How Do You Mentally Deal with Sending Big Checks For Care?
Since my sister moved in with me, I have been very careful with her money, squirrelling away every penny I can for her future. She's only 58 years old and could live a number of years yet.
Because of a fall, she spent some time in rehab and is now in a memory care unit, hopefully for only a month or so. The orthopedic dr indicated she has a foot fracture that is a bit sensitive and we need to be careful for a couple of months. My home has a lot of steps, including a crazy set up to get into the home. After discussions with my siblings and with the medical professionals, we decided my home wasn't the best location for a continued recovery.
Thus we will be moving her into a memory care unit I had checked out awhile back. So far, I've been okay with the amount of money we've shelled out to get her in here. If her stay only ends up being a month or so, as planned, that's fine, but we all know it's possible she won't come home again. It may all depend on whether or not I feel up to resuming the full time caregiving again.
The thought of writing those big checks every month and watching her money dwindle away really scares me. I'm a saver anyway, and I have worked so hard to make sure she has money. The possibility that she might run out at a young age scares me like crazy.
How did you all deal with the fear and prepare yourself mentally for the day when there isn't enough money anymore?
Comments
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If you live in the USA, then you need to see an elder care attorney. This person should be able to give guidance on finances, SSID, and Medicaid in your state. Should also make sure all the required paperwork done for Durable Power of Attorney, Health POA, etc. are in order.
Usually first consult is free.
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This is a very real concern that is best handled BEFORE the negatives happen. Seeing a Certified Elder Law Attorney will give much knowledge; and will position your sister best to retain her assets AND also provide much information on what is available as the financial situation changes. There is much to learn.
There is a cost to see an attorney; but it can often save thousands in the future.
J.
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I'm not concerned about retaining assets. The money I've saved is for her, not her heirs.
And scolding me doesn't answer my question.
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Dpoa etc was done several years ago.
My sister doesn't have a lot of money. She is eligible for the state run VA home in our city
When I last talked to the admissions director,there are 6 people on the waiting list for memory care.
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Even if an elder attorney could help, it doesn't take away the fact that it's scary writing big checks. That's what help I'm asking for.
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Marp i don't think anyone is trying to scold you, just asking to try to make sure that you've pursued every avenue open to you. I don't think any of us gets used to the breathtaking costs of care, so there's no clear answer to your question. It sounds promising that she might be eligible for the VA facility. Six people on the waiting list sounds pretty good to me, better than sixty at least...
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@Marp the best way to deal with it mentally is to ensure you’ve done everything money wise you can now that she’s in there temporarily -in case it turns into the permanent stay that is upsetting you. It sounds like you have ( and I’m sure Jo will agree when she checks back in. I don’t think she’s scolding as much as addressing your fear by suggesting an action to take).
Something I told myself is that my parents needed the care now and that’s what I had to focus on. I can’t predict the future and it’s not fair to them to restrict the care they need now in order to preserve assets for future care they may not live long enough to need. Plus, by the time they get to the point that they run out of money, they may medically qualify for a level of care that Medicaid will pay for. In my parents case, they have a couple more years of money for assisted living. They are 83/85
Your belief that the money is for her care, not her heirs, is also something that will help you overcome the mental block.
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It was scolding with the all caps on BEFORE. Nothing anyone can say will change my mind on that.
She is eligible for the veterans' home from the standpoint of being a properly classified veteran.
The one part that is uncertain is whether she qualifies medically to have the federal VA Healthcare system help pay for her care. The federal VA will not make a ruling on that aspect until she has been in the VA home for 30 days.
At that time, they review records from the home and make their decision. She has to qualify for skilled nursing care according to the VA. Unfortunately, no one but the VA knows what criteria they use.
If they rule she needs skilled nursing care according to their secret formula, they help pay, retroactive to the date she moved in. If they rule she doesn't qualify, the family becomes liable back to the date of admission, regardless of their ability to pay. That's a little scary.
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I like your perspective on paying for needed care now. My sister is only 58 and could live awhile longer. There is no way I can make her money last 20 years.
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I've attended some presentations by elder law attorneys who do estate planning and the reasons for having them deal with assets and income are two:
1. Protect some assets/income so as not to impoverish a spouse or dependents; and
2. Shield assets from the government so the individual qualifies for taxpayer funded care earlier and more of the individual's assets can be left to the heirs.
The first doesn't apply to my sister as she is divorced and has no dependents. The second is well...a little sketchy, legal but sketchy, and is a tactic really only useful to people with bucket loads of money.
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Is it the writing of the big check or fear that the money will run out before her care needs end?
When you are used to being a saver, single large outflow of funds is scary but there is no way to get around it unless she qualifies for financial assistance of some sort.
The same goes for running out of funds. The only way to relieve some of that fear is to have plans in place for financial assistance or placement.
The costs of this disease are staggering and most folks end up relying on outside assistance at some point, particularly those with a surviving spouse, which you indicate is not applicable here.
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Thank you for your perspective. It is the fear of running out of money before her needs end.
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Caps are for emphasis not for scolding. I often use caps for emphasis.
