Watchhttp://michiganelderlawinfo.wordpress.com/2009/04/22/children-responsible-for-elderly-parents%E2%80%99-nursing-home-bill/
So - in Connecticut, a woman was placed into a nursing home and her son signed the admission paperwork as her power of attorney. He didn't accept personal responsibility for the bill, but agreed that as her POA he would help her get onto Medicaid using her financial information. The Medicaid was denied because he failed to keep her assets below $2,000 (it appears that it was a few dollars over the $2k, but I could be wrong) and also didn't provide certain proof of information to Medicaid.
The nursing home sued him personally, stating that even though he hadn't signed as her responsible party there was an oral contract that he would do everything possible to have her Medicaid approved. And the nursing home won over $100,000 judgement. This is a precedent, and it's unclear as to how it will affect the thousands of people waiting for Medicaid to be approved while their family member lives in a nursing home.
http://www.scnursinghomelaw.com/2010/04/articles/medicare-1/family-not-responsible-for-nursing-home-bill/
This is different than the case above - the patient had given her home to her son just after a law took effect that made patients who transferred assets like this ineligible for Medicaid. So the Medicaid was denied, and the nursing home sued the family. The courts found that the patient's family wasn't obligated to return the home to her or even pay her - so the nursing home wasn't able to collect from the family. They did have to pay legal costs, however.
The bottom line here is simple: Don't sign the admission paperwork for a patient in a nursing home. If the patient is able to sign for themselves, have them do so. If not, it's not your responsbility to sign the paperwork. Most nursing homes meet with you to sign the admissions packet after the patient was admitted, so they can't force you to sign. If you have any questions, see an elder law attorney. It could save you over a hundred thousand dollars.
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Zlxr:
The simple answer is sure, you can't gift anything unless it's 3-5 years before you need a nursing home. However, it's much more complicated than that:
Medicare only pays for rehab services in a NH, possibly the first 100 days if you're admitted after staying 3 days in the hospital. There's no guarantee you'll meet the criteria for the full 100 days, and there's a co-pay of $137.50/day for days 21-100 (2010 amounts). If you have a secondary, it might pay the co-pay.
Medicaid is different, pays custodial care. If you have less than $2k in assets, one home/1 car, you're eligible. Your spouse can keep about $20k, after that they split the assets. Spouse can have up to $100k, you have $100k... and if you spend your half on stuff like paying off house, fixing up the house, or your healthcare you're eligible. Some states are now making noise about going after homes when the spouse dies. Single people, the house is gonna get a lien unless you do some pre-planning.
Asset transfers after 2/06 count back to five years, possibly. Creating a revocable living trust doesn't help because it's still considered to be your asset.
Email me thru my site, link under my icon on NH site - depending upon a bit of personal information, you either need to meet with an elderlaw attorney or not. Age, approx assets, state, etc. I might can save you a few thousand dollars in consult fees - or your home. Or not...
BTW, I'm hoping to get a "real" book out soon (instead of the shorter, less comprehensive versions for sale on my site), but my editor keeps telling me to fix stuff. :)
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zobub:
If your mother has the ability to pay privately or has a long-term care insurance policy, you're probably okay - at least for awhile.
If your mother can't pay for her placement, Medicaid will view the house as an asset that can be sold after she dies in order to recoup the monies paid out for her care. The Medicaid program doesn't recognize joint rights of survivorship, so it would consider that half of the equity belongs to your mother and attempt to file a lien for the amount owed (as long as you have been half owner since before Febuary 2006. If not, there's a current eligibility problem as well).
Please note that Medicaid will "allow" you to stay in the house, but will require that her income be paid to the nursing home as her share of cost. Think of it as a deductible. In other words, you'll lose her income which it sounds like you need to make ends meet.
There is a chance that you can circumvent the lien process after she dies if you are able to show that you lived with your mother and that by doing so, you were her primary caregiver that kept her from being placed into a nursing home. This is something that you would do in the future, after she passes away.
To be honest, you should meet with an experienced elder law attorney - there is a fee, but it's worth every penny - to ensure that you protect your financial position. He/she can let you know what your options are in your state. This needs to be an elder law attorney who specializes in Medicaid eligibility and has experience - estate planning attornies don't understand Medicaid law.
It'll cost you, but it will be worth every penny.
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oh yes I am a member.
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Zlxr says
me too. when it happens i shall shout it from the roof tops. but i was serious about you emailing me, i might be able to help a little. so far as the 20,000 other people reading this forum, i'll help you if you buy my stuff... :)
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So you put Grandmom (or mom) in a nursing home, Medicare Deny's the claim, and you refuse to pay, can the nursing home just put Grandmom on a bus with a one way ticket home?
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When Grammy was admitted, if you signed the agreement you might have a problem. However, the nursing home staff meets at least weekly to estimate how long you meet Medicare guidelines. Once they figure you're done they serve you a 3-day notice, which you can appeal if you wish (different rules for HMO/PPO - managed care such as Kaiser plans).
