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FAQs #20

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Q20. My mother, divorced for years from my father, was recently hospitalized for a fall which has left her disorientated, confused, and paranoid. My 32 year old brother has lived rent free with her most of his adult life, and for the two weeks since mother returned from the hospital he has cared for her. Because our mother is not improving, it looks like our mother may need to go into a more intensive care environment. Her house is her major asset. My brother is meeting with our father to see about getting her house put in "one of our names" to protect the asset from being taken by a nursing home. My mother's intention was always that her assets be divided equally between my brother and me, and her old will reflects this, so I am wondering if the will, can be changed now by my brother. Also, I am wondering if there is a difference between one's care in nursing homes that are "Medicare only and care if there is private pay, in which case it would be better if her house was used to help pay?"

A20. Elizabeth Kelly:
>Medicaid and Long Term Care
>Generally, a person's home is not counted as a resource for Medicaid eligibility if the home is the person's principal place of residence and the person intends to return home. However, the home is subject to the Estate Recovery Program. This means that the State Medicaid program can place a lien on the home and subsequently recover the money spent caring for the Medicaid recipient following the Medicaid recipient's death.

Usually, if a Medicaid applicant's home is sold within 36 months of the homeowner's eligibility for Medicaid a penalty is imposed. However, there are exceptions where the house can be transferred without incurring a penalty. One of the exceptions is "when the individual's son or daughter was who residing in the home for at least two years immediately before the date the individual becomes institutionalized and who provided the care that permitted the individual to reside at home rather than in an institution."

Assess Mother's Needs First
>Contact your local area on Aging or professional care manager in cooperation with your family doctor to assess what level of care your mother needs before making any decisions. The cost of nursing facility care is approximately 30-40 K per year. The cost of care in an assisted living facility varies but can be closer to the cost of nursing facilities care. Can she be cared for at home?<cite>

Options Concerning Disposition of The House
>A number of questions must be answered before deciding what to do with the house, including:<cite>

  • Can you afford to pay privately for care at home?
  • What is the value of the house?
  • If private pay is not an option, what about Medicaid home care programs like Home Care Allowance or Home and Community Based Services?

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If the person is not eligible for Medicaid but could be cared for at home, what about a reverse mortgage?<

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Will changed by brother
>The only person who can actually change their will is the person making the will. Whether another has unduly influenced a person is another issue. Ideally, you and your brother should attempt to resolve your concerns so that you are both free to assist each other and your mother in making care and living arrangements that will best meet her needs. Conflict or division within the family can become a barrier to getting the care and services needed for the parent.<cite>

Difference in Quality of Care/Standards in Nursing Facilities
>The real question is whether the care provided to strictly private pay residents is better than the care provided to residents whose care is paid for by either Medicare or Medicaid. First of all, there are fewer than 10 nursing facilities out of a total of about 200 in Colorado who do not accept payment form either Medicare or Medicaid.<cite>

Medicare only pays for short-term skilled care in nursing facilities. Medicaid is the primary payer for the majority of persons residing in long term care facilities. It is difficult to say if Medicaid recipients experience discrimination either at admission or in the quality of care they receive after they are admitted. The Medicaid daily rate covers most items and care needed by a person living in a nursing home, although the amount the resident actually gets to keep each month for personal needs is a paltry $34. Certainly individuals who can afford to pay for amenities not included in the Medicaid rate have more access to some amenities than a Medicaid recipient.

However, in terms of the quality of the nursing care and personal care, access to activities sponsored by the facility, and in other services made available to all the residents of a nursing facility, it does not appear that Medicaid recipients are treated differently. Where someone's Medicaid status may make a difference is when the nursing facility only has a limited number of beds that are Medicaid-certified. If the resident starts out as private pay and then later converts to Medicaid and the facility does not have a bed available, the resident may have to move to another facility.

When looking for a nursing facility consider the following:

  • Contact the Colorado Department of Health to receive a copy of the most recent survey report of the facilities
  • Contact your local Long-term Care Ombudsman  (usually housed in the local area Agency on Aging) to find out more about local facilities.
  • Take your loved one with you to visit 2-3 facilities. Visit unannounced in addition to any announced or guided tours.

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