Nursing-home payments sap seniors’ assets

Some facing thousands of dollars in bills turn to Southwest Senior Center

Southwest resident Mike Miller, 82, recently got a bill from Walker Methodist Health Center, 3737 Bryant Ave. S., for $14,059.70, to pay for his wife's nursing-home care -- an amount that would take half of his remaining assets to pay.

The bill has accumulated since the end of November.

Linda Walker, a community-outreach social worker with Southwest Center Senior Services, has helped Miller file the paperwork for Medical Assistance, a government health care program for the poor.

"It is nerve-racking to get those bills -- and they keep getting higher and higher," she said, noting people of the Millers' generation are used to paying their bills each month.

Southwest seniors such as Miller face a collision of wrenching decisions as their lives wind down. At the very time their loved one struggles with infirmity, they fear losing their assets despite a lifetime of responsibility.

People with more money than the Millers can hire a lawyer to help them make tough financial decisions when one spouse goes into a nursing home. Middle-class seniors throughout Southwest must find help some other way.

The Millers turned to the Volunteers of America's Southwest Center, 3612 Bryant Ave. S. Walker can't help them with financial planning, but she can help with Medical Assistance documents.

Walker spends 10 percent of her time helping people like the Millers, she said. Typically, they have $20,000 to $60,000 in assets, enough to cover nursing-home bills for six months to a year.

Some say they have saved for a rainy day and want to keep it -- either to pass on to their children, or to have it if things get worse, she said.

"I've looked at people and said, "'You've saved this for a rainy day and it's pouring.'"

$146 a day per bed

Miller (not his real name) said his wife had gone in and out of the nursing home four times, most recently readmitted in June. "She can't take care of herself and I am not able to," he said. "I'd have to be here 24/7."

Last fall, they began the formal process of splitting their assets, the first step to get Medical Assistance-approved.

"Pretty soon you'll get an MA [Medical Assistance] number and you won't have to worry about the medical bills," Walker told Miller during a recent visit to his Kingfield home. "It should pay retroactive to December."

Her nursing-home care costs $146 a day, Walker said. That's roughly $4,300 a month, not counting medications, another $110 a month.

Medicare, a federal health care program for seniors, paid for some of her prior, short-term stays, but it does not pay for extended stays. The Millers don't have long-term health care insurance.

It is a common situation. Jonathan Lundberg, executive director of health care and therapy services at Walker Methodist, said fewer than 2 percent of those in the 488-bed facility had long-term care insurance.

At $50,000 a year for a nursing home bed, it doesn't take long for people like the Millers to spend their life's savings and turn to the government for help.

Like many, Miller is trying to protect some assets for his daughter.

During a recent visit, Walker talked to Miller about taking his wife's name off the house title. If he doesn't -- and if he died first -- she would be sole owner of the $130,000 home and lose her Medical Assistance eligibility. She would have to sell the house to pay the nursing-home bills. Taking her name off the property means their daughter could inherit the house.

The Millers' tale

The Southwest Journal asked the Southwest Center to find a senior couple with one spouse in a nursing home, working through these tough decisions. Because financial issues are personal, we offered to withhold the couple's name.

Walker introduced us to Miller.

Part Swedish, part Norwegian, Miller fought in the Battle of the Komandarskis near the Aleutian Islands in World War II and was on the Battleship Missouri when Japan signed the peace treaty. He still drives a 1978 Buick Skylark (84,000 miles) and is a John Phillip Souza aficionado. He has stacks of Souza CDs and has a youthful smile when analyzing a piece for guests. ("Listen for the backbeat," he says, tapping it out briskly with an air baton.)

He met his wife (call her Susan) through a friend at Our Savior's Lutheran Church at East 24th Street and Chicago Avenue; they married in 1958. A daughter was born and the family lived in the same house since 1965.

Miller worked as a yard clerk and engine crew caller for the Great Northern Railway and later for the Post Office and receives roughly $1,900 a month from his two pensions. Susan, now 77, worked as a nurses' aide at Swedish Hospital and later Fairview Hospital, and gets a small pension.

Over the years, two talked "a little" about nursing homes and long-term care insurance, he said.

If things had gone differently, Miller would have liked to travel with Susan, "from here to Seattle, then down to California, then across the east coast and up the east coast as far as Boston," he said.

Susan's first nursing home stint, 31 days, came in the spring of 1997.

"She had back pain and leg pain and she couldn't navigate," he said. "It was getting worse and worse."

Uncontrollable pain returned and Susan spent 50 days at Redeemer Residence, 625 W. 31st St., in 1998, followed by 78 days at Walker Southview, 6130 Lyndale Ave. S., in 2001.

The couple's out-of-pocket costs grew with each stay. Medicare covered most of the first stay. The Millers paid $2,773 for the second and $6,597 for the third, according to his records.

The out-of-pocket costs have exceeded $20,000 for her most recent stay, not counting the outstanding bill.

"She still wonders when she is coming home," Miller said, but doubts it will happen. "Her knees are just too bad."

The couple's daughter lives in Wisconsin with her family. Miller said his son-in-law wants him to go into assisted living near his wife, or have the two of them move to Wisconsin to be closer to family.

"I don't want to leave the [Twin] Cities; I am too old," Miller said. "I like the Cities here too well to want to pass it up."

Adding and dividing

To qualify for Medical Assistance, couples must file an asset assessment, Walker said. The document is more than a dozen pages, asking for the value of bank accounts, stocks, bonds and life insurance and funeral policies.

The couple's financial snapshot is taken after one spouse has received round-the-clock care for 30 consecutive days, she said. The assessment determines the couple's marital assets -- and how much the community (non-nursing home) spouse gets to keep when the nursing home spouse applies for Medical Assistance.

The community spouse gets to keep the house, its contents and a car. He or she also gets the first $24,607 of bank accounts and other assets, according to a Minnesota Department of Human Services brochure. After that, the money is split, with the community spouse keeping a maximum of $87,000.

Getting the financial snapshot can be a headache, Walker said. It took her four faxes to the life insurance company to get the cash surrender value of Susan's life policy.

In November, the Millers got a letter from the county: he and his wife got to keep $27,573.95 each. It was money she had already been dipping into to pay her care.

Susan could apply for Medical Assistance on the month she could no longer afford to pay for her nursing-home care, Walker said.

After six months in the nursing home at $146 a day, Susan spent down her assets by December, except for the $3,000 that Medical Assistance lets you keep.

If someone had told Miller to file the asset assessment earlier -- after Susan's first extended nursing-home stay in 1997 -- he might have kept more money because his assets would have been higher, said Walker, who didn't get involved until 2002.

Still, Miller said he thinks the system has worked well for him in the end.

"The retirement checks more than cover the checks I have to write each month," he said. "The only thing I do with my savings is when something big comes along, like property taxes."