This must be an unusual question because I can't find suggestions anywhere. I'm hoping this forum can give me some ideas. My mother is in late stage dementia and has been in a nursing home for 3 years on Medicaid. According to the NH, in our state of CT, she gets to keep $60 a month from SSI and $90 a month from the VA. I find it a challenge to keep her bank account below the $1600 maximum so that she continues to qualify for Medicaid. A haircut in the facility costs a mere $20 and she definitely wouldn't enjoy or need a haircut every month. I buy her clothes, shoes, special toiletries, treats from time to time but $150 a month is alot to spend on these kind of items. I bought her flowers, seasonal decor gifts, cozy outfits and blanket, Alzheimer "toys". I'm at a loss of what else I can use this money on. My mother's dementia is at the point where she wouldn't enjoy leaving the facility so going out for lunch or ice cream is no longer a possibility. She already has a TV in her room that she doesn't watch. The nursing staff suggested a medical recliner for her room but seriously there is barely room for that and I know she wouldn't use it. She spends most of her days in her wheelchair in the community room. Recently I've had a massage therapist come in to give her a chair/hand massage which she enjoys. I will continue to do that but I need some ideas for more big ticket items so that I can get her account down to a balance that is easier to maintain under the limit. I know, its a ridiculous problem to have. Does anyone else have this problem? Does anyone have some ideas to spend money on for a late stage dementia resident of a nursing home?
Give her flowers every week or 2xs a week.
Anything that she can benefit from in anyway is exactly what you should do.
Can you hire a caregiver to come in and help her with interaction that she enjoys?
I think that you have good solutions already, you just need to keep them on a regular schedule.
Keep spending on your choices. Does she like music? She doesn’t watch television but would she listen to music? Or audio books?
- fresh flowers delivered to her room;
- eatable bouquet;
- chocolate covered fruit;
- meals/treats delivered to her room (with delivery services like DoorDash you - - can have a whole meal or milkshake or smoothie delivered);
- manicure and pedicure;
- wash & set;
- digital photo frame with slideshow feature;
- photo book of family, landscapes, birds, animals, etc.
- if allowed a small refrigerator;
- Walmart/grocery delivery of fruit/cheese tray;
- my father enjoyed high qualify chocolates (Godiva has a subscription service to deliver a box each month);
- mouth rinses (for dry mouth or dental health); and,
- essential oils along with a diffuser.
They have certain restrictions but this might spend down a healthy amount.
My SIL loves buying collector coins for gifts, the type from the mint. If I had to shop for her, I'd buy silver coins as gifts. Would look like I was stockpiling & hiding her assets though :(
hugs 🤗
I would also hire someone to read to her or play checkers if she can. A teenager could use the money and your mom might enjoy having someone around to read to her. I would also have her name embroidered onto her clothes. I just hate names written on clothes with a sharpie.
If she likes getting her hair washed in the beauty parlor, get it washed every week. It may be soothing for her.
An electronic device easy to use.
Have bottled water and a cooler delivered.
Get a hepa filter for clean fresh smelling air.
Hearing aids cost $8,000 plus.
Send her clothes out (pick up and delivery) to the cleaners.
Stock up on an emergency supply of food, flashlights, and meds.
Any crafts, maybe she can share some games with other residents.
Ask the staff.
What kind of wheelchair? Get an electric wheelchair, or an upgraded wheelchair, a walker?
K. Gabriel Heiser
A senior’s income and assets must fall below certain levels to qualify for Medicaid coverage of their stay in a skilled nursing facility. If their countable assets exceed $2,000, they will not qualify until the excess is spent down or converted to an asset that is not countable.
For income, the 2018 federal limit for eligible applicants is $2,250 per month. However, many states allow Medicaid applicants to spend down their income on medical expenses to get below the $2,250 limit and thus qualify. These states are known as “medically needy” or “spend-down” states. But what can an applicant do if they live in a state that has a hard income limit and doesn’t allow spend-down? Say their assets are below the eligibility limit, but their countable monthly income is $2,275. In this scenario, the senior has too much income to qualify for Medicaid, but they certainly do not have enough money to pay for a nursing home or other long-term care facility!
