Long story and I don't think 4000 characters would allow me to tell all the details of the past 6 weeks, but bottom line, both of my inlaws had medical issues causing them to fall a week apart. Both ended up in 2 different hospitals, Pop was discharged first on May 11th to a skilled nursing facility (he was walking when he went into the hospital (I drove from out of state to stay with him during the time MIL was in hospital), but when he was discharged, he said they put something on his legs and "put too much weight on them"...blood pressure cuff? He was in pain and hasn't been able to walk since. MIL was discharged to same facility 3 days later. They were on isolation wing (we learned after FIL was admitted there that there was a COVID case (per Area Agency on Aging Ombudsman. We were not informed.) So his 14 days quarantine was up last Monday, May 25th, and MIL the 28th. The home did not properly plan to test them to move them to another wing and out of isolation. FIL has deteriorated even more with the use of his legs. They both have a long list of diagnosis...MIL being delusional thinking she's been on a long trip and they were at the airport. The Social Worker, from day one, has NOT been helpful and has refused to do a Medicaid app for them (they had Humana Medicare), but financially, they both qualify for Medicaid. During the first 3 weeks they were there, the SW wouldn't update us at all (we did call daily to check on them and would speak to nurses). The one time the SW did call was last Tuesday right before 5 p.m. to tell us MIL was being discharged that Saturday (this past weekend), but "they will probably discharge them both together"...which was to a "personal care home" South of Houston an hour 1/2 away from their medical doctors, home, and all they know. We jumped through hoops and that home was a referral from supposedly a Dr. she knows that knows of homes (we had been searching assisted living all week...they did not have LTC policy nor did our parents have Medicaid (I'm working on that now). We called Friday about discharge to learn that they were ONLY going to discharge our confused mother...and the Ombudsman said that home wasn't on her list of licensed homes! We're so upset about that and that it's taken all this week for them to even get a POA signed and notarized correctly. We finally got a med and financial one done on both of them. They have 1 older car, very little in a checking account, and a home...they had 3 small whole life policies that we believe can go towards burial expense and we're learning of Irrevocable Funeral Trust...But what about their home? No notes, but they had a reverse mortgage at one time. It's appraised at about $160,000. We'll try to find out and call the mortgage co. to see if they owe anything back from what they borrowed against it years ago. Bank account doesn't reflect a payment. Is there some sort of trust that if it were sold, we could put the money in to be used towards their needs without the state getting it and without it knocking them out of the park on the resource limit for Medicaid? Seems letting the bank have it would be less trouble for us, but we don't want to be foolish if there's a way to sell and put those profits towards their needs. So many questions. And I know this is long and about as overwhelming reading and what we are going through...during a pandemic...because things weren't hard enough without one. lol. Thanks for any tips or advice if you made it this far. I just found this forum tonight. I'll try to not be so wordy in future posts.
What you need to do is find a certified Eldercare attorney who is familiar with Medicaid in your in-laws' state.
Is it not possible for them to transition into long term care at the skilled facility they are currently in ? It may be that the facility does not accept Medicaid or Medicaid-pending clients, or it may be that they are not medically at need of NHS level care.
What does the discharge planner at the current facility say about what their needs are? Assisted Living? Nursing home?
Have they been assessed for dementia? (At some point you want to get a geriatric psychiatrist on board as part of their medical team).
My mother has Parkinsons, Delirum, and a dozen more DX. She is the one we fear they will try to discharge too soon. They tried DS her last week after only 15 days (in isolation I might add) and was going to send her to an Unlicensed home an hour or 2 away in a confused state...unlicensed! We've let the TX Ombudsman know about that one. In fact it was she that said that the place wasn't on her licensed list. We've been reading horror stories. Thankfully, we've stopped that transfer last Sat. When the Admin found out that it was an unlicensed home she was going to be sent to, all of a sudden his on first name terms with my husband asking if his parents would want to consider staying there for their LTC. The SW who would not do a Medicaid claim for them...and it was her job to do so...told my husband that their is NO Medicaid pending homes. That's not what her Admin said. We're not to impressed with their office staff, but the nurses who care for them sound to be doing an outstanding job.
