Anticipating expenses in long term care facility advice needed. What expenses should I be expecting?

I advise spending down his assets with a pre-paid funeral. I just pre-paid cremation services for my MIL on Medicaid here in MN (but she gets to keep $120 a month).

We also pay for salon services, cable and phone, and clothing. When we visit her we call and ask if there's any special foods or treats she'd like and we buy that for her. We also use her funds to purchase a supplement for her to prevent UTIs, and to "tip" the staff on special occasions. Sometimes they have special dinner events and her funds pay for us to attend that with her. She is 100% immobile and has mild dementia and short-term memory impairment. She got 2 govt covid payments so her bank account swelled up but honestly has no where to go since there's really nothing else she needs. Medicaid paid for a very fancy wheelchair with a higher back and side supports because she leans to one side and has chronic back pain.

I would wait for him to be in and on Medicaid for a few months before over-thinking it. You've done a good job figuring it out to this point. My MIL is basically healthy 88-yr old, just cognitely impaired and refused to get out bed anymore. But your Uncle may be more able to do things than my MIL, or have different needs.

He will get a Personal needs fund if you allow the NH to be payee of his SS and any pension. By doing this for my Mom, I did not have to write a check monthly. If u do write checks, you will be able to put a small amount of money aside for his personal needs. In my State, its $50 monthly.

Other than clothing there is not much he will need. His toiletries will be provided. As will his Depends. Not sure if I would do the gift card thing. I would check with a Medicaid caseworker.

I’m with JoAnne and do NOT do the gift cards.
Geaton is spot on with her take on all this.

But what you can do is for every Care Plan meeting is request that someone from billing is in attendance. Normally they are not, it’s nursing, dietary, activities, social work, maybe PT/OT. But billing would be good as they can let you know what’s what and with input from the other teams as to where they see things he could need and that you can buy or they can order and either way you pay for it.

CPMs are required by Medicare. First one will be pretty soon after he officially enters as a custodial care resident. Afterwards they are every 90 days and you can do them via Zoom or just a on speaker phone call. Or have it set for a time to be when in person works for you. SW usually coordinate these. Fwiw I went to maybe 2/3 of my moms in person as I live in another State. And for these, I took in a snack (muffins, clementines, sm apples, sleeves of kids birthday party ice cream), after the first time I did this, nobody missed showing up for moms CPMs. They went from 15/20 minutes to 45-1hr. Anything extra went to the DONs office aka the Director of Nursing who is the goddess and ruler at the NH. Just sayin’…..

Some things to consider. Yes, as others have noted pre-paying for funeral expenses (within reason) are acceptable from a Medicaid spend down standpoint. Ditto for legal expenses w/the elder care attorney. These expenses should be paid from his funds.

In terms of pre-paying for services, I would advise against that. Once he qualifies for Medicaid long term nursing home coverage, each month (assuming he receives a monthly Social Security payment and perhaps other "retirement funds/pension" (?); your State will calculate a monthly "cost of care contribution" amount he needs to pay from his incoming income. Generally, most States take about all of any incoming income except for perhaps $80 or $90 dollars.

So you will have to pay (as his POA) this monthly amount to his nursing home. Some of these facilities are not set up for on-line payment and therefore a monthly check has to be sent in (kind of a pain if you do not live nearby). I would drop off a check each month for my mom when we were in this situation as I could not trust "snail mail" (the check has to arrive and process within the month) AS YOU MUST keep the total monthly balance in his account BELOW your State's incoming limit,

Because of this "need to keep the balance" below the State's income limit on a monthly basis, paying for needed items as you go will help you keep that Monthly Limit. If you pre-pay for things now; YOU WILL STILL NEED to spend funds on something as this moves forward JUST TO KEEP him below that monthly income limit.

Keep all receipts as you'll also need to file annual taxes for him, another reason to pay in the year incurred rather than upfront! Hopefully you have on-line access to all his accounts (any banking, SSA, retirement, Medicare, Medicaid, etc). Handling it all on-line is so much easier. Also, each year there is a "redetermination" process whereby you will need to upload into your State's Medicaid long term nursing home portal (bank statements for the prior year, state and local taxes filed, receipts of expenses for anything spent out of his funds, etc.). Again, so much easier to do with on-line access.

Good luck with this. The paperwork on this continues until they pass, with filing their final taxes the year after they pass.

One consideration -- talk with elder care attorney -- if (this often happens) your LO needs to go to the hospital, Medicaid long term nursing home coverage does NOT include (except for a day or two) a "bed hold" at the nursing home. This means, even if he's in a top quality nursing home that your have worked out, IF he has to be hospitalized for something you may loose his bed and upon discharge he may be transferred to another (perhaps poorer quality) facility. Worth figuring that out and how much (if any) you or he is willing to pay for a "bed hold" which can be $400 a day or more.

The other consideration is to work out what if any DNR (do not resuscitate) decisions need to be made now. As lacking this, the nursing home staff will do what ever to resuscitate them and that likely sends them to the hospital. Hard, but this is a thing to figure out now when placed rather than in an emergency situation.

You can do a pre-paid funeral arrangement. You can pay any bills he currently had. You also have a right to pay yourself (out of his funds) for doing the job of POA. People often think they have to do it for free. They don't. Ask the lawyer about it. I hope the lawyer is being paid out of your uncle's money and not yours.

