Hi all,
Looking for any thoughts/advice from those who have been in my shoes. My MIL (65) has been in poor health for many years. MIL is morbidly obese and has used a wheelchair/walker for short distances for years. Before being in a nursing home, she had at home PT/OT services off and on and a visiting nurse. She has had seven rehab stints post-hospital stays over the past 5 years or so. The most recent rehab stay (related to a diabetic ulcer) has been around 9 months. After many Medicare appeals, she was determined to be at a plateau with her rehab, but was not ready to go home. She lives on Social Security (~1.7k a month) and has a house (worth ~250k, no mortgage). We spent down her assets (a few thousand $) to be eligible for Medicaid. The nursing home allowed her to stay on pending Medicaid status. We received notice that she has been approved for long term care from Medicaid a month ago. My SO and I have been paying MIL's expenses for the past six months or so. We have spent $4k and will need to spend more if her house is not sold. MIL is indecisive about staying in a nursing home or assisted living. Nursing home's social worker recommended assisted living, but has otherwise not been very helpful. MIL has demanded to go home at times despite not putting in a full effort with PT/OT. MIL has had mild incontinence issues prior to being in the nursing home, but is now wearing diapers at night. MIL has had some lifelong psychiatric issues as well, which has only worsened since being in the nursing home. MIL gets some assistance with bathing, dressing, making the bed, etc.
We are at a loss of where to go from here. We found on our state's website that there is a transitions program that will assist those who want to leave a nursing home and provide a case worker. We just aren't sure that leaving the nursing home is even a possibility at this point. MIL is definitely capable of more and we have tried to encourage, but doesn't seem like anything we could do. A different social worker mentioned a few months back that the state could come in and review and find that MIL is no longer eligible for nursing home level of care and we should look into assisted living. We are left wondering if an assisted living would accept MIL with her difficult personality and level of care necessary (frequent skin issues, low level of mobility, bariatric bed, etc.)? Not to mention she does not have much of assets other than if the house was sold. We don't want to keep paying for her bills in perpetuity (real estate taxes, home owner's insurance, HELOC, and utilities). It seems like any chance we have of getting our money back is if she sells the house. Any advice is greatly appreciated.
If she does she would require enormous support.
I think that it is time to speak first with the social workers at her facility to explain that you will not/cannot participate in any home going care. That in fact if she chooses to go home you will WITHDRAW from any care whatsoever.
Then you and social worker need to have the sitdown with MIL to say just that to her.
And you need to STICK TO IT.
If you enable the homegoing, already clearly unsafe for an obese woman, then you are partially RESPONSIBLE for the chaos it will be.
Not only that it could be disasterous for her. Even a death blow.
Make it clear you will have no part in any such discussion of homegoing.
Make it clear her home should either be sold for her care, or maintained by you (if you are able) until medicaid clawback claims it.
If you sell home she is off medicaid until the funds are spent down on ALF. That is an option.
But you need to make it clear that the thing that is NOT an option is GOING HOME if she ever intends to even SEE any of you again.
It's unsafe.
Don't enable it.
SO and I at this point feel like at this point we have to put our foot down and force a decision on the house because while we can afford the expenses, we feel know appreciation for doing so. I guess it doesn't matter, but we would like to buy a house some day and while we can absorb the expense, it is not viable in perpetuity. Again, I appreciate your view and experience. It is very easy to feel alone and lost in all of this.
Medicare only pays for 100days in Rehab and 20 days of that 100%. The other 80days at 50%. So Mom should be paying privately for at least 6 months with her SS and any pension being used to help offset her care. I would say you have no problem with her staying. She has been found to be 24/7 care or the home would not have kept her once Medicare stopped paying.
Her house, yes if you sell, Medicaid will stop till she spends down again. You will need to sell at Market rate and may not be able to recoup any out of pocket costs. Thats what I was told by the Medicaid caseworker. Good records need to be kept. Unless you have already been living there as residents or Caregivers, you may not be able to move in. It can't be rented. Even though its an exempt asset, Medicaid can say how its used, A visit with an Elder lawyer would be a good idea. The house cannot be turned over to you especially now MIL has Medicaid.
MIL will get a small Personal Needs acct for things she wants or needs. If ur spouse wants, the facility will do her laundry. She will get 3 meals a day. Depends are given as are some toiletries. They should give you a list of what they provide. Other than maybe clothing, you will not be out of pocket for her care. Maybe she'll lose some weight. They will probably do a little PT. All your SO will need to do is visit if she wants to. At 65 with no Dementia its not too late to set boundries. If she is calling and texting all the time, then u don't pick up. You call when ur ready. Since she seems to be competent any complaints she has go to an RN not you. Like I said u visit when you want. If she gets abusive you say goodbye and walk out. Ur SO should not have to deal with any abuse. She can not visit. Whats Mom going to do about it in a NH and overweight. Your SO owes her nothing. Read the book Boundries by Townsend and Cloud. Its Christian based.