Iris
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I was going to let this go, but I'm afraid others will be hesitant about getting financial help.
I'm concerned about your comment that using a CELA to protect assets and qualify for "taxpayer funded care earlier" is sketchy, about inheritance, and only useful to people with bucket loads of money. The reason to consult a CELA, in my opinion, is to navigate a tricky and confusing system. Your sister deserves to have help in funding appropriate care. It's not sketchy to get help dealing with a system that seems designed to prevent approvals and cost more than almost anyone can possibly afford without insurance.
You're doing a great job looking out for her wellbeing. And yes, the big check is terrifying, nauseating, and awful. I was going through savings fast paying for medical bills while unable to work (because I needed to be a fulltime caregiver). Writing those checks can never be easy.
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While I agree the price of long term care is ridiculously expensive, I started to break it down. Three "restaurant" meals, daily; a hotel-style room with housekeeping; (?) hours of skilled, 1 on 1 care, daily. It does add up....
Maybe thinking in these terms might make it less painful to write those checks.
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One word: autopay. 😉 All the care facilities we've dealt with will not accept checks, only autopay, so the cringe factor of writing checks is gone. But there's still the dread of seeing the bank account diminish by leaps and bounds every month.
I always remind myself that there's no way I could give my mom the same level of care that she's currently receiving in her memory care. I could try--and I have--but both of us would be deeply unhappy.
It still is hard though. She lived an incredibly frugal life, saving every penny. She always made me promise not to give her money to a nursing home. A promise I obviously couldn't keep. She would be horrified to know that both the money from her house and small IRA nest egg have all gone to memory care. In fact sometimes I think she has an inkling.
The others are right: talk to a CELA.
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I hear you.
In my mind, CAPS used in a word or phrase is emphasis is entirely appropriate though I might bold if available. A whole post of caps is rude-- not just because of the "shouting" it represents but also because it's just hard to read.
But I do hear you on the massive checks. While it helped to remind myself that the saved money was meant for her later years. And while we looked at every check my mom wrote to the MCF or HHA in the context of the good that amount could have done spent elsewhere-- a month could have been passage for one on a luxury European river cruise, a semester's tuition at a state university for a grandchild, hardwood floors in the living and dining rooms, January and February in an oceanfront condo somewhere warm, etc. These aren't the golden years one would wish for your dear sister, or for you come to think of it.
Seeing a CELA helped my mom make peace with the ugliness of this all. Yes, it was upsetting and unfair to see the money they'd saved all those years sucked up by dad's care needs. It was scarier for her as a spouse because the money set aside for her future care needs was yoked to dad's with the potential that his would syphon off most of it leaving it harder for her to access a quality facility if needed while still of cognitively with it. She was especially livid to be coming into a considerable inheritance that would have been considered joint under Medicaid rules. Understanding Medicaid helped us see it as a necessary safety net for those who have been unlucky enough to been dealt this ugly situation in life.
HB
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Please explain in detail what your CELA did for you. How did it save thousands, as one person put it
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Emphasizing certain words has the same effect as capitalizing everything in the right context. This thread is clearly such a context. A distraught family reaches out for help and they are told they should have done something BEFORE. That's scolding.
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On these boards, we encourage people to consult CELAs like a CELA is Santa Claus - consult a CELA and you will automatically have the best care and your family will be rich. Between the comments on these boards and the presentations these attorneys give, that's the message.
I think we do each other a disservice on these boards when we don't explain anymore than that.
So I'm asking those of you who refer people to moneygrubbing CELA all the time, specifically, what did your CELA do for your? Did they help you protect assets so as to avoid impoverishing a spouse or dependent? Were you trying to protect money for your kids/grandkids inheritance? Or was it something else?
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When my parents were still alive, we consulted a couple of CELAs.
The first one wanted wanted to charge my parents nearly 10 percent of their assets to set up complicated trusts to hide money so my parents could qualify for income based Veterans' benefits and Medicaid earlier.
The second attorney refused to do that. He said my dad (who had Alzheimer's) would qualify for the Veterans' benefits we were applying for fairly quickly without spending 10 percent of his assets on an attorney. My parents assets were also well below the limit for Medicaid should my dad need it. This attorney felt that setting up fancy trusts then charging my parents 10 percent of their assets was like stealing.
Turned out, the second attorney was right. And we're glad we took his advice and not the first attorney's.
So CELAs aren't the answer for everyone, but, on these boards, we make it sound like they are.
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So, did the CELA actually do anything to save your parents thousands (as some on this board say they always do)? Or was it just a reality check that life sucks and there's nothing you can do about it?
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Tell me specifically what your CELA did for you. Did they set up trusts so the government couldn't get some of your LOs money? Did they find a benefit available that you didn't know about? What did they do?
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Part of the reason the system is so confusing is CELAs. CELAs have found loopholes and ambiguities in the Medicaid (and other similar assistance) laws that allow rich people to hide assets so they can get the income based benefits, even though they are loaded and could easily pay for their own care.
