I was wondering how people go about getting the 2-year caregiver exemption? We have lived with my mom for about 10 years. I have been her caretaker the last few years, helping with her with everything from bathing to medications and just everyday life tasks. She is in her mid 80's now and we are thinking a nursing home might be drawing close in the next couple years. Her PCP agrees she could not live on her own now but says he can't testify in a letter as to what we do for my mom on a day-to-day basis because he is not there and observing us. I understand that a physician's letter is critical. I am an only child, so there are no siblings to consider here. I have read a lot of sample doctors letters online that state without the daily help of the caregiver in question, the elder would be in a nursing home and so on. But our doctor says he would need to be able to observe the care we give on a long-term basis to be able to certify to that fact. That seems like an impossible task. It seems like the exemption is too high a bar to obtain. Any thoughts from others who experienced this process? My mom would like to deed the house to us and our estate attorney believes we qualify for the exemption, but would need the doctors cert. I don't know if it is really a great idea and maybe when the time comes, we just sell it and let the state take the cash and avoid any legal problems. Thanks, Dave
Mom was assessed as to what her needs are and what type of caregivers would be necessary to provide safe and effective caregiving.
Can you get Visiting Angels to provide a copy of their assessment as well as notes or documentation from the caregivers as to what they do for your mother when they are there.
I would think that would provide documentation as to what you and your wife do when there are no caregivers. AND you also do things for your mom that they do not do.
I learn so much here. Though this does not apply to me, I'm glad I am now aware of this and can pass that knowledge on to anyone who might benefit from it.
David1941, I can't believe her doctor won't certify the cares you provide without observing! Invite him to stay with you for 24 hours so he can observe! That's ridiculous! He should be able to document what cares she is unable to provide for herself, which a caregiver needs to do for her. And if she appears well-taken care of when the doctor sees her, he can assume you are meeting all her care needs. Or as Firefly suggested, perhaps a neurologist, or another doctor, could provide such a statement.
That said, based on the answers here, we are inclined to let the let the house go and make our way somewhere else when the time comes. I don't want to live under potentially years of stress over who will certify to what and when. Best to put it all in the rear view and my wife and I will buy a property for us and our daughter when the time comes. Maybe we could buy this house from Medicaid? Or just get someplace new. We love our home now, but it is stressful enough as it is without worrying about investigations, or even jail as I read in other forums, if something is done wrong and you don't have the money to repay.
Thanks so much for all your help and replies!!
Also, here is the answer on the timing in MA.
Can the exemption be approved “pre-death” while the elder still lives at home?
No. Massachusetts will not make a pre-determination. MassHealth does not evaluate the exemption until an LTC application is filed.
At this point, it seems like an easy decision. We will start putting some extra money away for a downpayment for a new home and move when the time comes.
Dave
somethings for you to mull over as you kinda have the vibe that mom will go into a facility in the near future….
- make sure your POA fully allows for you to sell her home
- make sure her will reads you are to be her Executor
- mom could be paying you to caregive. Mom gets SSA $ and maybe some other retirement, she can have an atty draw up a Personal Care agreemnt go pay you as her CG. Maybe you don’t need the $ as you actually do WFH but….. if she were to do this, say it’s 1K a mo…. this money you set aside in its own bank account for you to use for dealing with that house should she be in a NH on LtC Medicaid when it goes up for sale. Remember due to the SOC requirement, she will have zero $ to pay on any property costs on in a facility and on LTC Medicaid. And putting her house on the market will involve costs.
- think if it makes better sense to sell her home now OR do this ina year while you jettison stuff and get it market ready while everyone still lives there OR wait till she is in a facility OR she continues to own it till death. Sometimes elder homes are such that they cannot actually be sold at FMV and in a short period of time. Does mom strictly from her own $ able to pay to be in a facility and for how long? That’s something to factor in as well.
