I believe the proceeds of the property in which "mom" lives comes into play if she is not a private pay, and yet not medicaid qualified. Also, laws may vary state to state.

Are the actual children of this couple, (birth mom to your friend) and her siblings, if any, alive or around to help coordinate this?

I would assume the will (if there is one) has not yet been probated given the sudden heart attack.

Is there anyone in the family who can take "mom" to their own home until the family can get her into a nursing facility? Sounds like your friend is really getting worn down and this hasn't even gotten rolling yet. I've heard horror stories of trying to get loved ones settled in at a nursing facility, billing problems. I am hoping another poster will post some fabulous quick solution for your friend.

No real answers here, but wanted to tell you I think you are a sweetheart of a good friend to your co-worker. I hope it all works out, I'm just not sure how quickly these things move.

I don't know a lot shee, but dread it if that day every comes for my mother. I've made every effort and assurances to her to avoid it, but sometimes life takes twists we don't anticipate.

As far as the Medicaid deal (and don't quote me on this) if one has a certain $ amount in assets then Medicaid wants that $. I've known parents of my peers who have transferred title to homes and assets to one of their trusted kids, just to keep Medicaid from getting hands on it. But I've been told they will actually audit retroactively going back 5 years, so titling a house in a child's name or other attempts to 'hide' or remove assets to avoid it going to Medicaid for nursing home care isn't always successful if it's newly done. (An accountant can answer that better.) The caregiver forum here could probably fill you in on all the ins and outs of that too.

I'd suggest looking into home caregiving (live in or even part time for a reprieve). It's what we did for my mother, because she wanted to be in her own home and so far, she's been blessed enough to be able to with live-in assistance. Mom's happy and it saved my sanity and my health (well, it greatly improved, let's put it that way, because she relies on me to take care of all her financial affairs, etc.) It's not cheap. In my large metro area some local suburban agencies want as much as $300/day. (They are basing that soley on demographics, there are a lot of high income areas.) But we've found that many people from other countries here on a work visa will go through agencies in the city (Chicago) and they charge 1/3 of what suburban agencies want. In a year's time it amounts to 1/2 the cost of the crummiest nursing home in this area. Current caregiver we have is from Poland. She cooks, cleans, helps with bathing, dressing, etc. I won't permit her to dispense meds because there is a language barrier and my mother is on some medications (heart, etc.) that a wrong dose could be really bad. Even if there was no language barrier and she was highly skilled in home health, I'd still keep a hands-off the meds rule.

A lot of people are hurting for work, too. I was talking to the secretary at my mother's church about something and she told me they had several church members who either had nursing home experience, home assistance, something along those lines, and were looking for work. Part time, full time, etc. There are a lot of resources out there. I'd suggest a background check if possible. (In our case we couldn't get one - no SS#, but we keep a very watchful eye and lucked out. No theft, no abuse, she's a real sweetheart. I know some people who put cameras in public rooms of parent's homes to remotely monitor (or review tape later) as extra eyes.

It pays to be diligent, make many unannounced visits at various times, check on things. I would not suggest putting an ad anywhere out there unless there is a strong screening process used. Too many nut cases will turn up.

Although the Medicaid rules are nationwide, there are state guidelines. There should be a senior center or something like that to walk you through the process. Otherwise you may need to hire an attorney as an advocate who specializes in this type of case.

Has anyone been given *power of attorney* for her?? It needs to be done right away if it has not been done already.

Power of attorney cannot be given at this point - if she is not of sound mind. You would more than likely have to petition the court to become her guardian. I think that's what it's called.

Moonshadow is pretty dead on, at least for here in TN. We've gone through this with my grandmother and my aunt (her sister). My grandmother has always said she does not want to go to a nursing home and my mom has always said she wouldn't. My mom and dad (fortunately) live next door (some property seperarting as they have acreage)so my mom has been staying with my 93 year old grandmother. My dad eats most meals with them and mom goes home from time to time, but basically lives with my grandmother. It's what she (my mom) wanted to do. I have my grandmother's power of attorney and handle all financial stuff for her, etc. It works well that one person is not having to handle everything.

