How Do You Mentally Deal with Sending Big Checks For Care?

I would like further perspective on what you said about not being necessary for all of us relying on CELA. How do you know you need a CELA? This is situation I am presently in. Have a free appointment with an Estate Planner (attorney), not CELA. We don’t qualify for Medicaid and I feel a sizable portion of our investments will go toward his eventual care.

I don’t want investment money to go to it but always thought it would.

I am new at this, obviously.

For reals, that might be OK in most parts of the state but in certain areas around Philly, Pgh, Hershey and Happy Valley odds are high you'd need to downsize.

And to answer your question, we did not set up a trust to shelter money as dad was progressing rapidly.

Mine used the term, "preserving assets."

Hi Marp. I think it's good that you're concerned about consulting a CELA, and you have many questions. The reasons for consulting a CELA vary according to the situation. Does one need to set up trusts for a special-needs child as Housefinch had to do? A caregiving spouse who is concerned about financing their spouse's long-term care without ending up homeless and destitute is another good cause for consulting a CELA. Laws for qualifying for government programs differ so radically from state to state that one is well-advised to consult multiple professionals locally while struggling through the thicket.

When I took over my mother's finances and care I consulted with a CELA recommended by a friend and members of a local support group. I was not interested in hiding, shielding or shuffling around any of my mother's assets so that she could qualify for Medicaid earlier. Like you I believe that is unethical. I also wanted her to have the best chance possible to financially qualify to get into a high-quality memory care. The reasons I sought legal advice were diverse, as was the advice the CELA gave me.

Some examples: he talked me out of going to court to obtain guardianship, explaining that it would be expensive and unnecessary. He reviewed the durable and medical powers-of-attorney documents that my mother had recently had rewritten by a lawyer. He reviewed the titles on her property and bank and investment accounts and advised on changes that might be needed. He advised on how to consolidate and/or sell off investments to simplify my handling of her accounts and my applications to memory care facilities for her. He advised to prepay her burial and funeral costs.

My mother had begun acting erratically, threatening to sue me, phoning lawyers. She was also threatening to take a cab to a bank branch, withdraw all her money and buy a new car (something her sister with Alzheimer's nearly pulled off). The CELA assured me that in his 30 years of practice he often heard of such threats from dementia sufferers and I could probably ignore my mother's threats. Only once in his experience had such a threat come to catastrophic fruition. I must admit that her increasingly angry, irrational threats were among the reasons I sought help from a CELA.

I had prepared a long list of questions, and we went over those in a wide-ranging phone conversation that lasted about an hour. This was conducted after he had reviewed all the documents. The cost was $360. Some of the CELAs I contacted wanted $500 just to review the documents prior to a conversation, then another $750-$1000 retainer.

Taking over a family member's financial affairs is no trivial matter. I wanted to make sure I was doing everything right, crossing all the T's. I didn't want to screw up and turn a very difficult situation into a DYI legal and accounting mess. Consulting a CELA helped me to determine the best path. It gave me the confidence that I was handling my mother's affairs properly. I also wanted a lawyer I could phone if future problems suddenly arose, someone who was familiar with my mother's affairs and could advise properly. He ultimately reviewed the documents when I sold my mom's house to finance her care. He also offered to review contracts for memory care facilities.

That's my story. Yes, some lawyers are snakes. The ones that host the free seminars in which you are served a steak dinner while they tell you how they will help you to hide assets are the worst. Best to avoid those. 😄

one of the best things about these discussions is that they are a safe place to ask, vent, rant, etc. I’ve done all those things here.

I’ve been writing big checks for MIL since March and truthfully it hasn’t gotten much easier for me. I’m still trying to find ways to reduce the costs. I just realized this month that I could cut about $60 a month from her cable tv bill (since she is no longer deciding what to watch - she just likes to have the tv on.) That $60 is just pennies off her monthly bill but it makes me feel like I have at least a little control. Handling her assets weighs heavily on me

on the other hand I like paying for splurges for her like manicures because she still likes them, even though she’s late stage 6.

@Marp said : One concern I do have is, if one of these CELAs can preserve assets and qualify my sister for need based help sooner, she will move into a substandard care situation sooner. If we keep all her money and use it for her care now, she can stay in a decent situation longer. If we hide assets to qualify her sooner, she will be subject to Medicaid options which aren't near as nice as the ones you get when you private pay. I don't want to condemn my sister to a cesspool early just to preserve some money for when she dies.

Assuming you sister has no responsibilities for children, another thing a CELA can do is help you with is timing placement. Their local knowledge can be invaluable. Our CELA was familiar with many of the LTC facilities in the area because of her work. She suggested a few that were not on my radar. The MCF situation in any given location can be all over the place-- some areas are well served by MCF and have rooms available most of the time while some communities have fewer places that might have a wait list of 6+ months. My first choice for dad was a state-run veteran's home that had a 3-6 month wait which meant we had to place him in our second choice.

Our CELA was quite familiar with the local landscape-- in our community, as in many, the business model is that a PWD will self-pay for around 2 years before transitioning to a Medicaid bed in a semi-private room. Mom was inclined to keep dad at home as long as possible spending on in-home care which is more expensive at a certain point. Had she done this, she would have had fewer options available to her for MC when she thought she was ready. My concern was that something might happen to her after she spent most of the money and what would be available for him/them would be limited. In my state, Medicaid does not pay for care in a MCF-- only for skilled nursing in a SNF. Our CELA offered moving dad to a neighboring state 5 miles away where he would qualify for a MCF as an option.

Often Trusts are set up so that someone who can't afford care IRL has too high an income or asset level because of a pension and/or small savings to qualify on paper. A Trust can be established to pay a portion of the monthly fee with Medicaid closing the gap. After the individual passes, Medicaid can recover what they paid out from the estate if there is anything left in which case it acts more like a loan.

The above scenario is what some folks refer to as "Medicaid can take your house". I have a friend whose older brother had a stroke and went into a SNF for 18 months as a direct Medicaid. His wife remained in their home as a "community spouse". When she dies, Medicaid will recover the $162K from her estate, but she can live there until she dies the way I understand it.

HB

IRL - in real life.