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Old 09-17-2011, 02:43 AM   #1
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worried

Hi Again,
Ok as I posted yesterday husband has alot of aggression when I dropped him off at the center yesterday the aggression really came out. But he calmed down so I went to work for only two hours. They could not control him and worried about the safety for others. The center also told me they thought he should not come Monday either the appt is Tuesday. Then I get a call from the center that I will be getting a 30 day discharge letter if the new meds do not work. If they new meds do help him they will let him keep coming. I know I am looking ahead but then it would be time for a nursing home as I need to work and I do not have the energy or finances to take care of him 24/7. The other question is who pays for a nursing home as we have a house together. At this point I just want what is best for him as I know I can not live with the aggression. I guess the best thing for me would be to go day by day. See what happens with the appt on Tuesday and go from there. I hoping it is not going to be a long 4 days with him. Maybe this situation seems a lot worse to be as I have a bad cold and cough. As I am sure many of you know hard to get a good nights sleep with a person with dementia. Thanks for listening.

 
Old 09-17-2011, 05:21 AM   #2
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Re: worried

Quote:
Originally Posted by Chris OB View Post
Hi Again,
Ok as I posted yesterday husband has alot of aggression when I dropped him off at the center yesterday the aggression really came out. But he calmed down so I went to work for only two hours. They could not control him and worried about the safety for others. The center also told me they thought he should not come Monday either the appt is Tuesday. Then I get a call from the center that I will be getting a 30 day discharge letter if the new meds do not work. If they new meds do help him they will let him keep coming. I know I am looking ahead but then it would be time for a nursing home as I need to work and I do not have the energy or finances to take care of him 24/7. The other question is who pays for a nursing home as we have a house together. At this point I just want what is best for him as I know I can not live with the aggression. I guess the best thing for me would be to go day by day. See what happens with the appt on Tuesday and go from there. I hoping it is not going to be a long 4 days with him. Maybe this situation seems a lot worse to be as I have a bad cold and cough. As I am sure many of you know hard to get a good nights sleep with a person with dementia. Thanks for listening.

 
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Old 09-17-2011, 05:30 AM   #3
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Re: worried

Hi Worried---Im just writing to say I`m sorry things are so rough for you at the moment---sometimes we just don`t see a solution in sight.We can only take one day at a time,who knows how tomorrow turns out.It`s worse when you are feeling physically down and you have to worry about someone else allthe time and maybe finances as well.I do hope the new meds work for your husband and he can stay.I`ve just moaned in another thread because the weather is horrible and it seems to affect my husban`s moods.Now,reading your post,I really feel silly and should really count my blessings.He`s not aggressive,at least not yet.I`m sending you love and hugs and strenght to get through today.You are not alone

 
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Old 09-17-2011, 08:34 AM   #4
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Re: worried

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Originally Posted by Chris OB View Post
The other question is who pays for a nursing home as we have a house together. At this point I just want what is best for him as I know I can not live with the aggression. I guess the best thing for me would be to go day by day. .
Hi Chris,

I am so sorry the med does not work right away. For my FIL, they had to increase the dosage in a week and then it worked out better. Now my FIL is stable and not as combative. Certainly he declines a little bit in talking but at least the home can help him.
So definitely your husband may have some medication dosage issue. There are many drugs available so I am sure there are some but the day care center has to protect themselves. Maybe for a short time, you could get a part-time helper to watch him so you can work.

About nursing home, it does not matter who pays it. Usually if he has enough money or some pension, he can pay for it. Since you must be his POA, you are the one that makes the decision. I heard that he may apply for medicaid if he is poor enough and one house with you living there may not be the issue.
My FIL has enough pension and investment to pay for it. It is still expensive. It is unfortunate that his money earned is now meant for his nursing home and Alzheimer's care...

The nursing home will ask you about his financial background and how the family can support him. They would ask how much is the house and how much income and etc. At first you could pay it out of his/your pocket and then as money runs out, you may apply for medicaid but this needs a little bit of time waiting like 3 years of being poor and so on. (Please check with social security about the exact rules for your state.)

Also, make sure you find a nursing home that is for dementia or a memory unit - a confined area where the residents can enjoy the activities and peers given dementia-friendly caregivers/facility.

Chris, I am sorry that you also have bad cold. It is the change of the season. I think this affects my FIL too. So maybe your husband was affected by the change as well. If he has a one-on-one caregiver with him, he/she could help calm him down.

Take care,
Nina

Last edited by ninamarc; 09-17-2011 at 08:42 AM.

