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Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
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I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Yes, I know this through last year. I received a note/e-mail that indicated this question was being discussed again. So I did put in my fast forwarded response to this year's note that answers were being followed again.
I'm thinking of books, magazines, newspapers, cd player etc. - if interested and capable of enjoying such items. I think phone and cable TV can be paid using the monthly funds. All of these are actually expensive. Anything to help keep her in the communications loop and keep from going stir-crazy. If she is able to eat favorite foods that are never served at the snf, you could bring in food-to-go from her favorite places.
If none of the above applies to her, use it as a tool for achieving other goals:
I discovered by accident that what is purchased for snf patient can be a prompt or reminder to staff that certain needs are not being met. I've used this tactic for food, shaving, blankets, and cleanup. When the floors were being cleaned yet still retaining the sticky stuff, I bought large disposable cloths to wipe up the spills that went to the floor. No comments, No complaints, just vote with my husband's $50 monthly mandate.
My husband used both a razor and an electric razor to shave. They were not using the electric shaver soon after his admission to snf, so I bought a couple packs of hand razors. I knew loose razors would get the administrators attention because they have to be stored separately. He gets shaved more frequently now.
Extra large blankets got the attention of housekeeping and laundry. I did this because my husband asked several times on different days for an extra blanket. An extra blanket didn't seem to be available. A couple visits to the laundry and observing me bringing in more Wal-Mart balankets was a little more than they could bear. They assured me they would find him some blankets and they did. Well, "thank you very much" and use his money to enhance the personal attention he receives. It's a challenge as there is no abundance of staff.
If she does not need or want anything, spend it as a way to enhance the care she already receives. I told this to a friend of my husband's who quickly reminded me of some old expression about how money talks and other stuff walks. Money and non-verbal skills can possibly be used to her advantage.
Another thought is if you end up having to waste her $50.00 you should next consider how to make wasting money a therapeutic exercise for you. Dedicate maybe two times a month you will go shopping for her and use that as "time away" from everything else. I just tell people I'm going to do xxx for my husband. No one wants to tag along while you load the basket with personal items, stand in line for a cup of coffee at Dunkin' Donuts, or gas up the car.
If she doesn't want or need anything you buy that month, you take it to her room, put it in a drawer or closet, let it sit there. Medicaid is requiring you to spend, so fulfill that requirement and be done with it.
You didn't mention where you and your Mom are on the elder care timeline. Is your Mom still at home, and you're seeking to qualify for Medicaid programs that keep people out of nursing homes? Is your Mom already in a facility, and you need to spend down before Medicaid will pay? Talk to an elder law attorney in your state who can analyze the situation for you.
You can set aside any excess assets in a pooled trust account for your Mom. Talk with an elder law attorney in your state, who is familiar with the Medicaid application. Funds deposited in a pooled trust account (also known as (d)(4)(C) trusts) can be used for any suitable purpose that assists the account beneficiary. There is no need to spend down, if the Medicaid application is prepared properly.
The trust funds can be used to supplement care that staff in the nursing home are not able to provide, even after Medicaid starts paying for care.
Gifting is not allowed during the five year look back unless it is regular gifts that you can show a pattern of giving. For example 100$ or 500$ for Christmas and Birthdays. You have to show that it was done for a period of time. Gifting 5-10-20,000$ is not allowed and is considered Divestment. If a person has enough assets and income to pay for Nursing Home or Assisted Living Care for more than 5 years, they can gift the remaining money without penalty. Good Luck
See an Elder Attorney first. Consolation is free. The Elder Attorney will help you title their assets correctly and help you to know what programs are out their that they will quality for. Was your Father or Mother a Veteran?
Are talking about a monthly spend down? If your mother only needs to spend down $20 to $50 per month you can usually just pay that amount to the state prior to the month you want medicaid for and she will be eligible the beginning of the month. If this is a monthly spend down the only expenses allowed are for medical items. For example prescription or prescription co-pays. Some states allow for otc items if a doctor writes a prescription for the item. Keep receipts for all items. There are some creative ways to meet a spend down. Those who use authentic therapy dogs are allowed to use vet and food expenses. Any co-pays for medical treatment are allowed. Hope this is helpful. Good luck!
I don't understand why people worry about spending down. When they r ready for a nursing home, you use the money they have till its gone. You apply for medicaid before money runs out. Yes, find out what medicare will allow to be paid for is wise. But just to get rid of money so medicaid will take over...
I think the Medicaid laws are different in every state. You might do best to hire a elder law attorney first.
Some easily documented things I regularly purchase for my Dad in this price range are: daily newspaper, prepaid phone minutes, cable TV, haircuts, healthy snacks and juice he likes, clothes, dental checkups that aren't covered by insurance, and copays. I would feel less comfortable about documenting entertainment costs such as movies and dinner.