When I was POA for my father I charged for that service even when he went to the nursing home. Every check I had to write or phone call I had to take on his behalf was paid for. The nursing home didn't like it because they wanted every penny and then some, and tried to petition for conservatorship over him which they lost. Check with that lawyer because you may have a legal right to get paid as POA.

My comments only cover 1 topic: prepaid funeral expenses. Some time after reaching "senior" age 60 or so, my husband and I both purchased end of life policy or whatever they want to call it--ours from Neptune Society, but there are other companies that do end of life arrangements. When my husband died, I contacted Neptune Society, and they arranged the cremation, took the body, cremated it, and told me what to do, etc. took it to the cemetery, etc, I had picked out years ago, My grave with his is still there, awaiting me--I'm 84. And upon my death my family can call Neptune, give them my account number, and they will arrange to cremate my body and place my cremains with my husband's, whose remains are in the Veterans's area of the cemetery. I didn't want my family to have to do anything but call the company which does the cremation, and they take care of the rest. There should be no further costs, since it was prepaid. If there are more costs, my family can figure it out if costs are legal or not, per my contract for burial. People, don't make things hard, do some research now, when you have memory and health to think things through. Make it easy on your families.

Does your uncle have Dementia? Does he have a house, car or any investments. You should take it day to day. Don't anticipate too much. Not all facilities accept Medicaid. You are looking $3,000 - $10,000 a month. If he stays long term in skilled nursing, you should be okay. Don't spend too much on clothes, just make sure you put his name on every thing and do his laundry instead of allowing the facility to handle his clothes.

Take a picture of his clothes. That will prove easier to locate and proof of ownership should facility lose them and if so you should be reimbursed if they cannot locate items. They are more likely to be pressed about it. Keep the receipts for his recently purchased clothing

AMZebbC: In addition to all the monies he should be spending (not your financials), he could purchase funeral expenses as part of the spend down process.

OP here. Thank you all for the suggestions.

Once my uncle is on Medicaid he will keep/receive $50 per month. That seem paltry to pay for shaves, haircuts and clothing.

I have and am still in process of doing spenddown. I also have retained an eldercare attorney for the Medicaid application and sorting out his financial situation. WOW, this a long and arduous process.

AMZ, fwiw the LTC Medicaid system is NOT 1 & Done!
there will be a renewal process as well and very much some of the items just submitted will be once again required plus newer ones. I had zero idea this happened and had out all of my moms paperwork into bins AND INTO STORAGE. Then the renewal letter landed….. was due in like 14 days for the date of letter which was actually postmarked later than the letter created date. It was a long azzz weekend.

so get a binder going to keep items of his as they come in for the renewal. For my mom her initial application was abt 130 pages, the renewals abt 25/30 pages.

oh and that at the NH in-house trust account that u put $ in for barber shoppe, that is technically his. And whatever in it along with whatever else nonexempt assets he continues to have (like in a bank account he still keeps) all - ALL - count towards his overall asset tally. If his state has nonexempt assets at $2,000 maximum, be sure you count that barbershop $ in the overall figure.

Gift cards will not help with purchases while confined in LTC. Shaving can be done by staff with electric razers All he will need is an occasional haircut which will be determined by how much it costs and that allowance of about $50 a month. You need to see if a phone is provided in his room by the facility or does he need a simple cell phone. Cable may not be necessary if the TV can operate by antenna. Try to avoid pre pay anything because if he ends up hospitalized, he may end up in another facility.

Other expenses to anticipate: dental, glasses, hearing aids and batteries. Not covered by Medicare or by most Medicare advantage or supplement plans. Not covered by LTC Medicaid (at least not in our sate). My brother in law is on LTC Medicaid and we are fortunate that our state allows the recipient to retain a higher level of "cash" assets ($10,000) than many states, so his dental and vision costs can be paid from his assets. All he has left for assets is the remains of his IRA and a small amount in savings.

For the annual Medicaid renewal, we don't have to submit any paperwork. They send a printout with last year's information (value of accounts, cost of insurance, etc.) and we are to just cross out the old amounts, update, and POA signs. It also asks if any assets have been sold or disposed of, and in that case we'd probably have to send some kinds of documents.

AMZ, on the renewal and perhaps having the attorney do it…… fwiw the details needed for the renewal will be from documents that you as his POA are getting…. Like his bank statements, the every 90 day ledger from the NH on that personal needs account (the one the barber shoppe is getting paid from), his annual “awards letters” which are from SSA and any other retirements that state what he will be paid for the incoming year*, etc. So you are going to have to keep track of all this anyways and if it’s going to cost $1800 for the law firm to do this, you many not want to do that. If he lives 5 more years, it adds up as a good amount of $ from that $31,000 asset kitty NYS lets him retain. Just sayin’.

if he continues to own his home or has other exempt assets, that can be more complex, so maybe let the law firm do year 1 renewal then you do it.

* RE: the awards letters, some States internally X reference for this, so you don’t have to. But most still expect the POA to mail or scan or update to the renewal document thier info. For SSA it’s the letter that gets mailed out in Nov that states to the penny what SSA will be paying each month for the SSA retirement income for the incoming year. Other pensions & retirments do this as well. LTC Medicaid wants this as that is precisely what they base the copay or SOC due to the NH each & every month by your Uncle to the NH. Also by your sending it, it kinda establishes you know what his income will be…. so no excuses on not paying exactly what is owed.