My grandparents lived almost their entire lives in McPherson, Kansas.
Even though they traveled the world once a year on “the farm money”, they loved
to return to their beloved hometown. They had good friends they had known for
50 plus years. My brother and I like to say now that they won the “lottery of
life.” Good health, too many friends to count, a loving daughter (my mom), and
a strong sense of home. Like so many people of their generation, they survived
the Great Depression and World War II. I never heard them complain. Ever! It
simply wasn’t done.
As they become older and more frail, my Grandmother would
say to my granddad, “Leland, we need to talk about what is going to happen if
we can’t live in our home someday.”
Unfortunately, he never could talk about it. He had been
nurtured in the values of stoicism as a child and would only discuss positive
things. No whining . . . no looking on the dark side . . . no pessimism! These
character traits made my granddad a great friend and a wonderful person to be
around, but they made it hard to plan for the future.
When my Granddad had a mild heart attack in his late 70s and
started to lose his eyesight to macular degeneration, he remained committed to
staying at home. At the same time, my Grandmother started to decline. Not as
swiftly, but she started to have trouble taking care of herself.
When it came time to move to a nursing home with my mom’s
assistance, the transition was difficult and required multiple stops with their
pastor for encouragement.
My grandparents were lucky. They had enough money to pay
their monthly bill at the nursing home. Often, this is not the case. A set of
fortunate circumstances made it possible. First, they lived in a small town
where the local nursing home provided quality care at a reasonable price.
Because they moved together and shared a room, they did not have to maintain a
home while they were living at the nursing home.
Plus, the proceeds from the sale of their home and their other
investments generated almost exactly enough interest to pay the monthly bill.
At that time, interest rates were exceedingly high. Today, their investments
would never generate enough income to pay the way.
If my grandparents were living in a nursing home today, they
might not have been so fortunate. Almost certainly, they would have had to
spend down their hard earned investments to pay for care.
I don’t know whether they would have run out of money (they
needed care for many years), but they might have. If they had run out of money,
they would have done what so many people do—apply for Medicaid to cover the
cost of care.
Given the high monthly cost of care for nursing care, it’s
not surprising that nearly 70% or nursing home residents rely on Medicaid to pay for care.
With costs as high as $ 10,000 per month, people often end
up spending all their money on care—particularly if they have a slow moving and
progressive disease such as Alzheimer’s or dementia.
We work with families who are concerned about their ability
to pay for long term care—either they fear running out of money or they never
purchased long term care insurance when they could.
We sometimes receive criticism for providing guidance to
families who are trying to obtain Medicaid eligibility. I’ll admit it, the
criticism stings because we know how vulnerable these families are and how much
they need assistance. There are so many traps for the unwary and ways that a
Medicaid application can go wrong. When it does, often the spouse in the
community suffers the most because they were not able to keep adequate
resources to remain self sufficient in the community.
There is nothing better than when a family thanks you from
the bottom of their heart for taking care of Mom or Dad.
If your parent needs long term nursing care, and you are
concerned about their ability to pay, you should consider paying close
attention to preparing a Medicaid application. If your parent is already out of
money, the social worker/public aid coordinator at the nursing home can often
help you with the application.
On the other hand, if your parents are married, and only one
of them needs care, or if your parents is widowed/divorced and still owns a
house or has other assets, you should take a more strategic approach toward
eligibility and get good counsel and advice.
The main goal in working with a lawyer on a Medicaid
application is to make sure that your parent is able to obtain eligibility as
quickly and as easily as possible. There are multiple rules governing the spend
down and transfer of assets, and it is easy to make innocent mistakes.
In order to become eligible for Medicaid, an applicant must
have less than $ 2,000 in their name. There are certain resources that are
excluded from this calculation, of course, so you’ll want to take advantage of
The house is often protected (although it is “at risk” if
not handled properly) and the spouse in the community is entitled to certain
income and resource allowances. You’ll want to make sure that those allowances
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