Who Cares What Nansi Thinks?

Make no mistake about it, putting your loved one in a nursing home is the hardest thing you'll ever do. I've sat with tearful and stressed out families who try to comfort themselves with "it could be worse, I could be sitting in a funeral home..." But the truth is, planning a nursing home stay is much more painful and stressful than planning a funeral.

There are so many things to consider. How will the facility be paid? What level of care will be required? How will we tell mom or dad???

If you have an elderly parent who is NOT in a nursing home there are things you can do now to prepare the way. First of all, forget about buying Mom's house for a dollar unless you're sure it'll be at least five years before she needs skilled care. The new "look back" period for federal funding has gone from three years to five years. When a Medicaid application is made, any transfer of property must have been done at "fair market value". The difference between "fair market value" and what you actually paid for the property will be considered as a period of ineligibility for coverage.

Very few people have the means to pay for nursing home care. Our nursing home costs nearly $6,000 per month. PER MONTH. That doesn't include things like hair cuts, therapies, etc. My nursing home has about 175 people in it at any given time. Fully one hundred of them are on Medicaid. Ten of those people are on a VA (Veterans Administration) contract. Two or three are private pay. The rest are in their 100 days of Medicare coverage and are just weeks away from needing Medicaid.

Medicare pays 100% of skilled nursing home for 20 days. After that, a daily co-payment is expected in the amount of about $125 (depending upon the area) for the next 80 days. Then it's over. There's no more coverage. That 100 days is dependent upon the patient's condition and at least three days stay in a hospital prior to admission in the nursing home. As long as they are getting therapies and are improving, Medicare pays. But if their condition deteriorates or stagnates, their nursing home need is considered "custodial" and is therefore not covered. And that "custodial" determination can come as early as Day #2. Don't think "Medicare supplement" will cover after that 100 days. They don't. They pay as long as Medicare is paying. And if it's Federal Blue Cross, they only pay 9 days. Day 21-30.

That being said, there are five things you should do while your loved one is still capable of making decisions for themselves.

1) Look into long term care insurance. (If you can't do it for your elderly loved one, do it for yourself. Do it for yourself anyway!) LTC insurance usually covers for about three years. Right now most of them pay you directly and don't assign the benefit to the nursing home. Nursing homes aren't too helpful in filing claims when they won't get the check directly. This is something to discuss with the broker when you sign on. It saves a lot of time if you can "assign the benefit" to be paid to the facility.

2) Get a power of attorney. You can set it up so that it only comes into effect when the loved one is unable to make decisions for themselves. Sometimes POA's frighten the elderly because they think they'll lose control of their lives if they enter into a Power of Attorney situation.

3) Set up a living will. When it's done, forward a copy to your loved one's physician so that they can have it on file along with the medical records.

4) Streamline the bank accounts. There should only be one checking and one savings account. Obviously there may be CD's, IRA's, trusts, etc. But for day-to-day managing, the fewer checking accounts, the better. Impress upon your loved one to always have about a year's worth of statements on hand for every account they have.

5) Establish an irrevocable burial trust. All funeral homes in the United States are familiar with this kind of transaction and can advise you on how to set this up. These trusts are protected assets and cannot be considered in a Medicaid application. Your loved one may already have a life insurance policy that can be rolled into an irrevocable burial trust at little or no cost to you.

One more thing, have an honest and frank discussion with your loved one about long term care. Don't promise never to "stick them in a nursing home". With the advances of modern medicine, the chances are very slim that your loved one won't require long term care. By not making that promise, you will save yourself a lot of heartache in the long run.

I hope as you read my blog, you come to the conclusion that I have a calling in my life to care for the elderly. I'm not special. I work with a whole crew of people who care as much as I do, if not more. We love our residents dearly. We listen. We share our lives with them. We hold up their loved ones when they feel discouraged or guilty. We grieve at their passing. Going to a nursing home isn't a jail sentence.

In our home we do some really great things. There are church services of all sorts several times a week. We have a "breakfast club" of residents who love to go out for breakfast. We take Red Lobster trips. My own mom organized a "cookies for the troops" project where the residents followed desert-friendly recipes and packed care packages to be sent to Iraq. On Halloween, we asked the families to donate candy and opened the nursing home to local children for a safe trick-or-treat night. Everyone had a GREAT time. My mom's favorite time of day is "Morning Coffee and News". Every day our kitchen prepares coffee, tea, and cocoa along with scones or muffins. Someone reads the newspaper and they discuss current events.

I can honestly say that my mom's life is greatly improved since she's gone to a nursing home. She used to sit alone for days on end with very little contact with the outside world. Now she's made friendships, she gets balanced meals, and nursing attention.

So while putting your loved one into a nursing facility may be the hardest thing you ever do, it may also be the kindest thing you'll ever do. God bless you as you make this journey.