Long term care
 

I’m sure some of you have these questions or have actually experienced these circumstances. I am talking about Medicare nursing facilities, not private. Private ones run about $9000.00 a month so for me that’s out of the equation. Been to seminars where they tell you you can protect your assets including sale of your house and just your s.security will cover cost. A lawyer quoted me $5000 to do the paperwork. My lawyer who has done my wills in a phone conversation asked me why I would I spend $5000 and have no idea if I would or my spouse would ever go in a nursing home. You can fill out the paper work the day before you would go in or even after you go in. My lawyer does not charge like the ones in fancy offices, has a small office in a tiny strip mall in Eustis. Used to be in summer field but closed that one.

About 80 to 90 percent of fulltime nursing home residents (not rehab) are on Medicaid. When you move in, they actually have an office to calculate your "spend down" time plan to spend all of your money before applying for Medicaid. Your lawyer is probably talking about a plan to give most of your money away to make you eligible for Medicaid and avoid spending it all at the nursing home. To be eligible for Medicaid, you need to be almost broke, and they include a 3 to 5 year "look back" period to prevent people from gifting their money just prior to entering a nursing home. I don't know if you need a lawyer, but a gifting plan is a good idea to avoid spending all of your money at the nursing home. Most people cannot afford to live in any nursing home. Note that Medicare does not cover nursing homes.

Medicare only pays if you are there for rehab. Medicare does NOT pay for long term care. Medicaid pays for long term care, but only after you have spent all your money and have nothing left.

So start giving away your money to your heirs now, to establish a pattern and so that they get something from you.

Look back
 

Giving away your money is not the answer. They look back and if you have given to much you pay a penalty.Look back 5 years so do it now and hope you have 5 healthy years in front of you.

What a joke, dump your money on your heirs so they can live the good life while the rest of the population pays for your fanny. I think to stop this practice, which has been going on for a long time, long term care should be beds in wards, shared public bathrooms and very, very basic care including the food. How about your kids take you in, provide the care and you pay them? That would be far more equitable for the American people.

I have watched so many couples dump their money to the kids to live off the public coffers. Talk about a travesty...barf

I partially agree with you. But nursing homes are basically Government Medicaid-funded facilities. The nursing homes do the bare minimum to comply with Government rules and it is the nursing home owners who are getting rich. If you move into a nursing home with $100,000 in life savings, it will be gone in about a year or so, and then the Government will be paying the nursing home through Medicaid. You will be broke and won't even be able to go out to dinner or buy a TV or a piece of furniture. But, if you can gift that money to your heirs, they can help you out by spending some of the money on you. (hopefully?)

I have always thought along your same line of thinking, thought I must be the only one who thinks it strange that people would NOT want to pay for the care they receive (from any provider actually), yet find it morally sound to try to hide, or "get rid of" assets they have worked for all their lives and saved for the 'what if's", what IF I have to have nursing home care, etc. ? When people divest themselves of assets, surely SOMEONE has to pay the people who work in nursing homes ? If the people receiving care have money but don't want to pay, who then pays ? ? Isn't that similar to going to the doctor and needing heart surgery to save your life, but after the surgery you don't want to pay the surgeon for services rendered ? I can't help but think somehow, some body, must pay to build and staff nursing facilities !

Protect 1/2 of your assets now...............Divorce your spouse.

:popcorn::popcorn:

Lots of good (and accurate) observations about what Medicare pays and doesn't pay. Bottom line though is that if you are in a nursing home beyond what Skilled Nursing will pay (90 day Medicare limit, back when I was in the game) anything above and beyond comes out of your pocket and, when your pockets are empty, the public nickel (i.e. Medicaid). Florida has a 60-month look-behind when Medicaid is applied for and as other posters have indicated there are penalties if they find you've hidden assets. There are ways around some of that (irrevocable trusts, some other things) but those have tightened up as well. Some folks do carry long-term care insurance but unless those policies are purchased when the purchaser was relatively young and healthy the premiums can be pretty hefty.

Suggest you might want to look at some options other than a Nursing Home. Florida isn't great when it comes to "other options" but they do exist, and are designed to keep people in the community for as long as possible. Services such as homemaker services, personal care (PCA) services, Home Health Aides, and the like may be available, with the beauty of them being that you don't have to empty your bank account to pay for them but basically pay as you need them.

