Hi, stumbled across this website in a reddit post and looks to be a great resource.
I am 32, my wife is 27. We are in upstate NY. My mother in law is 61, 62 in May, and has MS. She is what I'll call "high functioning" because I know there are multiple stages of the disease - she has been working as a secretary, still drives, lives by her self just fine, is of sound mind, etc. Her husband passed away 2 decades ago.
Her condition has been worsening as she has aged, but isn't really critical yet. We finally convinced her to retire, since being at work is really too dangerous for her with covid, and there was no option for her to WFH. She is ready, anyway. She is using sick/Vaca, filing for short term dis ability right now, and will be filing for long term also. So, by the time she's 62, she'll (assumedly) be covered under one of those. She'll be eligible for social security disability as far as we know.
So, trying to plan next steps appropriately. My wife and I live nearby my family, which is 1.5 hours from where my MIL currently lives. So the plan is to move her closer to us. Financials are concerning me a bit.
Right off the start, she has negligible savings, and has a retirement account with about $120k in it, and another pension with pretty minor value. We'd like to sell her house - market value is $220k - $230k, she owes $140k with a "balloon payment" of $50k following it. I am unsure exactly the specifics of that, but best case she about breaks even on the house.
We'll need to get her into a good living situation nearby us. My grand plan was to own an affordable house for her & set it up to be handicap accessible, in which she would pay us minimal "rent", in an attempt to give her a safetynet in case financials get particularly dire for her- in the event she cant afford "rent" she'd just live there for free and we can carry the house as necessary and sell it when she's gone to help recoup our costs. But haven't found anything great yet - so we'll be looking for an affordable apartment for her in the interim. There are options in the $600-$800 range around us that arent "senior living" or "fixed income" apartments. Haven't really looked into those two options, just because we're young so we're not overly familiar with the options, but with covid around I'd rather keep her out of a complex. We do own a two family house that she could move into, but its not exactly handicap accessible, so it would be a good stopgap for a while but not a long term solution as the disease progresses.
Someday, she'll probably end up in a nursing home or some sort of assisted living. I'm not entirely sure how that works out, but I am sure she won't be able to afford that with her retirement account. I have read a little bit about Medicaid and understand there may be options where it would cover nursing homes, but it is all a bit confusing.
I guess what I'm hoping is that someone can read thru and just make sure there isn't any blatant, glaring errors with what we're thinking. I would hate to take a step that really screws things up for her in the future, or puts a huge cost burden on us down the road that could have been prevented.
Since your MIL has humble finances it is of utmost importance that she, you and your wife all understand the importance of being able to qualify for Medicaid. This is why you 3 must seek the professional advice of an elder law attorney/estate planner who knows Medicaid. Many Americans are responsible and have saved all their lives, but the cost of care and the increased lifespan of people is outstripping their savings. In the app process there is a "look back" period. In my state (MN) it is 5 years. In other states it is 2.5 but you need to know what it is in NY. She cannot make any transactions of cash or property or assets that may look like "gifting" (and Medicaid gets to say what "gifting" is). If during the app process they find transactions they don't like, this can delay or disqualify your MIL at a time when she may really need it -- meaning, she will have a gap in time without being able to afford her care. Caregiving for someone who cannot carry out ADLs (activities for daily living) can be all-consuming, exhausting and financially draining -- even for someone you dearly love. There is NOT much other "help" (care of financial) to be found (i.e. govt programs or charities) as many burned out caregivers have come to find the hard way. Rules about Medicaid can differ from state to state: in some states it will cover AL and others not. So, your MIL must qualify to medically need a facility. This is a discussion with both her physician(s) and the admins of any facility she is applying to. In most cases being a Medicaid recipient means she will share a room in a facility, but she will get the same level of attention and access to activities. So, when researching facilities your MIL MUST ask if they accept Medicaid. If they don't, move on. Also best to only consider facilities that have a continuum of care meaning: they have IL, AL, MC and LTC all in one connected campus (even ask about hospice).
I think moving her as close to you as possible is a smart idea. My mother lives next door to us. She gets to be near me, her only child, her 3 grandsons, and now her 2 great-grandchildren often. This is a wonderful blessing and she likes to help and be "useful". Not sure if you now or ever will have children, but living in close proximity to elders also teaches kids much they won't learn out in the world.
