Author Topic: Elderly Parent  (Read 1926 times)

LongtimeLurker

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Elderly Parent
« on: April 08, 2024, 12:34:00 PM »
So its been obvious for years that one of my parents was going to need long term care/assisted living. I have several siblings, none of whom seem financially prepared to share the costs of long term assisted living, which would be anywhere from $4,000 to $6,000 a month. There is a possibility of some of the cost being covered by the VA, but google says it would only be about $2,200 if approved, which is questionable. Assuming best case scenario, cheap but good living situation and covered by the VA, that still leaves $1,800 a month in costs. That is probably too much for just me to afford at the moment. I have talked to my siblings, and am not expecting a whole lot of consistent financial help.

So the possibility was brought up of selling their home, value about $230,000, and having the healthy parent move in with a sibling(probably me, cause again, I'm the responsible one... yay?).

I'm trying to imagine how to make that ~$200,000 last for as long as possible while also being a relatively safe, stable investment. I don't see parent #2 living another 10 years, but with modern medicine who knows. Just sitting in a savings account, it would last almost 10 years best case, almost 3 years worst case. Its very possible the account could run out of money before P2 passes away, leaving me back in the unenviable situation of covering thousands of dollars a month in costs.

If all of the siblings contributed say $150 a month to the account, and it was invested in some of interest producer, like a bond fund paying ~4%, with 3 months of cash available at any time, maybe it would last longer, but I'm not even sure how to calculate that. Also not sure my siblings could/would contribute regularly. Just trying to figure out how to protect myself, not alienate my family, and provide quality care. Any ideas?

Zamboni

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Re: Elderly Parent
« Reply #1 on: April 08, 2024, 12:48:19 PM »
Writing to let you know that you have my empathy. I don't know where you live, but your estimate may actually be on the low end of monthly costs, which is a pretty scary prospect.

I know this may not be super helpful, but I have more questions than answers.

Is the house the only asset that they have? No other savings?
Was it your parents who brought this up: has the healthy parent expressed any desire to sell their home and move in with you or one of your siblings?

Sibley

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Re: Elderly Parent
« Reply #2 on: April 08, 2024, 02:26:38 PM »
Investigate Medicaid in their state. You may wish to consult a lawyer. For that matter, with the VA stuff, it wouldn't hurt to consult with someone who has experience in navigating that.


LongtimeLurker

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Re: Elderly Parent
« Reply #3 on: April 08, 2024, 03:45:25 PM »
They have no assets that are worthwhile other than their house. They have been broke and near bankruptcy for a long time, even before major health problems. At one time I was giving them thousands a month to help cover costs but eventually told them enough was enough and stopped. They are very financially irresponsible even in the best of times. The healthy parent basically told me "I cant take care of" P2 anymore after yet another hospital trip. I pushed for assisted living five years ago, but got push back from pretty much everyone, including P2. P2's health has gotten much worse since then, and now there is agreement that it is necessary.

VA has a list of criteria for who qualifies and I don't know enough about P2's military career to know for sure, but I think P2 qualifies. For medicaid, there is an income limit which I believe P2 is under, but if they count total household income, I think combined they are over the limit, but it gets complicated because sometimes spousal income does not count, etc...

Its a mess, but we are currently waiting for the gov to send over P2's military records so we can apply for VA benefits. Hoping with VA benefits and a place on the lower end of the spectrum, maybe we can avoid selling the house and letting P1 keep living there, but I don't think that is a great idea. Not even sure P1 would want to live alone vs staying with family and not having to worry about home maintenance, paying utilities, etc...

So anyway... thanks for listening.

iris lily

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Re: Elderly Parent
« Reply #4 on: April 08, 2024, 05:37:46 PM »
Speaking very generally, if you’re one parent needs skilled nursing, that means he goes to a nursing home. Of course the VA is a possibility, and I don’t know how that works.

But with Medicaid paying nursing home costs,  Medicaid wants you to pay down your own assets before the taxpayers kick in.

However, there are rules where the surviving spouse gets to keep certain assets, and I’m pretty sure the surviving spouse can keep the home and stay in it. That is, until that surviving spouse dies, and then the house is sold and the money reimburses Uncle Sam for paying those nursing home costs.
« Last Edit: April 09, 2024, 09:09:20 AM by iris lily »

Nords

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Re: Elderly Parent
« Reply #5 on: April 08, 2024, 08:13:23 PM »
Its a mess, but we are currently waiting for the gov to send over P2's military records so we can apply for VA benefits.
@LongtimeLurker, if you haven’t already talked with your local VA office, please contact the VA in your area.  The best person to talk with would be a Veteran Services Officer,
https://www.benefits.va.gov/vso/
but if there’s nobody local to you then you can start by calling the VA (800-698-2411) or your county/state elder services office. 

I’m suggesting local help because the VA is just one resource of a bunch of other state & federal programs that can be stitched together for eldercare.  Your community will be able to help you navigate the VA’s benefits along with Medicare and other initiatives.

