Who'll look after you?

"Who will take care of you when you are old?"
My gun.

"It truly is the one commonality that every designation of humans you can think of has, there's at least one asshole."
--Me

Thanks k-man, I am glad you spelled out the facts because I haven't personally had to go through this yet and hope I don't, but I wouldn't want to break any laws or make things worse. I have known people who have been through it though and what I posted is exactly what some of them did, so I guess they just didn't get caught. They didn't do it a week before though, probably more like a year or two. The ones who didn't watched all of their parents assets get liquidated by the state. Maybe there was more to their stories than they shared. Anyway, thanks for posting some important facts.

One recent change to the Medicaid lookback rule is that it is 5 years from the date of application, not the date of actual enrollment. This makes it a little harder to to manipulate assets.

I do take issue a little with the "look poor" at the end of k-man's otherwise fine post. Someone who lives responsibly and saves for his future (and hopes to leave it to his loved ones) will see his savings get wiped out quickly by a nursing home or assisted living facility while someone else who spends money foolishly and recklessly (perhaps on his loved ones, perhaps not) and "makes" himself poor earlier in life will end up on Medicaid later and get his nursing home or assisted living costs paid for by the state. It seems like the responsible person is punished for living right and doing right while the poorer fool is "rewarded" for his foolishness. I don't fault those who did the right thing throughout their lives from trying to "game" the system and its perverse incentives to retain their rewards.

DeeGee, I agree with you about the conundrum. This does hit working- and middle-class families hardest, especially those who did try to save and do the right thing. All I can do is to emphasize the risk that without such enforcement, Medicaid will collapse and cease to be there at all.

But there were several cases that recently came to light about millionaire couples gaming the system. Some states allowed one spouse to get away with simply refusing to provide funds for nursing home expenses for the other spouse, and not much could be done about it if the state did not press the issue. New York state decided to do so and slammed several millionaires who had refused in this manner with bills and court judgements for what Medicaid had paid for their spouses' expenses. Ironically, usually the amounts were a small fraction of the couples' total assets because the institutionalized spouse was bad off and died soon after going in the nursing home—say, $20,000 in expenses when the other spouse was worth several million dollars. That kind of crap is what has led to the extremely punitive changes in rules we have now.

"The average nursing home costs$70,080 per year, or $192 per day, according to the 2004 MetLife Market Survey of Nursing Home and Home Care planning and housing finder - from the Alzheimer's Association.
www.alz.org/caresource... The highest being Alaska at $204,765 per year, or $561 per day, on average. The lowest rates were found in Shreveport, La., at $36,135 per year"


At these prices, I would say that an average middle class or even someone in a higher income bracket who managed to amass a million or so in assets would be wiped out pretty fast. This of course is only basic care and doesn't count additional medical treatments or care. I do not think it's fair for someone who has saved and invested their entire lives and worth perhaps a million dollars at the time of admission, to receive the exact same care as the lifetime welfare recipient in the next room and be wiped out financially. I am glad all of this is coming to light because it just makes me realize that financial steps must be taken early on, well before there is any indication of an impending nursing home stay, to make my parents appear "poor". They are only 64 and 67, but my father has a lot of health problems and is a likely candidate for a nursing home or perhaps an assisted living facility at least in the next ten-fifteen years, if not sooner.

It would make me sick to my stomach that my healthy, but elderly mother would have to liquidate ALL of their assets and live like a pauper should ( or when) it came to that, after my father has worked, saved, and invested (still does) his entire life so that if anything should happen to him she would not have to worry. He has amassed a pretty healthy financial portfolio, but at those prices his hard earned money likely wouldn't last more than a year or two, ESPECIALLY since a great deal of his assets are tied up in real estate. I am sure they would liquidate all of that at estate sale prices below market value, so there would be no more rental income, forced to sell out his share of his business, THAT residual income gone up a wild hog's ass, and then forced to sell their house, so no where to live, and wipe out bank accounts, etc....I do NOT think it's fair for my mother to have to live on a meager SS check in some flop house at 70+/- years of age, when she SHOULD be enjoying the fruits of their YEARS of labor. I absolutely will not let that happen, now that I know about how it works.