Nursing Home/ Memory Care placement for those with little assets/ income.

mstrbill, yes this is the info people need to know well in advance but for all sorts of reasons wait too long to inquire until there's a crisis, and then it becomes a dumpster fire of stress and problems.

Here is what I learned in my adventures with my in-laws. Please note that this was only my experience in Carver County, Minnesota, and everyone needs to check with their own state and county laws and do not assume this will be true for their location.

1) You must be having small, gentle discussions all along so that the LO doesn't feel "blind-sided" by all the sudden changes and can participate in their own futures. They need to prepare in their minds for this eventuality. Even so, this is no guarantee they will not be resistant, but one still must try to pave the way.

2) You can't help them if you don't have legal authority to do so. Please have your LO create a durable PoA that does not require proof of incapacity (if possible in your state).

3) Have your LO get a cognitive exam (and test for UTI for good measure), and after they create their PoA, by their doc so their abilities are documented in their records. Have them request a Medical Information Release form naming their medical PoA as their representative. If this doesn't happen, the doctor cannot legally discuss your LO's info with you, regardless if you are a close relative or their daily caregiver. Again, check your state if this is required.

4) Please know that each NH facility has very limited numbers of Medicaid beds. Residents already living in a facility get first dibs. This is why it is preferable to move them in on private pay first, so that they aren't put on a waiting list (my MIL was on one for almost 3 years for a specific facility). Make sure the facility you chose actually does accept Medicaid (my mom wanted to consider a facility that didn't and I told her she'd have to move out when she ran out of money--nope!). FYI Medicaid pays for a bed, not a private room. Most are shared rooms. Medicaid does not pay for AL, but in some states there is financial assistance that may pay for services in AL but not the actual rent.

5) If your LO doesn't have a spouse or a lot of assets, the form is not that complicated. The look-back period of finances by the county differs by state, but can be between 2.5 and 5 years. In MN where I live, it's 5 years. Medicaid approval usually takes at least 3 months after they receive your application. They will contact you by mail, and everything has a deadline so make sure you open up their mail immediately and look for the deadline date. Do not co-mingle funds, accept financial gifts or give them, and do not be co-signer on loans or credit cards. If things are more complicated, consider a consult with an elder law or estate planning attorney familiar with Medicaid application.

Being on Medicaid in a facility does not mean their care is any different from private pay. When my MIL finally qualified she was in a facility in a private room BUT the facility had no Medicaid beds available. Our options were to move her out until one came open, or to pay the difference for the cost of a private vs. shared Medicaid room. We chose the 2nd option and the cost was split between 3 siblings for a little over a year.

6) if your LO is already incapacitated with no PoA, or is in their right mind yet refuses to assign a PoA but can't live independently (like my stepFIL with Parkinsons) then you call the county and they will pursue guardianship and take over from there. At that point you lose all control over how their affairs are managed and where they are place, you are no longer informed of anything (medical, financial, etc) but you can certainly continue your relationship and visit and provide gifts and the guardian(s) are happy to entertain any info you provide about your LO but cannot discuss much with you unless it is in their charge's best interest. My stepFIL's guardian was Lutheran Brotherhood Social Services, so, outsourced

Thank you Geaton for the well thought out reply. Excellent start. I'm wondering what would have happened if you could not have afforded to pay for your MIL's private room? Where would you have moved her to? Also, how did you move her in in the first place? Private pay? I'm hoping to hear from others who tried to move in on Medicaid only. How easy/difficult was it? Did you move her in on your own by calling facilities or via the hospital?

Medicaid in some states actually does pay for assisted living-room and board included.

We haven't had to use Medicaid yet, but in general, my understanding is most cases of just dementia don't qualify for NH and although some states might cover some AL placements, most do not.

In addition a huge problem I read about is the income limits in some states are so ridiculously low that some elders' meager income exceeds the limit, but isn't anywhere near enough to cover any LTC facility.

If the market continues this free fall, we may end up needing Medicaid at some point!! Hoping the paranoia over the coronavirus settles down soon, so we can assume more normal-ty!!! I would rather not have to deal with Medicaid at all.

