What Happens When Money Runs Out

Applying For Medicaid

 

You may come to the time when your loved one has to be in a care  home, and they do not have the financial resources. This is not just for elderly people, it can also apply to other vulnerable individuals.  In this situation, people in the U.S. may turn to Medicaid, otherwise known as Medical Assistance (“MA”).  This is not to be confused with “Medicare”, the U.S. government healthcare plan for anyone 65 and older. Medicare may cover a short term stay in a care home, but it does not cover long term care.

As happened with my family, we had to place my dad in a nursing home due to his advanced dementia.   He had limited assets, and I knew if he lived long enough, we would have to eventually apply for MA. (He needed it the last five months of his life; the cost at that time was $7,000 a month to stay in memory care.)  Important things you should know:

  • If you or a loved one may need to qualify for Medicaid one day, there is a five year “look-back” period. You will need paperwork regarding house sales, vehicles, and nearly every other expenditure.    Come up with a good system to track every dollar, including what is spent on health care.  Also needed are birth, marriage, and divorce certificates, military service paperwork, home and vehicle sales, immigration documents if applicable, and more.  Keep all such documents in a central location.
  • The person qualifying has to “spend down” their assets. At the time my dad qualified, he could have no more than $3,000 in assets, including life insurance. One way to offset future costs is to purchase a funeral plan.  If done correctly, this money does not count against one’s assets. When my parents’ house was sold, we immediately appx. $6,000 each in funeral plans for each of them, which did cover their deaths and basic funerals.  (This did not count burial, as they were buried for free at Fort Snelling, as my dad was a veteran.)  It is not cheap to die!
  • We then had to pay back to the state all his leftover assets (less than $2,000) to make up for receiving MA.
  • I recommend seeking the help of an elder care attorney to understand how this all works. The laws may vary from state to state, are complicated, and it is difficult  to find specific information.

I wrote this in the book “Dancing With Lewy: A Father Daughter Dance Before and After Lewy Body Dementia Came to Live With Us”:

“In September 2011, Dad ran out of money. Of course, I knew this was coming, so I was prepared. (Thanks to my mother and her bookkeeping, I still had the records from when I initially applied for MA assistance years ago when they did not qualify.) Finally Dad was approved, and the government paid his nursing home bills of over $6,000 a month.

When my parents sold the house in July of 2006, they gave each of us four daughters $1,000….For five years, I wondered what would happen if my parents ended up needing MA, as the government has a five year “look-back” period. Would we have to declare that they “gifted” us this money? I asked my oldest son who works for the county. He said yes, we would have to declare any significant funds they gave away within the last five years.

The date he began receiving Medical Assistance was in September 2011. The five-year period ended July 2011.

Coincidence? Luck? No, I don’t think so. I believe God was protecting my parents, just as he had promised, and he was also looking out for us sisters, as this $1,000 was basically our entire Inheritance.”

Here is a link to a brochure explaining more about MA.

https://www.medicare.gov/publications/#results&keyword=11409

As your loved one ages, keep in mind the five year look-back period.  Any significant gifts given away during that time may have to be repaid. Financial and other related records will be needed for that five-year look back period.  Again, you could seek the advice of an elder-care attorney to learn more about how MA works, and what may be applicable to your situation.

Information about “Dancing With Lewy” and links to caregiving resources may be found on https://nancyrpoland.com. 

Support for our Veterans in 2021

As we move in 2021, let us move forward cautiously with hope for health, economic recovery and a return to family and friends.  Let us also remember those who are grieving, fearful and suffering.

A group we all need to remember and support is our veterans and their families.  In this blog I’ll highlight a couple veteran’s resources.

Veteran Centers such as this one being relocated in Anoka, Minnesota, are community-based counseling centers, providing a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active duty service members, including National Guard and Reserve components, and their families. These services help veterans make a successful transition from military to civilian life.  They also help after a traumatic military event. Looking forward to learning more about this facility when it opens.

As many of you know, veterans can receive healthcare and medications from a local VA Center.  They also offer mental health services and suicide prevention programs.   Your county likely has a Veterans Services Office (VSO) who can help connect you with benefits.

