How Do You Mentally Deal with Sending Big Checks For Care?
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I clearly remember going to the bank to cash 4 separate checks for 24/7 caregivers every week. It can take your breath away.
I hope you will keep us n the loop as to how you and your mother are doing.
-Judith
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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.
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Thank you for your response.
When my father was diagnosed with Alzheimer's in 2010, my mom and I attended numerous seminars conducted by CELAs and we met with two in person. The main crux of what most of them were doing was teaching people how to move money around so it didn't look like it was their money. They had money, but the way it was set up, it didn't look like theirs. On paper, it looked like someone else's money so the government couldn't use it in the calculations to determine when these people could get Medicaid, etc.
One of the two attorneys we met with individually wanted a large sum of money to do that for my parents. The second attorney wouldn't do it because he felt that would be like stealing because my parents financial situation was low enough that they would quickly qualify for things without paying an attorney any money.
Your situation is probably the exception to the rule, based on my personal experience dealing with CELAs.
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Some people are already dirt poor and easily qualify for Medicaid - they might already be on food stamps, etc. Other than to establish POA, etc, there isn't much a CELA can do for them, IMO. If they already have the POAs, etc set up, then I really don't know if a CELA can legitimately help them.
If you're not sure which bucket you fall into, you might want to consult with one. It's possible you could get one to do the initial consultation free; some of them do that.
If you don't have POAs, etc in place an elder law attorney could help with that. It wasn't expensive for my family, mostly because our situation was pretty simple. An Estate Planner may be able to help with POAs, etc too; I don't know if that's in their wheelhouse, but maybe it is.
When I was helping my parents after my dad was diagnosed with Alz, I went to numerous seminars conducted by CELAs and the gist of all of their presentations was strategies for pigeonholing money so you didn't have to claim it on a Medicaid application or an application for a similar benefit. The patient would still have money, but it didn't look like it was their money so it didn't count. Someone who is living hand to mouth doesn't have anything to hide like that so I would worry about them going to a CELA and getting snookered out of a big pile of money for Legal fees for services that don't benefit them in anyway.
That's just my two cents.
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Hi Vicki and welcome to the forum. I worked for our state's Medicaid health insurance program for ten years. I think one of the fundamental confusions is that there is a difference between the income and asset requirements for the health insurance piece (what most people identify as Medicaid) and the income and asset requirements for long-term institutional care. Dislike it as you will, the fact of the matter is that there is no other system in this country for financing long-term care, so unless you are able to afford to pay privately, what we have is a piecemeal system that varies state by state, and the laws regarding what is allowed as retainable assets and what kind of care is covered are extremely complex. I don't think this is a conspiracy on anyone's part so much as sheer ineptitude. For most people, it takes the expertise of a certified elder law attorney to sort it out. And with attorneys just as with physicians and every other professional service you may need in your lifetime, quality varies, quality matters, and caveat emptor. But if you don't ask, you may not be aware of facets of the law that apply to your individual situation. When such consults are advocated on these boards, it is not a knee-jerk response, and it is not motivated by trying to shield assets for inheritance.
If we weren't all so exhausted by the minutiae of caregiving, advocating for a better national system would be a very worthwhile goal. Most other western countries do a much better job than the US, but achieving it would require changes to the tax structure that have been rejected time and again.
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Thank you for your thoughts. My experience so far has indicated a different system,.one where hiding assets is the name of the game.
If ir truly isn't, why do CELAs only talk about that part of the process? Over the course of the years, I've talked to quite a few and that's what all but the one focused on.
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I feel sad that I may not be able to provide the quality of care she would receive in a good memory care.
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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.
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I saw a CELA and there was no mention of hiding assets.
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Mine used the term, "preserving assets."
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They don't usually call it that, but, in some cases, that's what it is. It's legal; I just don't know how ethical it is in some situations. I can see wanting to preserve money for a spouse or a disabled relative. What I have an ethical issue with is hiding/preserving assets to leave to someone else when you die. Sure, you want to leave something to your heirs, but an inheritance isn't an entitlement. When you hide money to pass on to your heirs, instead of using it to pay for your care yourself, you are essentially forcing tax payers to pay for your heirs' inheritance. I question the ethics of that.
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That's the word they use. I've called two attorneys this week and am awaiting return phone calls. I made it clear to the person who took my info that I had had a bad experience in the past with a CELA who tried to scam my parents by selling them expensive products that were of no benefit to them. I also made it clear there was no spouse to provide for and no dependent/disabled relatives that need to be considered. All of my sister's money could be used for her and that was what we had always planned on.
We'll see what the attorney says when he calls back.
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When you talked to the CELA, what he do for you? That would be helpful to know.
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Thank you, Judith. I left messages for two attorneys today. We'll see what they suggest when they call. I just don't want my sister to be taken advantage of by some money grubbing snake (and many of these CELAs are just that) and I don't want to do anything unethical. One of the reasons our taxes are so high for these programs is the way they are manipulated. Once upon a time Medicaid, etc was for people who truly had no means to take care of themselves; that's not always the case now when you have attorneys manipulating things to make someone look poorer than they are.
To boot, I have been to the doctor myself three times in the last two months, battling two different infections. Hard to sleep when you don't feel good and run to the bathroom all the time.
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Did I already ask what your CELA did for you? I'm just kind of curious as to what benefits people are seeing from CELAs.
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.
