<p>My sister lives with and is taking care of our Mom, who suffers from several physical ailments and dementia, and needs 24-hour care. I live several states away and visit every few weeks to give my sister a break. Determined to keep Mom at home, we (mostly she) have been working with an eldercare lawyer and accountant in terms of “spending down” Mom’s relatively meager assets so that she will be eligible for Medicaid. My sister has a question that neither of us can get or find a clear answer to, so I wonder if anyone has the expertise or experience to address it. </p>
<p>The basic question is:</p>
<p>Since assets are very limited in order to be eligible for Medicaid, how would it be possible to keep Mom at home…even if most of her medical and care needs are picked up, how can she be expected to afford food and other household/housing expenses?</p>
<p>There are lots of other questions, but this one is really basic. Any info or advice would be much appreciated.</p>
<p>Your question is not uncommon. The sad reality is that 24 hour care at home is actually the most expensive care of all (more than a nursing home) and that there is no program that will cover it. It is especially challenging when Mom is single (which sounds like the case since you didn’t mention Dad). Keeping someone at home often involves cobbling together a bunch of caregivers, combined with family members contributing their time and resources. I commend you and your sister for everything you are trying to do.</p>
<p>The short answer to your question is “it depends.” Not because that is the ultimate lawyer answer, but because even tho Medicaid is a federal program, each state administers its own program subject to federal parameters. The answers to your questions are going to depend on what state your mom is in. Those rules and your state’s laws are going to impact whether or not Mom can transfer assets to become eligible for community Medicaid benefits, whether or not she can participate in a pooled trust, and other strategies that may help expedite her eligibility while preserving some funds to pay for household expenses. Those rules will also impact possible strategies for preserving your mom’s home. Ideally, you will not have to completely “spend down” (as in never have again) all of your mom’s “meager assets” before she can access financial assistance. Your mom’s attorney should be able to discuss all of this with your family.</p>
<p>Are either your mom or dad veterans? If yes, perhaps the VA Aid & Attendance program may help. Much higher asset level than for Medicaid. Application process takes a long time, so you will want to ask about this ASAP to get the ball rolling. Talk to your mom’s atty about this.</p>
<p>Another option (if your mom owns her house) is to explore a reverse mortgage as a way to tap her equity to help pay for care. The funds she pulls out of the house may be treated differently than “regular money” under your state’s Medicaid rules. Again, talk to the atty.</p>
<p>Most elder law attorneys are members of the National Academy of Elder Law Attorneys (naela dot com). Is yours? You can search the member directory by town, state, zip code, name, etc. Your attorney can/should be your guide through the long term care maze, and should be able to be a clearinghouse for referrals to all kinds of help in addition to helping with benefits eligibility issues. He/she should be able to answer all of your family’s questions to help guide you through this challenging time.</p>
<p>Smdur: I am not an attorney, so please confirm whatever I may say with your attorney to make sure it is correct.</p>
<p>Medicaid allows a person to have a small income provided the income is not over a certain amount. The spend down refers to her assets (money in the bank, certain other things). So you need to find out what that amount of allowable income is in your state. She can buy her food out of that allowable income amount.</p>
<p>MJSmom is correct that every state administers the Medicaid program differently, so you have to know the particulars of your own state.</p>