Here are a couple veteran’s services that may not be well known.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

Eligibility for the PCAFC has expanded.  Go to this website to download all these free materials:

https://www.caregiver.va.gov/

new Caregivers PCAFC – Expansion Booklet (PDF)

Caregivers PCAFC – Application Process Fact Sheet (PDF)

Caregivers PCAFC – Expansion Fact Sheet (PDF)

Caregivers PCAFC – Eligibility Criteria Fact Sheet (PDF)

Caregivers PCAFC – Monthly Stipend for Primary Family Caregivers Fact Sheet (PDF)

Caregivers PCAFC – Current Participant Fact Sheet (PDF)

The veteran and caregiver will need to apply together and participate in an application process to determine if you’re eligible for the Program of Comprehensive Assistance for Family Caregivers. You’ll both need to sign and date the application and answer all questions for your role.

You can apply online right now.

 

Aid And Attendance

This is my dad, as a young Navy soldier.

Another benefit was a life-saver for my parents, and one I had not heard of until my sister and I attended a dementia conference at the University of Minnesota.  It is a special benefit to war era veterans and their surviving spouses called Aid And Attendance.  You can read in my book “Dancing With Lewy: A Father Daughter Dance Before and After Lewy Body Dementia Came to Live With Us” how this benefit helped my family.

This tax-free benefit provides financial assistance to help cover the cost of long-term care in the home, in an assisted living facility or in a nursing home.  It is for those veterans and surviving spouses who require the regular attendance of another person or caregiver in at least two of the daily activities of living such as bathing, dressing, eating, toileting, and transferring.

It may take time to obtain the benefit. However, if your loved one qualifies, they will pay the monthly benefit back to the day you first apply.  If the application process seems overwhelming to you, contact your local VSO, or an elder care law attorney.  I had to follow up and be quite persistent when I applied for the aid for my dad, but he received the backpay, plus the healthy monthly allotment for several years. This allowed my folks to live in decent housing and have the resources they needed to live almost to the end of my dad’s life. I called the local VSO a number of times for advice on how to obtain this benefit.

  • If you or a loved one are veterans, be diligent in seeking out resources.
  • If you have the means, support veteran’s organizations that supply housing, healthcare, mental health resources or other needs for our veterans.

May God bless each one who is serving, has served, or has loved one who has faithfully served our country.

Free! Resources for Caregivers

Greetings friends.  We all feel like 2020 has been the longest road ever.  There will be an end, at least to 2020, and if all goes well, the pandemic.  Meanwhile, I offer hope, encouragement, and resources to caregivers.

Did you know there is a resource section on my website specifically for caregivers?  You can find it at: https://nancyrpoland.com/caregiver-resources/.

There are ideas for books, organizations, and links to other websites. All these resources below can be found on this caregiver resources page.

A gift for you – a FREE E-book, “Caregiver Anxiety –  Is there an Antidote?”  

With just a click of a button you can download the PDF of this booklet.  I speak from experience, as my husband and I have struggled with his health during the COVID crisis.

I offer a special section for veterans.  It is worth the time to seek out the many resources to help those men and women who have served our country.  Learning about and utilizing veteran’s resources made a huge difference in the quality of life for my parents. 

Check it all out nancyrpoland.com, and for more resources and ideas, you can subscribe to my monthly newsletter, “Caring for the Caregiver.”   

My passion is to help caregivers know there is help and support.  As we are in the midst of the holiday season, my heart is with you as we look forward to a better tomorrow.

God bless us, every one.

Three Legendary Men; One Shared Tragedy

What Do These Three Men Have in Common?

A Minnesota Congressman, the owner of a nightclub, and a baseball Hall of Famer – what could they have in common?  For one, they whole-heartedly pursued their individual passions.   Second, they all died within the past few months, in mid-to- late 2020.

There is something else they shared in common, a tragic connection.  But first let us first meet these three great men.

Jim Ramstad served in the U.S. Congress for 18 years. He is known for working across the aisle, and championed mental health and addiction issues.  (Couldn’t we use more of that now days!)  https://patch.com/minnesota/across-mn/longtime-minnesota-congressman-jim-ramstad-dies-74

Allan Fingerhut was the first owner of First Avenue, a Minneapolis nightclub made famous by the filming of Prince’s “Purple Rain”. First Avenue is world-renowned and has hosted many legendary artists. He was also a Vietnam Vet. https://bringmethenews.com/minnesota-lifestyle/allan-fingerhut-first-avenues-original-owner-dies

Tom Seaver was one of baseball’s greatest right-hand power pitchers. He won 311 games for four major league teams, primarily the Mets.  (He had COVID-19 when he passed away).  https://www.nytimes.com/2020/09/02/obituaries/tom-seaver-dead-coronavirus.html

What tragedy did these three men share?   All three suffered from some form of Lewy body dementia (LBD).

