AnnMW1157 You need to talk to your husbands Physician, if you are wanting to place him in Long Term Care Nursing Home then it is the Doctor who will need to fill out an FL2 form, this is a form stating what type of care your husband needs, this tells the nursing home the level of care he will need, the Doctor will know if he needs to go to a Nursing home and what level. You need to find the nursing home, have the doctor send the form to them and place him.
If you want community Medicaid then you will not qualify because of your resources as you have been told. If you need long term care nursing home then the nursing home will help you after your Doctor fills out the proper form.
Unless your husband has a medical reason or needs to be placed in the hospital for medication adjustment then you will just have to place your husband straight into the Nursing Home after the Doctor signs the FL2 form and the Nursing Home has a bed, then proceed to apply for Medicaid. You will qualify for the Medicaid after he is placed if your resources are what you describe to us here on the forum. Forget the Choice for Care it is not what you need if you want him placed long term now.
There is really nothing else to do from this point that I can see.
Thank you, Jane. No one has ever mentioned this before.....Both his neurologist and primary care have said he needs nursing home care, but every social worker has told me it had to be through Choices for Care. I've never done this before, not even with my parents. They never were in a nursing home and I was their caregiver. I was with them when they died. Most likely it is my fault. I insisted on caring for them and did the same with my husband. However, the time has come (and gone) for help. I really felt as if I was doing the right thing........looking, but not jumping into the NH situation yet. Obviously I was very good at covering for him and continue to smile.
My parents both died due to cancer and they were being treated. But, as you know, AD is a whole different ballgame.
Look forward to hearin from you again. You must be the only person on Earth who understands these laws!
Ann, Do a google search for the choice of care, I don't know why I did not do that before now. It looks like Vermont is one of a very few States trying to limit people from getting long term nursing home care. It will explain every thing to you.
Jane--Isn't Choices for Care a version of Medicaid Waiver? As I understand it, the waiver was implemented to encourage people to stay in the home and receive care there. It sounds like a good concept, but the qualifications are so strict and in our state there is a huge waiting list. I've known very few who have qualified.
I did meet in the "big" city today and I was told to start the Choices For Care process again........No one seems to know about the FL2 form......Do you have any information on how I might find it, or is it state by state. I did find it in NC.
I've also done the Choices for Care search and my husband went through the process last August. I agree. They are trying to limit the LTC. I was told that some NH will admit someone before approval........Doing a search for that now. Just hate to move him 2 times.
MarylininMD Yes, Choice of Care is a Medicaid waiver, it seems that Vermont has enforced that and in order to qualify for even Long Term Care they have to go through the Choice of Care FIRST, It is appearing to me that Choice of Care makes the decision about long term care.
I tried to post a link but it did not take. When you google Choice of Care it is appearing to me that Vermont is requiring people to go through this system first. I cannot understand this system, looks like it is required but yet no one would qualify. If this were me I get a letter from my Doctor stating the level of need and then straight to the Governor's office for help.
http://dail.vermont.gov/dail-statutes/statutes-ddas-cfc-documents/cfc-regulations CFC choice for care regulations and criteria info..
according to what i read dementia related illness is listed at HIGHEST tiered for eligibility for this program but fianancial criteria may be what is in question as far as Ann goes. Ann there seems to also be long 'waiting lists' that you must get on as well if there isnt an immediate approval.
i think if it were me, i'd be looking for a free or paid if necessary consultation with a medicare/medicaide certified elder law atty Ann, and see if you can get someone to help you find a way thru this maze and speed up the process for you. its seeming to be a very long waity process to get thru and verify that you are eligible. if you can find an atty who would offer his services you may have a better and faster run at eligibility. if you have a trial lawyers assoc in the largest city near you they almost always have a source for finding you an atty pro bono (who will do it for free) to advise you.
Thank goodness I'm not the only one to find this confusing! Now I'm wondering if anyone has even been approved for CFC. I was told it was such a WONDERFUL program too!
divvi.........I live in Vermont....We don't have anything even close to a city. Senator Patrick Leahy's office is working on finding an attorney Pro Bono and am expecting a call tomorrow from an attorney from Legal Aid who specializes in LTC. It is unlikely we will qualify for Legal Aid, but it is worth any information I might learn!