As you’ve probably found from search engines about the VA, you’d start by applying for Aid & Attendance:
https://www.va.gov/pension/aid-attendance-housebound/
And yes they’ll need to see a DD-214, but that’s the only military piece of paper you’ll need to get started.  Then they’ll want financial documents.

While you’re waiting on the National Archives, if your parent is living in America then it might also help to go through their files or to contact your county recorder’s office.  With older vets, about 30 years ago it was popular to record a DD-214 with the county to ensure that you’d always be able to get a copy from the recorder’s office.  This practice died out a couple of decades ago over concerns about ID theft but there are still hundreds of thousands of DD-214s on public record.

You’ll also be asked whether you want to have a VA caregiver visit your parent at their home instead of your parent going to a care facility.  Personally, my father did a lot better in a care facility where he immediately became more social-- and where skilled medical personnel were already on site.  Nobody would have diagnosed his chronic depression if he’d stayed in his home.

While you’re sorting out the care services, you can also see whether your parent qualifies for a VA pension.  This is not a military pension (from the Dept of Defense) but rather a needs-based stipend (from the VA) for some wartime vets:
https://www.va.gov/pension/
The “pension” word causes a ton of confusion among vets & families, and you’ll want to carefully parse the eligibility requirements at that link.

Note that there’s also a VA Survivors Pension mentioned at that link, but again it’s needs-based.

Finally, some states have VA-supported veterans homes:
https://www.va.gov/GERIATRICS/pages/State_Veterans_Homes.asp
They seem like a great deal but if they’re not near you (or your siblings) then you’d have to carefully consider the family commuting burden for visits or other help.

While you’re talking with your local elder services office, you could ask for a referral to a geriatric care manager who’s in business near your parents’ location.  It’s probably a paid consultant (or possibly subsidized) who’ll guide you through the labyrinth of resources in your parents' ZIP code.  It’s very much worth paying a few hundred dollars for a few hours of their time-- both for your parents and for you. 

It’s not just for veteran’s benefits or financial support but also to help you find a good care facility, see what assistance P2 needs around the house, and find the caregiver support that you’re going to need to get through the legal requirements to assist with your parents’ finances & home.  I’m going to speculate that you’ll start with a Durable Power of Attorney to be able to care for either or both of your parents whether they’re perfectly cognizant or if they become incapacitated.

Please let me know if you have more questions.  Caregiver stress is real.  When my father started his Alzheimer's journey in 2008, he had never even arranged a power of attorney and he declined all offers of help.  He kept telling my brother and me "No thanks, boys, I'm fine!"... until he wasn't.  When he could no longer live alone, I spent over six years managing his care & finances-- with no prior knowledge of any of his accounts or investments.

Fru-Gal

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Re: Elderly Parent
« Reply #6 on: April 08, 2024, 09:49:33 PM »
Do not discount the VA, it's a HUGE advantage. Please follow the resources provided by the poster above.

Don't shoulder all this yourself when your parent gave such an important service to the country.
« Last Edit: April 09, 2024, 03:57:57 PM by Fru-Gal »

reeshau

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Re: Elderly Parent
« Reply #7 on: April 09, 2024, 06:11:13 AM »
Speaking, very generally, if you’re one parent needs skilled nursing, that means he goes to a nursing home. Of course the VA is a possibility, and I don’t know how that works.

But with Medicaid paying nursing home cost, they, of course, want you to pay down your own assets before the taxpayers kick in.

However, there are rules where the surviving spouse gets to keep certain assets, and I’m pretty sure the surviving spouse can keep the home and stay in it. That is, until that surviving spouse dies, and then the house is sold and the money reimburses Uncle Sam for paying those nursing home costs.

My Mom was in this situation with my stepfather, who was disabled in a motorcycle accident in MN.  Yes, she gets to live in the house for her whole life.  The State will put a line on the house, to recover their money when it sells.  The extent to which States pursue assets, and their method, does vary.  But there is consideration for a spouse's situation.

This is definitely a situation that calls for help from a lawyer, and a CPA.

Dee18

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Re: Elderly Parent
« Reply #8 on: April 09, 2024, 07:11:03 AM »
Consult an attorney before selling the home.  I rent part of the year from the family of a woman who is in memory care/assisted living.  She is probably going to run out of money but owns the condo which is worth quite a lot.  In that state if the condo is sold now the money from the sale will be used for her care.  When it is gone Medicaid will kick in. If the the condo is not sold, Medicaid will kick in earlier when she runs out of cash, without selling the condo. Then when she dies she the family gets to sell the condo and keep the money.  In many states Medicaid would go after the proceeds of that sale for reimbursement.  But not in the state where I am renting, which is why they will only rent it and not sell it yet.  I had never heard of this before.

slappy

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Re: Elderly Parent
« Reply #9 on: April 09, 2024, 09:46:15 AM »
Consult an attorney before selling the home.  I rent part of the year from the family of a woman who is in memory care/assisted living.  She is probably going to run out of money but owns the condo which is worth quite a lot.  In that state if the condo is sold now the money from the sale will be used for her care.  When it is gone Medicaid will kick in. If the the condo is not sold, Medicaid will kick in earlier when she runs out of cash, without selling the condo. Then when she dies she the family gets to sell the condo and keep the money.  In many states Medicaid would go after the proceeds of that sale for reimbursement.  But not in the state where I am renting, which is why they will only rent it and not sell it yet.  I had never heard of this before.

