Thursday, December 29, 2016

The Heartaches of a Spenddown

Right now Mom's room doesn't seem right without Mom in it, but in years to come the laughter of her great-grandchildren will fill the empty spaces as we host family gatherings here.  The church pew to the right is from the church where my parents were married in 1946. Memories old and new, memories yet to be made!   
During the years my mother lived with us, her monthly income was nearly adequate to provide for her needs, and so she still had a small but comfortable sum in reserve when she entered nursing home care. This we began "spending down" in anticipation of an eventual need to apply for Medicaid.

When you don't have a whole lot to start with, it doesn't take very long to spend it down at the rate of about six thousand dollars a month for nursing home care, doctor visits, and prescription drugs. The dreaded Medicaid application process looms before us, and although my head tells me everything will work out, my heart tells me differently.

When we are in the process of losing someone we love, the material blessings they leave behind gain emotional value. For example, I am writing this post while seated in a comfortable chair in the spacious addition to our home that my Dad's careful saving made possible for Mom. She spent twelve years in this warmly lit, lovely space, was happy here, and we were happy to have her. My dad would have been so pleased.

He was brave, my dad. At age 50 he knew he had not saved enough money to keep my mom secure, should anything happen to him.  He went to back to school for the better part of two years and became a Federal Meat Inspector. The savings he accrued in the final 15 years of his working life helped provide a secure, handicapped accessible place for Mom when she was diagnosed with Alzheimer's. I will have this space as a testament to the beautiful way God provided for my mom through my dad.

A spenddown, however, is the opposite of comforting.  Mom is now paying other people approximately five times the monthly amount she paid me as per the care agreement* our attorney drafted when she decided to live with us. Again the heart/head disconnect; this feels unfair, but my brain works well enough to understand the costs of providing 24 hour a day care in a facility. There are eight or ten aides on each of three shifts at the nursing home, and this doesn't include the charge nurse, administrator, or cooking staff.  The amount we pay for care at this small nursing home in a rural community begins to look like a bargain...when I use my head, that is.

My heart sees it differently. It feels as though my mother's remaining financial assets are evaporating into thin air.  She is receiving services for her payments, but, probably because I was her primary caregiver for so long, I feel usurped.

It's important to recognize these emotions and to allow my Christ-directed mind to take precedence over my emotion-driven heart. Otherwise, some strange behaviors can erupt, because emotions can't be kept in a box.  They will escape their confines and influence seemingly unrelated situations so that we act, in a word, weird. The past few months I have been at best, stingy, and at worst, irrational regarding matters of money, and it is because I've confused losing an earthly inheritance with the loss of my mother. The one can be released without regret, but the other is an eternal connection through Christ.  I don't have to mourn my mother's slow passing away as though I had no hope of seeing her again when we are resurrected in Christ. Our relationship will evolve but it won't disappear.

Meantime, I'm going to do my best not to act weird about money.  It'll be a challenge, but I think even in the face of a Medicaid spenddown, I can do it, because the Lord is my help.


Do not store up for yourselves treasures on earth, where moths and vermin destroy, and where thieves break in and steal. But store up for yourselves treasures in heaven, where moths and vermin do not destroy, and where thieves do not break in and steal. For where your treasure is, there your heart will be also.  Matthew 6:19-21


*If you consider becoming a primary caregiver for a loved one who is infirm, it is highly recommended to confer with an attorney who is an elder law expert. Membership in the National Academy of Elder Law Attorneys doesn't guarantee expertise, but it is a starting place to help you find someone who keeps up with Medicaid laws and is an advocate for those who have special needs and their loved ones. You can use their search tool to find an elder law attorney in your area.

P.S.  My blogger friend, Georgene, from over at Living On Less Money, asked why it is recommended to see an elder law attorney when one becomes a caregiver for a loved one who is infirm. Here are the reasons we spent several sessions with a local attorney who had worked for Medicaid and was on the board of a local nursing home:  1) I needed Durable Power of Attorney for health care and financial needs for Mom.  This is a legal document that, as far as I know, needs to be drafted by an attorney.  2)  Mom was adamant that she would pay me a salary, but we worried that anything she paid me would have to be paid back in a Medicaid recapture of funds. The attorney assured us that if both parties desire a care agreement (she called it an in-advance contract) that this is acceptable to Medicaid.  That contract was very specific as to the services that would be provided Mom (right down to washing her windows at least twice a year!!), and was written to protect her rights.  The salary she paid me was small, but helped defer the financial loss I incurred when I quit my teaching job to care for Mom.  3)  Mom wanted to create a living will.  She does not want to be put on life support.  We needed the attorney to create that document.   4)  Mom wanted to set aside monies for funeral expenses, which are safe from a Medicaid spenddown, and had no idea how to go about this. She ended up purchasing a prepaid burial plan, but this isn't always recommended because if a funeral home goes out of business, the investment could be lost. We needed the attorney's advice on how Mom could safely set aside money for these expenses.

When we were in transition into the role of caregiver and patient, our emotions were running high and we weren't necessarily thinking clearly.  We had many decisions to make with Mom shortly after her Alzheimer's diagnosis.  Building a mother-in-law addition was the most monumental of these, and our attorney led us through this process in a way that blessed Mom and protected her rights as well as ours.  The attorney's suggestions were invaluable.  I don't know whether we would have had courage to move forward with the addition without our attorney's guidance, but it proved to be a wonderful blessing for my mother.  No one (but the Lord) could have anticipated that she would spend twelve happy and peaceful years with the security of having us next door whenever she had a need.

Hope this clarifies the reasons I recommend the guidance of a competent attorney who has an interest in elder law.


  1. Hi, Linda! Why is it important to see an elder law expert if you are caring for a family member?

    Thank you for sharing your struggles. I am stopping to pray for you right now. I appreciate your transparency!

    1. Hi Georgene--I'll answer your question in a postscript to the blogpost above. As always, thank you for your kindness, encouragement, and prayers. You are an encouragement to so many through your blog.