patrick.net

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. :)

Zlxr says

I can only add - be very careful of what you sign. It seems like they always try to get someone to take responsibility.

Hell ya.

Zlxr says

I hope you can get your book published.

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... :)

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?

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.

I just got a call from the SNF my Mom is at, they told me I need to come in and sign a paper regarding her leaving the NH 1 day prior to medicare covering her stay.

She has 2nd insurance...do I sign or not???

I need to find out by this Friday.

Thank you, btw this facility was tits!

She will now go back to her former RCH!

eta i WOULD love TO ADD THIS FACILITY AND i WILL WHEN i FIGURE THIS SITE OUT!!

So sorry I got back to you so late. It was probably a 3-day notice that informs you that your mother's stay will no longer be paid by Medicare. You're under no obligation to sign anything - but if it's a 3-day it's a meaningless document that Medicare requires be given to the patient & family.

The reason for 3-days is that many nursing homes weren't informing patients/family members that the Medicare rehabilitation stay was done, and were sticking families with bills. Since you took your mother out, it's not an issue.

bottom line: if you don't know what it is, don't sign it. It's the nursing home's problem if they needed a signature, not yours.

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.

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

momof5 says

If she still had “assets” and can pay is this truly a problem? I have 6 months of liquid assets remaining.

In case I wasn't clear in my previous answer, as long as your mother can pay privately it's not a problem. If she runs out of money, that's a different story. And Medicaid doesn't care about "liquid" assets, it cares about assets. If they can be cashed out, even with substantial penalty, Medicaid won't pay for the patient.

See an elder law attorney asap. You need legal help.

Thanks, I did dodge a bullet for my Mother's last visit outside of her RCH.

A few days ago, I did get a call, and her current RCH sent her via ambulance last week, without telling, calling, notifying me!

And she was sent to a hospital out of her secondary medical group!
She went to the ER and had a stay in ER bed for 5 days.

I DID not sign admitting paperwork for that stay. I did not sign anything! I did visit my mom.

Now she is at a SNF for 10days, and the ADMIN is calling me to sign papers and I do not want to sign them!

I did not authorize any of this and although my mom is better I do not want to sign papers.

I want to visit my Mom for the holidays, BUT I do not want to sign any admin stuff....

I am just gonna lie about who I am.

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.

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!

marianne says

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.

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.

elliemae,

Thanks for educating me (and others!) I will not be signing anything, period.

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.

trulygreeny says

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.

There are legal ways of becoming eligible for Medicaid to pay for nursing home placement - and they should be used to the fullest extent of the law. In this country, we aren't legally responsible for our parents' finances (nor are they responsible for ours). What I was referring to was a person who signed as a patient's power of attorney and was personally sued for the nursing home bill. This person didn't dump his elderly mother on a nursing home, but he was held to be responsible because he didn't write a statement denying personal responsibility on the admission forms (there was no "space" for him to write that, nor is any person signing their parent or family member into a nursing home told they should write it or see an attorney).

I find it disturbing that the nursing home won the lawsuit. I don't personally know anyone who can afford hundreds of thousand of dollars to pay for a family member to stay in a nursing home - but if they can afford it, that person can also afford an attorney to protect his finances.

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!!

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

I wouldn't put too much thought into this. The nursing home is wasting their time. I've worked in medical billing before. In this business, people can owe you five figure sums all the time. Trying to get them to pay up is another story entirely. Some simply can't and never will be able to. Others, have the money, but feel a sense of entitlement and don't want to pay.

Yea - oakman, you're right. In order for the billing to be worth fighting for, it's got to be at least $20k. Court costs, etc. Some corporations follow thru, some just send bills and turn people into a collections agency.

It's when someone signs responsibility for their family member that there's a problem - it can affect their credit even tho it's not their bill. That's why it's so important to not sign accepting financial responsibility for someone else.

I will be looking to buy that book, Ellie! I will also post it on the AD forum and chat room too.

Just heard today my Mom will be released from the SNF back to her Care Home next week.

My Mom had been living at a Residential Care Home. She is on private pay. She has Alzheimer's Disease and will be 68 this month, and she is latter stage now. I hope she can just stay there because she can afford it.

She seems to bounce between that place, the ER and the SNF for the past 6 months anyways with a UTI and blood infection and a hip fracture...

Look forward to reading the NH book!

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.

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?

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.

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?

http://patrick.net/nursing/survival.html

That's a link to my book, which shows the table of contents and allows you to buy. However:
marianne says

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?

About 2 years ago I posted the following info (follow the links). The numbers have changed but the programs haven't.

http://patrick.net/?p=16361
http://patrick.net/?p=16353
http://patrick.net/?p=16352
So, to answer your question, Hospice is a type of care and not a place. If you stay in a hospice-dedicated environment, you will have to pay room & board at a rate comparable to what you've been paying (or close). There are some non-licensed homes that take patients in if they're on hospice - but if you can afford it go for a licensed & certified place where your mother will be well-cared for and you don't have to worry about.

