I WANT TO tell you a story.
The story is about my mother.
Many of you have heard bits and pieces of this story, because it illustrates some aspects of long-term care, and because I’ve had a number of questions come to me lately that relate to how this can work, I’m going to tell it again.
The point of the story is not my mother.
True, she was an amazing lady in a lot of ways — but she’s long since moved on to better things and wouldn’t mind me telling this part of her story, if it might help someone else.
I know that to be true.
A few things we need to know, on the front end: (a) she was single and lived alone, with the exception of two small, fat dogs, (b) she owned her home (well, OK, the bank owned it, but …), and (c) we had a durable power of attorney.
NOTE: The fact is that some years earlier, as a gift, I’d paid for her to sit with an elder law attorney and re-do her will, durable power of attorney (DPOA) and advance directive. It was not necessary for me to be present at those meetings, as she was quite capable of calling her own shots, thank you very much, but the work was done to her satisfaction, and she gave me copies of the final documents.
Well into her 80s, she drove herself to a local store one day, missed a step and fell, breaking a hip.
It wasn’t anyone’s fault, as she was quick to tell me in the ER, she just missed it.
She was helped by a number of people present, then (of course) the EMTs and ambulance people, which is how she got to the ER.
By the time I got there, she was receiving excellent care and was already scheduled for hip surgery the next day.
She let me know that she wanted to do her post-surgical rehab in a local skilled nursing facility, where she had rehabbed from an unrelated surgery and loved the staff. OK.
The surgery was “textbook,” and off she went to “recovery.”
The clarity of hindsight eventually revealed that, at some point in “recovery,” she suffered a massive right-brain stroke.
The best medical guess was that she had probably been on the brink of said stroke for some time, and the inevitable trauma associated with surgery, anesthesia, etc., was enough to bring it on.
Regardless, there we were.
There are twists and turns here, but the bottom-line was that (a) she would not “rehab back” from this type of stroke, and (b) she would require 24/7 care forever.
Oh, and you need to know that the results of the stroke “mimicked dementia,” in my non-medical opinion.
In other words, she was not able to understand what was going on or make any decisions.
This is where the story becomes relevant for other people.
Because I had a copy of the DPOA, I was able to take it to her doctor the same day, who didn’t hesitate to sign-off that she was incapacitated.
With that document in hand, I was able to transact business on her behalf (pay bills, make deposits/withdrawals, etc.) that afternoon.
That was huge.
She remained in the hospital beyond the mandatory “three overnights,” so there was no question about Medicare paying for 20 days in the chosen nursing home.
In fact, Medicare paid for a decreasing percentage of costs beyond the “20 days” (which is standard operating procedure for Medicare), with my making up the difference out of her finances.
Eventually, we moved to paying 100 percent of the costs out of her relatively meager finances.
And, of course, her Social Security and less-than-impressive pension continued to come in.
Watching the bank balances dwindle, and knowing full well that she would never be able to come back home, it was apparent that Medicaid would have to pick up the costs of her nursing home care, so I set about de-constructing her life.
Turn off every bill that could be turned off (e.g. cable), but keep the power, heat and water on, then start cleaning out the house.
That’s a story all its own, but it came down to: rescue a few mementoes and “special little things” of no substantial dollar-value for myself, find a home for two small, fat and heartbroken dogs (happy ending), haul off/recycle/donate massive amounts of stuff and sell the car.
I was blessed to find a wonderful local gal who took on the job of staging an estate sale (I’m sorry to say that she’s no longer in that business), and it was very successful.
So, that money goes into the bank, because we’re paying for the nursing home, remember?
Of course, the balance in that checkbook was getting very low, so I did two things simultaneously: (1) I put the house on the market for fair market value, and (2) I submitted an application for Medicaid.
Because the house was on the market for fair market value, it didn’t pose a problem for Medicaid eligibility.
(NOTE: If I’d listed it too high or too low, it might have been a problem, but I didn’t, so it wasn’t.)
In the meantime, Medicaid kicked in and was paying 100 percent of her nursing home bill.
The house eventually sold.
When it did, I reported it to the financial worker (let’s just say, “Medicaid”) who correctly classified that money as “income,” which made her ineligible for Medicaid, so we continued on, paying 100 percent of the nursing home bill ourselves, out of those proceeds.
When I could see that we were getting close to “not enough,” I reapplied for Medicaid on her behalf.
There was no issue regarding her eligibility, which kicked in almost immediately, and paid 100 percent of her nursing home costs, for another almost two years, until she moved on to better things.
Upon her death, I immediately reported it to Medicaid.
Because she no longer had an “estate” (we used everything to pay for her care, remember?), there was no question about “estate recovery,” known colloquially as “… the state will take the house,” so that was that for that.
Obviously, I’ve spared you the emotional aspects of all this, as they don’t make you smarter.
And, certainly, there are some aspects of this story that are peculiar to her situation, so maybe I’ll call out a few of those next week, but the point for now is for you to see how it all might work in similar circumstances.
Yes, it was a crazy time, and yes, it got complicated. But it was doable.
And, believe me, Medicaid was not the problem. It was the solution.
More next week.
Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing [email protected].