Not true that most states do not cover AL. Most states cover memory care and most of the time memory care is in an AL facilities.

Disgustedtoo, that has been my sense as well based on the amount of posts I've seen here about people not being able to access NH care. WorriedinCali are you sure memory care is covered by Medicaid? You may be right(I don't know), but why do I see so many people have trouble placing their family member in a facility?

Yes I am absolutely sure mstrbill. It’s covered by medicaid waivers in most states. I find a lot of people are ill-informed through no fault of their own.
https://www.payingforseniorcare.com/medicaid-waivers/assisted-living
https://www.dementiacarecentral.com/medicaid/alzheimers/amp/

Also on the subject of AL....44 states offer some sort of financial assistance for AL.

From the link you posted:
https://www.dementiacarecentral.com/medicaid/alzheimers/amp/

"In almost every state, Medicaid will pay for some care in assisted living / memory care residences. However, an important distinction must be made. Medicaid, by law, is prohibited from paying for the cost of room and board or “rent” for its beneficiaries who reside in assisted living residences. Rather, Medicaid can pay for their cost of care in those residences. In very ballpark terms, half of the monthly cost of memory care goes toward “rent” and the other half towards the care the residents receive."

~Half the cost isn't going to help some. While this may be helpful to some, it isn't always going to be enough!** Our mother has a very nice federal pension (thanks dad!), which even includes yearly increases. She also gets SS (which has been reduced recently because they consider the trust money fed into her account as "income", but except for some OTC items (meds as well as briefs and a sunday paper mostly) ALL income goes to the residence. I wouldn't mind if the "income" was being used by her to party, shop and travel, but it isn't - it's all to keep her OFF Medicaid!

Now, if she were like some others, with SS only, there is NO WAY she could stay at this MC place as the "half" she could afford would be less than 15% of the total! Sale of her condo would cover a bit, but once that is gone (or for those who have less net or no home to sell), up the creek!

There is a link within that article for waivers, but in bold highlighted red is this:

! Assisted living waivers do not cover room and board in memory care, they only pay for care costs.

Sounds the same as the original paragraph to me. NO room and board, just the "care" portion of the cost. Am I reading this wrong? Again, my plan is to NEVER have to even think about Medicaid, but at the rate the stock market is going...

** From a recent thread by Tiredmomma:
3) mom's income ($1400) > Medicaid limit
4) mom's income way < MC facility ($4000)
5) mom has no house, no assets of any kind - no spend down or home sale
So, this mom would be short of the "half" by $600/month, if that's what Medicaid did cover, plus OP said she was denied Medicaid as the income was over the limit for that state.

I am just on the tail end of going through a penalty period
Due to the Medicaid look-back laws..
before you do anything apply for community-based medical assistance if your loved one has an income of less than $23,000 ..

If your loved one has transferred any assets , property, graduation gift, wedding gifts, etc , monetarily within the last 5 years, ur loved one will b penalized .
He/she will enter into a five-year look-back period..
what this means is medical assistance will take any asset your loved one has and use that to pay for their care until medical assistance kicks in after look back period is over.

If your loved one has a house in their name that has to be sold , and that money given to the nursing home.

if your loved one transferred the property in your name within the last 5 years their will be a hefty penalty.
Medicaid comes up with an equation to determine how many months of self paying for nursing home care will be the family's responsibility.
Most most nursing homes are $350 per day .

Medicaid only pays $7000 per resident in a nursing home ...
so , of course they are hoping to find a glitch within the look back period.
If you're not on top of your game like I have been this last 11 months you will lose everything
Your loved one worked/saved for.

Nursing homes love nothing better than billing you for $10,000 a month or $11,000 a month depending on how many days are in that month ..
More money is gotten from self paying families then by medical assistance ..
You can bet that they hope to find somewhere , that your loved one has given away a potential asset ,that cud have paid for their nursing home care.

This is this is just the tip of the iceberg of what I've discovered I saved our family and my mother's home by applying for community-based medical assistance .
I cannot stress that enough !!!
do not wait until your loved one is in the facility...
if you can