Know The Medicaid / Medicare Rules Before A Crisis Hits

Contact us at www.SeniorLiving.com

A fall, an unexpected hospital stay, and suddenly your family is making life-changing decisions with a clock ticking in the background. We sit down with Lisa and Paul Marsh from Senior Aid, senior living expert Deanna Allen, and Kelly Denny to cut through the noise around Medicaid planning, long-term care, and the real steps families can take before hospital discharge turns into an expensive scramble. If you have aging parents or you’re planning for your own future, this conversation is designed to replace panic with a clear path forward. 

We get specific about the biggest misconception we see everywhere: people assume Medicare will pay for long-term care. We explain why long-term Medicaid is often the primary payer for ongoing support, why it is not limited to “the poverty line,” and why the process can take months if you wait until a crisis. Lisa shares what she wishes she had known earlier about eligibility, planning, and the uncomfortable but critical step of understanding exactly where Mom or Dad’s money is and how it’s structured. 

We also dig into waiver programs and what families should listen for when they hear the word “waiver,” including Utah’s New Choices Waiver as an example of how state-by-state rules can change the best strategy. Then we shift to the real estate side: how to sell a parent’s home without getting trapped by delays, lowball offers, deed transfers, or gifting mistakes that can trigger Medicaid penalties. Finally, we address the emotional weight: guilt, stigma, and how touring modern senior living communities can change everything. 

Subscribe, share this with a sibling, and leave a review so more families can find the guidance they need before the next emergency hits.

Transcript

SPEAKER_02 0:00

Hey everyone, this is Romina Pattern on the Real Estate News Radio Show. And we cover so many topics as you know if you've been listening for the last 14 years. And today we're here to discuss Oh my gosh, what do families not know about Medicaid, long-term

Why Families Get Blindsided

SPEAKER_02 0:17

care, and moving mom or dad safely into the next chapter when aging in place? And maybe aging in place is no longer an option. Most families don't even pl plan for this. They don't plan for long-term care until some kind of crisis is going on. And today we're talking about what you need to know before the hospital discharge, before the assisted living or the independent living uh wait list, before the nursing home conversation, before the senior living community conversation, before the family starts making expensive mistakes. And oh my gosh, this is a time, as we all know, of extreme trauma. And this is new usually for all of us. And we'd like to welcome Lisa and Paul Marsh today from Senior Aid, who focus on helping families navigate how to plan for long-term care, along with Deanna Allen, who managed a large senior living community for 14 years and is now a senior living CPO expert working with seniors along with Helly Denny. So the key issue we're focusing on today is providing clarity to this really complex process and how families can move forward with confidence. If you're watching this on YouTube, you can see us and you can pause it, obviously. You can pause it on the podcast too. It's all fine. So Lisa, you went through a really difficult transition with your own mom. What happened? And is there anything you wish you'd known earlier?

SPEAKER_04 1:46

Oh, a hundred things. Um, so I'm at work, I get a call, mom's in the hospital. This is a surprise because

Lisa’s Hospital Call And The Shock

SPEAKER_04 1:54

this is not something that was expected. She's been living on her own. She's been looking for her own place. She's been sharing the uh her apartment with a family member, and it's just it's not providing what she's needing. And with her income, it wasn't gonna be possible for her to find her own based on the rental prices right now. So my mom didn't have a lot of assets. So we were like, okay, well, she's going to the hospital. We know that'll be covered by Medicare. And then what? Well, I guess she'll go back home, but the stress is high. The fact that that metal medical incident happened, it was like, I don't know if she's safe going back home because when's the next fall? Right.

SPEAKER_02 2:33

So at that point, right? So that's the families to be going through.

SPEAKER_04 2:39

Yeah. Well, and then what is there to do? Like, I don't want to make the decision to send her to assisted living. Besides that, who's gonna pay for it? How are we gonna manage that? My husband was working with someone called a Medicaid planner, and he said, This is the time to make a choice of like, let's move her into an assisted living. I was like, I don't want to make that decision. I don't make good decisions when times are stressful. So things I wish I'd known. Oh, this is an opportunity for her to get to be eligible for this kind of care. She doesn't have to have a lot of money. It's okay that she has some assets. Like we didn't know any of I didn't know any of that. And so sharing with my family, everyone was like, you know what? We all want to know she has care. The last thing I want is for her to be on the ground after a fall and no one's home. Right? Like then what? Right? Then then we're back to the hospital and we don't want to keep that up. So now she's in an assisted living, she's getting supported financially, she's doesn't have to do laundry or dishes, she gets help with her cell phone, gets her medications brought to her, the whole world a bit. So now she's taken care of.