 
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Old 09-17-2011, 05:39 PM   #5
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Re: worried

In my opinion, you need to see an elder lawyer. Bring a list of your bank accounts and assets. Some elder lawyers have a checklist that they will give you before the consultation, so you can fill in things like cars, home value (and mortgage), rental properties, bank accounts, etc. You will need to know all of your finances, including how much social security your husband receives, whether he has life insurance with a cash value and if you have prepaid burial plans. You will have to identify whether your husband will be Medicaid eligible immediately, or if you have assets that need to be counted, divided to give you a spousal share, and then spent down.

Some assets are not counted when dividing the assets in half. For example, in some states they will not count your 401K account although they will count his retirement savings. They will not count one car, or the house under certain circumstances, or prepaid burial plans. If you have two cars, they will value the second car and include it as an asset. Countable assets include life insurance policies, but will not count personal items such as clothing, jewelry or furniture. Even though they may not count an asset like the house, you will still have to make disclosures about it.

After they count all of the countable assets, they allow the spouse to keep half of the countable assets up to a specified amount. I believe the spouse's half is capped at about $109,500., but you need to verify this with the elder lawyer.

Your spouse's half has to be spent for his care as of the date of nursing home admission. However, you are also allowed to spend his half on certain other joint obligations like your joint credit cards and mortgage. The timing of this "spend down" is critical. If you spend-down before his date of admission, you are just reducing your countable assets and your own spousal share.

You need to confirm with the lawyer when the "snapshot" date will be, for purposes of identifying the assets and your spousal share.

You can apply for Medicare as soon as his share is spent down. In our case, the lawyer was able to have all of the paperwork ready to file the month after his admission, since our spend-down was planned with the attorney.

You will need to collect lots of paperwork for the application -- everything from copies of deeds, funeral plots, titles, copies of all bank statements for several years, etc. This is a really big job, and locating documents can take awhile. I also had to prepare a log of all checks that were in excess of $500 to show where that money went, and a log of all income that wasn't salary or Social Security. My lawyer submitted this log as part of my application.

You need to have someone explaining your state's rules, and working on your behalf. The nursing home offered to help me with the Medicaid application when our assets were spent down, but they did NOT tell me about my right to keep a spousal share. Fortunately, I had been working with a lawyer and knew what I was going to be allowed to keep. If I had listened to the NH, I would have lost my spousal share! I'm sure many nursing homes are more honest, but they don't provide spouses with legal advice and their interest is in getting private pay as long as possible.

Once your spouse's share of assets are spent down and the Medicaid application is filed, you have to pay your husband's social security (and long-term disability income, if any) to the NH, less any amount that is used to pay for his health insurance and a tiny monthly allowance for his personal needs. There is a formula that is used to determine if you're allowed to keep some of his social security money for your own support. It's based on your income, and I'm not sure how that formula is applied. You will be allowed to keep your own wages.

It takes several months for the Medicaid application to be processed. During this time, the NH may still bill you for the full amount of your husband's care. When the Medicaid application is approved, Medicare pays the amount that is due back to the date that the application was filed. The lawyer warned that it is important to continue to pay the Social Security part of the payment during this period.

An application can be denied or additional information may be requested. Using a lawyer might help to ensure that the application is submitted correctly the first time. I paid a few thousand dollars for a lawyer to do the application for me, but I collected the paperwork and did some of the other work for the application myself. It took approximately six months for my application to be approved. Now I file annual updates confirming that DH's financial condition has not changed, that he doesn't have any new assets or income, and that I still live in the house.

Finding a NH was another issue. We were on waiting lists for several NHs. When DH's day care center said that they couldn't handle him anymore, it still looked like we were going to be on the waiting lists for months. DH was admitted to a hospital for various tests by our primary care physician. (A patient being released from a hospital has priority over waiting lists.) The hospital social worker started calling NHs to find a bed for DH. Our financial information and DH's medical information was faxed to some of them. He was ultimately admitted after 2 days, as a private-pay patient by one of the NHs where we had been on a wait list. If he had been Medicaid eligible immediately upon admission, it might have been a little harder to find a NH with Medicaid beds open.

This is really general information, but you will find that each state is going to have some differences -- especially in calculating the countable assets and exemptions. I'm sure that some people do this themselves, but it's very stressful. I honestly do recommend finding someone to help you with the process.

Last edited by Beginning; 09-17-2011 at 05:50 PM.

 
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Old 09-18-2011, 09:09 AM   #6
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Re: worried

Hi Chris -

Sorry for the difficult time you're going through Beginning did a great job of outlining what needs to be done. I just wanted to second the recommendation that you find a good elder law attorney. Make sure elder law is their specialty.

Although I did the medicaid application myself, it was after consulting an elder law attorney and knowing everything I needed ahead of time to get my stepdad on medicaid. I'm thinking of you and sending you hugs & strength - this is one heck-of-a-journey we're on........

 
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