Before making decision consult an Elder Law attorney in your area.
1.) Unless you mother is incompetent you cannot sell the home without her permission LEGALLY.
2. You can only participate in selling this home for your Mom if a well written POA allows you to.
3. You can only sell it for fair market value.
4. You must put all funds in your mother's name with you as POA. This will take away ALL Medicaid benefits on the day of the sale.
You need to have good solid EXPERT educated advice on this one.
Whatever you do, it is not going to turn this woman into someone who is pleasant and doing her best to co-operate. Forget about the house. You might not like it as much as you think, if you even did live there. There are other nice houses, and it is complicating things far too much.
Others may not agree, but my take would be to forget about the POA as well. While she is mentally competent (even if stupid), you will have a struggle to over-ride anything she wants or doesn’t want to do. It pulls you in to the problem, without advantages. It means that others will expect you to be responsible, and it can lead to big fights with her.
You and your wife could probably be best to leave MIL to make up her own mind what to do, and to make visits where you don’t talk about her problems or her options. The weather is a useful topic, and it changes all the time. Leave her be.
if MiL came into the NH via a post hospitalization rehab admission, then MediCARE was paying for her stay initially. & at 100% first 20/21 days and at 50% perhaps a few weeks more. Medicare pays at least double, even triple if not more than what LTC Medicaid custodial care pays a NH. So as long as she was a rehab patient, she’s good income & maybe even profitable as a rehab patient. But as custodial care, getting whatever her States LTC Medicaid pays as for room & board she is definitely not. She’s high maintenance. Plus not nice. It’s a bad combo. NH can find a way to jettison residents like this. Not pretty.
That her daughter, the OPs wife/partner/SO does not have POA poses imo issues. Which is both + & -. The positive is as she isn’t POA they - the NH - cannot force OP or the wf to do anything, they truly have zero legal responsibility. Too bad, so sad. But the NH will try to buffalo the OP & the wife to take on the responsibility.
Same holds true for OP dealing with MiL house, they have no legal way to deal with selling MiL house. If MiL wants to back out, she can. It would be beyond a clusterF if she did. In this tight real estate market, Sellers agents know to get their buyers to slap a lis pendens onto the property. If OP & wf are involved they will be named in the lis. You do not have to be POA to be included in the filing. Anyone involved in showing the property or as a contact for the listing will be included in the lawsuit. Lis Pendens does a big reach. It’s title hell; it creates a tar baby of the property.
The more I mull this over, the more this MiL may be best off becoming a ward of the State with a court appointed guardian IF she will not fully do the paperwork to have her daughter become POA with full authority for all finances and have the daughter become a signature on the moms bank account and online access to her SSA account etc. The mom is young, they could be dealing with her for decades and mom is only going to become even more difficult and challenging for her health care needs.
If this were my mother or MIL, I'd tell her she is remaining where she's at in the nursing home bc AL is not going to accept her and moving back home is NOT AN OPTION. Since she's morbidly obese, she's shown you she has no commitment or determination to get her health in order, so why would she comply with PT and OT? All human beings are capable of more but not when they have no motivation or dedication to change. That's where your MIL is at.
I don't like that the other social worker told you the state may come in and determine MIL is not qualified for the NH. What are you supposed to do? Live in a constant state of fear and anxiety that she'll be asked to leave??? If they accepted her to begin with, and more importantly, Medicaid is footing the bill, how does this statement make sense?????? It doesn't.
If there's any doubt in your mind that MIL will be asked to leave this NH, then ask the social worker to help you get her evaluated for Assisted Living. To see if it's even possible to have that as a back up plan. Otherwise, how can you make decisions w/o all the facts?
It's sad this woman has put you in such a position to begin with.
Wishing you the best of luck with a difficult situation.
We're also doubtful that AL would be a good option, if they even accepted MIL. We definitely do not have all the facts despite multiple family meetings. MIL has lied consistently and we see no other option other than her staying put. My SO has been abused and taken advantage of by MIL since childhood and just can't indulge MIL anymore at this point. We are trying to get other family involved to support SO and convince MIL to take responsibility. We are so frustrated with MIL when there are others who have no power to change their situation. I appreciate your thoughts and support.
