can be paid for "out of pocket")
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So glad you were in on the meeting. I know when I went with Mom to Dr appts and other things, she seemed to miss some of what was being said. Hard of hearing? Too overwhelmed with info? Cognitive decline? Whatever, 4 ears are better than 2.
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