<p>Thank you all for the feedback about basically trying to hide assets so elderly can qualify for Medicaid. In my opinion it is fraud & as a taxpayer it really irritates me that there are possible loopholes! Sad to say but I hope it doesn’t fly for my coworker. </p>
<p>This is such an interesting thread and you are very patient and helpful .</p>
<p>@Dharmawheel thank you for sharing all the details with how the elder attorney worked her magic. Amazing story. Lady obviously cares very much about her clients and appreciated your thoughtfulness with the card. She had techniques that worked with your mom, including bringing up how she helped her legally with your dad’s estate issues. The stroking and body language. Used the right words.</p>
<p>I view some legal things are like the IRS - it doesn’t have to be logical, you just have the steps to follow. We use legitimate IRS rules. Same thing should go for legal rules to use in your state.</p>
<p>Maybe at your next sitting the attorney can go over the Promissory note issue so you feel comfortable with it, if it is key/important to do.</p>
<p>I agree with the others to not have any assets go to sister until after mother’s death - if any assets there to split. Would the promissory note need to include sis?</p>
<p>Someone questioned why AL costs are not neatly spelled out. So many places have tiers of service that do get more individual - so a patient assessment is needed first. Probably the most cost effective AL is one that is stand alone - however, families like facilities with range of service so families do not have to move patient out of the complex when NH is needed or more acute care.</p>
<p>I believe you are asking the right questions, turning over the necessary stones. I agree about concentrating on moving mom and getting house realtor assessment. Attorney may know how to proceed with mom since she seems to know techniques that will work with mom. Attorney is a great resource in this regard!</p>
<p>All fees (even if 2nd legal opinion is needed) should be incurred by mother. These are legitimate expenses. If you are custodian there may be a monthly amount you are eligible to draw for your time/attention in your state.</p>
<p>I think I’m going to be another voice about such things as the “promissary note” of which things I have been reading about and still don’t understand. If I was doing all the things dharma has done, I would want to get paid for that. Isn’t it reasonable that she prepares an invoice for all the services rendered and take that amount from the estate once the house is sold? I certainly would do that and I think my brother would be supportive of such a move. After notifying dharma’s sister, and if no response, also assumed supportive. </p>
<p>As to hiding assets from Medicaid, are you a chump if others are doing it? As to my parent’s estate, they seem a couple of years away from the nursing home. But I could see them gifting money until they have just enough of their estate to pay for several years in the nursing home. They are not competent at this point to make such a decision, and certainly I and especially my brother would not be comfortable with the strategy now that I have control of the finances. But, if they did not have dementia, I am sure that they would make a decision to gift a good percentage of the estate rather than see it go to nursing home care. Is that wrong?</p>
<p>I am with those who think its morally wrong.</p>
<p>Yes, you can often reimburse a child or other for expenses, fair and reasonable. But that’s another set of things to look up. Yes, the mom should be paying the attorney. She does have funds for that today. She can reimburse Dharma. </p>
<p>Make sure you have POA for the real estate transaction, that’s its own category. And did you clarify the other POA you have?</p>
<p>Some AL doesn’t have its own NH or dementia care in the same building, but it’s adjoining or next door, under the same management. That is so much easier than a full on search for a new facility. </p>
<p>FYI … In Concord, NH there are a couple AL centers with dimentia units that cost under $10k a month for a single … the Ledges and the Birches … double are a lot less.</p>
<p>PS - and if you would like any detailed info just ask … I know a bit about most of the AL or nursing homes within about 20 miles of Concord.</p>
<p>I think it’s a good idea to just show up at AL and politely ask for a tour. That’s worked for me the majority of the time and you will get a little less of a “canned” tour. You can still go again for the formal dinner and assessment, but nothing beats getting to see what you would just walking in the door, with or without your mom. I would be a little suspicious of any place that wasn’t open to this.</p>
<p>We had issues because sometimes only one person is on duty and out running an errand, giving a tour or handling something. So, in itself, not a flag.</p>
<p>Otoh, the time we had a set appt and the dining room was full of dirty dishes still on tables- no staff around- that bothered me big time. </p>
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<p>GT, for me it comes down to the intent of Medicaid, which is to get care to people who otherwise could not get it because they’re destitute. My parents are not destitute. If they voluntarily make themselves destitute, then they are either preventing <em>real</em> destitute people from getting care, or more likely, forcing taxpayers to foot their bill when in fact they are very well off and quite capable of paying their own way. </p>