SPEAKER_01 3:50

And can I add something in that? Yes. One of the things that um we wish we would have known, and this is uncomfortable a lot of times for the kids, is the exact specifics of mom or dad's financial situation. So uh a thing we ran

The Financial Details Families Miss

SPEAKER_01 4:07

into once the decision was made to have mom um, you know, hire uh my company, we found out she had a certain amount of money in her checking and savings. That creates a problem if you don't have it all in checking in terms of spending the money down so that you qualify. So what we wish we would have known is where is the money, how to have it be where it needs to be, what are the assets? So that goes to planning. You know, ideally you do it way before the incident, but once the incident happens, if you already knew what everything is and were certain, it makes sense. The other thing is the process, you know. Um, it I knew the process, but I would imagine you and your family, if you had known the process from A to Z, and that the outcome would be she's in an assisted living facility, taken care of, not having to cook, has all the care she needs, has an extra $150 worth of grocery money to spend, plus the money that she gets doesn't have to pay the facility. She's covered for life. So there's amazing. So does that communicate? Yeah.

SPEAKER_02 5:21

Yeah. So let's look at so part of what you're talking about, I think there is the Medicaid versus uh Medicare confusion. So most families assume that um Medicare will pay for long-term care, correct? And Medicaid is usually the primary payer for long-term services and

Medicare Versus Medicaid Explained

SPEAKER_02 5:39

supports nationwide, including institutional care, what we call, we don't call them institutions anymore, do we, Deanna? We call them communities. And some hope and some home and definitely hope and community-based services. So, you know, what's the biggest misconception families have about uh Medicaid and Medicare? See, I'm getting confused already.

SPEAKER_01 6:01

So I'll I'll answer that one. So I used to sell Medicare, so I knew the need for seniors. I thought Medicaid was a one-dill thing. You're you're on the poverty line, there's there's medical Medicaid, and that's it. It's not true. There's different arms of Medicaid. What we specialize in is long-term Medicaid, so long-term care, skilled nursing or assisted living. That's a different branch, and the qualifications you can make a lot more. So it's more for middle America. I mean, you know, if even if you're really super rich, we can show you how to protect assets and qualify. It's so dynamic, it's different than traditional medical Medicaid. So that's the number one myth. And then the other one is people, I can say we do long-term Medicaid, and they still say Medicare. They can they they don't know the difference between the two. Medicare, Medicaid, it's the same word for most people. Or they think Medicaid, I can't ever later until I spin everything down and blah blah blah. Well, that's in our situation, you want to plan for that because it takes two or three months at least to get you qualified. So you want to be ahead of the game.

SPEAKER_02 7:27

Let me ask you, Paul, can individuals do this themselves or is it just relying on? I love how we, you know, we always talk about this. Um, the kids, you know, the kids are usually our age and in their in their 60s. Uh, we'll leave Deanna out of that because she's a little bit younger. Um, but you know, usually we're the the kids are 50s, 60s, and 70s and 80s sometimes going through this. So can an individual deal with this, can they call you directly and do the planning for themselves, or are we just relying on the kids?

SPEAKER_01 7:57

They can absolutely call us directly. Um, we work with, so I had um, this is a funny story. I had somebody who's 75 who called me for his 104-year-old mother because he's like, she's gonna outlive us all. We know she's gonna go to a facility. We want to plan. She had like $60,000 that needed to get protected, and they were smart. I mean, I was blown away. He's 75, him and his wife, planning for mom who's 104, has extra $60,000, calls us in advance. Within six months, we had everything set so that mom could go to the facility. Like that was miraculous for me. It opened my eyes because I would have automatically got caught by one of those myths. Like, oh no, she has 104, she doesn't need it. That's very easy. That didn't, that wasn't what served them.