What is LBD?  It is the second most common form of dementia, after Alzheimer’s. (Think of “dementia” as the umbrella term; Alzheimer’s, LBD, Vascular dementia, and certain other degenerative brain diseases are types of dementia.)  Some people with LBD have symptoms similar to Parkinson’s disease, and many of the brain changes are the same.  Jim Ramstad was said to have “Parkinson’s with Lewy”.  However, LBD can also take its own path.

The most common symptoms of LBD include:

  • Changes in thinking or executive function (planning, processing information), memory, or the ability to understand visual information.
  • Changes in cognition, attention, or alertness
  • Problems with movement such as tremors, stiffness, slowness, and difficulty walking
  • Visual hallucinations
  • Sleep disorders
  • Mood changes such as depression, apathy, anxiety, agitation, delusions, or paranoia
  • Bodily changes such as blood pressure control, temperature regulation, bladder, and bowel function https://www.lbda.org/10-things-you-should-know-about-lbd/

Why is this noteworthy?   Recognizing symptoms will help family members know when they need to seek medical intervention.  A physician may order a neuropsychological evaluation be performed; however they will count on family members to report specific behaviors.  While there is no cure for LBD, you may be able to help a family member or friend by understanding this and other dementias.

Part of the reason I wrote “Dancing With Lewy:  A Father Daughter Dance Before and After Lewy Body Dementia Came to Live With Us” was to educate people about dementia.  My dad was first diagnosed with vascular dementia, then six years later, several months before he died, we were told he had LBD.  (He likely had both diseases).  Without knowing he had LBD, we had little idea what to expect as his dementia progressed.

You can educate yourself by visiting websites such as Alz.org, lbda.org, or other ones specific to the diagnosis.  Be an informed caretaker; visit https://nancyrpoland.com/caregiver-resources/ for ideas and links to many other websites.

If you would like to obtain a copy of “Dancing With Lewy”, there are three ways to do so:

  • Order it off my website, https://nancyrpoland.com, and I will ship it to you.
  • Buy the E-book off Amazon.com.
  • It will be officially released on February 16, 2021.  You will be able to buy it in on-line bookstores.

I hope you will never need this information, but chances are you will have a loved one suffering from dementia at some point.  Learn all you can, be patient with those who dementia-related symptoms, and find ways to advocate and support research.

No Immunity – to the High Cost of Caregiving

The Cost of Caregiving

Young people – Will you be responsible to take care of a parent or other loved one someday?  If so, this is for you.

Older folks – Have you set the course, so your family will not need to leave the workplace or spend their own family resources taking care of you?  You also need to pay attention.

When was the last time your family sat down to discuss what the future may hold? 

My advice: Prepare for the worst and hope and pray for the best.

In an article in the Minneapolis Star Tribune, Carla Fried (rate.com) wrote, “Millions of Women – yes, it’s mostly women – end up in midlife weighing a temporary work exit to care for ailing parents.  The economic cost can be devasting.”

This of course can apply to men also, as they could be the primary caregiver juggling a job, family, and ageing parent.  Or it could apply to one’s spouse, partner, or to a single person, affecting the household finances.  No one is immune.  Us Baby Boomers are getting old fast!

We need to plan ahead for caregiving.  Here are a few steps you can take before a crisis (some are mentioned in Ms. Freid’s article):

  • Ensure your loved ones have the proper legal paperwork completed,  and review it periodically. An elder-care attorney costs money, however the legal advice could can save money and heartache in the future.
  • Try not to take your own social security too early. There is a higher guaranteed payout if you wait until your full retirement age, and there is an even greater payout at age 70.
  • Think about your parent’s future living situation. Do you have the space to transform a dwelling unit for your loved one as they age?  It will simplify your life to walk across the yard to make meals or sort the medications for your loved one, vs. driving across town.

If you are in the midst of decision-making about a loved one, consider:

  • If one sibling has to quit work to care for a parent, the other siblings could  pay the caregiver, or even contribute to an IRA to replace their lost retirement benefits.
  • Reduce your hours at work, vs. quitting all together.
  • Plan to pay for a caregiver for your loved one. That is not cheap but may be a viable alternative.
  • Explore available benefits,e.g. Social Security Disabilty (if the loved one is under 65), Veteran’s benefits, Medicare Supplemental Plans, Medicaid or community resources.

The bottom line is communication; understand the financial and legal situation, and plan ahead. Yes, these conversations may be difficult now, but there are alot worse alternatives. 

As they say, “Denial is not a river in Egypt.”