1. Getting Good Help Even in a Crisis


What happens in this story is fairly typical.  The first part is that there is some kind of crisis.  When that crisis is a major illness, the scope of what is needed suddenly changes.  It throws everybody into a state of panic and the parties get desperate because they think there is no solution.  Any plans they had seem like they’ll no longer work and there is a perception that not only isn’t there going to be a place for the person in need, no one knows how they’ll pay for it if one is found.  The panic then escalates into fear

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and inaction.  We then step in and guide them through the process of getting him into the right place, that they can afford, and everybody is going to be safe.


Roberta (fictional name) contacted me about her parents, a couple in their 70s living in Brooklyn, after hearing about me through a friend who is a physical therapist.  She presented her circumstances as being “concerned about both of my parents, but it’s not too serious.” In fact, her mother has an arthritis condition resulting in her having difficulty getting around and her father has diabetes that’s flared up.  She wanted me to evaluate their Elder Plan insurance as she’s not sure what it covers.

Upon my arrival, the wife did most of the talking.  The husband seemed coherent and friendly but for whatever reason he wasn’t talking a lot.    Initially, there was very little that seemed to need to be done, but she indicated that she is on Medicaid already.  She gets two days a week of housekeeping, but now she wants more help because he needs care and it’s hard for her to provide it.  I went into detail about examining the situation and quickly determined that, in fact, he would also be eligible for Medicaid.

“Why didn’t they apply for him right from the beginning when they applied for her?” The wife replied, “Well because then they would count his income also and we didn’t want to have to deal with that problem.”   I said I know how to deal with that problem.  I can explain what that means.   Basically if you’re a couple and one of you wants Medicaid, you can apply and sign a form called Spousal Refusal, where Medicaid says as long as you have this form, then they don’t count the income or the assets of the spouse and you can get all the Medicaid benefits you want.  You can transfer everything to your spouse in cases where you don’t even want to transfer it to your children.  There are other advantages for doing that, too as we will see in what happened here because very shortly thereafter, Roberta tells me, “Steve there’s a crisis.

The Crisis

“My father needs to go to the hospital.  His diabetes got in his toe, and they’re going to amputate the toe.  It’s really bad.”   It was much worse than that.  He went in and they said they have to amputate the leg.  And this is all very sudden and unanticipated.  So everybody is flipping out, Roberta, her brother and her brother’s wife.  Roberta is now calling me frantically.  What are we going to do?

Roberta not only was in a panic about her father and his condition, but her mind was racing ahead, fearing the worst. She was anticipating that her mother too, had increasing needs, and she was in a panic about that also, as well as their limited finances. Their only asset was the coop that they lived in.  By this point we had already set up a meeting with an elder law attorney to review how they would deal with the co-op and how that impacted on Medicaid.

It soon seemed likely that he would not be able to come home because he’s very sick and needs a lot of care. That he would need a nursing home.  They didn’t have a problem hearing that, but it just panicked them about how it’s all going to be paid for, while preserving the co-op. Roberta was really set on the idea that her mother shouldn’t stay in the coop anymore, that she needed to be around people and go to an assisted living facility.  “We think she’s so totally isolated where she is.” I told them about an assisted living facility that Medicaid pays for, and they quickly went to see it and with her mother’s wholehearted agreement, set about for her to move in there.

We then have this conference call with the lawyer who tells them what they can do in view of the crisis.  While it’s kind of complicated, there actually was a way to preserve everything and have them both get Medicaid, have his nursing home stay covered by Medicaid and have them keep the co-op.  The point is that this all happened because of my work in conjunction with the lawyer.

I played a key role in helping the lawyer do what she needed to do because Roberta and her family were in such a state of anxiety that they regularly called me to review what the plan was and to reassure them that everything was going to work out. I could take the time to clarify each aspect of the plan in a way that the lawyer could not.

The Resolution

Well, their father did die a few weeks later, which in some ways was a relief to the family because he was suffering. The mother did move into the assisted living, and the lawyer was working on preserving the proceeds on the sale of the coop without jeopardizing her Medicaid.

Steve’s Role

I worked in several areas, but because the lawyer was needed to execute many of the needed actions, my work with her was very important as I was able to help the family overcome their anxiety so they could focus the meeting on what could be accomplished for their father and their mother – that they would essentially get everything they wanted, despite their fears that this was not going to be possible.   Before I spoke with them, they kept thinking that this was a disaster because they were going to lose everything and that both parents were to be out of luck and not where they wanted to be.  It was really a terrible situation emotionally, but from the financial prospective, the crisis was not there.  Had I not clarified the issues for the lawyer, it would have taken her much more time to put it all together because the family’s anxiety was so high that they were bouncing all over the place.  It would have been very confusing for the lawyer to try and  figure out what the real issues were.

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