With all this manipulation of the system happening, Medicaid and other programs have to minutely scrutinize everyone to try to catch people who don't qualify and keep them out of the programs. The manipulation of the system by those who can afford to do it is a lot of the reason the system is so complicated and difficult for everyone, including those who truly need the help. CELAs are making millions a year off a system they helped to complicate and they have an incentive to keep it complicated - the more complicated it is, the more people who come to them and pay for their help.
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It was actually a little of both.
CELA was well-practiced in finessing the situation and managed to get dad to actually sign the DPOA and Health Care Proxy which he had previously avoided (per his lawyer and CPA who'd suggested it themselves). This saved us the expense and the potential for triggering dad into even more agitation and aggression. Based on what my friend and my aunt paid to obtain guardianship of his father/her sister we saved anywhere between $6 and 10K.
CELA wrote the DPOAs with the expectation that I would be acting on bother parents' behalf around selling their homes, accessing bank accounts and safe deposit boxes, accessing the investment accounts, etc. Because the documents were so well drafted vs boilerplate, they were accepted by two different title companies, 3 different banks and 2 investment houses after their legal departments vetted them.
The CELA explained Medicaid in our state so that mom didn't make any moves that could have delayed Medicaid if needed down the line. She gave mom the green light to improve the new-to-her home she bought but advised against doing all her Christmas spending last minute.
Not specific to Medicaid or estate planning, the CELA vetted the paperwork for the contracts on both houses we sold and the contract for the MCF into which we moved dad. I live in a state with filial responsibility laws, and she made sure the language in the contract didn't include language that might expose me to collection if mom died first and dad outlived his money.
My aunt's CELA helped them establish a Special Needs Trust to help support her disabled daughter going forward while still qualifying for Medicaid. That was in another state and I am not privy to the details.
Our CELA turned out to be a woman I knew from DS's scouting (I was one of the troop advancement chairs and helped him through the process of his Eagle Scout paperwork) and marching band days. We paid a la carte for the services as needed. TBH, I did probably get a friends & family discount, but she worked for a massive firm, so I am guessing it wasn't all that big a percentage.
I realize these people aren't available to all of us in the same way geri psychs are rare in very rural areas. But, IME, a good one is a valuable resource.
HB
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Thank you. This is very helpful.
About the Christmas spending - I assume you're referring to the improvements on the house? Was the reason the attorney recommended not waiting until the last minute to do the improvements because Medicaid would assume your mom was updating the house specifically to spend money so she could qualify sooner?
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Wonderful that you have a CELA you know and trust. At least you know he/she isn't getting you into the office to sell you a bunch of things you don't need.
Did he/she advise setting up a trust to shield any assets? That's what almost all CELAs do when they get you in for a consultation - they try to sell you these trusts, etc, each of which costs thousands of dollars to set up. If you have a bucket load of money, such moves are an effective financial strategy for protecting assets. The problem I have with these strategies is that they often shift the burden of paying for care to the taxpayers when the person has the money to pay. Medicaid and other programs are for the truly indigent not for people who have a ton of money. That's where these asset hiding schemes bother me - they pervert the purpose of these programs and taxpayers foot the bill for care of people who can pay themselves. Poor people pay taxes to fund care for people who may make 50 times what they do. Not the purpose of the programs.
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I guess I wasn't clear. The attorney was all about spending money on making the house how she wanted. The idea was to make it as maintenance-free going forward in case dad did need Medicaid. She ended up replacing the kitchen appliances and HVAC system as well as replacing the roof. The caveat is that there is a state-determined limit for the value of the home a community spouse can own. PA sets the limit at $572K currently which is only a little more than her 2BR, 1500sqft twin home is worth.
Mom and dad generally cut checks or spend generously for Christmas presents-- there was guidance not to write checks all at once especially to me as she sometimes goes over $500. This also meant no gifts of things like cars or down payments on houses.
HB
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Sounds like PA needs to update the value of the home the spouse can own. The way real estate is skyrocketing these days $572K buys a closet in some areas these days.
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CELAs have found loopholes and ambiguities in the Medicaid (and other similar assistance) laws that allow rich people to hide assets so they can get the income based benefits, even though they are loaded and could easily pay for their own care.
I'm not rich and none of my assets are hidden.
You asked what specifically my CELA did for me. They set up our will, trust (yes, a trust so assets will not have to be held in probate if one of us passes), and POA documents. Like HB, our CELA was able to tactfully and respectfully work with my husband so that we did not end up having to go the guardianship route. When it was becoming clear I could not work and care for my husband alone, they helped me apply and get approval for my husband's LTC Medicaid. The application hides nothing. Every bank statement, my retirement account, every thing we own is clearly and honestly reported.
Now my husband has a home health aide. He has good insurance. It wasn't about saving some money. It was so we didn't end up destitute and he could get the care he needs. I've worked from the time I was 14 until he became so progressed that he needed fulltime care. And because of the help from our CELA, I can go back to work now and hopefully retire someday.
Is the system a disaster? Yes. Does it suck that we need a lawyer to navigate it? Heck, yes. But there are good ones out there. Your sister worked hard and served. You're doing all you can to care for her. I honestly just want the two of you to have a little help. Take care.
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