My husband is on the waiting list for several nursing homes. I can't imagine how anyone else is paying for this. Any private payer would tend to go to the trendy areas of Vermont, not our little town.
I have asked the doctor about the form stating that he recommends NH care. No one knows about this one either. The only way for this is the 3 day hospital stay........I was just told what I already knew......Should my husband ever be admitted again, do not let him leave after 2.5 days!
divvi, I also read that Dementia related is rated at highest level but if I am reading things correctly, Vermont with the Medicaid Waiver is trying to limit Nursing home care, you have to jump through hoops to even be selected. It would not surprise me one bit if that is the trend a lot of States will take. With the new budget they will be doing an overhaul of the Medicare and Medicaid system as we now know it.
I agree with you, Elder Law Attorney versed in the Medicaid laws would be the way Ann should go but most likely she will run into this until her husbands long term disability insurance checks run out. 13 more months Ann if you can wait it out.
yes i agree Jane. if other states follow suit we are in trouble with AD spouses. limiting isnt the word, and yes jumping thru hoops and hoping you lose interest due to all the red tape. :(
i agree Ann once your disability runs out you need to have your ducks in a row. and get as much help as you can get from atty. to know how to proceed. mess is right.
divvi, In the new budget discussions Waiver is exactly what is being discussed. With the Medicaid Waiver it allows the states to establish their own rules for eligibility and benefits, in other words Medicaid will cease to be a government program and be a strictly State program. Right now States are allowed to set SOME of their own rules as long as they are inside the main Federal rules but with the Waiver that will no longer be true. The States are allowed their own rules and do not have to follow government guidelines.
I am most sure in the 2012 budget we will be dealing with that. Lets all hope that the Mandatory spending will rule over the discretionary spending. I do think the way of Medicaid payment for Long Term Care is nearing the end as we now know it. Makes you wonder if a person who is already placed will be kicked out or be grandfathered in under the new spending rules.
We better hunker down and know that we won't have much of an option for placement unless we are truly destitute.
Vermont seems to be an example of how it will be for most of us soon.
from most new rulings and how things USUALLY are treated, they would most likely be grandfathered -but maybe for a limited time. good gosh. this is going to be really important issues for anyone trying to place under medicaid /and or medicare under state controls if it happens. ann from vermont is a good example. it could possibly mean folks moving to another state to become residents to quallify for better programs... wow. will be interesting to follow. and yes we know they want to reduce medicaid/medicare by billions. divvi
Oh divvi.......I certainly have thought of moving to another state more than once!
Jane.....Thank you for putting this language that we can understand! I would love to copy your statement and send it to my brother-in-law who has always said I was doing everything wrong......THAT won't change, but he is insisiting that Vermont medcaid cannot be any different from KY because it is a federal plan.
Let's hope that those already in care are granfathered!
ann may not be a bad move at some point. get him residenced and placed under medicaid with easier restrictions, in a neighboring state before anything could change. sounds like there isnt much to lose if you dont get some needed help soon. divvi
I have finally received some hopefully news through the attorney. I'll explain more later.......But, a bit a hope is very nice.
Jane.........Just wondering if you know the answer to this....Is the spousal allocation with medicaid based on income or housing expensenses? I'm asking because we MAY be able to refi the house under the Obama plan. If so, it may be the same as renting. However, I'm not sure of the timing or would it not have anything to do with medicaid?
I also wasn't sure about Life Insurance policies.....I had read that the ownership should be changed, but didn't really understand it. Certainly it isn't a lot of money, but would that be in the 5 year look-back if it is changed to the spouse as owner?
