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Understanding how to legally not pay for assisted living
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amother
Mustard


 

Post Wed, Jul 11 2018, 3:52 pm
amother wrote:
We put most of my parents' assets in a trust a number of years ago. What this means is that once they've used up the balance (and after we're penalized for any funds they spent which we can't document) they can have Medicaid pay for them to be in a nursing home.

The rest of the trust can allow us to pay for a private aide for a few years, we hope. Because we don't want them languishing there, waiting hours for a diaper to be changed etc. At least with a private aide there will be some better level of care.

I don't think there is anything wrong with this.

Note that in order to take money out of the trust it must be paid to me or one of my silbings as trustees, on which we pay taxes.

A nursing home will not allow a private aid to administer any health care such as changing a diaper, giving medications etc.
The reason for this is because if the patient is injured in some way, the nursing home is liable and can be sued and lose their license. You are in fact, allowed to hire a private *companion* to be with the nursing home patient. That companion can remind a CNA that the patient needs to have their diaper changed.
Eta: You are allowed to have a private aid to be with the patient, but that aid will essentially be acting as a companion.
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rikki 1




 
 
    
 

Post Wed, Jul 11 2018, 4:35 pm
There is a big office in Lakewood that deals with this exact issue. They'll help you create trusts, arrange spend-down, go through all financial statements for the 5 year period. They deal with nursing homes and Medicaid offices across the tri-state area and some beyond. They are much better priced than a lawyer. You can Google to get more info about term: Senior Planning Services.

Hope this helps!

Hatzlacha
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amother
Lime


 

Post Wed, Jul 11 2018, 6:02 pm
Medicaid will pay for assisted living. Not all assisted living facilities accept Medicaid. I know this for a fact, because I have a parent in assisted living (which is being paid for by a private long term care policy). Most of the other residents are on Medicaid.
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Librarian




 
 
    
 

Post Wed, Jul 11 2018, 6:39 pm
It is 1000% legal to place your assets into a trust as part of estate planning. As long as it was done at least 5 years prior to making a claim for medicaid it is absolutely kosher. Please do not call it "stealing". This is the LAW in New York. And it is a very standard and recommended part of estate planning. In fact, as soon as one makes a living trust and qualifies under the legal income standard, medicaid will pay for a home health aide - IMMEDIATELY, no 5 year wait period, if the person is found to require such care. We are in the process of establishing such a living trust for my elderly in-laws
with the help of an elder law attorney and I can assure you it is completely legal and above board.
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amother
cornflower


 

Post Wed, Jul 11 2018, 6:47 pm
Librarian wrote:
It is 1000% legal to place your assets into a trust as part of estate planning. As long as it was done at least 5 years prior to making a claim for medicaid it is absolutely kosher. Please do not call it "stealing". This is the LAW in New York. And it is a very standard and recommended part of estate planning. In fact, as soon as one makes a living trust and qualifies under the legal income standard, medicaid will pay for a home health aide - IMMEDIATELY, no 5 year wait period, if the person is found to require such care. We are in the process of establishing such a living trust for my elderly in-laws
with the help of an elder law attorney and I can assure you it is completely legal and above board.


Who called it stealing?
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amother
Purple


 

Post Wed, Jul 11 2018, 7:19 pm
Librarian wrote:
It is 1000% legal to place your assets into a trust as part of estate planning. As long as it was done at least 5 years prior to making a claim for medicaid it is absolutely kosher. Please do not call it "stealing". This is the LAW in New York. And it is a very standard and recommended part of estate planning. In fact, as soon as one makes a living trust and qualifies under the legal income standard, medicaid will pay for a home health aide - IMMEDIATELY, no 5 year wait period, if the person is found to require such care. We are in the process of establishing such a living trust for my elderly in-laws
with the help of an elder law attorney and I can assure you it is completely legal and above board.


This. I was going to write the same but thanks for typing it out !
I am unfortunately very familiar with the entire process as my very young parent turned disabled suddenly and now needs 24 hour care. Thankfully we were able to transition the patient from a nursing home (for which we paid privately to for a year because of the 5 year waiting period) to at home with a full time aide. Medicaid pays for the aide since all assets were transferred to a trust.
We did all of this legally with a NY Lawyer who specializes in eldercare.
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Librarian




 
 
    
 

Post Wed, Jul 11 2018, 8:28 pm
Ginger called it stealing
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out-of-towner




 
 
    
 

Post Wed, Jul 11 2018, 9:33 pm
The look back for Nursing Home Medicaid is 5 years give or take, but the look back for community Medicaid is much less, I believe it is 3 months.

As crazy as the pooled trust thing is, it is 100% legal if done right.

I work with a lot of people with pooled trusts, although I don't consider myself to be an expert, you are welcome to PM me with any questions.
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amother
Ginger


 

Post Thu, Jul 12 2018, 4:55 am
amother wrote:
I'm sorry for you parents situation. It's really not clear why you aren't taking advantage of whatever assistance is available.


We are. That's why they're doing so well.

