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Elder Care Journey Part 6

To highlight Elder Care month, we published a five-part “Elder Care Journey” in May of 2020.   If you want to experience the journey from the beginning, you may read the first five parts of Bill and Sue’s story here:  

Names were changed for reasons of confidentiality.   The story as we share it is based on actual circumstances of one family.  Reading about Bill and Sue’s experiences gives good insight about not only the challenges that regularly occur along an elder care journey, but what little-known tools and opportunities are sometimes available.   We now share the phase of the journey which occurred over the past year.

Sue is beginning her sixth year of receiving long-term care at the Regal Nursing Home, where she was placed by her late husband, Bill, a little more than five years ago.   Sue had suffered a debilitating stroke, so soon after retiring that she had not yet begun to collect her pension.  Bill was devastated as he adjusted to the reality that he faced his retirement alone in the family home, unable to share it with his wife of 50 years, who he had married shortly after her high school graduation.

The five-part story of Bill and Sue’s elder care journey started with the need for advocacy to ensure that Sue would not be discharged to a personal care facility out of concern for her ability to pay for the skilled nursing care that she needed because she could not get out of bed without substantial assistance.  Bill obtained Medicaid funding to pay for Sue’s care so that he would not become wiped-out financially.  The story followed Bill as he dealt with loneliness, which was eventually addressed by Bill being shown a legal strategy to enable his son, Joe, and his daughter-in-law, Gail, to benefit economically from moving in with him, to provide companionship and care as Bill began to suffer from a progressive chronic illness. 

Bill and Sue had no prior hint that their lives would change so radically and suddenly.   The priorities at the early stage of their journey were making sure that Sue had an appropriate care plan, helping Bill to cope and adjust, avoiding adding an additional burden to their children’s already challenging circumstances.  It was a bonus to find a legal way to transfer some of their modest family wealth to their children. 

Bill maximized the present value of Sue’s retirement pension fund as he cashed it in.  He accelerated Sue’s eligibility for assistance and increased his own monthly income by getting a Medicaid-compliant annuity at just the right time.   Seller financing of a life estate deed for the family home enabled Bill to benefit from the companionship of Joe and Gail.  Bill stayed in his home as long as was safely possible; and Joe and Gail were able to afford homeownership that otherwise had been out of their reach.

When we last checked in on Bill’s elder care journey, he was at a different skilled nursing facility than Sue, suffering from a progressive disease.  Joe had just completed the process of applying for Medicaid for Bill’s care, which enabled Bill to offset a final gift to his children, Joe and Mary, while making sure he could pay for his care during an expected penalty period.

Despite receiving excellent care, Bill’s condition deteriorated rapidly over the last year of his life.  For various reasons, including Covid restrictions, Bill and Sue were not able to visit one another during Bill’s final months.   Ironically, although Bill and Sue’s elder care journey started with Sue’s need for nursing care and Bill coping with being home alone, Bill died first, less than five years after Sue’s stroke.  

Bill’s death was mostly peaceful, but circumstances which followed it required Joe to seek legal guidance.  The main issues related to understanding the rights of the beneficiaries of Bill’s Medicaid-compliant annuity, the legal duty of “spousal election” of Sue’s inheritance right, the impact of the penalty period in relation to Bill’s Medicaid application, and questions about how the survivor’s benefit from Bill’s pension would affect Sue’s ongoing receipt of Medicaid.

Bill died three months before the penalty period expired.  He had paid privately for the nursing home.  Although both he and Sue were in skilled nursing homes, Bill had been able to leave a house to Joe and Gail, give a car to his grandson, give $40,000 to his daughter, Mary, and set-aside around $100,000 for whatever Sue might want that Medicaid would not pay for.  Joe and Mary would inherit the remaining funds after Sue’s death without a need for probate or inheritance taxes.

Sue continues to thrive in skilled nursing.  She is wheel-chair-bound and requires assistance with her essential activities, but she has a positive mental attitude and participates in group activities. 

Sue was always a sharp dresser.  One of her favorite hobbies was shopping.  Sue continues to enjoy shopping on QVC.  

Joe has established a limit of a couple of hundred dollars per month on his mother’s credit card.  This allows Sue to keep her wardrobe fresh and enjoy QVC-shopping without spending recklessly because of cognitive impairment from her stroke.

The end of Sue’s elder care journey probably will be a smooth landing.   Her eventual death will occur at the nursing facility where she has been receiving care.  No estate administration, burdensome paperwork, or financial hassle will be left for her children.  Funds have been set aside not only to bury Sue, but to celebrate her life with a memorial service.

Next week’s seventh chapter in the elder care journey will look at the details of the issues which Joe faced after Bill’s death, even though he had been well-prepared, and there was no need to use Bill’s Will to probate his estate.

Dave Nesbit, Attorney