After another night of 3 hours of sleep, I have decided the exhaustion has outweighed the fear, I am confident my respite will turn into placement. Thanks for your advice and discussion here and say a prayer for me if you can that it all works out.
dog--it sounds like you are making the right choice. Lack of sleep/exhaustion would be my line in the sand too. I think later on you will look back and see you made the right decision. Please keep us posted.
dog, I have just went through the placement proccess and can tell you it is the hardest thing I have ever done in my life. I am sitting on 4 days since and still have a hard time even being in our house. It's hard to even imagine why I placed my DW now just this short time ago. The financial troubles for me are huge since I just got another monthly bill for her care plus all of our regular stuff. I at least had my sons and Brother here to mourn with and it helped. What you said about exhaustion I know to well, the sleepless nlghts and troublesome days. I believe this is what brought me to the brink and our Dr's saw it and responded to save me from myself. Please know that my prayers are with you and all of us as we continue on this dreadfull journey.
I have been reading this conversation with interest.. When we met with our elder care attorney and she went over our assets it seems because of my dh's income from his retired military pay we would never qualify for medicaid..if we end up needing the nh it would be private pay. As I see it this would take nearly all his income. I have my own smaller retired pay. Our house is paid for and we have no big debts other than our usual bills.. Our house is in both our names as are the cars and bank accounts. I have no problems with him as regards the banking issues, he is only too happy for me to take care of all of this sort of things including taxes!
Is there any reason I should have the house put in my name only? I have 3 step kids by the way and they do not give me any problems and I hope they never will. I will be meeting with our attorney soon as we are updating our trust. I would appreciate insight and perhaps this will lead me to asking the questions of her.
Quick update. DH did well at respite care. They now have an opening, which I am tempted to take, as they don't get many. Chest pains from stress and lack of sleep have been a motivator. The place is a better environment and cheaper than a nusing home. It is 5 miles away and has other EOAD male residents. I am thinking I will see how it goes for a few months, as I re-evaluate my whole sitation. My daycare has been very good while I am at work, but it isn't enough any more with DH's late stage 6 traits.
L. has been in a nursing home for more than a week now and he seems adjusted comfortably. I stop by every day for an hour or so. It's convenient for me, about ten minutes away and near shops I frequent. we had a meeting where I tried to convince them that he yells no matter what, that it doesn't necessarily mean he's in pain. The hospice nurse we have had for a year, an imposing man who likes L and me, confirmed this to them. So they are going to try to get him up more. Apparently since he's on hospice the default is to not cause any pain, but leaving him to lie in bed with nothing to watch, even his beloved TV, isnt being kind. So they are upping the Ativan and agreed to get him up! Well see. This is a good place and I like the people there, it's just getting him settled in. And getting the Medicaid application filled out. What a pain that is!
But I must say I am NOT tearful or sad, just relieved. It's been a long haul up to now. One of the nurses asked how long have you been taking care of your husband? I said fifty five years. And quite Honestly I need a rest.
briegull its good news to hear L is adapting so well. and yes what a relief it must be. cant you bring a small tv for his room for him to watch in bed? that would be bad if they are used to watching it. mine likes to watch it too from his hospital bed. i hope things continue on a positive note! divvi
dog, So glad that respite went well. and that there is an opening available. It best to do it while you are in the "zone". Your health is important and you can't do anything if you are sick.
briegull, You and I are going down the same road right now. I just had to place my husband last week. It is a very heartbreaking process. I also am going through the Medicaid application and the grand and glorious Spend down. My husband does not even know he is in a facility, we will begin our 12th year in November and he declined to the point I could no longer care for him at home. Hospice is still with us and is also seeing him in the Nursing Home. It really means even more with them in the Nursing home than it did here at home as there are more eyes and ears to look after him.
Don't worry briegull, the Medicaid process is lengthy and a lot of paper work, did I say a lot, that is an understatement. I am going the Annuity route and it is working out just like I had thought it would. Good Luck with the application process.
Jane, I've heard of "annuity route," but don't understand exactly how it works. Would you explain, please. My-email is in my profile if you'd like to answer there. If explanation would benefit folks here, answer here. Appreciate your knowledge and experience and KNOW you're not an attorney or "certified advice giver."
Jane, I'm sure the decision to place him was difficult, but as divi says, you've made a good journey and taken care of him so well. I am one who would also benefit understandin the "annuity route". My email is in my profile, or if you could, please post the explanation here.
