Question: “Help! My mother has been diagnosed with Alzheimer’s Disease and my family and I have no idea how to proceed in helping her. At what point do we consider nursing home care, and how will we afford this, etc?? Please provide us with some guidance as to how we should proceed and what our options may be.”
Answer: The first place to start is with your mother’s doctor. He will be in the best position to assess your mother’s need for long-term care. This could be an immediate need or one that will develop over a period of time. If the doctor feels that she needs immediate long-term care then he will complete the necessary paperwork to have your mother’s condition reviewed by the Medicaid people in your state.
Assuming that Medicaid agrees that your mother needs long-term care at this time, your next step is to sit down with an experienced Medicaid planning attorney. The Medicaid planning attorney will review your mother’s legal documents –particularly her durable power of attorney- to make sure that they comply with current law. Of course, if your mother is still married, then the attorney will review your Dad’s documents as well. If not, then he will prepare a new durable power of attorney for her (again, she must be competent at this stage to avoid a guardianship proceeding) and perhaps your Dad as well.
The Medicaid planning attorney will review your mother’s monthly income and overall wealth to determine what type of Medicaid planning tools are needed to protect her estate. If she has too much monthly income (over $2130 per month), then he will prepare a Qualified Income Trust to insure that she passes the income test. If she received less than $2130 per month, then this step will be unnecessary.
Next, the attorney will review her assets. As a Medicaid applicant she is only allowed to retain $2,000 in assets (cash or cash equivalents, stocks, bonds, etc.). If excess assets exist, the attorney will look to see what other avenues are available to protect the remaining assets. This may include a personal services contract, trusts for the benefit of a disabled adult or minor child, purchasing a pre-paid funeral contract, setting aside and designating a burial fund, purchasing a burial plot and arranging for and paying for the headstone. There may be other purchases for clothing, etc. that may come into play to get her down to the $2,000.00 limit. If Mom is married this will be somewhat easier as she can transfer property to your father without incurring a penalty.
Either your Mother’s doctor or the attorney that you pick to help you should be able to recommend the proper living environment for your mother. I would suggest that you personally visit all of the facilities that are discussed to make sure that you get the proper fit for your mother.
The Medicaid application can be completed by any number of people. Your attorney may do it, a paralegal can do it or someone at the assisted living facility or nursing home can do it for you. The attorney and the paralegal, of course, will charge you for this work. It is best to seek their help as they should have the needed experience to do it properly and to avoid the pitfalls that you might see.
As long as you put together a good team of doctor and attorney you should not find the application process to be all that difficult. The difficulty usually comes up with searching for the back-up documents that support your answers on the Medicaid application. Just remember that each application is different from the last one so do rely on the help of the individuals mentioned in this answer.
ElderCareMatters.com is a good resource to use to find Medicaid Planning Attorneys across America who can help you with these types of Elder Care Matters.
I. Michael Tucker, Attorney at Law
Law Office of I. Michael Tucker, PLC
Altamonte Springs, Florida 32701
Member of the national ElderCare Matters Alliance, Florida chapter
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