In my aunt's case, she is also widowed but has no children. She went into an assisted living/nursing home type place last fall. She was able to pay for a month up front and see how she liked it. She is doing the private pay for 3 years and if she is still living after that, she will need to sell her home and use those proceeds to continue living there. Not a problem, there is someone who would like to purchase the home and if my aunt agrees before the 3 years are up, all the better.

I would look at Medicaid guidelines online and see what you can find for your state.

tina

Getting ready to head out the door but real quick...

Coworker is the power of attorney.
She does have other siblings and her biological Mom is alive. I don't know the whole story other than the family doesn't get along well. I don't know that she even talks to her real Mom. Mom (Grandma) can't go home with any of them because everyone works.

In California, whoever admits a person into the nursing home has power of attorney automatically. This is how I became my Uncle's POA. He had dementia too.

I would advise your coworker to see an attorney who specializes in elder law (in the state of residence) for advice. I paid for two visits in my Uncle's six years under my care. It was the best money ever spent - especially if there is conflict in the family.

This legal council should be paid for by Mom/Grandma. Hopefully your coworker is already a signer on her bank accounts.

Does she have both financial and medical POA? Both are necessary.

My mom had a massive stroke in 10/08 and went into a nursing home the end of that month. For the first 100 days she was covered under Medicare. At day 101 we had to start paying the daily NH rate. We had contacted an elder law attorney in October and he was in the process of getting her Medicaid eligible (it doesn't happen overnight), but we never reached that point, because my mom passed away.

Gifting laws have changed dramatically. My two suggestions would be to contact an elder law attorney and do a thorough search online on local nursing home inspections (health and fire) and any violations. They have to be public record. From there pay a few unannounced visits and ask for tours. And use all your senses (eyes, nose, and ears) to get a feel for the facility.

Shee, here's the Medicare site we used to check the public record on nursing homes.

Here is a link that might be useful: Under Search Tools click Compare Nursing Homes in your area

again...

Here is a link that might be useful: same link

The advice to consult an eldercare attorney is right on, especially if there is real estate involved.

An easy solution to the real estate is for the mom to deed the house over to her children. Then it won't be considered an asset. Many here do that so the state won't use it against the patients.

But the mom would have to be in a period of "the right mind" to do so, along with witnesses and a notary.

Yeah, they need to see an attorney for this one. You're a good friend!

Oakley, I'm pretty sure it's too late to do anything like that. Not just because of the Alzheimer's, but because the laws have changed. An attorney can manage to "move assets" to some extent, but it's tricky. That's why they get paid the big bucks.

Yes, natal. It is way too late. States have gotten smart. Typically they will honor transfers two or more years earlier. Too many people ripped off the system, Oakley.

Moving assets is tricky business indeed. This is why I think an elder law attorney is the best way to go.

Been there, done that.

An easy solution to the real estate is for the mom to deed the house over to her children. Then it won't be considered an asset. Many here do that so the state won't use it against the patients.

I'm glad that people can't do that any longer because of the look back period. Why should the state pay when they have assets?

I agree with Terriks. The state should not pay if there are assets. People need to make their own way, when possible. Inheritance be damned.

My Grandmother had a massive stroke 11 years ago. She was far, far too well off to qualify for medicare. So the house was sold, the assets were liquified and my Aunt has had to use Grammys money to pay for the nursing home...for the last 11 years.

The first place she was in was nice, a private home converted to a small place, she had a private room. It was very expensive, but no one really expected her to survive too long. About 3 years ago she was moved to another place, shared room in another facility that is not nearly as nice. I hate that she's there, but no one is equipped to keep her at their home (she needs 24 hour medical attention). The place is your sterotypical nursing home, and she's just gone downhill so much, yet she still lives. She told my cousin last year that she just wanted to die, but she's got those damned genes...longevity is in her system.

Sorry to be such a bummer, but this is a situation that really bugs me.

I hope your coworker can find some respite care...is there an Alzheimers support group? They might have some options or suggestions. My next door neighbor's mother has alzheimers, and she's finally gotten to the point where she's basically bed ridden now, so he can finally get out of the house on occasion. But it's really, really tough on the caretakers in the meantime.