It is more likely that Medicaid is accumulating a lien against the property, which will be satisfied when the condo is sold.

In my state, we are private paying 12k per year for nursing care. Medicaid only pays 3k. My MIL has 3k worth of income. The way it was explained to us was that if we rent out her home, Medicaid can kick in because she doesn't have liquid assets. Then Medicaid lien will accrue, in this case at the rate of 3k per month. If you have lot of equity, it can take quite a while for that 3k to add up to the equity in the home, and the average stay in a nursing home is only 3 years.

reeshau

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Re: Elderly Parent
« Reply #10 on: April 09, 2024, 12:06:06 PM »
In my state, we are private paying 12k per year for nursing care. Medicaid only pays 3k.

A year?  Or a month?  Stepdad's care was about that a month.

wenchsenior

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Re: Elderly Parent
« Reply #11 on: April 09, 2024, 02:46:55 PM »
In my state, we are private paying 12k per year for nursing care. Medicaid only pays 3k.

A year?  Or a month?  Stepdad's care was about that a month.

Yeah, that's a typical per month cost in most states. My dad's 24 hour care at home costs a bit over 13K per month.

slappy

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Re: Elderly Parent
« Reply #12 on: April 10, 2024, 06:12:37 AM »
In my state, we are private paying 12k per year for nursing care. Medicaid only pays 3k.

A year?  Or a month?  Stepdad's care was about that a month.

oh, yes, per month, sorry! It's 12k per month for private pay and Medicaid would only pay 6k per month.

lollipop_hurricane

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Re: Elderly Parent
« Reply #13 on: April 10, 2024, 12:16:10 PM »
I would consult with an elder attorney, right away!  Tell them exactly what you've posted here and ask for advice.  It's vital to do that to 1. save the $$ from the house, and 2.  cover costs completely for both parents.  What I think they might suggest, is that your parents actually go through a divorce, so healthy parent can keep their income, and parent who needs to be a nursing home, can get their medicaid.  Otherwise, medicaid will come for the house after the first one goes and try to recoup all the $$ by claiming the house. Elder attorneys are very knowledgeable about this exact thing.

Also, there is a type of trust for putting "excess medicaid" income into, in NY it is called a pooled trust but the name of it varies from state to state.  A quick google search, and I found this:  https://www.commonwealthcommunitytrust.org/65-and-older.  I'm sure there's plenty of other places in Virginia to choose from. 

It's well worth the money spent towards the lawyer to figure this out. 

FlytilFIRE

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Re: Elderly Parent
« Reply #14 on: April 10, 2024, 03:43:18 PM »
Here's another possible asset, depending on your location.

https://www.seniorhomes.com/pace-programs/

Good luck!

NV Teacher

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Re: Elderly Parent
« Reply #15 on: April 10, 2024, 06:38:42 PM »
The best piece of advice we got when we started looking at assistance for my mother was from an RN that worked with families to find appropriate care.  She told us to be prepared to be disappointed by most things along the way.  My initial reaction was that she was being very cynical.  Turns out that she was right.  Best of luck to you.

kite

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Re: Elderly Parent
« Reply #16 on: April 12, 2024, 01:25:42 PM »
Where does your healthy parent want to live?
And is the house safe & accessible for them to age in place? 

I modified my home to make a fully accessible bathroom suite (actually 2 of them) as my mother declined, expecting she’d move in with me. Dementia made it so that it was better for her to stay in her own home. Beyond the point where she didn’t know our names, there was muscle memory and she could get from her bed to her bathroom under her own power. Keeping her where she lived for over 60 years enabled that.  She did not, as her siblings did, have to learn to navigate an unfamiliar area.

Everyone is different. Every family is different and you’ll make a choice that works best for your family. I just point this out because sometimes the best solution isn’t the one we think of at first.

No opinion on what VA covers. I know a guy for whom it’s covering the full gap between his retirement benefits (pensions, SS) and the total expense, not requiring sale of the wife’s home. They DID need to get legally separated to protect her finances.

Good luck to you. You have my sympathies.

LongtimeLurker

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Re: Elderly Parent
« Reply #17 on: April 15, 2024, 10:15:18 AM »
Thank you everyone. Lots of good information. We are still figuring things out. Good news is we got the military discharge paperword and everything seems to be in good standing. P1 is flip-flopping regarding wants and needs. P2 is currently still in a rehab hospital, no clear release date right now. If there is ever some sort of resolution, I will update.