We paid for the nursing home for my dad ($6200/month) and home improvements for my mom since she was the community spouse. We even used the expense of the elder care attorney towards the spend down. Just be sure to keep documentation and receipts all around.
I had an attorney help me with "estate planning". My mother had about 200K in assets, including stocks,annuities and CD's. I sold and cashed in those and bought two new bigger annuities which will pay out monthly to help pay for her monthly memory care facility bill and other medical expenses. I am also applying for the VA "aid and attendance" for her also. All this will spend down her money and last for approximately the next 5 years, by paying for her own care. On a side note, my brother and I talked to her a couple of years ago (before her mind was gone) about "gifting" money to her grandchildren in order to "spend down" to be eligible for Medicaid. We explained that it was either give it to her family or give it to the government (to pay for her care). I don't think she really understood, but she was not ok with "giving" money to her grandchildren. She is from the school that you must "earn" the money you get and I supposed she felt that her grandchildren were not deserving. Anyway.... the above is how we are handling her assets. If she lives longer than 5 more years, she will be eligible for Medicaid by then.
I could kick myself for not knowing ahead of time, or thinking clearly how to best spend that excess to qualify for Medicaid. We have an old, rinky dink shower stall in her bathroom that could have been replaced with something much more convenient and roomy. However, we felt an obligation to pay off some of her long-time accumulated medical bills. And those medical bills were not all paid off, but I also don't even hear from them any more... I wonder, don't they care? Couldn't pay it off now anyway, but I don't know if we did the right thing or not.
If you really think about it, your mom is actually in a better position than you realize. What I'm saying is that she can use the extra money in a different way by just saving it toward buying her own insurance and getting off of Medicaid. If I was in such a position where I had extra money, I would use that to my advantage and climb out of poverty and out of the cycle of it. If you wonder why many people just can't get ahead, bring about how much we unnecessarily spend annually. Add up how much you spend yearly and it will completely blow your mind. Many people don't realize the opportunities they have until they're gone. SSI for instance allows you up to $2000, whereas Medicaid says $1500. What I would do is go with the higher amount and save the extra money, drop Medicaid and just buy my own insurance. Again, this can be done with any money that's over the medicaid limit. You can shop around for insurance premiums until you find something that will give your mom the best care for that amount of money, and she'll probably get far better care, services and products anyway if she just buys her own healthcare policy with that extra money. What she can do meanwhile if she gets direct deposit is bring home a certain amount of extra money to keep in the safe. As long as she doesn't spend any of it, that extra money will buy an insurance policy.
If your Mom is already in a Nursing or Memory Care Facility, continue to pay for her monthly care. It is a good idea to spend a little of her money on things that improve her quality of life. If she likes to get her hair or nails done, continue that. If there are specific clothing items she prefers, you can stock up on a few extra. For people who have large amounts of money and are trying to find a way to spend it to get on Medicaid, there is really no advantage to hurrying up the process. There are states that allow disabled persons to set up special needs trust accounts. That money can be used for things like the additional cost of a private room, ( Most Medicaid programs pay only for a shared room in a facility) Cable TV, Salon Services ( hair, nails, massage) Lunches out ect.... Good Luck
I've met one family that is using their dad's excess money to pay out of pocket prescription costs as his meds are VERY high priced. That's an easy way to document too. Receipts are good and if receipts are lost, you can ask the pharmacy to print out the year's prescription - handy for income taxes too.
There are requirements to be what is allowed for spend down... My Mom was admitted to hospice (her spend down was $850 monthly) ... Hospice Bills for spend down which meets that requirement. Mom brings home about $1.400 a month and we were paying $850 a month for day care... We are waiting/ hoping for passport approval. Day care or home care would most likely account for spend down, plus medical bills, etc.
We had our feet "worked on" although I know some folks have told me that her insurance would have reimbursed us for it if she were taking blood thinners......I don't know about all of that but I had a podiatrist get her feet so she could walk - it was a $200/weekly visit! Good and well worth it.
If you are talking about $20 - $30 per month (as you state in the question) I am going to assume its so you don't go over the $2,000 monthly asset limit because of the personal care need spend she receives each month. How about flowers for her room, or anything else she might enjoy? Something to make her room more comfortable for her visitors, say a nice chair to sit in, while a few hundred dollars, you'd have a few months to not worry about the $2,000 limit.
Lift recliner could be used at home or in a nursing facility, lightweight wheelchair for easy transport, motorized wheelchair, ramp for house, stairchair. I am sitting at home thinking of all the things my dad uses. Both my parents used lift recliners so I had 3 of them when I moved dad in with me. I have one in his bedroom, one in family room and one in enclosed sun porch. If I think of anything else, I'll write back. Funeral expenses as mentioned above would be the first purchase i would make.
Why approach it this way? Seems like your making more work for yourself...