If a parent wants to retain their home and be on LtC Medicaid, it can be done. And then the property is dealt with however her will reads and however MA does their Estate Recovery. But it pretty well means that the POA and potential heirs have the time, $ and sense of humor to deal with the home for possibly years and years. It’s kinda like having a 2nd home but one that you do not own and perhaps will not own. So has costs and risk. Most of us cannot afford a 2nd home and don’t like risk.
imo could be a good idea to speak with an attorney on all this. Elder law attorney may do a referral to a probate atty as to how MA does their MERP. The atty fees are moms to pay. Good luck in your decision making!
It reads like you want to get this paperwork (caregiver exemption) done now and get ownership of the house your mom owns title / deed transferred to you; that you and your wf live in it and you provide FT caregiver services for her in. Is this it???
Find out from an atty in your State who is experienced in MERP if doing this is at all feasible. All Medicaid programs done administered by each State uniquely but under overall Federal guidelines.
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Family / heirs wanting to keep elders home can be done but will be challenging……. What usual path is….. elder leaves their house bc their health is such that they now required skilled nursing care with pretty much 24/7 oversight ability. They are “at need” medically. Once elder becomes “at need” financially for whatever nonexempt asset limits their State has for its LTC Medicaid program (most are 2K max) and in a facility in an open LTC Medicaid bed, they can be “Medicaid Pending” then Medicaid eligibile for LTC Medicaid program. fwiw Medicaid as health insurance is an entirely different program although it ends up being intertwined with LTC Medicaid.
By & large elders primary residence with homestead exemption is exempt asset for LTC Medicaid their lifetime. But upon death the State via MERP or its outside contractor's (OC) will do a required attempt to recoup cost paid by the State via LTC Medicaid. & not to get too too in the weeds on this, a State can also include cost paid for Community based Medicaid programs & HIPP as well. LSS once elder dies there is a Medicaid $ tally that has to be dealt with. All sorts of exemptions, exclusions can be done on the supposed tally owed by elders Estate.
As far as I’m aware, its an after death process. Done as a response to the NOI/Notice of Intent sent by the State to the former POA. Maybe your State does it differently. Really it’s attorney consulting by you & mom as to if feasible.
Issue often for POA / family/ heirs is…. as elder required to doShare of Cost / Resident Responsibility of most of their income paid to the facility, they have zero-no-nada $ to pay costs that home in their name. All they have is sm Personal Allowance & is restricted spending so not used on anything “house” as LTC is paying room&board. House costs all on POA / family to pay & till beyond elders death.
After elder dies, you file caregiver exemption with documentation from her old physician or social worker that she required skilled for at least 2 years prior to her entering SNF. Full time 2 year min period of time. So no other job.
That you are living there being her full time caregiver right now with some sort of documentation establishing that it’s needed will help you in that bc you are doing this, once mom files for LTC and living in the SNF, you will not have to pay rent to live there due to being her FT CG prior.
Butt rash in the concept of keeping elders home often is flat not financially sustainable. CG had stopped working so no income. CG, POA, potential heirs have to have their own $ to pay house costs. Often home costs were paid by elder’s SSA income which now is their required SOC to the NH. If there is a mortgage (horrors), costs could be a tidy sum. If homestead exemption goes away as owner moved to a facility, property taxes will increase. If any of this could be your situation, it can be challenging to keep her home. Just sayin’….
Families often gobsmacked that almost all elders SSA& retirement income has to be paid to the NH. If it’s not affordable to retain the home, try to sell house b4 entering a facility,
I've been my husbands caretaker for a while now and needed a letter to become my husbands representative payee for Social Security, which I'm in the process of doing.
His primary care physician could not give me a letter but my husband had been to a neurologist that did. I would suggest that you get a referral to a neurologist from the primary care physician if it's necessary to have a letter. It may be a good idea to make copies of the letter for whatever else comes along and to have the letter notarized.
If her dementia is bad enough the neuro will notice pretty quickly and if not, they might test her. I had a video of my husband doing certain obvious things at home. For instance, how he walks without an audience. I also wrote down the various behaviors and dated them so there would be a progression of events that would show how things were changing. It may take a little while but with all the cameras and video available why not use them to help her?
Might your attorney be willing to contact the PCP and explain what the letter needs to contain?