SPEAKER_02 8:52

So let's talk about shocking. Yeah. So the waivers allow qualifying people, and tell me if I'm right here, to receive care in a home or a community setting instead of an institution, depending on the state. Medical need, what we've just been talking about, the financial eligibility and program

Long-Term Medicaid And Who Qualifies

SPEAKER_02 9:11

eligibility, depending on where you are in the states. Medicaid.gov goes through the HCBS as services that need help beneficiaries, uh, receive care in their own homes or communities rather than the institutional setting. So when families hear the word waiver, what should they understand? And what does it mean and and what doesn't it mean? Can you kind of clarify the new choices waiver?

SPEAKER_01 9:37

Yeah, so the new choices waiver, most people never even heard of it. They don't know that it's even available, at least here in Utah. And so what the New Choices Waiver is, is um there's two ways to be able to get on the New Choices waiver. One is if you're in an assisted living facility and you have private paid for a year, then if you qualify medically and financially, you can get on the new choices waiver, which helps bridge the gap with your with the senior's income to pay for the facility and not worry about money. That's a slower way. In Utah, that's one window into the opportunity of the new choices waiver. The other one is if mom or dad is in the skilled nursing facility, that opens up the window to qualify for long-term Medicaid and then transition and then do the waiver, that's a shorter time frame. So the waiver, think of it like this it the waiver itself pays the gap for mom or dad in an assisted living facility once they qualify. And there's two ways to start the process. Either if they're in a skilled nursing facility, rehabilitation, or they've private paid in the assisted living facility for 12 months. One question we get often asked is can we apply when they're at home and they qualify medically and financially? Unfortunately, not here in Utah. That's not, it has to be those two windows. They've paid 12 months privately at an assisted living facility, or they're in the skilled nursing facility, and uh we start the process from there. And they're a good question.

SPEAKER_03 11:28

Go ahead, Deanna. We should make a distinction there too. Um, obviously, you know, if you're listening on the radio, we're we're across the country and we have CPO experts all over. But we're talking specifically to the New Choices waiver to Utah. Every state has their own program, but they're called different things. Yes. And when you hear the the you know the term new choices waiver, that's specific to Utah. Um but if you're if you're seeking more information on that, you can reach out to you know someone like Lisa and Paul, or you can go directly to a community and the the marketing manager there should have information to help guide you as well.

SPEAKER_02 12:03

That's awesome. And I want to keep uh Deanna in the hot seat now. So, Deanna, let's talk about the home itself that the senior is living in, all around the real estate um question around that. So we all got together, and Kelly's here today as well, who also works inside

Real Estate Timing And Wait List Pressure

SPEAKER_02 12:21

senior living senior living communities on a regular basis. We we started this in the first place because um I was raised by grandparents, we've all got our own stories, right? And um I saw how people just wanted to take her home. And we find this with a lot of seniors that investors come in and try and sell their homes for for cents on the dollar, which uh we have a real problem with. We don't want the houses stolen, right? So we come in and we make a full market offer and we use various funding partners and we also improve the home. So it's funny, I I noticed in a neighborhood Facebook marketplace or something like that, this morning somebody talking about we're 80 years old and we need some help. Can anybody help us clear our house up because we're going into senior a senior living community? And I thought, oh my gosh. So of course I reached out to them because we've got a whole team. Anything from clearing up the house to um, you know, making the house look a little better. Maybe we've got some avocado in there, or maybe it's beautiful and just needs a deep clean. And um, you know, what I don't mean avocado, I mean avo avocado fixtures. You all knew that, right? Not not the avocado, the vegetable or fruit or whatever it is. So um, you know, we go in and we make the house look a little bit better and usually sell it for more than they'd get on the open market. So it's keeping the money in the seniors and the family's pocket, which is way better. So what kind of questions should the family ask? Should um the kids ask, should the kids, that's our age, right? Should the seniors ask um about selling the home, transferring the home, renting in between, or moving assets around, Deanna's talk specifically about uh real estate and what kind of problems go on there, because it's it's really horrible.