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I'm also concerned that, if we "preserve assets" so she qualifies for Medicaid or other assistance sooner, I'm sentencing her to living in a cesspool sooner than would be the case if we private pay. By "preserving assets" we switch to the need-based programs sooner and limit ourselves to the substandard options available through most of those programs earlier. Is that fair to her to condemn her to a cesspool to save some money for her heirs?
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Hi Marp,
She had my DH execute a DPOA and Healthcare Proxy. In a separate meeting without my DH present, she had me change my DPOA and Healthcare Proxy by taking my DH's name off as my representative. She had me take my DH's name off the deed to the house.
I was told that my DH's IRA had to be spent on his care. My assets could be put in medicaid compliant annuities so that I am not left broke. I have not made these changes yet as my DH is still at home with me.
EDIT to add: My elderly parents consulted the same CELA and they were told that they had sufficient assets to pay for LTC and were not eligible for Medicaid.
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Thank you. This is interesting.
I spoke with a CELA today about my sister's situation and he didn't see any financial moves that we need to make at this time, and she already has her DPOAs etc. He did say there is some work in our state legislature that may change some of the Medicaid rules and there may be some things to do then, but he can't really say until they see if anything happens and what it is.
So he didn't try to help your parents shield any assets so they could qualify for Medicaid? That's unusual because these CELAs make a lot of their money off these strategies and are usually quick to try to use them for anyone who has enough assets to justify it.
I guess, though, the way it worked for your parents is the way it's supposed to be. It's difficult if you're someone who has worked hard to save all your life with the hope of leaving something to your heirs and then watch it all disappear because you get sick.
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I think the sad reality in the US is that no one should anticipate leaving an inheritance to their children unless they are millionaires or die suddenly. Unless they have very large amounts of money that will pay for LTC with $$$ left over. Or give your children what you want to pass along earlier, before you develop dementia, and consult a lawyer about avoiding gift taxes or whatever. An inheritance, frankly, in today’s economy, is going the way of the dinosaurs.
If you want expert advice, you may have to do your research and be ready to pay for it. We have a special needs child and were told by our specialized financial planner to be prepared with $4 million to cover the cost of her lifetime care because the state programs only provide sufficient care to keep her from living in a gutter. We have paid several thousand dollars just to set up supplemental needs trusts for her which we then must figure out how to fund. She can have no more than $2000 in her name or else loses eligibility for important programs—this means we have to have our wills and family wills spelled out correctly.
There’s a difference between someone hiring a forensic accountant to hide assets (eg a vindictive wealthy spouse trying to cheat a less rich ex in a divorce) and a CELA instructing someone how to protect some assets for a spouse of someone with dementia. I think this is the difference people have been trying to explain to you. There are ethical and unethical professionals in all fields. Best wishes.
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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. 😄
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It's interesting you mention the attorneys who do the seminars with the steak dinners because a bunch of the attorneys on the Alzheimer's Association resource list are those attorneys, including the one who tried to sell my parents a bunch of things they didn't need.
At least, that's the case in my area.
I don't think the difference you between different attorneys, etc is what people were trying to explain to me, in most cases.
The first comment in response to my post was rude, emphasizing words that would only be emphasized when you are scolding or judging the person you are addressing. Unfortunately, that insensitive comment set the tone for this whole thread.
I also believe we have an obligation when we post comments to be responsible with our advice and suggestions. So often, we squawk, "CELA!" "CELA!" like the CELA will be the answer to all of our problems, and I think we mislead people when we do that. There's nothing wrong with suggesting someone consult a CELA and giving some thoughts as to what they might do that would be helpful. We just shouldn't be flip about it and I think we often are.
Like I say, some of my reactions, and maybe that of others, was triggered by an insensitive comment early in the thread. Things seem to be calming down now, which is good.
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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.
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$60/month doesn't sound like much, but that's over $700/year. It adds up.
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@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
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Thank you for your response. Lots of good information in here, and this is the type of thing we should be saying to people when we refer them to CELAs; the more information someone has when they contact a CELA, they more prepared they are to vet out the skanky ones and not get taken advantage of.
I don't know what IRL is so that paragraph is a bit muddy to me. Could you tell me what IRL means?
With the private pay for two years before transition to Medicaid, like your state, it would probably only apply in a SNF in my state as Medicaid doesn't pay for memory care here. Some assisted living facilities accept the Medicaid Waiver program to help pay for the personal care portion of the fee, but, if you're looking for Medicaid to pay for anything else, you have to go to a SNF. So, the split the cost with Medicaid scenario you mention might not work in our case, unless we go directly to a SNF. And we're not close to a state line where we could zip over there for care.
So, did you place your dad in the MCF in the neighboring state? Or did you move him into a SNF in your state?
My sister doesn't have a home so we don't have the option of turning that over to the state after her death to pay for her care.
I worry about the Medicaid Asset Recovery process should she end up on full Medicaid - the estate settlement process is already challenging enough with adding extra t's to cross and i's to dot for Medicaid during that process. You already have, potentially, heirs disputing how you value any remaining assets then you add Medicaid into that mix questioning why you sold the house for $162,000 when they think it was worth $200,000.
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IRL - in real life.
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Commonly Used Abbreviations
DH = Dear Husband
DW= Dear Wife, Darling Wife
LO = Loved One
ES = Early Stage
EO = Early Onset
FTD = Frontotemporal Dementia
VD = Vascular Dementia
MC = Memory Care
AL = Assisted Living
POA = Power of Attorney
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