If Medicare denies the claim, you aren't responsible for the past bill. Only for any future charges. The nursing home will make damn sure that they're able to bill... or fudge their records and hope that Medicare doesn't audit that file. I'm sure it happens alot - when the inspectors come, they audit a representative amount of charts unless there's a complaint. 10% of the charts in a 100 bed home is 10 charts... current ones. They rarely pull more than a couple of old charts unless there's been a complaint.
If Grammy is done with therapy and safe to go home, it's ok for the place to put her in a cab. If the door is locked they might send a locksmith to let her in. The thing is, if she isn't safe and can't go home, they can't just dump her out. They might intimidate the hell out of you, which I've personally witnessed. It can get nasty - but that's why you don't sign the agreements.
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I am my mom's POA - I have a gifting clause in the POA forms. I have gifted some of her money to her grandchildren and other siblings including myself. This was an understanding we had as she wanted us to have something. This money was distributed after she went into an assisted living home as that is when the funds were available. My question is - I still have her house yet unsold and 2 investments annuitized I cant liquidate according to her financial planner. He has told me to seek information regarding medicaid to keep my mom in a nursing home. From what I have been reading now she can be denied admittance due to the gifting. If she still had "assets" and can pay is this truly a problem? I have 6 months of liquid assets remaining. Mom haas now since declined to an Alzheimer's home and requires skilled nursing care.
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momof5:
The simple answer is that Medicaid doesn't recognize gifting as a legitimate expense no matter what the patient's wishes or intentions might have been - and if the money was distributed within the past 5 years you probably have a reason for concern. Medicaid's rules are that the gift will make her ineligible for however long it would take to spend the money if she were in a nursing home and was otherwise eligible for Medicaid. The formula varies from state to state.
For example, if she gifted $60k and 2 years later she enters a nursing home and is eligible for Medicaid based on her current income & assets, if the state's calculation is $5,000/month your mom won't be eligible for Medicaid for a year from the date of the application, not the date of the gift. If the money is gone and she can't get it back, Medicaid still won't pay.
There are so many issues here, tho - the unsold house, the gift and the investments - that I recommend you find an experienced elder law attorney. Not an estate planning attorney, because they don't understand Medicaid - but make sure that the elder law attorney has successfully pushed thru some Medicaid applications. There are usually several from which to choose. If there is anything that can be done to help, an elder law expert can do this; they're worth every penny. Please don't listen to random people you meet who think that they know what they're talking about, hire an expert and you might be able to help your mother while preserving assets using legal loopholes. Remember that the laws change often and someone's story from a couple of years ago probably doesn't apply in today's climate.
Btw, your mother doesn't require "skilled" care unless she has wounds (bed sores) or something that requires the services of an RN or Physical Therapist; she needs specialty care that can often be provided in licensed assisted livings or other less expensive settings than nursing homes. If your mother isn't eligible for Medicaid, you may be able to find a facility that can help her that costs substantially less than a nursing home.
good luck - ellie
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Medicare is probably covering the stay 100% (first 20 days is 100% unless she's a managed care patient).
Don't lie about who you are. You are not legally required to sign anything. The administrator probably isn't calling you - unless it's a small place - but the admissions person is. Tell them to have your mother sign her own paperwork.
You have the right to visit and they can't do anything about it. If they give you a hard time, ask them for the number of the state ombudsman.
Once again, you don't have to sign.
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Thanks for the reply.
I have signed nothing yet, but might sign on her 11 day stay at her latest SNF. Medicare says they will cover it
I still do NOT WANT TO SIGH DUE TO THE INITIAL HOSPITAL STAY NOT covered by her 2nd INSURANCE.
She had a severe UTI with septic blood issues.
She has recovered again.
I am seeing a pattern here where my Mom will be rotating between the ER hospital, and a SNF when she is not at her normal RCH!
The pattern seems to be every 2 or 3 months.
eta, Good thing my Mom has good 2ndary insurance!
Happy Holidays! I will go visit my goofy sweet Mom tomorrow!
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marianne says
You never, ever HAVE to sign. However - if you want to (why you would I have no clue), please sign in the following manner:
"Marianne, POA for Marianne's mother" or "Marianne's mother by Marianne, POA." You are not her POA (power of attorney) if she didn't give you POA on a form competed legally in the state in which she resides - so don't write POA unless you have a form to back it up.
If you do decide to sign the paperwork, write the following phrase on the bottom of the form that addresses financial responsibility (it doesn't matter if there's a place to write it, squeeze it in there):
"I am not personally responsible for my mother's financial responsibilities." There was a lawsuit in CT that a family member lost to the tune of $120,000 because he didn't write that on the paperwork.