SPEAKER_03 14:10

Of course. Yeah, well, it's all about providing options. A big reason why I I joined um our team and became a CPO expert is because most of the time I had people on my wait list and they continued to be on my wait list for up to two years, not because we didn't have the availability, but because when I would call them to say, hey, that two-bedroom that you want is ready, they would tell me, oh no, I haven't got my house ready to sell. I've been meaning to get to this or that or everything on the honeydew list. And the fact of the matter is most of most of them don't have the the mobility to be able to move around and walk out for showings whenever that's needed if you are listing the home, um, trying to get it sold so that they can afford to move in. And so our program helps alleviate that. Um, some of the questions I would ask is, or if they were coming in to ask more questions, is you know, what's what's most important to you? What is your mobility like right now? How are you getting around your home? How would your life change if you were able to be in a community where you had access to the resources like Lisa's mom now has access to in terms of daily care, caregivers, a nursing team, uh, meals provided, right? A lot of these people might not be getting regular meals because they can't get up to make them for themselves, or they can't get up to answer the door to answer the meals on wheels delivery that's available to them sometimes.

SPEAKER_02 15:41

So funny you're saying that because I'm going on a listing appointment this afternoon. And these guys have the most beautiful townhome, and it's around $400,000, $500,000. I'm about to go this afternoon. And they're selling for sale by owner. And I noticed uh I got in touch with them again because somebody locally in in the same neighborhood had sold at about $10,000 less than what they've got listed on for sale by owner. And I said, Oh, okay, so uh what's your next plans? Where are you going? And they said, We're moving back to Michigan where we're from and moving into a senior living. So what we could have done is six months ago, back to Paul's point, six months ago planned all of this out in um a much more seamless way. So now they're not trying to sell for sale by owner and they haven't sold, you know, it's just been sitting there, and they're gonna be moving in the next month. So now we're up against the gun. When you're up against the gun, the best decisions are just never made. So let's talk about what should families be careful of when somebody says, because we know this happens, right? And I know some communities do this as well. Just transfer the house, transfer it over to us. Do you know anything? Yeah, Lisa's nodding her head, so uh nodding her head the wrong way. So what do you think about that, Lisa?

Avoid Gifting And Lowball “Solutions”

SPEAKER_04 16:56

So just handing money off when when we go to um check eligibility, anytime money is gifted or assets are gifted. I mean, the state's like, well, hey, why didn't you just give that to us? Because now we're having to pay for your care. So you're either sanctioned or you're not approved at all. So it it either delays the potential of you getting care or you don't get it at all. So um, do you have more to say about that?

SPEAKER_01 17:28

Um, are you also pointing to when uh maybe I misunderstood the question? I understand that part, but like a lot of times what I know is somebody will come in and say, oh, hey, just sell the house, sell it for subpar. Because hey, what does it matter? You just want to be covered for a year if you're doing the program. You want to actually, it's no problem if you sell it for less because it'll help you qualify earlier, which is not the case. So I don't know if that's a tangent question. That's that goes back to what you said, like, oh my gosh, taking advantage of our seniors. Unfortunately, we do hear that that happens a lot. I'm sure you do too. So you don't want to gift anything, you don't want to give your car, like, oh, you know what? Hey, I'm not driving anymore. I'm gonna give it to the grandkids without a professional guiding you on how to do that. And then the same thing with selling your house, you don't want to just sell it for pennies on the dollar because, oh, that person says you need to spend it down because you're gonna, you know, you ought to be broke basically to qualify. No, there's a way to protect assets compliantly for our programs. So it's good to get really educated by someone who knows what they do and can explain like DNA said options. When you, if you hear a lot of different options, I think that's a key indicator to go, okay, I can give a little more trust to this person when they're giving me lots of options versus, hey, just do this. I'm leery of someone that just says, hey, just do this, if if that makes sense, if that answers your question.