It was this very situation that led to the 1990 case of Miller v. Ibarra in Colorado. As a result of the decision in this case, those states that do not permit an income spend-down all offer Medicaid applicants the ability to set up a simple irrevocable trust to hold their excess income. Funds in this trust can be used to pay the Medicaid recipient a monthly personal needs allowance (approximately $60, but this varies by state) and, if applicable, pay their community spouse a minimum monthly maintenance needs allowance (MMMNA). From there, any funds that are left over are used to pay the Medicaid recipient’s nursing home bill. The difference will be covered by Medicaid, assuming the applicant otherwise qualifies. Such a trust is called a Miller Trust (after the court case mentioned above), but it can also be referred to as a Medicaid Income Trust, a (d)(4)(B), an Income-Only Trust, an Income Diversion Trust or a Qualified Income Trust (QIT).
Each state has different rules, but in “income-cap” or “categorically needy” states that don’t allow spend down, at least the excess over the income limit amount must be placed into the trust. The Medicaid applicant cannot be the trustee of this account since they are essentially giving up their rights to the money it contains. The trustee is typically a family member, and each month they use money from the trust to pay the Medicaid recipient’s share of cost (SOC), personal needs allowance, their spouse’s MMMNA, and other medical costs and premiums not covered by Medicaid and Medicare. Assuming some basic rules are followed regarding this process, excess income will not prevent an applicant from qualifying for Medicaid, unless their income is so high that it exceeds the amount that Medicaid would otherwise pay to the nursing home each month for their care.
Keep in mind that a Miller Trust can only be used to hold income going to the individual who is trying to qualify for Medicaid, and many states require this income to be direct deposited into the trust account. Applicants cannot put only portions of certain income sources into the account. For example, you cannot put part of your pension or social security check into the trust—it’s all or nothing. Assets and income sources that do not count towards eligibility limits should not be placed in this account either. This includes a community spouse’s income, VA benefits like Aid and Attendance and housebound pensions, income tax payments and some annuity payments.
Hello Iggy!
Or maybe a visit from a therapy animal, if the facility allows that.
3.
Examples of Personal Needs Expenditures
Some examples of acceptable personal needs expenditures are:
a.
Clothing
Disability-related adaptive clothing, bathing suits and caps, boots, gloves, hats, scarves, seasonal garments, shoes, slippers, etc.
b.
Convenience Items
Music players, e-readers, computers, phones, clocks, clothes hamper, stationery, televisions, wristwatches, etc.
c.
Health and Hygiene Items
Bath scale, brushes, combs, nail clippers, cosmetics, cosmetic surgery, dermatology treatments, elective or cosmetic dental treatments, hairdresser or barber costs, soaps, toilet articles, etc.
d.
Hobby and Craft Items
Art supplies, cameras, photo albums, games, athletic equipment, etc.
e.
Living Area Furnishings
Bedspreads, blankets, carpets, curtains, lockable chest or trunk, mirrors, pictures, pillows, posters, quilts, recliner, rocking chair, etc.
f.
Miscellaneous Items
Magazine subscriptions, reasonably priced holiday presents for family or friends, restaurant meals, gift cards for movies or music, etc.
g.
Staff Travel Items
Using the beneficiary's funds to pay the expenses incurred by staff accompanying the beneficiary on an outing or vacation may be an acceptable use, provided:
•
a correlation exists between the expense incurred and a direct benefit to the beneficiary;
•
the beneficiary does not have unmet current or foreseeable needs;
•
the expense is reasonable in relation to the beneficiary's conserved funds; and
•
the staff member's travel expense (e.g., food, transportation, lodging, admission ticket) is not paid for by the payee organization or from another source. The payee should never use beneficiary funds to pay for a staff member's salary or hourly wage or to compensate the payee for these costs.
NOTE: A payee must obtain SSA approval prior to using benefits for staff travel items. Add a relationship note in eRPS to document the approval, see MS 07415.002 Make Note.
For me, the legal avenues are what I want to investigate; not just buying things . . . although some good ideas here.
I've heard that setting up a trust is very expensive. He is still in the process of deciding how to proceed. Although he wants implants. He might be able to get through VA although at his age, he might not be able to get them. It is a painful process from what I've heard. Thanks again for posting.
CNA--$35 an hour (they do hands-on care)
make sure your state approves of this sort of thing--talk to the nursing home's social worker