Implications of Moving Mom to Another State

Parent Cafe
1

<p>Hello,</p>

<p>My elderly mom needs to move into an assisted living facility, and one of our top choices would move her from North Carolina to South Carolina. She will continue to own a car, a home, and a beach rental condo which are all in North Carolina.</p>

<p>Us siblings are overwhelmed with the emotion of this decision, and I wanted to check in here and see if there are legal/financial implications that might impact her that we aren’t yet thinking about.</p>

<p>She does receive pension and social security and has a 401K account.</p>

<p>Thank you in advance for advice and suggestions.</p>

2

<p>I am not certain that there are any implications if the person is “self-supporting”, as it sounds as though your mother is.</p>

<p>At the point in time where your mother’s assets are depleted, and she becomes a ward of the state (if that happens at all), there are differences in the medicaid rules and practices by state. There are also differences from area to area in the costs of assisted living and skilled nursing homes, although probably the difference between north and south carolina is not all that great.</p>

<p>If you get to a situation where there is a need for “skilled” nursing, you will find that your mother will become “taxed” at the highest rates in the country, based on the difference between the medicaid reimbursement rate and the private pay rate. In some places, the publicized private pay rate can be as high as 14-15,000 per month (although in the carolinas that is likely to be lower by a third or more). </p>

<p>Assisted living facilities have an odd way of billing. They quote in daily fees, which quickly add up to large monthly fees. At the point she needs assistance with taking pills, or any kinds of oversight or monitoring, its likely going to raise the basic rate by $10 per day…in other words, $300/month extra to have someone make sure she gets the medicine. There are other things like that , so you should take a hard look at the likely costs at the point where she actually needs some level of assistance, as opposed to just the cost for those who don’t really need much assistance. There is a huge cost difference.</p>

3

<p>I would look at facilities that do not charge for each and every little service. You may think she doesn’t need something now but sometimese those additional services are very needed at some point. I like where there is one cost for all the services. The cost can up very quickly when you pay individually for individualt things. I would suggest having it be close to where one of her children are living so you are able to visit often. You know the old adage - while the cat’s away the mice will play. There needs to be a checks and balances. The staff need to be aware that a family member will be in to check up. It is natural in my mind that people slack off if they don’t think anyone is checking up on them. Kind of like a college student who does not have any tests - are they really going to make themselves do all the work if no one checks. I am an older adult social worker - have been for 25 years and the decision is hard. Use your common sense when looking at facilities. See how the staff interact, use your nose - should not be noticeable odors - especially no smell of urine, go for a visit and taste the food. All of this is important. And see what is important for your parent - if you know she likes soft, feminine looking facility or would she prefer no frills - you know her best. Good luck with the decisions.</p>

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<p>If this is a long term move and she would be considered a resident of the second state, you might want to have her will reviewed. I know my will is set up with some specific provisions for my particular state, and my attorney has advised me that if I move to another state I will need to have it revised.</p>

<p>Have you found this thread in the Parent Cafe? I am sure someone posting there has done this and can provide some advice.</p>

<p><a href=“http://talk.collegeconfidential.com/parent-cafe/1385049-parents-caring-parent-support-thread.html[/url]”>http://talk.collegeconfidential.com/parent-cafe/1385049-parents-caring-parent-support-thread.html&lt;/a&gt;&lt;/p&gt;

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<p>It might be helpful to have someone with power of attorney to take care of all the financial and governmental change of address information. It will be helpful for the assisted living center, also, as there will be tons of paperwork with that to establish a primary physician, dental care. Not to mention change of address information for any banking or financial related statements/documents, etc.</p>

<p>If your elderly mom still has great mental faculties, phone skills, etc. she might be able to do it on her own, but in my opinion if she needs an assisted living facility, she probably could use the help and the only way for someone else to do that is with power of attorney. The move might be a good opportunity to make sure all her paperwork (wills, trusts, durable medical, house title, car title etc.) are in good shape and accurate. The power of attorney will also make the process of paying taxes and bills associated with the car, home, etc. much easier on the entire family. </p>

<p>We just went through this with a elderly relative who will actually return home later in the year after some stroke related rehab and even though their mental faculties are quite good it was so very much easier with the durable power of attorney to get everything in place since there is so much bureaucratic paperwork this days related to banks, the government, the medical care industry…the legal fees were minimal to draft the power of attorney compared to the hours of time it would have taken to run back and forth to the facility gathering signatures, arranging phone calls, filling out change of address forms at the postoffice etc.</p>

