$400,000 short

Whyzit

Yesterday we were financially evaluated for MC placement for DH. We are $400,000 short for qualifying. Even though this facility advertises they accept Medicaid, they only accept Medicaid for long term care nursing patients, not assisted living memory care. I wish I had known this prior to sending in the paper work and $100 application fee. But they did place DH on their long term nursing care list. He is #234 and they figure it will be three years before his number comes up. LOL

Ok, now onto the other places on my list. I won’t send in another application fee til I know Medicaid is accepted across the board. Ah, another learning experience. Glad I’m starting this early. It is probably going to take awhile.

Happy Friday everyone!

harshedbuzz

In many states, Medicaid will not fund assisted living or memory care. If this is the case, your CELA can confirm, no facility will have Medicaid funded beds in their MC unit.

LadyTexan

Happy Friday Whyzit.

I had the same learning curve in June when I was investigating placement for my DH. 

None of the Memory Care options around here accept Medicaid. Most Memory Care here are private pay.  The private pay cost is around $4,500 - $6,000 per month depending on many things, that I took little time to understand because it was so far out of our financial reach.

My DH would qualify for a Medicaid bed in a long term care facility. The options I observed here were a shared room that was not very big. Of the 3 facilities that I visited, that accept Medicaid for long term care, one stood out as having more engaged staff and more engaged residents.

Another facility that accepts Medicaid near us, which was not included in the 3 Medicaid facilities that I described above had a warning on the website indicating abuse. I did not take time to visit it.

Crushed

This is an incredibly painful reality which is why you Need need need need need to consult an elder care lawyer familar with this area and who understands the medicaid qualification system and alternatives to nursing homes

DWs care is $9,000 for the facility and $3,300 a month for her personal caretaker

LadyTexan

Allow me to EMPHASIZE how important it is consult an elder law attorney early in the process. What Crushed is saying is VERY VERY important.

I consulted an elder law attorney two years ago. This was important for multiple reasons that I hadn't even realized:

1. Although DH and I had already executed what we believed were well thought-out legal documents such as wills, durable power of attorney, physician directives, et cetera, several years prior, mine, in particular were not appropriate for a spouse with dementia. Specifically, I made my spouse my agent. Because of his dementia, DH no longer had the ability to effectively make decisions on my behalf if I were to become incapacitated. This was unwise and NOT fair to my DH. The elder law attorney drafted new documents for me.
2. I wrongly concluded we would not qualify for Medicaid because we were above the poverty line. I was still working. I had an income of $85,000 annually. We had a house and two cars. At the time, I was not aware of exempt assets or the Medicaid rules in our state (Texas).
3. DH was verbally aggressive and I contemplated divorcing him. The elder law attorney described options for me to consider.
4. I thought that obtaining guardianship might solve some of my problems. The elder law attorney explained the process and possible scenarios that may not be in my best interest at the time.

I think my attorney costs were around $2,500. It was a worthwhile investment for me to have legal documents suitable for our situation, an education about Medicaid eligibility, and also developing a relationship with an attorney I trust that has come to my aid, more than once since I engaged his services 2 years ago.

What I didn't know then, that I know now is specifically what the different types of facilities are for long term care. For example, what the difference is between memory care, assisted living and skill nursing facility. Maybe the attorney explained it at the time but I didn't understand the relevance until recently.

I wrongly thought spending money we had on an attorney was not warranted. I was wrong. There are many legal items to consider on the dementia journey. Taking a do-it-yourself approach may cost one big time when you can least afford it. 

I cannot emphasize enough, what crushed said about the "Need need need need need to consult an elder care lawyer familiar with this area and who understands the medicaid qualification system and alternatives to nursing homes."