Your MIL must have all her legal protections in place and she must understand what it means. This is the other reason to see the elder law attorney. She must give durable PoA to her daughter (or anyone she chooses to trust). I recommend your wife if she's going to live closest to her). She must understand when the PoA kicks in. The PoA must understand the duties and responsibilities. MIL should create a Living Will and a Last Will (so that if she does have possessions at the time of her death, the probate process can be hastened or avoided).
I fully agree with those who have said that MIL living with you "says easy but does hard". There is a human tendency to romanticize caregiving for those we love. You and your wife must educate yourselves because in the vast majority of cases it is not how it plays out. Just read the many many posts on this forum under the topic of Burnout. It will be good for MIL to be as fully in charge of her life for as long as possible and then she transitions to a care facility that she chooses in advance. A good facility will have more social interaction, activities, good medical care, etc. You and your wife will have peace of mind and not be burned out. My MIL is in a fantastic place (as a Medicaid recipient) that is a faith-based organization. They and the staff see the caregiving as a mission, so they are not so focused on profit. And, they recently moved her into a private room.
I wish you all the best and hope that MIL is as interested in planning for her future as you two are.
If you buy a house for her to live in, would you seriously be able to carry the cost of that if she can't pay rent? If she's going to be on disability SS, she will have some income, but probably not enough for long term rent. Make sure you set things up properly so that the money she pays you for rent will not be considered a gift to you if she ever needs to file for medicaid for a nursing home when her disease progresses. I don't know how to tell you how to do that so talk to an accountant or someone that knows how to do it correctly.
Encourage your mom to stay as active and independent as possible. Set reasonable boundaries NOW. Do not take on more and more. Help her find helpers to do for her what she can't do for herself. Before you get in a habit of doing too much. Much easier to set the tone in the beginning.
Is mom on board with selling and moving close to you? Seems like a good idea.
If you have siblings, don't count on them for anything and don't waste your energy resenting their lack of assistance. They are free to make their decisions too. Even if you disagree with them.
Best of luck. She's lucky to have you helping her get settled with an eye to the future.
Your Mom may like making an account here as well. Welcome to the Forum.
And, yes she is absolutely on board with this plan.. My wife is her only child and we're planning to start our own family soon, she is excited to be close by and be a part of it. Hopefully it all works out as good as it can!
Please take your MIL to a family practice lawyer, She should have powers of attorney drawn up for medical and financial. Preferably, she should name either you or your wife to manage these affairs if she becomes mentally incompetent to manage her affairs. Also have a will drawn up with one of you to be the executor. You'll need this to settle her affairs after she passes. Talk to your MIL about advanced directives and what kinds of medical treatment she wants if she can't make decisions: CPR, ventilators, artificial means to deliver hydration and nutrition... Have a document drawn up that outlines whatever she says she wants and does not want. Keep a brightly colored folder with all her documents in it: medical/surgical history, current medications and allergies, powers of attorney, advanced directive, doctors information, pharmacy, insurance information...
Staged Living Facility
It might be a good idea to look for a place that has staged living: where she can have an "independent apartment" with amenities like dining facility and recreation, then it phases to "assisted living" where she can have help, and finally phases to "total care" when she will need somebody round the clock to care for her. Talk with any facilities about the types of payment they accept, You will want a place that will take Medicaid and Medicare, the place gets bonus points if their social workers will help file the necessary paperwork.
Another option - Granny Cottage
My mom currently can live independently at 77 in her 2 bedroom condo, I expect in the next couple of years, I will help her with cleaning it and running errands since her eyesight is going and she is a little off at times. Rather than having a sitter for her, we plan on buying a home with enough space to put a small "granny cabin" in the back. Basically, it will be a 2 bedroom place with an everything room - kitchen, dining table, and sitting area - and a smallish yard. When my mom needs to live there permanently, she'll pay "rent" to cover utilities, taxes, and may mortgage as long as she maintains enough in the bank to cover for future hospitalizations. If she can't pay, she'll stay for free. Look online and in your community, there are mobile homes that are set up for this type of living arrangement.
Since you already have a two family house, I would focus on that. Let's say you move her into an apartment. She begins to fail just ever so slightly. You/your wife will have to start splitting time between your own house and her apt in order to help her out. That gets old very quickly. Would work out the same if you purchased a house to rent to her or let her live there rent free. A two family home is ideal. She lives independently as long as she can with very easy access to you. Anyone in your family can check in on her during the day, share a meal with her, etc without having to drive to her location...and those drives can increase over time.