SPEAKER_02 18:55

Absolutely. And that comes back to planning as well, because so we we do make a full market offer. However, if someone's in touch with us six months earlier, we can do what's called a certified pre-owned listing. If somebody still has mobility and still wants to, you know, list in the more traditional way. We do an inspection up front, the houses fall out less, it's a lot less stressful. We do a walking tour video, so they actually don't get as many showings, but they get more actual interested people. The bit I was referring to before is that some communities, um, and and it can all be sold in pretty ways, you know, and spun in pretty ways there. I just said it. Is that they have people like um reverse, not that there's no place for reverse mortgages, there are, but they have lenders that they work with or or or option people that they work with that are pushing a cash offer that's a low ball. Or it might be a reverse mortgage, or it might be give a deed in lieu of your house to the community or the community partner who's managing it. Whereas we've got a program where we can just get the the seniors out, get a huge amount of equity up front, get them into the community, then do some work on the house and essentially flip the house for them, which it means we bring them another check. I mean, it's it's really fun and it's very, very, very fulfilling work. Kelly here takes a cake every month. We've got some lovely pictures of him taking the cake into the communities. We do a birthday cake every month. Like it's really, really wonderful work. And I should say, agents, if you're interested in joining us, then you know, definitely reach out to Deanna Allen, Rowena Patton, Kelly Denny. We are always looking for people to basically volunteer at the the the um the communities. But aside from that, you can help their seniors that are coming in, and that's a large number of seniors every month. So let me ask you, let me ask Lisa and Paul here. So, you know, families feel guilty, they feel overwhelmed, they feel like they're failing their parents, or they feel guilty. I've got a friend who is in a senior community in a big metro area in a different state, in Georgia, actually. And her daughters live in Salt Lake over on the Utah side. I'm in North Carolina, in Asheville, you know, spread out all over the place. Um, we have agents all over the country that can help you. So what happened was about six years ago, and this is such a common story, um, she uh broke her hip and then she had some heart problems. She's had five surgeries since she moved into the senior community. We did get a home sold. I didn't have this program at the time, which is just a wonderful program to be able to do. I've been helping her for 20 years since she bought her house that I then sold to help her to get into the community in a different state. So, um, you know, how do we help those families that feel guilty? The ones that have said, Listen, I can't keep flying back from Park City three times a year because something is going on. I want to be there with you, but we need more care for you. Cause that's what went on there. How do we help those who would like to take that one? And Uh, maybe everybody can have uh some uh a word in. So we'll go to Deanna and then Ket Kelly. Like w what do we do for those families? And then we'll move on to Paul and Lisa. So Deanna, let's start with you.

SPEAKER_03 22:11

I always, you know, like like it to start with a conversation. A lot of, you know, we we use the word communities, but for elderly people, back in their day, in their younger years, assisted living communities weren't even a thing. They weren't even

Reducing Guilt With Better Options

SPEAKER_03 22:28

around until almost the 90s. Wow. Yeah, I don't know if any if you knew that. But so it was it was all skilled nursing facilities, right? And that's a scary thought for a lot of people because when they went to visit their loved ones, it was a different time, a different place, different care, different standards, right? So, you know, having this having when when it comes time and they don't have the mobility and they're no longer able to be at home on their own and they've got children with aging parents out of state, you know, there's a struggle there and they don't know what to do. And oftentimes what happens is a major event happens like a fall, um, you know, or or something else. And that that's when they realize that they need the care. And so, you know, starting with a conversation and having them be able to bring their loved one to the community so that they can see with their own eyes. It is not the facility that was 30, 40 years ago that they remember. It's actually a place where people can thrive and enjoy their later years surrounded by companionship and love and care and all of the things that we want for our parents as they get older.

SPEAKER_02 23:43

I've heard them call cruise ships sometimes. So I love your description of them. I saw your face light up where, and if you're listening on the podcast, you can go and watch this on the video and see Deanna's face light up too. What would you say to that, Kelly? And of course, we should mention like the people I'm going to see this afternoon, it's not all always about mobility. You might be going into independent living. But that basic basically means you're going into a semi-rental situation. So we need to plan early. Plan six months before, plan a year before. If you're on a wait list, talk to us. We don't mind if it's two years or three years. We'll start going through the process of what it looks like to get that extra $50,000,000, $300,000 out of your home. So it could be you're going into independent living too. What would you say, Kelly? A few final words.