Cynbar

This post also underscores the need to start very early if Medicaid will be the funding source. In my state (Massachusetts), it will not pay for memory care, only nursing homes. I believe that all of our local nursing homes do accept Medicaid, but getting a bed is very difficult. Apparently there is no requirement that they keep a chronological waiting list and stick to it --- they are free to take a private pay patient who just applied over a longtime Medicaid patient on the waitlist. The best ones are nearly impossible to get into direct from the community. There seem to be two ways to snag a desirable bed. The first is to save enough private pay funds to go in without Medicaid, that's roughly $120,000 for a year.  The other is to pursue short term rehab after a hospital stay in a preferred facility. Most skilled nursing facilities here also do rehab, and are keen to get those patients due to the high Medicare reimbursement. Then, when the Medicare days end, the family says the patient isn't safe to go home. It sometimes results in an earlier placement than the family may have preferred, but it does get the desired end result. It's a shame it has to be this way, but if you don't learn how to play the game you can find yourself in a crisis with nowhere to go.

Crushed

Getting approved for what you need can require you to be sneaky and conniving.  

Who does that better than lawyers? 

 
and if you don't have an attorney
We've got millions of them  

60 falcon

Whyzit wrote:

Yesterday we were financially evaluated for MC placement for DH. We are $400,000 short for qualifying.

Whyzit, I'm just curious, did this MC require you to have that much money available before they'd even consider allowing placement at their facility? Enough cash to cover a few years?  If so, is that a common practice?

Obviously I haven't researched MC facilities yet, but when the time comes, I'd maybe be able to afford a couple of years at most before needing to get my wife qualified for Medicaid and moved to a NH or whatever.  If it's common for MC to require enough money to cover xx number of years, my wife wouldn't even have the option of a "short" two year stay.

LadyTexan

This is a link to a presentation from a virtual caregiver conference that I recently watched. The presentation was very helpful to me in understanding the different types of facilities and costs in the Austin Texas area. The actual speaker begins at the 11 minute mark. The Ins and Outs of Long-Term Care - YouTube

Check out the other session videos, slides, resources and speakers here Striking A Balance Caregiver Conference – AGE of Central Texas (ageofcentraltx.org)

Saljid

In the early 2000s my financial person advised getting long term care insurance. I qualified but my DW did not. In 2018 DW was diagnosed with Dementia.  I learned that the Ohio Retired School Employees could purchase a long term care policy. Unfortunately, once you start Donepezil, you can't qualify. In 2018 we went to Elder Care Attorney who set us up with some good programs but I later learned of another attorney who was more specialized. 

What I learned from him is that getting services of any residential facility will be > $8000/mo. until you have exhausted most of your savings. I believe that you can't have much in savings to qualify for Medicaid. 

The retired school employees were offered policies for home care. I am paying about $150/mo. for the policies but I don't really know how well this will work. 

Whyzit

60 Falcon, to answer your question, yes. Our financial assets had to be $400,000 more than what we have in order to be considered for MC placement at this location. It is a “not for profit” continuum for care facility where DH is currently attending day care twice a week ($80 per day). I was hoping it would work out because it is close by and we like it.

I have the names of a couple of facilities that do accept Medicaid MC patients. Hopefully I will be successful. If that doesn’t work, we will wait for a disaster and go that route. DH and I are both 80 and I use a walker and DH uses a cane, so there is no way I will be able to assist him when that disaster hits. I just was hoping to have plan B set and be prepared for all contingencies. Time will tell.

60 falcon

Whyzit, thanks, and I hope things go your way.  It's really tough and frustrating that MC facilities seem to be out of reach for what I consider to be of average/modest income and savings.

DJnAZ

The previous comments and the outrageous costs of MC or Long Term Care are the reason I'm considering moving overseas. Our income is high enough we don't qualify for any financial assistance yet we would not come close to meeting the financial qualifying criteria for MC. Monthly cash costs in the thousands are simply out of the question.

Adding to my long and increasing list of things I did not adequately plan for, now I could be facing financial devastation and potential bankruptcy. I suppose the good news is medical bills can be discharged through bankruptcy. Small consolation at best.

