Financial cost for assisted living and memory care

sunshine5

Here in Virginia, it runs around $ 10,000. Per month. I think memory care may be more!

If Medicare doesn’t help financially, how is a person on a fixed income supposed to pay this hefty bill! 

I am sure lot of caregivers  would be in the same predicament as me!

Your thoughts please!

Stuck in the middle

Medicaid, not Medicare covers memory care.  I suggest you see a certified elder law attorney to find out what your options are.

Cherjer

My husband chose not to have Long Term Care many years ago as he said we would be able to finance any health issues. Had I been more assertive at that time, I would have purchased LT insurance, But who would have know that one of us would be dealing with AD. Never in our wildest dreams. Most people do not have LT insurance.

I have started looking at Memory Care here in southern California and visited a beautiful facility in Costa Mesa, CA that begins at $7,000. Unless one is on Medical, those of us who will private pay will see our savings dwindle. Just so expensive and hope to be able to keep my husband home but that may be unrealistic. Other than AD he is healthy.

Stuck in the middle

My CELA explained a way I can keep most of our savings if our LTD runs out.  You need to see a CELA in your State before you spend your money.  Once it's gone, it's gone.  A good time to call a CELA would be Monday.

Being old is bad enough without being old and poor.

Crushed

I/we have been paying over $12,000 a month for DW's care.   Her pensions and social security and retirement savings  cover her cost but that is because were always financially lucky.We both always worked at the high end of the civil service ,  owned our house since 1977, stayed married, kids went to state university and we had no health issues for us or either kid  

But the fact remains that a diagnosis of Alzheimer's for most people means you  have 

instantly become poorer than you ever thought you would be  

Medicaid is your lifeboat and medicaid planning an instant necessity the moment you hear a diagnosis  

LeBret

according to our attorney:

Medicaid allows you:  

To keep your house.

Up to 100 k savings

1 vehicle.

If you have assets more than the aforementioned, pay down the following [in so far as possible]:

Pay off your car.

Pay off your house.

Clear your debts.

Pre-pay your funeral/burial arrangements.

Ed1937

The cost of long term care is simply unaffordable for most of us. And we can't do a thing about it.

[Deleted User]

The user and all related content has been deleted.

Crushed

Victoria2020 wrote:

Cherjer wrote:

I

Cherjet - California is changing Medicaid asset rules: here is a summary : 

https://www.elderlawanswers.com/california-removing-asset-test-for-medicaid-eligibility-18652

(converted to a hotlink )

Rescue mom

Cherjer….several in my support group IRL are getting, or just got, Medicaid. They were all surprised at how much they could keep. They thought they’d have to give up everything and basically impoverish themselves, and they were all surprised to find out that was not the case.

 It may be be as bad/hard as you think. They also said they could not have done it without an attorney’s help. I know some here did it without a lawyer, but that’s just what these people said.

Also, please don’t beat yourself up over the LTC. My DH and I tried to get LTC insurance about 15 years ago. We were both rejected. Him for heart issues (I get that) and me for what was widely  considered a minor (albeit unusual) condition. 

Many many people were rejected for  very (IMO) minor health issues.  And to be precise, we were not always “rejected” but the monthly price was about $5,000, as much as care then.

Anyway, unless you tried, you don’t know how it would have gone. Lots of people couldn’t get that insurance.

Yes, the situation is horrible. So many people assume Medicare pays. Nobody thinks about it unless they’re there, they don’t  realize what this is, and I don’t expect anything to change. We are not enough, and too tired to take much action.  As said, getting old is tough enough, then this.

Kenzie56

I see many people posting Medicaid as the way to go. I also live in Virginia, but what I have found is that the facilities that accept Medicaid near us are unacceptable and I would not place my DH in them. Most of the facilities that offer the best services and environment are private and only accept Long Term Health Insurance or Veteran funding. DH has neither and our pensions, Social Security, savings are too high. I will see an attorney, but I guess what my question is - do all facilities have to accept Medicaid? What do people do if they find the facilities that do accept Medicaid are unacceptable?

dayn2nite2

No, not all facilities have to accept Medicaid.  My state does not pay for AL or MC at all.  Only NH.  My mother went in Medicaid pending and received wonderful care.  Facility was clean and full of caring and loving staff, food excellent, my mother received the same care a private pay person would - only difference was she had a roommate (private rooms not allowed on Medicaid).  That was fine.

If you have visited every single Medicaid facility in your area and you have determined all of them unacceptable, then you look farther out. 