Pesky, I completely understand! I can't imagine eleven years! My mother voiced the same sentiment about wanting to die. It was horrible watching her 'live' like that ... a feeding tube, incontinent, but still with all her mental faculties. Which meant she knew how bad it was. Her death was a blessing.

Thank you everyone for sharing your thoughts and stories! Part of the problem is I don't really know all the details for you guys to answer. My first thought was also attorney and I think it will definitely save her more misery later. I'm sure money was a big factor with that. I didn't realize the money would come from her Mom. Makes sense though. I think she's just very overwhelmed right now.

I don't know if she's both the financial and medical POA. I thought it was all one deal. I was assuming she was both.

Natal thank you for the links.

Her Mom isn't completely 'gone' with the Alzheimer's but it's enough that she can't be alone anymore.

I think it's so sad when people don't want to be here anymore because of these types of situations. I remember going to visit my Great Grandmother in a nursing home when I was in my early teen years. The whole 'live out your years in a nursing home' most of the time sounds terrible to me. The place was nice but.... old people just make me want to go hug them and cry. I don't know how to say it. I don't ever want to be in their shoes.

She headed out this morning to be with her Mom through the weekend. Hopefully she can get some things cleaned up. Thanks again everyone. I'll post an update when I know something.

To make matters worse....

Dad had a heart attack while taking out the trash. Neighbor found him on the ground about an hour after it happened. Coworker thinks maybe her Mom did see him. The next day Mom ended up in the hospital because her heart rate was all erratic. Dr. said it's not her pace maker and is probably from stress. She missed the funeral because she was in the hospital. :( Kids had to keep explaining to her where Dad was. Then eventually she started tell them constantly he passed - forgetting they already knew. Sad, sad, sad. Mom apparently said she never got to say goodbye. Coworker says she's not sure if she'd remember being at the funeral if she would've been able to go.
She's home from the hospital.

I too would suggest a visit with a lawyer. I've been through this 2x with elderly, ill relatives. Believe it or not the Social Worker at the nursing home was extremely helpful too.
Yes, they will look at all assets including her home, her savings, IRA's, and life insurance policies. They "look back" 5 years now, so transfering the house or other assets to try to hide them will not work. The first 100 days are covered and then they start looking for the patients assets. They will leave enough to cover a funeral in the future, but the rest goes toward the nursing home bill.

The social worker was really helpful in giving us ideas on how to "spend down" some of her assets when she went into the nursing home. (Example, maybe she needs a flat screen TV in her nursing home room, but she sure doesn't need a ride-on lawn mower--that would be disallowed.)
It's not any easy thing to go through. You are a good friend to ask for ideas to help her.

just a note: deeding a house to children can cause a huge tax burden on the children who, when they sell the house, will have to pay capital gains based on the original sale price of the house rather than on a stepped-up basis as when a house is inherited. We have put our home in a revocable trust with our son as the successor trustee. He will be able to sell the house a minute after we die if need be. We also have given each other POA and I will do the same for our son if I am the surviving spouse at some point (we did this when we were in our 40s/50s-I hope we both die at the same time or very close). Planning ahead is so vital these days. It took us several years to settle my parents estates-ugh what a nightmare-because they did practically no planning! My father's will had not been updated since the 1950s when we were kids despite repeated requested. The family lawyer said it was the oldest will he had ever probated.

An alternative to an attorney is to make an appointment with whatever dept handles medicaid in your state. In GA it's the Dept. of Human Resources, Division of Family and Children's Services. They can walk your friend through the Medicaid process, and they know a lot about how to get someone into a nursing home. They were extremely helpful to me. Around here, almost the only way to get someone admitted to a nursing home is for the patient/client to be admitted to a hospital. Then a doctor can declare the patient unable to return home. If a nursing home bed cannot be found right away, the patient can be kept at the hospital in what's called a "swing bed" for up to 20 days. This is the way we got my mother into a nursing home. She was admitted under Medicare for the first 100 days. By that time I had the Medicaid application completed and had spent down Mama's meager assets to below the $2,000.00 limit. We weren't required to sell her home, but we did so several months later. Then she came off Medicaid, and we used the proceeds of the house sale to finance her nursing home care. She's just recently re-qualified for Medicaid because the funds from her house are gone.

Best of luck to your friend. It's a stressful, sad time.
Pat