Everyone wants our money to last as long as we live. That’s a plan financial advisors offer when they can. But it may not work out that way when long-term illness creates a demand for long-term caregiving.

In one case at AgingParents.com running out of money has indeed come to a person still in need of expensive caregiving.  Katy is 84, on hospice and she has around the clock caregiving. Katy’s daughter, Chloe is frightened, as she has put off a decision until the present crisis: Katy is down to her last dollars.

The huge cost of care at home over the past months has depleted all but the last of her cash. Hospice pays for medical and nursing supervision, plus equipment but not for caregivers. That is up to the patient. Chloe describes that her mother has two weeks left of cash to pay for care. “My brother and I don’t know what to do” she says, asking for advice.

We review the facts. Katy is on Medicaid, for which she had to qualify by being low income and having low remaining funds in her account. She owns her home outright. A reverse mortgage might have been a solution, but the lender turned her down. Her late husband had built a second story onto their home, but he didn’t get proper permits. No reverse mortgage.  One can still own a home and qualify for Medicaid but you can’t have a stash of cash on top of that. The need for cash is the problem. Selling the house would result in a mind-boggling tax consequence and no one wants to do that.

In Katy’s state, Medicaid recipients can get limited in-home care paid by the state, but the state sets the rate of pay for workers. It is often too low to get enough steady and qualified workers to do the caregiving job well. Chloe tried that and it was a disaster: irregular workers, incompetence and she just gave up after too much stress.

What is left? Unfortunately for this family there is no choice but a nursing home. Medicaid will pay for that. It’s Chloe’s worst nightmare, having to put her mom, near the end of life, in a nursing home. Of course it would be cheaper for states to pay for full time in-home care than it would be to pay for a nursing home, but there is no logic to our system of care in that regard.

What can we do for Chloe and her brother by way of advice? We can teach them how to wisely choose a nursing home. This should not be a random undertaking.  We can teach them how to be Katy’s advocate, how to hold the nursing home accountable for their mom’s care and safety and how to deal with their own guilt at having to take the step no one wants to take.

Nursing home costs are so high, most people can’t imagine how quickly it can wipe out all one’s savings. When the reality hits, there is no good choice left. It is sad to me that Chloe waited until essentially the last minute to seek advice. Now she is stuck with whatever is available in nursing homes that accept Medicaid, as many do not, particularly for long-term care, rather than short-term rehabilitation. If the search had started about two months earlier, she would have had time to research her options and get the best of the lot. Beds in the better homes are not always available when you want one.

If you foresee yourself in Chloe’s situation, consider getting competent advice before the cash is nearly gone. There are ways to address the need better when a crisis is not happening. At AgingParents.com, we have a booklet How to Choose a Nursing Home with good guidance for anyone. The information and much more is also contained in The Family Guide to Aging Parents, at AgingParents.com (Amazon as well), in print, audio and digital formats. If you think a frail aging parent may run out of money, get your copy today. Looking ahead now can save you a lot of stress!

Carolyn Rosenblatt, RN, Elder law attorney, AgingParents.com

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