Are you basing "unacceptable" on your visits or on what people say about the facility?  Both?  If you are rural you definitely will have a challenge and probably will have to look further out.  If you live in a metropolitan area, it would be next to impossible that every single facility is unacceptable.

You cannot expect fountains, beautiful furniture and concierge services from a Medicaid facility.  You should expect clean, no odor, functional furniture with a warm feeling and caring, long-term staff.

If you require an environment like a Sunrise facility, then you will definitely be having to pay for that out of pocket.

Kenzie56

Dayn2nite2, Thanks for your input. This is my second go-around in the search process and thought perhaps I missed something. I guess what I am looking for is a MC facility that is MC only and built in a circle so the residents can walk as much as they like. I'd like for the staff to be well-trained in working with PWD. I'd like the facility to be clean and the staff ratio to be be enough so that the needs of the residents can be met without waiting hours. DH is on a wait-list for one nearby, but it does not accept Medicaid.

In 2018, we placed my DH's mother in a MC wing of a AL facility nearby and supplemented financially. The residents could only walk up and down the hall to locked doors at either end. After placement, we discovered they would often have aides from the AL side of the building come over when they were short-handed on the MC wing and these aides were not adequately trained on how to care for a PWD. Before we placed my MIL, we visited many facilities and settled on this one (which did not accept Medicaid) because she was introverted and a smaller facility was best for her. She also had LBD and had behavioral issues that would have impacted a roommate. 

DH is very social and a larger MC only facility in a circle would benefit him because he is constantly pacing. A roommate for him would be fine. Fancy furniture and fountains are not on the list of requirements. DH doesn't even know me or recognize his surroundings at this stage. The Medicaid facilities I visited in 2018 seemed to be more like nursing/rehab facilities, where the staff seemed to be overworked and patients left unattended (and smelled) - but like you mentioned, I need to research further. Perhaps the attorney can help me in this area as well. If there isn't one nearby, I am prepared to pay...I was just curious. 

Crushed

Important to remember that California had to retain  the income qualification for medicaid

To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, based on the number of people who live in your home. The income limits based on household size are: One person: $17,609. Two people: $23,792.

Crushed

Kenzie56 wrote:

Dayn2nite2, Thanks for your input. This is my second go-around in the search process and thought perhaps I missed something. I guess what I am looking for is a MC facility that is MC only and built in a circle so the residents can walk as much as they like. I'd like for the staff to be well-trained in working with PWD. I'd like the facility to be clean and the staff ratio to be be enough so that the needs of the residents can be met without waiting hours. DH is on a wait-list for one nearby, but it does not accept Medicaid.

In 2018, we placed my DH's mother in a MC wing of a AL facility nearby and supplemented financially. The residents could only walk up and down the hall to locked doors at either end. After placement, we discovered they would often have aides from the AL side of the building come over when they were short-handed on the MC wing and these aides were not adequately trained on how to care for a PWD. Before we placed my MIL, we visited many facilities and settled on this one (which did not accept Medicaid) because she was introverted and a smaller facility was best for her. She also had LBD and had behavioral issues that would have impacted a roommate. 

DH is very social and a larger MC only facility in a circle would benefit him because he is constantly pacing. A roommate for him would be fine. Fancy furniture and fountains are not on the list of requirements. DH doesn't even know me or recognize his surroundings at this stage. The Medicaid facilities I visited in 2018 seemed to be more like nursing/rehab facilities, where the staff seemed to be overworked and patients left unattended (and smelled) - but like you mentioned, I need to research further. Perhaps the attorney can help me in this area as well. If there isn't one nearby, I am prepared to pay...I was just curious. 

Crushed

My wife is in a very nice MC only facility however The patients  cannot "walk freely" around the facility  There are 4 16 single room corridors.   current census is 13 per corridor 

Each corridor has two   well trained staff on duty at all times.   Meals come from a central  kitchen.  When the weather is nice two corridors at a time are open to the outside   an activity  Staffer is always outside.   Patients in activities are escorted in a group to the activity room.  
 Medications are handled by the nursing staff.  

its clean and the residents are clean  that is about as good as it gets.

I doubt you will find a medicaid facility that is MC only

Virginia Medicaid Programs for Memory Care

Virginia’s Alzheimer’s Assisted Living Waiver program expired in 2018 and was not renewed. Currently, Virginia does not have a Medicaid waiver program that helps cover the cost of assisted living.
 https://www.memorycare.com/memory-care-in-virginia/
 

Jo C.