I would contact an elderly attorney if you plan to charge her rent at the two family home so that everything is document and above board. Medicaid looks back 5 years at her expenses. Without a legal contract, they could consider money she gave you as gifts and it would penalize her from getting a Medicaid bed at a time she really may need one. Whatever you charge in rent on the contact will need to be reported as income when you do your taxes. So consider that, too.
Use her house sale money to handicap proof the two family house. Widen doors, especially the bathroom so that a walker or wheelchair can get in (amazing how many bathrooms have skinny doors). Get a wheel chair and sit in it yourself and see which rooms are the easiest to get in/out of, straight shots to inside of room w/out a lot of turns. Also from sitting in that chair - where would you put a bed, dresser, nightstand, potty chair if you had to. I highly recommend a walk in shower with very minimal lip on outer edge so shower can be accessed as easily as possible. I left the tub in my mom's house and installed a lift chair that she sits on from outside the tub, lifts her up, and lowers her all the way to bottom of tub so she can take real baths - best money I ever spent. (spraying someone off while they sit on a shower chair is a wet job and person on chair is cold all the time. I ordered this lift chair and installed it myself while someone just held it still/straight while I secured it to floor and ceiling. It's called Probath Chair lift. Private msg me if you want a phone number to call the person who manages the mfg of them now. ( I shoutout this chair from the rooftops!!)
Then use her monthly income to pay for in home health care and increase hours as needed. If you get her started off with little things like someone (not you) come in to dust/vacuum weekly in the beginning she will be used to having hired help. Then when you/wife want to get out of town, you will feel ok about leaving her and she will be ok in the care of hired help. Maintain that arrangement as long as you can to avoid becoming 24/7 caregiver and wearing yourselves out. Again if you or relative interested in being paid to do things for her, get elder atty to create the contract, issue tax documents at the end of the year, and the 'employee' pays taxes on earnings. -- You do NOT want to deal with a penalty period when she will need 24 hr nursing care the most).
So nice to see someone getting into the details BEFORE an emergency happens and you end up just throwing darts at a wall hoping to pop a balloon with answers. Bottom line - move once, save as much of her money to be used as her needs increase, get her used to outsiders helping her.
For sure, a visit to an elder care attorney will be in the not so distant future.
-Centers for Independent Living. These are not for profits that help people with disabilities. A wealth of information and help with services and education. My husband used to run one.
-County Offices for the Aging will come out and do a needs assessment. In the county we were from, they would be able to get you a Care Manager to help with your questions.
-The ARC may have some ideas for you. The one near us may have been only for people with Intellectual Disabilites- I can’t remember. But I do know that they have Social Workers with knowledge about local resources.
-Spend a bit of time each day here on the forum. You will find info on so many topics related to care giving.
Best Wishes.
I am going to move on to the medical side of things. MS frequently causes emotional lability as it progresses. Get a good geriatric psychiatrist on MIL's team as soon as you can and get one close by when she moves closer to you.
Good luck and hope you will stick around to let us know how you and MIL are doing.
My cousin was diagnosed with MS at 50. She was an RN at the time. She was told that the sooner she applied for SSD the better. The longer she worked the more likely Social Security would not approve her because she "had" worked with MS, why can't see now mentality. This "was" 30 yrs ago. Things change.
The house should be sold for Market Value. The proceeds being put aside for her care. Medicaid does not allow big amounts of money being given away. Nor do they allow an addition to a childs house or like me, I remodeled a bathroom for my Mom when she lived with me. I could not recoup that from the sale of her house if it had sold while she was on Medicaid. Medicaid looks at it as an approvement I get the advantage of if I sell.
Now, selling the house. In my State, at one time, you could sell property one time after the age of 58 and not pay Capital Gains tax if u don't by property within two years or at all. This is something that you can discuss with a lawyer. Which I think is a good idea to consult with.
I would not have her buy another home. Even though its an exempt asset when applying for Medicaid, MIL once in a NH on Medicaid will not have the money for upkeep. Her SS and any pension will go towards her care. There is more to this but Moms house was my Albatross and I so wish I had talked her into selling when my Dad died. Then all I would have had to deal with was cleaning out an apartment and being able to walk away,
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