Jane, Briegull and Dog, you have all done everything possible to keep them at home as long as you could, and now you have taken the next step, for their sakes and your own. May you get rest, recover, and continue to caregive from your heart, knowing you have done all you can.
Zibby, Dog, and LFL, The Medicaid Annuity is allowed in MOST States, it will depend on where you live and many things regarding your assets, it is not an Annuity that you just go out and buy from any Insurance Agency. It has to be timed exactly right so the payments will not drop in too fast and put you back over the spend down limit, it has to pay out in your life tables. In my case my life tables are 16 years but I am having the Annuity pay all back within 18 months so as to get it back under my own account and control. It is a method of moving countable assets to non countable assets and unless you are very well versed in Medicaid you should not attempt this without the guidance of a Certified Elder Law Attorney. You want one who is certified in Medicaid and who knows the rules.
It can save your life savings as it is doing so in my case but it is not something you can do without the help of a good Elder Law Attorney.
Anyone with more than $21,000 in the bank should see an Elder Law Attorney before applying for Medicaid.
So many have recently placed there loved ones in a facility. I did, too, on March 4, 2011. I hope things go as well for all of you, as it has for my DH.
There were pitfalls and learning and issues here and there, but he is thriving and the staff CARE! I am thrilled and rarely feel guilty. Just really lonely.
My best wishes to all of you on this next road we are on.
Many thanks, Jane. My elder law attorney had mentioned an annuity (special name) but I didn't jot down all he said. I have an annuity; so wasn't sure if it would work. Doesn't. He said to wait until hb was actually in a facility. I didn't know it could be paid out so soon, either. I talked w/the man who has my annuity and he hadn't heard of what I was talking about--medicaid annuity. Another reason to consult a certified elder law attorney. I'm hoping to hold off placement for a year and am trying to gather info, even tho' it could change.
I decided not to do an annuity. It would have had to stretch oUt my whole life expectancy as I understand it. I also decided not to get a new car. I am keeping my ten year old Outback but having it tuned up etc within an inch of it's life. I am seventy five and can't imagine that I'll want to continue to drive too many more years.
Our house is old. It is two story with full basement and full attic and I want to eventually sell it and move to a one story! It has knob and tube wiring in most of it though the kitchen and dining room where the computer is have been updated. I asked a friend who is a real estate agent to look it over and tell me what the best place to spend some money on it would be. She said upgrade the wiring. So if I have enough money that's what I will do. It's in my name and I'm in no hurry to move, but that is where the spend down will go.
Divvi, l. Does have a tv and they are good about turning it on for him and he still enjoys watching it. They have gotten him up the last couple of days but he fights them when they try to dress him so he ends up with a Johnny on and a diaper and a sheet, sitting in a Geri chair. Not sure what to do about that. He has plenty of clothes there.
briegull, The Annuity does have to go no longer than your life expectancy but that does not mean it has to stretch out the whole time, my life expectancy is 16 years but we are having the annuity pay out in 18 months and it is a large annuity with a large monthly payment not a small amount at all. If you have a good Elder Law Attorney experienced in these types of Annuity you can have a very short pay out back to you and then once all the funds are paid back it is no longer considered income to you, this money can be left in your bank account and then you can possibly be deemed funds from your husbands account. It is a win win for most anyone who is not still working and drawing more than $21,000 per year income from their own earnings. This way you still have the nest egg you worked for all your life and also extra income from his funds that they will allow you. Just remember, money you have in the bank once he is qualified is not considered income, after the annuity does the final payout it is no longer income. The shorter the Annuity payout the best.
We really didn't have enough left in his half to make the annuity worth it, Jane. I'm drawing just about $21,000/yr from my own pensions and may get some allowance from the state for a bit more.. but there are definitely things I need to do with the house before trying to sell it AFTER. And I won't have the money again, so might as well do it now. He's 86; I think your husband is a good bit younger.
As I mentioned, his hip crumbled, apparently. What happened with your husband - or was it just the forever nature of it all? Which is enough, in my book!