In many states, MC and ALFs are not covered by Medicaid or Medi-Cal.  Also, there are many NHs that do not accept Medicaid or Medi-Cal which makes it necessary to screen only those facilitys that do accept that source of payment if that is what must be used. 

If one has met the savings requirement to qualify for Long Term Medicaid or Medi-Cal, but has too much income to qualify; yet cannot afford the cost of a NH, there is a way to succesfully deal with this.

Many states have what is called either a, "Miller Trust," or a, "Qualified Income Trust," they are both the same. In this, when a person has too much income to qualify for Medicaid, but not enough income to pay for the cost of NH care, one can establish a Miller Trust.

One puts the NHs patient's income into a Trust, when a bill is received from the care facility, one writes a check out of the Trust and Medicaid then picks up the rest of the shortfall.  This has been very helpful for people.  In many states, only the income in the NH patient's name is used; the at-home spouse's income in their name only does not count.

In many states, Medicaid will not cover MC or ALFs.  Some will have a "waiver" program, but is often limited to a certain number of people and when that number has been reached, there is no more room in that program.

Seeing a good Elder Law Attorney is the best approach far before one needs such services.  One can then gain knowledge needed and also be assisted to position oneself as best can be.

Remember; Medicare does NOT pay for custodial care in a NH.  Medicaid and Medi-Cal do.

As for California's changes to income levels, that sounds great.  However, they still have a recovery of money to get paid back after a person has died, and they also still have a 30 month lookback period to ensure people are not trying to hide or give away assets or selling homes or other assets far below fair market value.
 

In light of this, I have tried to find out if the 30 month look back period is no longer in place, but do not find that.  So; it may be that despite being able to have much more in the way of financial assets, one may not be able to give away any money or try to hide it. Still a problem issue regarding not being able to give money to a LO who may need some assistance.

When looking up to see what your state's criteria are for qualifying for Medicaid Long Term Care, be sure to use the current year, 2022, and be sure you use the term, "Medicaid Long Term Care," that is very different from regular Medicaid. 

J.

Bill_2001

What a complicated nightmare full of red-tape. As if dealing with Alzheimer's and dementia is not difficult enough. Last time I checked, I thought I lived in a first-world country.

What a disaster. I love my country, but for God's sake, don't get sick here.

Lynne D

Jo C.,

Thanks for that information. All states have Medicaid Estate Recovery, by federal regulation. California, however, only recovers assets subject to probate, so if one’s assets are in trust, they should not be subject to recovery. Also, I believe California allows a couple to retain equity in their primary residence of up to $550,000. In any case, Medicaid lets a couple stay in their house, and will put a lien on it for any amount subject to recovery that was spent on the client.

You seem to have a lot of e parties in this area. If you could verify that for us it would be great.

bummed

My friends daughter applied for MEDICAID in Missouri in Nov. She has got nothing but incopentance and non communication. Long telephone holds up to 2-1/2 hrs. with no one answering. Finally Feb 25 she talked to someone who told her to fax a bunch of information that was never asked for before. We are still waiting for some communication after sending required information. The Missouri legislation is stalling from allowing new applicants to gain MEDICAID. We don't know what to do for my friends care. She can no longer live alone.

NW_Mike

I am currently researching all of this and will pass along what I have found. Keep in mind you need to consult with your own advisors and that these things vary from state to state.

First, most states have what is called a Spousal Impoverishment guidelines for Medicaid. Google them for your state. It is more generous than you might think. In my state, the non-applicant spouse can keep the house (as long as they live in it, that is), with equity of up to $750,000. (Over that and it counts as an asset); up to $137,400 in assets and one vehicle. The applicant's IRA is exempt if it is in payout status and the non-applicant spouse's IRA is always exempt. These rules can change annually.

Under those rules, I could almost qualify now if I got rid of my DW's car which has been mostly in the garage for years anyway. However, as mentioned in previous posts, Medicaid applicants for MCFs face both a limited choice of facilities and, even where Medicaid applicants are accepted, there are very, very long waiting lists. So, one strategy I am considering is to take a reverse mortgage on my home and have my DW be a private pay applicant -- at first. Most of the MCFs I have talked to so far have a rule that as long as a resident remains private pay for a certain period, typically two or three years, then they will allow them to transition to Medicaid even if there are no Medicaid beds available. (Obviously if under the private pay the resident was in deluxe accommodations, those would have to change to basic accommodations) By being private pay, we will have our choice of facilities and a much shorter waiting list at most of them.

