Meeting with CELA/Irrevocable trust?

mrahope

At my son's request, we met yesterday with the CELA who prepared our DPOA documents about two years ago. My son was hoping that my DH (who has been extremely uncooperative) could be compelled to accept care under this document, which was not the case, the lawyer told us, because "dementia is not a mental illness" and those who suffer from it are considered competent. This seems backwards to me, but I only know what I see day-to-day. But the law is the law.

More concerning is this: the lawyer offered to create an irrevocable trust, which would shelter our assets from the Medicaid spend down. But there are two "gotchas". First, as of course many of you know, is the five year "look back" period. But the one I didn't know is that assisted living and/or memory care can't be paid for by Medicaid, ONLY nursing home care. Do I understand this correctly? So, yes, I can protect my assets, but what if I have to spend so much on assisted living, etc. that there's little left by the time DH requires the level of care of a nursing home? Has anyone created a trust like this, and are you glad you did?

FWIW, my spouse is 84, so maybe some of this is moot.

Crushed

Your profile does not say what state you are in medicaid varies by state

mrahope

Thanks for asking. We live in Virginia. Any light you can shed is appreciated.

towhee

Not a lawyer, but here is some standard info. Virginia Medicaid Programs for Long Term Care (medicaidlongtermcare.org) and to go with it Microsoft Word - UAI Long-Term Care Council JPG.doc (ucsf.edu). not sure how recent the UAI is, and no idea exactly what constitutes nursing home level of care in your state. Looks like the lawyer is right about Medicaid not paying for AL although it might pay for some memory care costs. I think you are right to be wary about that irrevocable trust, I would try to contact your long term care ombudsman from your local area agency on aging Office for Aging Services, DARS Division for Community Living (virginia.gov) for info on MC and check with a second lawyer. You might have to go to another state, it might be cheaper.

Caring4two

I’ll try to explain. Medicaid does not cover what they call “custodial care” ie: room and board and comfort care. Most assisted living facilities don’t provide “skilled nursing care” ie: care provided by an RN or LPN. Skilled nursing care is provided at the nursing home level (which is the most expensive because of the registered nurses).

Most people aren’t aware of this. So, while Medicaid is useful at the nursing home level, it’s not much help at less skilled levels of care. CNAs usually are the ones giving the “comfort care” ie bathing, bed changes, feeding assistance etc.

toolbeltexpert

Mrahope you are correct,I learned this the hard way. My dw is in al mc. My pay, under 4k a month which is alot but not any where sn cost that was almost 9 k my pay! The look back period is 5 yrs and at 84 you might be right about it being moot, but do what you can to protect what you've got because you can't never tell.

Thank you for asking about the irrevocable trust I have read up on that but it is complex and I couldn't offer any advice on it.

Caring4two I agree with what you said about custodial care it works that way in Tennessee.

The facility where my dw is offers three types of care. AL,Sn and ALmc. If something happens where my wife would need to be in sn they would be able to transfer to that section,I would have to continue to pay for her mc room if she needed to go for a longer time. That recently happened to a resident and the family declined to pay for the room they were fortunate the room was still available once she was better.

None of this is easy or cheap. Let us now how it goes

Stewart

mrahope

Thanks so much to all of you. I am probably going to go ahead with it, but I'm going to look at the web sites you suggested, towhee, before I commit. I am also very grateful for your sharing of your experience, Stewart. The reason I am tempted to go through with this, despite it's drawbacks, is that it would cover me, as well, should I be the one to need care, and I'm younger than my DH by 13 years. Might save my children some worries.

Still gotta say, this whole thing about him not being "mentally ill" baffles me.

HollyBerry

Different states, different experiences, but I found the social worker at my mom's facility to be really helpful in decoding all the different rules about who pays for what, and when. They can't advise you about your personal financial situation, but they know all about Medicare, Medicaid, and what their facility charges and receives from which type of insurance. When she moved in she was 92 and had about 3 years of her own funds remaining, so we had frank conversations with the facility about what would happen if/when her money ran out.

JC5

Always learning from this group! Does NY state consider dementia a mental illness? Thanks for posting!

towhee

If you are thinking of going ahead with the irrevocable trust, please get a second opinion and make sure you know all the pros and cons before committing. What you do has to fit your particular circumstances, or you can make things worse for yourself. This is a video giving some reasons why not to do a trust (although not from the point of a spouse). I am not a fan of youtube lawyers but this seems fairly basic. 9 Reasons NOT To Protect Assets From Nursing Home - YouTube

W.L.

My only thought is an irrevocable trust is just what is says, "irrevocable". Good suggestions here about second opinions

Lee

mrahope

Thanks, again, Towhee for your insightful contributions. This was EXACTLY the question I've been asking myself about the trust: why should I NOT do it? I needed to hear the con side of the equation. A question I need to ask my son and daughter is what their expectations are for any inheritance. I can see where that might be important. OTOH, when I had this kind of decision to make before my mother passed, I couldn't have cared less about the $$, as long as she got the kind of care she wanted both in quality and quantity. This is SUCH a tough call.