It's wonderful she is now on Medicaid. I'd be dancing a jig about that if I were you. Under right of return Medicaid rules, the house does not need to be sold but it needs to be maintained and taxes paid. But if you do sell the house, she will have to pay out of pocket until she exhausts that money and then Medicaid will kick in again.
Your MIL needs to consult an elder care attorney to explore the options available.
Good luck to you and your family.
As to staffer telling you she could move to AL or back home, imo, this NH would like for her to become a resident somewhere else. MiL is only 65, obese, wound care, diabetic, 2 person assist resident that takes up alot of staff time. Care could be years & possibly decade+. It’s harsh, but NH can be ruthless on trying to jettison high maintenance resident.
Regarding her home, some issues you may or may not be aware of but should take into consideration…
- does wf have POA? & does it fully allow POA to sell home? If not, you need to have this done ASAP with full powers to buy & sell real estate & deal with securitized debt (that HELOC). My concern is that unless full powers POA, so all actions able to do 100% without MiL present or personally sign off on, that she will change her mind last minute and back out of sale. Were she to do this, buyers can file a lis pendens & house will be in title hell.
if MiL will not do a POA like this, Realtor needs to be super experienced in selling true “as is” w/short DOM (days on market) track record. All need to be & stay motivated seller.
- if current tax assessor value is way off for what it can realistically sell for, I’d suggest house gets inspected 1st & report goes to licensed and registered appraiser to use if they choose to (they will). Whatever value appraiser comes up with is new FMV. LTC Medicaid is going to want it sold at FMV which tends to be assessor value unless you get an appraisal done. Appraisal is considered legal document; comps Realtor does is not.
- as she is on LTC Medicaid program, it is paying custodial costs in NH each & every day at whatever daily reimbursement rate her State has set. Amount varies; abt $280 day rate. Tally required to have an attempted recovery on costs paid against assets of her Estate after death (via MERP). But some States allow for this proactively… & important if house sold w/costs LTC Medicaid paid to date are a lien & taken from Act of Sale. Try to ask her caseworker on this, & what LTC Medicaid daily reimbursement rate is. 6 months @ $300 a day = 54K.
- No mortgage but HELOC securitized lending. Do not let Bank know she has moved out (if you can).
- all property costs - taxes, insurance, utilities, repairs, yard etc- all are being paid by you, right?
- is it vacant? Or are you & your wf living there? If so, were either of you living in her home for two years while she was also still in her home and you did not have a full time job?
- LTC Medicaid has required copay or Share of Cost (SOC) of her mo income less whatever her State allows as a personal needs allowance. PNA tends to be $50 - $60 and to be used only for items needed for her in the NH but not covered by LTC Medicaid, eg beauty shoppe, clothing. Due to SOC, you & wf are paying everything house, including HELOC, right? What is your max risk for this, 10K? 30K? more?
.
Any paperwork done to establish that $ is owed? Like Memo of Understanding or a Promissory Note btw MIL and you/wf that’s notarized & witnessed? Heres why, as property owned by MIL, all $ from Act of Sale less HELOC, less if LTC Medicaid wants early recoup, less Realtor commission, closing costs etc, payout all paid to MiL. All into her bank account. She cannot pay you any $ as looks like “gifting” which places Medicaid penalty on eligibility once she’s spent down house sale $ to do new Medicaid application
Medicaid tends to view what we do is out of a sense of familial responsibility, done for free &/or with no expectation of payment. Unless there’s a Memo or Promissory Note or Contract. Caseworker may allow some reimbursement but maybe not. Because of this, if $ spent is a concern, you have got to make Realtor know it’s serious “as is”. & you DIY yard, cleaning for free & check utilities after all showings.
Taxes can get paid from Act of Sale $ if $ is tight.
There is no POA or other legal assignments in place. We were hoping to avoid this process if not necessary, but seems likely that we can't avoid it. Thank you for this information on the appraisal, MERP, etc. We will definitely consult an attorney and get all these ducks in the row before trying to sell the house. MIL is definitely the type to change her mind at the last minute, so we would need to do everything to avoid that.
Correct, house is vacant and we are paying all costs associated with the house. Wife and I are not living there and wife hasn't lived there in many years. We haven't discussed a particular amount that we're willing to outlay but we want to find a resolution soon. We can't afford $30k that's for sure. It would cost us ~$10-12k a year to keep the house. Barely affordable for MIL and not affordable for us with our own financial goals.
No promissory note or any documents for the amounts we've paid. I'm being to understand based on the comments here that I guess we shouldn't be expecting this money back. We understand why, but just motivates us more to stop the bleeding.