<p>My relative has long term assisted living insurance, but there was a 100 day qualifying period, so the first 100 days were out of pocket. The regular medical insurance covers the “normal” medical stuff like physical therapy, medications, durable goods etc. The very nice facility we chose has a fixed rate and all in is running $3700 a month (day rate is available, but it doesn’t matter, the $3700 is based on a 31 day month so a 30 day month is the same price). But we did find lots of facility that had a base rate then add on for this and add on for that depending on the level of care needed. Assisted living is not cheap.</p>

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<p>Thanks for all the advice. We don’t HAVE to move her across the state line, but there are some advantages at the facility we are looking at, plus it would put her 20 minutes from two different children. If we keep her in North Carolina, we will probably place her 5 minutes from the NC child and the SC child will drive about an hour to see her. So there are pros and cons to this decision. </p>

<p>Hadn’t thought about her will, she does have a family attorney she likes and so it shouldn’t be too traumatic if we have to revise it.</p>

<p>Keep the posts coming, I am glad to learn from others who have gone down the road before.</p>

<p>And thanks for the thread link. Will check it out too.</p>

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<p>We just moved my mom from ND to VA. </p>

<p>If you can manage it, the biggest help so far has been having someone with power of attorney at both locations to deal with anything that comes up during the transition. My brother also has a financial power of attorney to deal strictly with her investments. He is a CPA so that is handy, but I think that any responsible person would be fine. In her case only typical retirement accounts are involved as well as long term bonds.</p>

<p>Finding a new doctor and making sure there were no problems with insurance coverage and benefits was the first thing we took care of, nice and easy with Medicare/Social security online.</p>

<p>Our move was basically done with three days notice, so there are still things to take care of. I am so thankful my mom decided a few years ago to downsize and sell her house so we only have the contents of a small apartment to deal with, and she sold the car before she left.</p>

<p>I hope things go smoothly for you, it can be a very difficult time emotionally.</p>

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<p>One last thought that I discovered but hadn’t thought about. Because my relative is not home, we notified the utility companies and basically shut the home down so there were minimal to no costs. We turned off the cable/internet/etc. We also notified the car insurance company who put the car insurance on hiatus. We put every bill on auto-pay that we could (electric, gas, phone, TV, internet, water, sewer, etc.) so no one needed to deal with them. Ultimately our senior won’t drive again, but that’s a hurdle to cross later this year. Basically we minimized or eliminated every cost associated with the former lifestyle to conserve cash. The out of pocket costs for the assisted living the first 100 days before the long term care insurance kicked in were greatly minimized this way basically just property taxes and some minimal utility charges. In actuality the “cost” to live after the long term care insurance kicked in is “less” than when this relative is home, driving, using utilities, garbage service, etc. Your mileage will vary depending on how structured your mother’s retirement planning is.</p>

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<p>I think probably the most important aspects are - </p>

<ul>
<li><p>Convenient access to at least one relative who can check on her fairly frequently and help her with errands/transport (regardless of the transport available at the facility). By checking on her they’re also able to check on the facility itself and make sure it’s providing the services expected and that they’re treating her well. When they know someone will be popping in frequently checking on the resident they have that much more incentive to make sure they’re doing things properly.</p></li>
<li><p>Convenient access to her doctors and whatever hospitals she might use.</p></li>
</ul>

<p>I don’t know which of the two locations would be best for the above but I’d guess it might be the area she currently resides in (the one with the kid 5 minutes away) since it’s likely her doctors are in that area.</p>

<p>The main reason people move into an assisted living facility is because … they need assistance or are at least close to that point. By that point it’s pretty common to have various medical issues and therefore have pretty frequent doctor appointments and often need some help in getting to them. Even if she doesn’t need a high level of this help now chances are high that she might within a year or so. </p>

<p>Moving into an assisted living facility often means entering a new phase in one’s life. Chances are good that her house isn’t really needed anymore, the rental condo just becomes a complication/hassle anymore, and perhaps her car isn’t needed anymore and she’d be better off not driving anymore (and so would other drivers). I’m generalizing, of course.</p>

<p>This is a good time for her to simplify her finances and not worry about things like a rental, house maintenance, the stock market (if she’s invested in that), etc. She might want to consider at least selling the condo and probably the house as well. If she retains the home then she needs to be concerned about its maintenance, it sitting there empty (and therefore more subject to burglary, vandalism, etc.), or having renters which is a whole other kind of hassle she doesn’t need now. The other issue with a house/condo are electric bills, water bills, trash/sewer bills, maybe association fees, etc. It won’t be quite as easy for her to take care of it all when she’s in an assisted living facility.</p>

