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Welcome to CareNotes. In this special section we will feature a reader's letter and provide an opportunity for an interactive exchange that will help find some answers and possible solutions to concerns. If you wish to respond to this letter, simple follow the link provided at the end of the letter and add your comments and thoughts to our CareNotes Board.

This Week's Carenote - 10/16/08
My wife is getting to the point where she will not be able to cope on her own. We were wondering what it is we need to do financially and otherwise to prepare for the day when she has to go to a nursing home. (As much as I try not to think about it, it is inevitable) Our life savings is quickly disappearing  and she is only 46 years old.

I would welcome suggestions from those who have gone through the same experience, or those who might not have gone through it but are familiar with the process.

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Name: Aida
Location: New York
Date: 10/16/2008
Time: 08:34 PM


Don't wait. Run to an elder care lawyer. It will be money well spent. Although when the time comes, the nursing home staff will help you with the applications, you need to have everything in order. In addition, many states have different policies.

Name: Jim
Location: Maryland
Date: 10/16/2008
Time: 11:37 PM


I have been there but my wife had this happen at age 59 following two massive hemorrhagic strokes and subsequent AVM removal. The AVM was located on the left temporal lobe and she lost 70% of her blood both times. You are vague as to the cause which makes it difficult for me to tell if my situation is similar to yours but regardless of the situation I can tell you must, and I stress must, find a good elder care attorney to set up a “special needs trust”. You need this to protect your wife from having Medicaid take all of your assets for her care should she survive you. They have a right to all the assets not protected by this trust, your life insurance, everything. Good private pay, long term care will cost you 9 to 10 thousand dollars a month. You can only apply for Medicaid if your wife is in a nursing home. You cannot pre-apply after researching what homes are available in your area. The home you choose may not have a ‘Medicaid bed” available. Medicaid is a poverty program and you must prove you are in that condition. Now, you get a spousal allowance and they cannot take your home from you. You cannot give assets to your children if there are any now that she has reached the level of health you indicate she is at. Do not believe your friends and family if they tell you to do that because Medicaid can go back 5 to 7 years to check for transfer of assets. If the asset was given 5 to 7 years before she became this ill that is ok. Maybe you already know all of this but believe me unless you or a friend or family member have gone through this process you have no idea what is coming as part of this process if you have to get things ready for the application to Medicaid. There is what is called a “spend down” which you are allowed to do after you make the application. You take all of your assets as of the 1st of the month in which you apply (try to apply early in the month because you only have a month to do this) and total them up except the value of the house that you live in. You then are allowed to spend one half of that sum to pay off taxes, bills, credit cards, etc. buy a newer car, and also set-up financial instruments that are exempt from Medicaid. You must prove you did not give money to a relative. Keep all receipts and records for any transactions. It must be used to pay items off and purchase items that you need to subsist. Fix a leaky basement, etc. There is a list of eligible items for use in this “spend down” process. This is something you need legal and spiritual help doing because it is dissolving half of your life's savings and financial worth just to meet the qualifications for Medicaid. But if you think of it your wife could live for 20 years at the home and you would need $108,000 per year which is over 2 million dollars. So it is the only option for long term care. Any long term care insurance policy you may have will only pay 1 to 200 dollars a day and you will have to pay the remaining $100 dollars a day plus personal things like hair care and settings, TV, Phone, etc. Again, find a “good” elder care attorney. The rules for Medicaid change frequently and a good attorney is hard to find and may cost you some money but it will cost nothing like just one year in a nursing home. God bless you. He did us or I would not be here to tell you this. I hope this helps with your caregiving decision or at least guides you to a compassionate, honest elder care attorney. Jim in Maryland

Name: Jane
Location: Kansas City
Date: 10/17/2008
Time: 06:58 AM


My first suggestion is to contact an attorney who is a specialist is elder law. I realize that your wife is not an elder, but some of the preparation work needed to fund nursing home for her comes from the area of elder law. The attorney can tell you what you need to do to prepare for the time when she may need to have your state Medicaid Program pay for her care. If you are depleting your financial assets now, she may even qualify for Medicaid now. But there are consequences for you, the "community-living spouse," when she enters a nursing home - which is why you need to see and elder law attorney. Check with your start Bar Association for a referral to a specialist or contact the National Academy of Elder Law Attorneys for a listing of lawyers in your area.

Name: April
Location: Carson, CA.
Date: 10/18/2008
Time: 09:16 AM


I am not sure what type of income you have, but disability income from social security. Try and get some type of medical from the state. This will save your pocket. I know that everyone is in a different situation, but I just do not like NURSING HOMES. Most nursing homes have something going on with them. Please check the facilities and go onto this website I can't remember the name but it gives report for the different facilities(nursing homes-hospitals) its free and shows what has been reported and their scores of how well they care for patients. My father was in one for a short time and I did not like what I saw. He was in two different ones. I had to switch due to a medication overdose. PLEASE BE CAREFUL with your decisions. I don't want to sound judgmental. Maybe it is because my father passed recently. I know that you want to do the best for your wife. Take care...



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