The nursing home has an intake packet that requires about 30 signatures that was created by their lawyer to protect them only - it addresses everything from their laundry policy to billing from the pharmacy for non-covered items (as long as Medicare pays her bills, there will be no pharmacy charges). It offers you no recourse if they sue you. If your mom can sign her name, she should do so. It's her bill and her health. Doesn't matter if she can barely sign or can only make an "x". She should be responsible for her own bills. If she can't sign, you still aren't responsible to do so. Politely decline, and ask them to have your mother sign.
Your mother has 100 days in the SNF benefit - the first 20 days are paid at 100% and after that the co-insurance kicks in. This applies as long as she has traditional Medicare with a secondary - if she has managed care the rules are different. Traditional Medicare doesn't have in-network and out-of-network providers and the secondaries pay wherever the patient is.
You said that Medicare said they'll cover the stay, but Medicare doesn't make any determination until long after the patient has been discharged. It's different with managed care (as mentioned above), which has case managers whose job is to get her out of there as soon as possible. Either way - don't sign responsibility. It's your mother's bill, not yours.
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I appreciate this site, all of it, however, this is just wrong:
"It could save you over a hundred thousand dollars."
I find this comment disturbing as people that get to live in their homes for free. Dumping you're elderly on someone else, then refusing to pay for it is stealing not saving.
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Ellie Mae, thank you for the advice!
I spoke with the SNF my Mom is for now, and I told them I am not responsible for signing the paperwork. I was firm and they accepted it!
She will be there maybe 10 more days or so. I am going to contact social services tomorrow to find out what is going on with her discharge back to her Residential Care Home.
She just got a new 2nd health care plan through Anthem Blue Cross. It is from a pension she got when she retired. She had Blue Shield but Calpers is no longer a health care option through her employer so I had to choose between Anthem or Kaiser.
So I know she has the coverage if the medicare part of her stay runs out...
Thank you so much!!
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you're welcome. btw, patrick will be posting a link to buy my book (a bargain at whatever price we decide upon) within the next week - for everything you ever wanted to know about nursing homes in about 300 pages please buy a copy. And tell everyone you know, the info is so valuable and I'm hoping to sell many.
elliemae
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Marianne:
I'll let you know about the book (link should be up within the next few days) - Patrick is working on the link. It's an ebook but will be a hardcopy soon too. I'd like to educate as many as people as possible, while making a little money.
Your mom is in the latter stages of Alz Disease, has experienced multiple trips to the ER. Have you considered hospice? This would mean that you would no longer aggressively treat her (oral medications okay, but no more trips to the ER unless it's for a fracture or something unrelated to the Alz Disease). It would save you money on supplies and equipment, as well as giving her a personal attendant to bathe her 3x (or more) each week plus a nurse to oversee her meds. She would also have many medications covered and there's no cost to you for this.
Hospice is different from home health in that your mother would not have rehab services to get her "better." If this is what you want, or you want more info, ask around. I personally prefer hospices that are smaller but have been in business for awhile. If you speak with a company that does both home health & hospice and has done it for awhile, they can help you without an agenda. If you call a hospice (such as a national one), their focus is to get you to sign onto service no matter what it takes. Your doctor will probably refer you to the one that markets him the heaviest and they'll pressure you to sign on, or the one with whom he's affiliated.
Remember that the person with whom you speak (at the hospice) usually gets a commission or has a quota and is normally a sales person with little medical background, so their goal is not to help you as much as it is to get you to sign on. Call and only speak with a nurse who can help you understand how hospice might or might not benefit you. Call several if you want, but tell them that if they call and get a doctor's order without your permission you won't use their service.
You have the right to choose the treatment that your mother will receive. Personally and professionally, I don't believe that hospice belongs in a nursing home unless the patient has uncontrolled pain or symptoms. It's different in an asst living home, they can help the patient stay there rather than continue the revolving door of the hospital.
I'll post the book link. Good luck - and please let us know how your mother does.
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My mother and I have had our house for 12 1/2 years. We are still paying our mortgage, which is in Mom's name, but the deed is in both of our names with survivorship. Will I lose the house if she has to go into a nursing home?
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Elliemae, From my understanding, Hospice is covered by Medicare and secondary insurances.
Are there Hospice institutions where my Mother could live at? Is that how it works?
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Thanks for the links, elliemae.
Now my Mom has a new infection called C-Diff. The are treating her with the less expensive antibiotic.
I see no end in sight.
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C-diff is an infection of the stool called Clostridium difficile.
http://en.wikipedia.org/wiki/Clostridium_difficile
Try not to worry, unfortunately it's a common infection; but does cause diarrhea. You might want to hire an in-home caregiver to help out - or place her in a nh.
If she were on hospice they would pay for a five day respite, then send her home or help you place her somewhere less expensive. They might also pay for the meds because they are comfort meds. You should speak with your doc.
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Sorry - I didn't re-read your post and forgot she was in a SNF. I do wish you the best - I know that it's difficult to have an ill parent. Just curious as to whether you've contacted tthe Alzheimer's association for info & support?
ellie