Availability of services vary state by state, but it might be worth your while to contact The State of Florida Health and Family Services to see what is out there and what it takes to access services.

Sad but true.

Spend some time in a nursing home. It's some of the toughest, most difficult work out there or people would keep their parents in their home.

If you want to work, maintain, change adult diapers, dig dentures out of returned food trays and locate their owners, bath, shave, hair groom, lift and move patients, the list goes on and on for $15./hr, they will hire you immediately. Appears to be bare minimums to you because it's not a spa.

The buildings, maintenance, heating, air conditioning, insurances including liability, food, entertainment, skilled employees, managers benefits and all the incidentals not even mentioned here make the care very expensive. Look at what pro athletes are paid and so called movie/entertainment people, this world is very upside down. As mentioned early, apply to a nursing home and advise us how to run it as a nonprofit entity.:loco:

Also, if you are in a nursing home, you won't have to worry about going out for dinner.

Not sure I understand your post. I have spent time in nursing homes, but not as an employee. They had the required number of employees, but they were not first class. In one that I remember, the call bell rang 24/7 because there were not enough staff to respond, but apparently, the Government required the bell. I think nursing homes are very profitable for the owners. But my point is that I don't blame people who want to keep some of their money.

There are many ways to qualify for Medicaid despite having substantial assets. It is imperative you contact an experienced elder law attorney who has extensive knowledge in this field.
For instance, you are allowed one car which is not counted as an asset. You could buy a $200,000 Bentley to reduce assets. The current limit on your primarily residence is $713,000 if single and no limit if married. If your current home is valued less than this, you could upgrade to reduce countable assets. A Qualified Income Trust (aka - Miller Trust) can allow your income to exceed the threshold and still qualify for Medicaid. These are just a few of the many strategies that can be utilized. Contact an elder law attorney as there is a five year look-back on asset transfers. Spending $10,000 for an attorney to get this right would be a bargain.

Keep some of their money? So others can work harder, go without and have to subsidize them when this is exactly how their money should be spent if required? When did this something for nothing mindset begin?

(If that bell keeps ringing it's because you can't get enough people to work under those conditions for so little income.)

If we could somehow get rid of Medicaid entirely, then the calculus would change. That has its own moral problems, but I think it would be better.

Are you saying that people who follow the rules shouldn't take advantage of a Government benefit, like Medicaid? Medicaid allows them to gift their money to avoid paying for nursing home care out of pocket. If done timely and correctly, they are entitled to the benefit.

It’s Medicaid, not Medicare, provided by the Federal gov. (as tweaked slightly by some states). The greater percentage of us will need Medicaid when we can’t continue to live alone/at home due to being unable to competently perform the basic functions of living independently. There is also a ‘Waiver’ program that allows a person to remain in home & receive services there.
There is a monthly income amount which one must be below (usually about 2300) to qualify & if married, the spouse (community spouse) can retain most of the joint assets (technically to a max of about $140,000, but there might be more protected from access by being in a Trust) . There is a five year look-back period during which, if any gifts were made, Medicaid would only be available five years after that date (or they charge you the full amount of the monthly rate). The biggest mistake people make is to sell their house as Medicaid, theoretically puts a claim on the house, effective after the death of the person & no gifts of money or sales of property are allowed during the 60 month ‘look back’ period.
However, many attys will do a Trust to transfer assets to a ‘Community Spouse’ or another, to essentially keep funds out of consideration.. When the monthly income is too high to qualify, a different Trust (Qualified Income Trust, also given other titles) to transfer income to that place when those funds are over the legal income limit to qualify for aid - that allowed Trust is meant to provide other additional medical care & appliances for the person. Theoretically, the Dept of Health & Human Resources has a type of lien on the person’s home upon the person’s death, although they often have not exercised that right to pay back the system - possibly changes will be coming under Doge, but I think it would be a few years before that gets changed. (This Dept has often been used to dispense money to migrants.).
If applying, the forms detailing bank accounts must be provided for the prior 60 months (5 years) & all information must be accurate. Google Medicaid & the state you would be living, and the rules are explained well. Each state can tweak the rules slightly & some states are aggressive in their Medicaid recovery through Probate.