As for cost, the MCFs I have talked to usually have a 3 or 4-tier pricing schedule. The more care your LO needs, the higher the tier. How much help they need dressing or bathing, or situations like incontinence can all push that tier upward. In my area, most Tier 1 rates are around $5,000 for basic accommodations. (studio apartment, typically). Once at Tier 3 the rates hit $6,000 to $7,000. So if you were going to plan on private pay until you could transition to Medicaid after the 2-3 year period, you'd have to plan on $200,000 to $250,000 out of pocket, or out of your reverse mortgage if you went that way.

And, yes, there is a Medicaid Recovery program in most states that will ultimately try to recover the costs from the estate that Medicaid incurs paying for someone in an MCF. Typically that means they will place a lien against the home so that when it is sold they can recover some of the money. There are all sorts of exceptions and rules and I'm sure strategies to avoid that, but those are not my concern at this point.

There are all sorts of variables for each individual situation so I am not suggesting this should be YOUR strategy. However, since I have been collecting real numbers from MCFs recently and have looked into the Spousal Impoverishment guidelines in my state, I just wanted to pass this along.

Best of luck to anyone facing this decision.

Crushed

 https://wallethub.com/edu/states-with-the-most-and-least-medicaid-coverage/71573
  

 according to Wallet hub these are the worst states to live in for Medicaid (not specifically for the elderly and dementia but it gives an idea)

 

Crushed

And here are the best states

 

toolbeltexpert

Crushed would you clear up something. Income limits? Is that my social security. that is my only income or is it income from say a part time job? Or maybe combined? Thanks

NW_Mike

toolbeltexpert wrote:

Crushed would you clear up something. Income limits? Is that my social security. that is my only income or is it income from say a part time job? Or maybe combined? Thanks

I assume you are asking regarding the Medicaid applicant and not the non-applicant spouse. If so, here is what my state's Medicaid website says:

"For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks do not count as income, and therefore, do not impact Medicaid eligibility."

DJnAZ

I am in the initial stage of applying in Arizona and just completed the financial phone interview and faxed 21 pages of required documents yesterday. The program for long term care goes by the acronym ALTCS (Arizona Long Term Care System). It is the state's version of Medicade and is partially funded by the federal Medicade program. The state Medicade program is called AHCCCS (Arizona Health Care Cost Containment System).

From what I understand, if my wife is accepted only her income (Social Security) will be counted and I will be considered a "community spouse". That designation will allow me to keep sufficient income and assets to support myself, help with her care as needed and avoid bankruptcy and poverty.

As much as I would prefer to use an attorney, I am tackling this myself rather than spend money we can not afford on legal assistance.

After completing a review of the financial documents I faxed, the next step is a medical interview. .Since my wife is not able to communicate and participate in the interview process I am her designated representative.

For any Arizona forum members or anyone that may be interested, the link to the state's ALTCS website is:

https://www.azahcccs.gov/Members/GetCovered/Categories/nursinghome.html

 

dayn2nite2

Not many nursing homes do this, but when my mom was accepted Medicaid pending the social worker at the home assisted us in applying.  Yes, there is a long, long wait for approval, but my mom was basically destitute and there was no question she would be approved.  Approval took 11 months (and this was years ago well prior to COVID backlogs for state services) and the state paid the NH back pay for that time and I was writing a check for her entire Social Security check minus $60 for per personal spending to the NH, and a separate check for $60 to her account set up by the NH for her personal money while we were waiting.

Crushed

DJnAZ wrote:

As much as I would prefer to use an attorney, I am tackling this myself rather than spend money we can not afford on legal assistance.

This is quite simply the most expensive and financially risky decision process in your life .  Its not what it costs its what you can lose

Think of not paying for a home inspection on a house purchase

 


  

 

Lindsay22

I would also like to add that these are the types of things you should consider when voting.  The evil "socialism" touted as a threat to our country is what we are talking about here.  We need expanded government support of the elderly and social safety nets that would help all of us. We are one of the only rich countries in the world that doesn't provide support to families.

OrganizerBecky

Lindsay22 wrote:

I would also like to add that these are the types of things you should consider when voting.  The evil "socialism" touted as a threat to our country is what we are talking about here.  We need expanded government support of the elderly and social safety nets that would help all of us. We are one of the only rich countries in the world that doesn't provide support to families.

Agree 100%.

agr

Lynne D

Lindsay22, I also agree 100%.