As long as my wife is still reasonably able to get out and about, there is no question we could live much less expensively in another country. Such as Spain. And when the time comes and she needs one on one care it is available for a fraction of the cost in the U.S. 

Complete health care in Spain costs about what a couple pay for Medicare Part B. The difference is everything is covered including vision, dental, prescriptions and there is no deductible or max out of pocket. I'm not 100% certain this is the answer for us, but I plan to explore our options in detail. Dementia will not let us survive financially in this country.

Crushed

DJnAZ wrote:

And when the time comes and she needs one on one care it is available for a fraction of the cost in the U.S. Complete health care in Spain costs about what a couple pay for Medicare Part B. The difference is everything is covered including vision, dental, prescriptions and there is no deductible or max out of pocket. I'm not 100% certain this is the answer for us, but I plan to explore our options in detail. Dementia will not let us survive financially in this country.

FWIW I am a Dual national, with an Irish passport  I do know that in Spain the overwhelming burden of dementia care falls on families  Around 80% of patients with Alzheimer disease are cared for by their families, who bear 88% of total costs.60 The remaining 12% is covered by public funds and corresponds to part of the direct costs (mainly healthcare direct costs).60 In the case of dementia, non-healthcare costs constitute the greatest part of total costs, mainly due to informal care.

 Non-EU nationals: non-EU/EEA nationals may have to provide proof of private health insurance before getting a Spanish visa. Some non-EU nations, however, have an agreement in place with Spain. It’s important to know what you’re entitled to, so check with the consulate or embassy in your home country before arrival.

  

DJnAZ

Thanks, Crushed. I am basically aware of the implications and complications of being an expat and have received information and pricing from Sanitas, private health cover, that will be required for a long stay visa. The main issue at this point is they will not cover pre-existing conditions. Utilizing the state health care is really not a consideration.

Our friends in Spain agreed with your observation that the type of care my wife will need is generally paid by the individuals family. A relative of theirs has 6-day per week home care for their mother at an out of pocket cost of $900 per month. I was also told about a "first class" managed care facility that costs about $1600 per month. Both costs are well below those in the US. 

At this point the idea of going overseas is a possibility at best. Working on the specifics helps keep my brain active and engaged. Considering we are in the early stage of her dementia and realizing what lies ahead, I'm trying to find realistic ways to avoid financial ruin. Going overseas may or may not be the solution.

Thanks for your EU knowledge as is the type of input I need!

OrganizerBecky

I'm in a Facebook group for caregiver spouses of folks with dementia. There are several ladies there who have placed their husbands in a care facility in Ajijic, Mexcio. They are able to rent a small apartment to live in close by. I think the care for the spouses is like $1500 - $2000 a month, so even with the apartment rent, it still much, much less costly than the $4000 to $8000 a month in the US. They rave about the good care their husbands are getting. I think they have to come back to the US every six months or so for visa reasons. 

At any rate, I'm tucking that information away for future reference. 

DJnAZ

Costa Rica is another country that has more affordable care facility options. I have heard of several near San Jose, CR as well as the one you mention in Mexico. 

Getting a residency visa in Mexico is relatively easy and will avoid the visa runs every 6 months. Same with Costa Rica. 

In addition to the long term effects of the disease and the toll it takes on the patient and their family, the financial implications are onerous at best. I'm trying to find a solution with quality, affordable care for my wife. If the solution is overseas, so be it. She deserves better than what we can afford in this country.

Stuck in the middle

Sounds like I should be brushing up my Spanish.

Puerto Rico is part of the United States.  Is that an option?

aod326

Whyzit, you may know this already, but just in case. When researching MC for my husband, some needed proof of ability to private pay for two years, bank statements etc., but some didn't. I knew I didn't have enough available money to show two years available upfront. I was relying on decent sized annual bonuses from work - and the fact that I knew it was highly unlikely he would live for two years. (And he didn't.)

So, if one place has denied you, worth checking with others. Good luck.