As for the future: our parents begged us to never put them in a nursing home. We will respect their wishes, but in order to afford alternative arrangements, we need to hustle.
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amother
Ginger


 

Post Thu, Jul 12 2018, 5:05 am
Librarian wrote:
Ginger called it stealing


Is it illegal, or halachicly stealing? Certainly not. In that respect, it's completely above board.

But coming from someone whose family hasn't been above the poverty line since she was 5 (we live in NY), who spent years living without healthcare, and on pasta and lentils(it was cheap), I can tell you that the system is overloaded. The only reason we didn't end up on the street, the only reason we had clothing and food, was because of chessed - and yes, my parents work hard.

Too many people need help, too many people are asking for help, and if you don't need it, then the moral thing to do is not to use it - no matter how many legal loopholes are present.
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Librarian




 
 
    
 

Post Thu, Jul 12 2018, 8:43 am
This is not a "loophole". It is the standard letter of the law. And the people who are setting up these living trusts for themselves are the ones who have spent 50 years paying very high taxes into the safety net programs that you are talking about. Social Security was created as a way to force people into saving for retirement. It is not perfect by a long shot, but it belongs to everyone who pays taxes.
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amother
Purple


 

Post Thu, Jul 12 2018, 10:11 am
amother wrote:
Is it illegal, or halachicly stealing? Certainly not. In that respect, it's completely above board.

But coming from someone whose family hasn't been above the poverty line since she was 5 (we live in NY), who spent years living without healthcare, and on pasta and lentils(it was cheap), I can tell you that the system is overloaded. The only reason we didn't end up on the street, the only reason we had clothing and food, was because of chessed - and yes, my parents work hard.

Too many people need help, too many people are asking for help, and if you don't need it, then the moral thing to do is not to use it - no matter how many legal loopholes are present.


What you are saying is beautiful and idealistic, but totally not reasonable to carry out in real life regarding the situation for eldercare.
I have lots of experience in this area, and to explain it all, I'd probably need to write a book, but just to explain to you a bit in short:
Should one need 24 hour care (or even 12 hours) and not "use" medicaid, they would need to use up their life's savings, and then their entire meager "income" (ss, 401k etc) which would buy them about a year or two (tops three?) of care and then end up on medicaid anyway for the rest of their life. And once on medicaid how would their meager income cover their daily living expenses? In NY even a big SS income (which most elders do not have) does not begin to cover expenses especially for old age. The children will need to be in debt?
The government knows all that which is why they put these laws in place to protect them! There would be a major problem without this.
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amother
Purple


 

Post Thu, Jul 12 2018, 10:14 am
And just to add to my point above - we are not talking about young working individuals who take advantage of programs illegally.
Talking ONLY about care for the elderly.

There is a reason you wont find LEGAL ways for regular young people to be eligible for all of these things, and why there aren't attorneys to help you receive medicaid, food stamps, section 8 etc by protecting assets and income.
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amother
Forestgreen


 

Post Thu, Jul 12 2018, 10:15 am
I realize I should call an attorney who deals with this, but what happens in a situation where an elderly parent is getting a pension of $4000-$5000 per month? Even if they put their assets elsewhere they still have this money coming in monthly in their own name. Would a person like this be disqualified because they have to much income?
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amother
Purple


 

Post Thu, Jul 12 2018, 10:19 am
amother wrote:
I realize I should call an attorney who deals with this, but what happens in a situation where an elderly parent is getting a pension of $4000-$5000 per month? Even if they put their assets elsewhere they still have this money coming in monthly in their own name. Would a person like this be disqualified because they have to much income?


You create a pooled trust, where the excess income is deposited into. From there you can withdraw money for qualified expenses for the patient. It's called a "Disability Pooled Trust". After 120 if there is any money left in the pooled trust it goes to Medicaid, but as long as the person is alive, he can take out the money for qualified expenses such as food, rent (if applicable) clothing, any medical expenses that are not covered by medicaid (such as extra therapy etc).
It's not an easy process, but you need to weigh how much you would pay for an aide without medicaid, and make a decision as to what will be better.
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amother
Purple


 

Post Thu, Jul 12 2018, 10:21 am
amother wrote:
You create a pooled trust, where the excess income is deposited into. From there you can withdraw money for qualified expenses for the patient. It's called a "Disability Pooled Trust". After 120 if there is any money left in the pooled trust it goes to Medicaid, but as long as the person is alive, he can take out the money for qualified expenses such as food, rent (if applicable) clothing, any medical expenses that are not covered by medicaid (such as extra therapy etc).
It's not an easy process, but you need to weigh how much you would pay for an aide without medicaid, and make a decision as to what will be better.


Are you in NY? If yes I can recommend some.
http://www.wnylc.com/health/entry/4/
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amother
Purple


 

Post Thu, Jul 12 2018, 10:25 am
Also, there are special agencies who help you enroll in medicaid with a pooled trust, as the process is not so simple. Again, if you're in NY, I can recommend such agencies.
Community agencies (Like UJO) would also be able to help.

This is for applying for medicaid with a "Pooled" trust - not for estate planning and trusts for assets. (Thats a trust that your attorney would set up).
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