Lower asset/lower income parent with Alzheimer's

almost.life

My parent was diagnosed with Alzheimer's a couple of years ago. They live with our family, and with small children we are stretched very thin and increasingly concerned about safety/ability to care for the parent. Parent worked low income jobs and social security amounts to less than $2k per month; they have lifetime savings of under $200k. My understanding is that our best chance at a decent facility would be to find a place willing to take her as a private pay resident, and then spend down (versus spending down now in hopes of finding a medicaid bed for her as an external resident). Can anyone confirm this? Further, I'm having a very tough time finding facilities willing to take someone with her financial profile. Any advice?

Michele P

https://alzconnected.org/discussion/77137/lower-asset-lower-income-parent-with-alzheimers

I would consult an Elder Law attorney. They are best equipped for advising you. Medicaid will go back five years with financial records.

H1235

Welcome. In my state assisted living and memory care facilities will do not generally accept Medicaid. We have something called a Medicaid waiver where Medicaid will pay a portion of the bill, but family’s is expected to pay the rest. I did find a few facilities that would accept the waiver as payment in full, but they were dumps. The other thing I found was that if you private pay for two years (or until they have spent down) in some facilities they will waive the family copay and just accept Medicaid as full payment. The only thing that is for sure covered by Medicaid in my state is a nursing home, which is not ideal for a person with dementia. I imagine a facility gets paid more from a private pay person than they would from Medicaid. This may explain why the places that accept Medicaid waiver as full payment from the beginning were dumpy. I would be very very careful with the spend down. They are very picky. In my state their home doesn’t count as an asset and would not necessarily need to be sold, although in some states they can come back for it once your loved one has passed. An elder law attorney is really the way to go. We saw a regular lawyer (who was not good) and was not made aware of all of these things. Unfortunately I was forced to bring mom to a nursing home when her money ran out. It’s so complicated! I was an absolute wreck trying to figure out what to do, how best to spend down and worrying about if she would be approved. We had family members taking advantage of mom before her diagnosis, so there were things they might have questioned (thankfully they didn’t). I will attach a link that may be helpful.

https://www.medicaidplanningassistance.org/medicaid-eligibility-income-chart/

Victoriaredux

Getting advise from an elder law attorney is the best way to get a solid personalized plan. Yes, not inexpensive but the legal bill will save potentially thousands long run. The laws that apply are complicated and can change frequently- Google and AI won't give you options that you can depend on.

https://www.naela.org/Web/Shared_Content/Directories/Find-a-Lawyer.aspx

There are other experienced lawyers that aren't listed in the organization listed above , but this gives you idea of what to look for.

RMremdler

https://alzconnected.org/discussion/77137/lower-asset-lower-income-parent-with-alzheimers

Agree with prior comments about using a lawyer specializing in elder care for your State. I made a mistake using a regular lawyer for our legal docs and am having to pay to re-do.

MN Chickadee

In my state of MN, yes that is pretty much the model. Our Medicaid is a waiver program. Some memory care homes will take the waiver some will not. Some will only take it if you private pay for 1-2 years first. Having $200k to start with would definitely open up options in my area. An elder law (estate planning) attorney in your area is the best option to make a plan specific to your LO's finances. Every state is different, and an attorney can advise the best way to spend down. There are caps on gifts but your LO can gift the max amount each year, probably pre-pay a funeral and some things like that aren't against the rules with the spend down. Some states allow a Miller Trust, where if they have a bit too much income their money can go into a trust to pay a portion of the care. If they or their spouse were a veteran there may be further options. An attorney will advise.

notequipped

Every facility that we looked at will accept Medicaid as payment after a period of self-pay. The shortest self-pay period was 18 months. It sounds like with the savings and social security, she should come close. One of the facilities had a religious affiliation. Their stance was that once they accept a resident, they will allow them to stay. Might be an avenue to explore.