<p>Definitely make sure things like power of attorney, will, living trust, living will and advanced directives, etc. are in place and the immediate family has copies of the documentation. </p>

<p>You may also consider having one of you take a close look at her bill paying and consider whether she needs help with that. It’s not unusual for bills to not get paid on time due to forgetfullness or disorganization and ‘out of sight, out of mind’ when she’s no longer living in the house.</p>

<p>Finally, don’t view her moving into this facility as a negative. It can be quite positive. Life should be easier for her due to being able to get help with things and being able to eat in a dining room and not have to prepare meals is both convenient and for many, healthful since sometimes the elderly don’t bother to prepare healthful meals for themselves because it’s too much hassle, they don’t want to do the shopping, etc. There are a lot of other people there in a similar life point as her, similar age, and due to them being just down the hall or in the dining room, or library, etc. they’re more convenient to hang around with and be friends with and do things with whether it’s playing cards or working out or watching a movie or going on a facility sponsored excursion.</p>

<p>There can also be some ‘peace of mind’ for the resident since some of them can become quite fearful of falling in their home when alone or how to handle various things they need assistance for. Going into an assisted living facility puts them in charge of themselves and actually can help them be independent longer - i.e. not dependent on the kids. Hopefully she’s thinking about the move in this context and hopefully you and your siblings are as well.</p>

<p>Good luck with it all.</p>

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<p>One thing to think about is what happens when she needs more care than she does now. Does the assisted living facility have the ability to provide that care? Do they have a unit in the facility for those with more demanding needs? I have a family member who spent many years managing assisted living facilities and as much as we don’t want to think about it, many people enter these facilities and begin to decline at a much faster rate. Not everyone, certainly, but many. You don’t want to be having to search for another spot in the near future so it’s best to address that possibility now.</p>

<p>Good luck. It’s no fun having to do this with a parent or in-law.</p>

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<p>As an estate planning attorney, I always advise my clients to have all of their estat planning documents reviewed (and possibly re-written) when they move to another state. The laws of each state vary. This is particularly important for powers of attorney - even more so than for wills.</p>

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<p>Unfortunately, unless her present attorney is licensed to practice in the new state, she will need to find a new attorney in the new state to review and update her documents.</p>

<p>Additionally, domicile is generally determined by subjective intent (which is supported by evidence of objective factors - e.g. voter registration, mailing address, tax filings, etc.). If she moves to SC with no intent to return to NC, she will likely be deemed a resident of SC immediately. </p>

<p>I had a case once where someone with a terminal illness sold her house and belongings and went from CA to OR to spend whatever time she had left in the care and company of her family. She died intestate (without a will) a week later. A dispute arose between her husband (who had stayed behind in CA) and her family over which state laws applied. Husband wanted OR to apply because under OR law he would get a larger share of the estate. Family obviously wanted CA to apply. I represented family and we filed for probate in CA. We argued that she was still a CA resident because she went to OR to die, not to live. We lost. The court ruled for husband, saying that she left CA voluntarily with no intent to return, making her an OR resident as soon as she crossed the border.</p>

<p>(Disclaimer: Nothing stated herein is intended to constitute or be relied upon as legal advice, nor to create an attorney-client relationship.)</p>

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<p>As an elder law attorney, I want to echo and add to DGDzDad’s response above and suggest (or encourage, urge, beg) that you to be sure that the attorney your mom will be working with going forward in either state is someone who concentrates his/her practice in Elder Law. Elder law attorneys all do estate planning; only a portion of estate planning attorneys know the ins and outs of elder care planning. You need to be working with someone who is familiar with the continuum of care, with available resources in both the health care and financial worlds, and the eligibility rules of the various government assistance programs. You can get likely ask for referrals from the assisted living facility you are considering, or the local senior center, or you can search for yourself at the website of the National Academy of Elder Law Attorneys (NAELA dot com … Sorry, but I don’t know how to post a link.) There is a “locate an attorney” feature on the top right corner of the home page. You can search by town or zip code and by distance. Good luck!</p>

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<p>NAELA: [url=&lt;a href=“http://www.naela.org/]Home[/url”&gt;http://www.naela.org/]Home[/url</a>]</p>

<p>(note to MJSMOM: to post a link, I just go to the web page in question, copy the address bar, and then paste it into the message. I will come out like this ^^^)</p>

<p>Based on the facts presented by OP, it does not sound like OP’s mom needs public assistance planning at this point, but that could certainly change down the line.</p>