PS: You have to find a Nursing Home which has available ‘Medicaid’ beds. Not all are geared to Medicaid, & many predominantly Medicaid NHs are in terrible condition, under-staffed, over-patiented, and frequently get violations for patient falls, poor medical care, and other failures of required care. There isn’t enough oversight by the authorities, & owners of these Medicaid homes have inadequate oversight & auditing.

It is tough from either point of view! I have had several family members go through the spend down Medicaid process. The taxes we have paid in all these years is being put to use.

Thank you! That's what I wanted to say. People who have lived a moral life then deteriorate in their old age because lawyers told them this was the smart thing to do. Sickening.

The problem is that the Government doesn't collect enough in taxes to pay for all of the wasteful spending. That is why the country is $36 trillion in debt.

Who pays for the nursing homes? Our tax dollars. We have all paid taxes for years right?

Hopefully, DOGE is on the way.

good point for sure!

Something not mentioned in this thread is what is called "Aid and Attendance" for veterans. It is a monthly amount to pay for in-home assistance for those not able to take care of daily chores by themselves. If you are a veteran, look it up.

Be careful.

Medicaid was setup for people who are very poor or destitute. By hiding or giving away money or assets you are ripping off the government and the taxpayers.

If you need a nursing home, would you be going out to dinner or buying furniture? That would make you healthy enough for assisted living.

It is not ripping off the Government if you follow the rules that the Government established within the program. And, people have every right to give away their money to anyone they want. I would also point out that, in 2023, 91 million people were enrolled in Medicaid, not just the very poor or destitute.

These are the same people who begrudge needy people being on welfare or help for those less fortunate.

That's how the rich get richer. They know how to skirt around the rules and find the loopholes.

Yes, because not everyone living in a nursing home is bedridden. If you need a certain level of medical care, you may not be eligible for assisted living.

If you are there on Medicad they take your Social Security and give you $100 a month for personel care items. So you won’t be going out to dinner or buying a TV. Your kids can do that for you with the money you gifted them but I have seen where once they have the money you are on your own.

I totally agree. But, you don't need to give all your money to your kids, especially if they don't deserve it.

The travesty is the cost and quality of long term care, and this country's entire medical system.

We have all worked hard for our money and let’s just hope that we have children to where If we give them money they will save it and use it to take care of us when we need it! I know I trust my son explicitly! And some of the threads I’ve read have said they think it’s awful for people to live off of Medicaid later? Well, I would rather see the government take care of its own senior citizens then spending billions on illegal immigrants, that’s just my opinion.

Depending on the amount of wealth you have, there is an option to protect it, keep it, and still be able to go into a nursing facility. Buy long term care insurance. Yes, you pay an annual premium, but again, depending on your wealth, it could be money well spent. Basically, with LTC insurance you can keep all your money, go into a nursing home, and insurance will pay for the costs up to a certain number of years. Depending on the level of care you want you may have to supplement the monthly cost. Premiums are based on your age when you purchase the policy...the older you are the more the premium, but the younger you are the longer you pay the lower premium. I'm not generally in favor of insurances, but in this case it's worth considering for wealthy people.

Most long term care insurance experts say that the insurance is best suited for people who are either not poor or those who are not very wealthy. Those who benefit most from LTC insurance are those "in-between" people who have some wealth, but not enough to self-insure for long term care. So, it is not recommended for wealthy people who can afford to self-insure.

Another option
 

I went through this with my mom a few years ago before her death last year She was stubborn and wanted to live in her home in PA and not with me which I respected Then came the hospital and rehab cycle

When time for long term care came the nursing home gave me the whole spiel abt how the state takes over the house and assets to pay the bills and I choose another course of action

I chose a wonderful (after much research) personal care facility over a nursing home that I paid out of pocket. (Much less than 9000/month) They were wonderful and hospice provided services at the end of life they were very kind and caring and it was a great experience

So tell me this, if you have the means to pay for your nursing home bill, why do you want to pull off financial shenanigans to qualify for welfare? Why stick the taxpayers for your care when you can full well afford to pay your own way? So you can give it to your children? Once upon a time children were supposed to take care of their parents, not slough them off upon the taxpayers so they can leave a big estate.