<p>My parents saved all their lives for the expenses of old age. Isn’t it reasonable to expect that they should spend that money before asking the taxpayers for help?</p>
<p>I am surprised that Congress has not closed that loophole (promissory note). It does seem like Medicaid is scrutinizing these cases closely.</p>
<p>Visiting an AL during ‘normal business hours’ M-F 9 - 4 (maybe avoid lunch 11- 2), you should be at least able to pick up literature. Many times there is an ‘inside’ sales person, but also the business office personnel which can often answer questions, tour, etc. You can have a scheduled return appt if you like what you see.</p>
<p>GTalum, I’m all for family members getting paid at the time for work done while the elder is still living. Many won’t ask for it, but I wouldn’t have any problem with it at all. But the promissory note the attorney mentioned is a whole different animal. </p>
<p>Is everybody doing it? No, not really. It’s only in a very specific population that it even makes sense to try. Medicaid law is complicated, so it could really rack up some big legal bills. </p>
<p>I was just reading “Beyond the Grave”, a book about estate planning and family consequences of how you set up an inheritance. With the promissory note scheme, you get your inheritance when your elder checks into the nursing home. Imagine the fun and family adventure that can cause! And legal bills, lots more legal bills. </p>
<p>Popping in at lunch time can give you a really good sense of how things are run. You can see if people are rushed, if they are happy with the food. It’s a frantic time of day, but it shouldn’t feel that way. Also that is when you can get a good overall view of the population to see if you think your parent will fit in. This place will be your parent’s home and they shouldn’t be uncomfortable with people coming and going and seeing what’s going on at all hours. They might be inconvenienced but should be willing.</p>
<p>Agree that unannounced visits are a good way to gauge how things will work (or not) for a loved one. AL and similar places should be used to visitors that come and go when they please, during normal business hours, as that is when you will be visiting once your loved one is a resident. You want to be sure it is a good fit and not a place that just puts on an act and is on “best behavior” for special tours.</p>
<p>This can narrow the list a lot and save time to focus on the most likely candidates.</p>
<p>Wow. Lots going on here and interesting things to contemplate. Options for Medicaid spend-downs and sheltering of assets vary by state. Recently met with an elder law attorney secondary to m-i-l with assets requiring nursing home care in a southern state. Lawyer described how her spouse (not father of her children, who was deceased prior to this second marriage) could sign a legal document stating he refused to care for her, her cash/investment assets could be used to purchase property which could be rented, etc. Our heads exploded at the thought of asking her beloved husband to state he refused to care for her, that she would be on Medicaid despite having saved for this eventuality, and that at 90 and perilously frail, her children would be managing property from hundreds of miles away. It was wrong from top to bottom. Gifting relatives a bit many years prior to infirmities and anticipated care is one scenario, and sheltering assets at a time when care is known to be needed is another one. While either may or may not be legal, I am with others who question unnecessarily burdening others with an elder’s care. I do wish appropriate care for those in need; that is a different topic.</p>
<p>Dharmawheel- here’s to a smooth and sensible way to a long term solution. As a boss who was giving me my first promotion once said, “I am shutting every door behind you; you are only moving forward.” Worked quite well. </p>
<p>I would like to think that the quality of care at top, $$ facilities would be just as good at the medicaid facilities, but I know thats a complete pipedream. I’ll save my pennies and stay in a nice place.</p>
<p>Those of you going to check out AL and NH facilities, trust your nose. Take a deep breath when you arrive, and see if the smell turns you away.</p>
<p>^^So true! I found a place I liked, but when i took my brother to look, he immediately noticed a smell which i had missed. This is also why it’s a good idea to take someone else along. We can’t see/smell/hear everything. </p>
<p>Agree that all care faculties must pass the sniff test. My father’s SNF cares for elders with advanced dementia and other ailments. Zero odor. Short-hand barometer for some aspects of quality of care. </p>
<p>On the price point issue, while they may be hard to find, non-profit facilities may be an advantageous option. </p>
<p>My H has a very good nose and can detect odors that sadly my nose can’t. D is also really good at sniffing out bad odors and also bad PEOPLE–she’s quite uncanny (but we try not to expose her to too many situations that will make her uncomfortable). It is good to go on several unannounced visits, as there are often shifts and you will see different staff on different times and days. Your loved one will live there every day and night, so you want staff that are good EVERY day and night.</p>