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<p>That’s sad. The assisted living facility I found for my family member has different buildings - an Alzheimer Building, a hospice building, an independent living building and two assisted living buildings…one for older people recovering from hip, knee, shoulder surgery but will eventually return home and one for older people who need assistance because of decline. The recovering building also takes on respite care, which is what the managers call it - families who take care of seniors can bring them there for a week or 2 if the family is going on vacation, traveling for business etc. </p>

<p>By the was MJSMOM my family uses an elder care attorney - even H and I…after all we HOPE we’ll be elder when those documents come into play :slight_smile: I have a different attorney for our real estate stuff. I encouraged my (elderly) parents to have an elder care attorney review their trusts,wills etc. and she (the lawyer) did make modifications and made great suggestions for my mom about changing up some things regarding my 90+ year old father who is definitely starting to decline. Another vote for an elder care specialist.</p>

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<p>My mother lives in another state and I would like nothing more than to have her nearby. She has serious medical problems but at this point is still able to live in an assisted living facility that allows her to have her own furniture, etc. and gives her a lot of support. The cost is around $6K a month. My father still lives at home, with a part-time caregiver who comes in daily to cook, clean, help with meds and drive him. As you might imagine, this is rapidly depleting their savings; though they should be good for at least a couple more years.</p>

<p>The concern for me is were I to move them here and they outlive their savings the medicaid accepting facilities in the area are pretty grim. Meanwhile, the county-run nursing home where they are now is quite good. Not having any idea of how much longer they will “be with us” makes moving them here a gamble. There is no way I could afford the cost of private facility for them.</p>

<p>Two and a half years ago my parents were in good health. My mother was gardening a half acre lot, volunteering and cooking up a storm. They navigated Amtrack Chicago to Pittsburgh without assistance. The decline has been rapid, but none of their health issues are life threatening.</p>

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<p>Is there a reason why she will continue to own two pieces of real estate in NC…and a car? I’m not an estate planning expert, but it might be width considering what to do with these properties now (assuming your mom has her wits about her).</p>

<p>I’m not sure continuing to own properties and a car in another state is a good idea. Why?</p>

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<p>1moremom:</p>

<p>That sounds like a tough situation. You’re right about how the costs can rapidly deplete one’s funds. If they own a home with no or little mortgage then it can be a nest egg that can be sold to help but sometimes that’s not enough either. You’re also right about being extra careful about facilities that accept medicaid since many of them have cut their costs to the to the point where the quality of care might be compromised.</p>

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<p>I have a girlfriend going through this. The closer a family member is the better.<br>
The parent will decline over time and planning should be done up front/aka now to anticipate that. Assisted care facilities are technically a wierd loophole akin to sharing a house with others. The assistance provided more caretaking then medical. NPR recently ran a great program on assisted care. </p>

<p>FYI my gi doc (in his 60’s) recently was relaying to me that both his parents were in nursing care at a rate of almost $10k per month for close to a decade w ALZ and they had NO IDEA they would live that long at such a low quality of life. He said they had about one more month until their resources were tapped.</p>

19

<p>I would definitely do some movement of assets now. Yes, your parents will live a very long time in these facilities. My mother lived eight years in ALF then SNF, and we were about out of funds when she passed away. I kept putting off and putting off transferring cash to the siblings because I was worried that money would not be there for her when she needed it. But, had she not passed away when she did, I was probably going to have to take out a loan to pay for her care until she qualified for Medicaid. I think there is a five year look back period now, used to be three, maybe, and I stupidly thought she wouldn’t live three years in a “facility”, so I wouldn’t need to worry about transferring assets.</p>

<p>As for proximity to relatives, just because someone is nearby does not mean that they will regularly check up on your parents. My brother was in the same city as my Mom, but I probably saw her more than he did, and I live six hours away. But, when Mom had a medical crisis, he was there, and would stay with her in the emergency room, through surgery, etc. But, as far as buying her toiletries and other things she needed/wanted while she was in ALF, I had to buy them and ship them to her. I could not count on him to run to the grocery/drugstore for her. Thankfully, when she moved to SNF, most of her things were provided, and even though the monthly cost was the same as the ALF, I saved money not having to buy shampoo, vitamins, etc.</p>

<p>The most important thing, I feel, is to have your parent in a place where they will get good medical care and have access to good health facilities. We left my Mom in Houston after Katrina because obviously, she would not be able to get medical care in NOLA for a while. But we kept her in Houston because the medical care was so far superior, and she was very happy in her new place. And if you are going to be the primary caregiver, power of attorney, make sure your parent is in a place that is easy for you to get to, ie, easy to fly in, drive to. </p>

<p>Good luck!</p>