I met with a woman tonight whose father is in the hospital and they're getting ready to discharge him - she is considering rehabilitation in a nursing home which will help dad recover and give them time to figure out the next step (maybe moving closer to the kids back east). A hospice is sniffing around him, and the marketer told her that their inpatient unit would be a better choice for dad because they have private rooms and he'll like the food better. They omitted the part about how dad will be able to stay about 3 days and then he'll be discharged somewhere else - and that he won't be receiving any therapies like the physical therapy he's getting in the hospital acute rehabilitation unit. The hospice told the family member that you don't have to be dying to be on hospice. This is so typical of high pressure marketing tactics and it gives all hospices a bad name. The guy works on commission and will never see the patient or daughter again - so what does he care? I was disgusted, to say the least.

Ask the hospice your specific questions and if you like their answers, go with them. But speak with more than one to get a feel for what will actually be provided.

I hope this answers your questions.

elliemae

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.

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.

Thanks elliemae.

My Mom is not in my care anymore.

She is in a NH (SNF) since being released from the ER for the UTI.

Her Dr said 10 days to follow up on having an IV in for fluids...then she got the C Diff.

Before that incident, she resided in a small Residential Care Home that is in the process of becoming certified for hospice care.

Thanks again

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

oh yes I am a member.

You've hit it..Medicaid does not pay for long term care unless the person has assets within or below the poverty level or agrees to deplete assets to gain Medicaid benefits.

That story simply tells us that long term care is very unpredictable and risky, so it's crucial to plan ahead and cover the necessary areas before you enter nursing home or any facility. buying long term care insurance pays off, and there are ways to cut the insurance premiums. read this article for some tricks http://www.completelongtermcare.com/resources/how-to-save.aspx

Planning for long term care is not only a financial matter, it's more of emotional.

Sure, long term care insurance is great for those people who can afford it. You offer some cool options and those people whose assets are well above $100k will need a policy like this. Especially if they don't want to structure their assets to make them eligible for Medicaid.

However, people who have substantially less should see an elder law attorney and split their assets - they can become eligible immediately and they should do so before purchasing an expensive policy.

Does this apply to Texas as well regarding signing for your parents to be in a nursing home? What if no one signs at all, will they kick them out? I signed for my dad to be in because it was under duress. I was told I couldn't sign it on the Resident line. I told the Admissions administrator I was nervous about signing as responsible party as I didn't have the funds to cover the bills. Dad is now on Medicare only. Mom was next to go in the same nursing home - - all within 6 days of one another. She has dementia. Now they want me to sign her papers too. What to do? Help me!

Sasebone

Sasebone:

First, I'd recommend that you buy my book: http://patrick.net/nursing/survival.html

It's chock full of information, such as this. It also describes everything in minute detail (and tell everyone that you meet to buy it...) ;)

The nursing home is going to attempt to pressure you to sign, but have your mother sign her own paperwork or have them write that the patient is unable to sign. If you feel pressured and don't want to be contrary, sign but write this sentence on the financial responsibility pages:

"I am not personally responsible for my mother's bills."

While you're at it, ask to see the paperwork that you signed for your father and amend those pages to add the statement. Make sure that you write that on the pages that discuss pharmacy billing, physician's billings, and any other financial pages.
-----------------------------------
But don't freak out. They'd have to actually sue you to get any money out of you, and they don't want to do that due to the publicity nightmare and financial outlay. The important thing is that your parents are cared for - and that they can't make you do anything else if you don't want to.

You have so many other issues to deal with - if your parents are there long-term, the facility will have to apply for a payment source - and he might have a payment issue after the 20th day if he doesn't have co-insurance. Once again, I'd recommend that you read my book due to the multiple issues involved - it will answer your questions and help you figure out where to go from here. If, after you read it, you still have questions, please post them here and I'll be happy to address them

-elliemae

My mom has paid over $350 K over the past 3 years for skilled nursing care she needs. She has been giving them her income for the past 18 months, when they talked to her about medicaid is when she started to give then her income. She thought they were going to file for medicaid. She has be diagnosed as situational competent. In her mind when she started to give them her income 18 months ago, she thought she was on medicaid. She is bed ridden due to MS and depression and needs to be catheterized 4 times per day. She doesn't understand what is going on. Last week I received a 30 discharge notice kicking my mom out saying she owes over $100 K and she has 30 days to vacate. I believe my mom has just officially applied for medicaid last month and may get approval this year. The home is a special home for Jewish people and my mom is Jewish and was told by them when she goes on medicaid she won't be kicked out. Now she is being kicked out for non payment.
martyz@msn.com

If the person admitted to a nursing home or assisted living place has assets, why shouldn't they pay for his/her care? All of these strategies being investigated by the heirs to dump Mom's care on the rest of us - tsk, tsk, tsk,... And yes, do not become responsible for the care yourself, but that is a different matter entirely. I guess the hospital believed that the son bungled the Medicaid application process, and should be responsible for the loss.

Blurtman says

If the person admitted to a nursing home or assisted living place has assets, why shouldn't they pay for his/her care? All of these strategies being investigated by the heirs to dump Mom's care on the rest of us - tsk, tsk, tsk,... And yes, do not become responsible for the care yourself, but that is a different matter entirely. I guess the hospital believed that the son bungled the Medicaid application process, and should be responsible for the loss

So if someone works all their life, pays into medicare-the state will grab all their remaining assets. But if some bum who never worked, received welfare for life is admitted to the same medicare, they get all the same benefits and don't owe a dime??

Now Elimae speak it the English huh?

While I was ranting about the outright strong arm robbery that is our healthcare system. She said it was only because I hate the black guy in the White House.