To me, what to do & how is very much interdependent on how much $$ we're talking about. 200k is a lot different than 20k; and if the elder is still living on their own (IL, with family, on their own) or in AL or abt to enter or already in a NH.
Whatever the scenario, I'd suggest that you get all their legal done or updated and they use their $ to do this as part of their spend down; and then get a clear picture of what their financial & health situation is. If they are imminent to go into a NH which costs $10,000.00 a month, then spending $ 23.67 at Target, then running to CVS for $ 34.78 then $43.21 at Walmart is kinda moot & a big waste of your energy & time.
So what's the backstory? You'll get good ideas from the folks on this forum if you provide details.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
John, the elder attorney, answered even though the last post was Aug 2015.
If she is able to eat favorite foods that are never served at the snf, you could bring in food-to-go from her favorite places.
If none of the above applies to her, use it as a tool for achieving other goals:
I discovered by accident that what is purchased for snf patient can be a prompt or reminder to staff that certain needs are not being met. I've used this tactic for food, shaving, blankets, and cleanup. When the floors were being cleaned yet still retaining the sticky stuff, I bought large disposable cloths to wipe up the spills that went to the floor. No comments, No complaints, just vote with my husband's $50 monthly mandate.
My husband used both a razor and an electric razor to shave. They were not using the electric shaver soon after his admission to snf, so I bought a couple packs of hand razors. I knew loose razors would get the administrators attention because they have to be stored separately. He gets shaved more frequently now.
Extra large blankets got the attention of housekeeping and laundry. I did this because my husband asked several times on different days for an extra blanket. An extra blanket didn't seem to be available. A couple visits to the laundry and observing me bringing in more Wal-Mart balankets was a little more than they could bear. They assured me they would find him some blankets and they did. Well, "thank you very much" and use his money to enhance the personal attention he receives. It's a challenge as there is no abundance of staff.
If she does not need or want anything, spend it as a way to enhance the care she already receives. I told this to a friend of my husband's who quickly reminded me of some old expression about how money talks and other stuff walks. Money and non-verbal skills can possibly be used to her advantage.
Another thought is if you end up having to waste her $50.00 you should next consider how to make wasting money a therapeutic exercise for you. Dedicate maybe two times a month you will go shopping for her and use that as "time away" from everything else. I just tell people I'm going to do xxx for my husband. No one wants to tag along while you load the basket with personal items, stand in line for a cup of coffee at Dunkin' Donuts, or gas up the car.
If she doesn't want or need anything you buy that month, you take it to her room, put it in a drawer or closet, let it sit there. Medicaid is requiring you to spend, so fulfill that requirement and be done with it.
You can set aside any excess assets in a pooled trust account for your Mom. Talk with an elder law attorney in your state, who is familiar with the Medicaid application. Funds deposited in a pooled trust account (also known as (d)(4)(C) trusts) can be used for any suitable purpose that assists the account beneficiary.
There is no need to spend down, if the Medicaid application is prepared properly.
The trust funds can be used to supplement care that staff in the nursing home are not able to provide, even after Medicaid starts paying for care.
Good Luck
If this is a monthly spend down the only expenses allowed are for medical items. For example prescription or prescription co-pays. Some states allow for otc items if a doctor writes a prescription for the item. Keep receipts for all items.
There are some creative ways to meet a spend down. Those who use authentic therapy dogs are allowed to use vet and food expenses. Any co-pays for medical treatment are allowed. Hope this is helpful. Good luck!
Some easily documented things I regularly purchase for my Dad in this price range are: daily newspaper, prepaid phone minutes, cable TV, haircuts, healthy snacks and juice he likes, clothes, dental checkups that aren't covered by insurance, and copays. I would feel less comfortable about documenting entertainment costs such as movies and dinner.
On a side note, my brother and I talked to her a couple of years ago (before her mind was gone) about "gifting" money to her grandchildren in order to "spend down" to be eligible for Medicaid. We explained that it was either give it to her family or give it to the government (to pay for her care). I don't think she really understood, but she was not ok with "giving" money to her grandchildren. She is from the school that you must "earn" the money you get and I supposed she felt that her grandchildren were not deserving. Anyway.... the above is how we are handling her assets. If she lives longer than 5 more years, she will be eligible for Medicaid by then.
Good Luck
To me, what to do & how is very much interdependent on how much $$ we're talking about. 200k is a lot different than 20k; and if the elder is still living on their own (IL, with family, on their own) or in AL or abt to enter or already in a NH.
Whatever the scenario, I'd suggest that you get all their legal done or updated and they use their $ to do this as part of their spend down; and then get a clear picture of what their financial & health situation is. If they are imminent to go into a NH which costs $10,000.00 a month, then spending $ 23.67 at Target, then running to CVS for $ 34.78 then $43.21 at Walmart is kinda moot & a big waste of your energy & time.
So what's the backstory? You'll get good ideas from the folks on this forum if you provide details.