We haven't had any communication with a caseworker, but that may be something that could help us get clarity.
So you and your spouse need to lay some serious truths on her and don't sugar-coat anything and do not baby her for any reason. It's for her own good.
Like she will HAVE TO recover well enough to be able to do some things for herself independently if she wants to go home. Like transferring from her bed or toilet to her wheelchair independently. This isn't going to happen unless she cooperates with physical therapy and puts the work in.
She will have to learn to keep her difficult personality in check and learn to get along with homecare workers because they will be the ones taking care of her basic needs.
So, if she has any hope of returning home, she has a lot of work to do. Make sure she knows and understands this. Otherwise she does not ever go home.
As for AL. If she is so obese that she needs a bariatric bed, an AL will not take her. She will have to go to a nursing home. Nursing homes that can accommodate the needs of a bariatric patient aren't exactly a dime a dozen either.
I agree that if an AL does somehow accept her (and she can afford it) she will need to pay for "a la carte" services which may include 2-person assist, but I doubt this will be available to her in that level of care.
Socially she will be much better off in a facility, especially given her mobility and mental health issues.
Regarding paying to keep her house: I agree with others that this is a question for an estate planner familiar with Medicaid or a Medicaid Planner for her state.
- as y’all do NOT have POA, in theory, neither NH staff nor Medicaid caseworker really should be discussing MiLs situation to any ANY degree in depth with you all. Ditto for any Realtor or anyone at MILs Bank. So far y’all have been lucky as folks do love to talk. So use that to your advantage till you can’t. Comprende? And make notes on all this because….
- you (the Royal you of you & wf) need to find your own atty to discuss your best interests in dealing with her mom for the future. As your best interests and MiL best interests intersect but are not necessarily parallel. And this is where in my not an attorney - but have been an Executor x 3 and dealt with 8 facilities (pp & LTC Medicaid) for our “moms” including crossing state lines) - opinion needs to happen and soon. It may not be an elder law attorney that you seek but family law one….. it’s not about estates & passing assets generationally… it’s about segregating liability & settling debts between family members while still maintaining concern. Your & wfs situation has different layers than what most are dealing with on this forum. You’re finding an atty to protect your interests 1st & foremost and 2ndary to that it creates the legal needed for wf to become POA for her mom if that is what is best for how LTC options can be done for your State. What a family law firm may do is you pay for yours and disability law affiliate do the work for moms and that bill attached as a lien onto moms property.
It may be the attorney’s suggest mom has guardianship done & the law firm finds a way to use moms house to pay all the costs to have all this happen & someone in the firm will be the guardian. Mil will be a lot of work & constant distractions….. so having someone else shoulder this could be ideal so y’all can buy a home, start a family and your wf can be a daughter & not a constant overseer. Or atty does it for 3 years and then Daughter takes over. Just sayin’.
MiL is really young. Many of the savvy folks answering you are older than her! Y’all have got to get a defined legal handle on this asap or it will make you crazy and empty out your nest egg on someone seemingly ungrateful who repeats bad behavior.
**********
RE: HELOC, it’s securitized debt.
I’d make an effort to find its paperwork if u do not already have it. Do NOT go to the bank to get it though. U do not want them to know MIL has long left the house. HELOC tends to have restrictions. Like if owner moves out, if property gets homestead exemption removed, etc. If a change that according to the terms of the HELOC, the bank supposedly needs to be notified of in X # of days AND IF NOT & bank finds out, bank can call in the loan. Which means balance due in full in 30/60/90 days & if not paid, bank can foreclose. Usually as long as HELOC payment is made, and house is maintained, bank doesn’t care. Bank does not care who is paying either, crediting is going to MiL as she took out loan.
However, you might can use HELOC fine print in your favor, if you / your attorney can be hardball…. If HELOC reads it must be reported if she moves out - which she has done - and it is more than 6/8 months - which it is, & more than once, so beyond compliance for the HELOC; you tell her: Mom/MiL you need do POA for your daughter to be able to manage your financial &medical affairs or we stop paying HELOC and as per the terms of HELOC you did, they will foreclose. Nothing we can do as we are not POA so the Bank cannot speak to us at all. If you do POA, we can deal with this for you. Otherwise house will be lost.
It’s a Come 2 Jesus risk. Attorney & mobile notary is with you. Might be a risk worth taking.
Remember until POA there is no legal requirement / no fiduciary duty or responsibility for your wife to her mom.
Sense of familial duty, yeah. But that has zero legally binding.
This stuff works both ways.