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I have read many of the messages regarding long term care insurance, medicare benefits, and medicaid. I have a vertical learning curve for the whole process, however. My grandparents are both ill and live in another state (Illinois). Last weekend we had to place grandpa in a nursing home, because grandma had open heart surgery and couldn't care for him (he's bedridden with prostate cancer). I need to help ease grandma's mind about what will happen in the next few months.

I know that medicare will pay 100% for the first 20 days. After that, their AARP policy should cover the $95/day copay until the 100th day, when medicare runs out. After that they either pay themselves, use private insurance, or apply for medicaid. My grandparents have their assets in long term savings bonds, their house, and savings accounts (it is not a large estate - maybe $40,000 tops excluding their house). Everything is jointly owned. The nurses and social workers don't think grandpa will ever come home, because he needs constant care now that he can no longer walk. Everyone expects grandma to fully recover and return home in a couple of months. Grandma is afraid that 'they' will take everything she has if she can't care for grandpa at home (they are both very independent and a bit stubborn). Even if grandpa uses a wheelchair they won't let grandma care for him because of her heart condition. So if I understand what I've been reading, I think our concern is with the 36 month lookback period and the 'spending down' issue with qualifying for medicaid (if grandpa remains in a nursing home beyond 100 days).

Before I seek the advice of a professional I want to be more knowledgeable on the subject. Does anyone know how much of an estate can be protected from the 'spend down' clause? (i.e. how do we divide out who's is what?) And once assets are divided for qualification purposes, how much does the recipient (in this case, grandpa) get to keep of their portion of the joint estate? Will grandma have to sell her house and split the proceeds? How many of their savings bonds will we need to cash in for medicaid? And who do we pay, the nursing home?

And does anyone know if medicare will cover any type of assisted living (in case grandma needs this later)? And exactly what that might involve (is it an at-home nurse, or just another type of nursing home)?Once I can increase my knowledge of the subject matter, I can to to grandma about letting me put some of her assets (the ones that won't disqualify grandpa from medicaid) into some better investment vehicles, so we can maximize whatever she gets to keep. We also want to move them both closer to us so we can better manage the situation. And it's important that they stay together - they are all they have (married 62 years! Amazing!).

(note: I haven't seen their AARP policy, but I am certain it doesn't have any long term care coverage)

Unfortunately, I don't think my grandparents expected they would both get this sick at the same time, so there was no time to 'prepare' for this. Hindsight is always 20/20 - now I want to do the best I can at getting them the care they need without causing extra stress on their health with worry about where the next dollar is coming from.
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