SPEAKER_00 24:28

There's There's a number of things that have tied into some of the recent visits I've made to these communities. Yes, the cruise ship without the ocean is one of 'em. And I was talking to one of the marketing directors just the other day, and there's a stigma attached with how bad these senior communities are. And people are stuck in that and they need to, just like our stigmatized homes, if they sit on the market too long, people need to go visit. I have been I'm I can literally say I'm dumbfounded by the experiences I've had because I had no clue before coming in with this group of what these communities were. And now I have literally friends and family in these communities that I deal with that I get to stop in and see. Saw one just yesterday, gonna go see a couple more today. And I am it's just it's baffling. It's like this is where you wanna be. And we the the emergency, the thing the thing I fell with Lisa's story is the emergency creates the situation and that's way too heavy. I believe that's a high percentage. But with the planning, six months ahead and getting that going, just it tied it tied into it. It's like, yeah, get started on it so you know what to do. I'm hearing things that I'm not aware of as far as the planning, and I've been shown you know the the spend down and the skilled nursing and I'm like, I see all these things tying together. This is this is a symbiotic relationship, definitely. And when Deanna mentioned the the level of care, like in the 90s, it's like it's all skilled nursing, and it's like I think that's where the horror shows came from. I don't know, but these places are fantastic, and people their minds will literally change when they become a resident of these communities. Their life improvement is it goes up. It absolutely does. Do not doubt that. Walk in, visit these places, meet the marketing directors, and the ki level of care that I've seen is top-notch. They literally care. This is where you want your seniors to be.

SPEAKER_02 26:40

All right. Well, on that note, I'm definitely moving, and I've thought that a few times when I've seen the menus. Oh my gosh. So, Paul and Lisa, a few final words from you guys, and how do people get on?

SPEAKER_01 26:52

So, so the what I my wish for people that are um, especially the children, uh as they're they're navigating this, whether they're planning or it's a crisis situation, what will help them not feel guilty, I think, is you're you're you're paying attention to two dynamics.

Dignity Safety And Final Takeaways

SPEAKER_01 27:09

One is the dignity and the independence that our seniors want to keep, but also their safety. So if you come from, okay, it's about them and those two dynamics and getting educated on how to navigate it. Like, like Kelly said, the stigma of uh facilities, and and I think Deanna pointed to it too, they're amazing if you actually go and visit them. It's a whole different world. So being educated and going, okay, it's about their dignity and about their safety and navigating that. It's not a cookie-cutter approach. But if you come from there, you'll be satisfied at the end of the process, and it takes something. That's what I'd have to say about that.

SPEAKER_04 27:51

The other thing too is, you know, uh I mean, we actually had a conversation. Do we have mom move in with us? Right now we have too many stairs, so that would that it would have to adjust a lot of things. But having to work with her every day with her ins and outs, and you know, am I physically capable? What uh all of that. But then, but then when do I actually get to just go enjoy mom? It it isn't, it's not a good setup for that. My mom would rather I be there enjoying her time versus like, okay, well, let's do the routine that we did each day. So I really feel like it gives me the freedom to enjoy that versus the have to, have to, have to. And are there gonna be times when I'm not in that have to? Sure. But it it's gonna take more effort on my part to have it be the have to. So right now, I get to go be with my mom when when it works for me and when it works for her, and then we get to build on that.

SPEAKER_01 28:50

And that's a real contribution to mom. Like, mom is a whole different person. Her well-being is distinct because kids get to visit her that works for them and for her, because they go to her a whole different human being, free from that guilt.

SPEAKER_02 29:04

Yeah. And also, just like you're saying, they're able to concentrate on mom rather than okay, have you taken all your pills today? Let's cut them out and all the mundane things. You're able to go just like you would if she were independently living, which you may still be, because it may, I mean, with your mom, it's a little different, but they could be an independent living as well. We we help with everything from independent to through full skilled. So thank you so much, Paul and Lisa, Deanna and and Callie today. And any final things that we missed? You want to get in real quick?

SPEAKER_04 29:37

Delightful to just be part of this. Thank you so much for inviting us and sharing your world with us so that we can go out and actually impact seniors.

SPEAKER_02 29:46

That's wonderful. Let let's be a really positive impact on seniors in all the ways we're doing it and help the kids who are going to be seniors real soon. Let's let's be honest. And you know, we're all learning more about this too, because that might be us in 10 or 20 years. Thank you so much, guys. This is Rowena Patton and Kelly and Deanna and Lisa and Paul, realestate newsradio.com for all the episodes. We'll see you on the radio next week.