Hurray for you getting their PoAs taken care of. This will make managing care legally easier. I agree with BarbBrooklyn that with the mysterious reverse mortgage you should definitely spend the time and money consulting with an elder law attorney who specializes in estate planning and is familiar with Medicaid apps. You will need to go to that meeting with correct info about the home.
The SW did not fill out the app for you because she can't -- even YOU don't know answers to questions the app will ask (again, the reverse mortgage thing). You will need your parents' SSN, birthdates, bank account info, and details no SW would be privy to. Also, not her job to fill out the app for anyone. I know, I filled it out for my MIL.
Every facility is under the gun with the virus complications right now. They are understaffed and overwhelmed, as they are at my MIL's place. She has the virus. So, please be patient with them, most are doing the best they can under the circumstances. Start researching facilities near
Your mom's confusion may be due to an undiagnosed UTI, which seniors get quite frequently and often have no other physical symptoms, at first, except confusion and personality changes. Antibiotics will clear it up.
If your parents have some funds, definitely get a pre-paid funeral trust set up before they apply for Medicaid (if they need it). Medicaid won't hold it against them. Make sure your parents don't do any gifting of money or assets until you talk to the attorney. Medicaid has a look back period of up to 5 years and no less than 2.5 yrs. Check in your state. Also, be sure to secure and get control of all their sensitive financial info, especially if anyone will be coming or going into their home like checkbooks, licenses, etc., valuable jewelry or possessions, and remove any medications from their cabinets. To simplify things, set up online banking for them. To get you authorized as their financial PoA with their banks you will need to go there with your original copies of the PoA paperwork).
This is plenty for now. I can't help you with placement suggestions but see this Medicare website for nursing home comparisons. It lists many, if not all, in your area and gives some details (but often, not prices). I strongly recommend you settle your parents in facilities that have a continuum of care, from AL to hospice, in one location.
Another helpful resource is their local area's Agency on Aging.
https://www.medicare.gov/nursinghomecompare/search.html?
I wish you all the best as you sort things out for them!
We have been going through Area Agency on Aging. Right now, they are in a nice home that we pray will be there LTC home. Our Pop needs to be able to build up his leg strength and be able to walk again. Something he could do before he went in to the hospital last month. After putting too tight blood pressure cuffs on his legs over night, he began complain about them being extremely painful, and then he couldn't walk. The he laid in a bed for 3 weeks during isolation. Mom was admitted in 3 days after him, so he was waiting a couple days more to be transferred to another part of the facility with her. They didn't prepare well to have the kits ready to test for COVID. They were going to make them wait until the following week...and then another 2 days for results....Pop was literally wasting away and giving up the will to live. They should have gotten out of that isolation ward on the 28th. It was another 5 days before they did. It was a really huge set back for him, and she was almost hauled off to an unlicensed home...it just makes me wonder how many elder have been put in unlicensed personal care homes and have been moved around and across state lines. It's scary to think about, because they often mistreat them. We're thankful for God's intervention on that.
if Galv, on the mainland or the island, & are docs UTMB?
They currently are in a SNF in Montgomery County. This weekend we have been trying to gather information for the Medicaid app. We didn't get the POA's on them both until 3 weeks after isolation, so we've been jumping through hoops.
The Medicaid application is not entirely completed and turned in yet. There's still info on the RM that we need to learn about. My husband was able to get 3 whole life policies they had with cash out values transferred/set up to the funeral home in a irrevocable trust for their burial and funeral expenses. I may not be using the correct jargon yet, so I hope I got the jest of it out. lol.
As far as bank accounts, I saw 2 little accounts. One in her name, and one in her and Pop's names. One had a balance of $650 and the other almost $400. How in the world were they making ends meet. She has SS deposited at $1012 in one account and a very small Metlife annuity at the tune of $12.68. ??? She worked for a company years ago doing health insurance claims. Neither my hubby or I know the company she worked for. Pop has a $781 SS check being deposited. That's it. We saw today their $1200 stimulus check apiece came in. They have a couple of credit card bills, utility bills...lights, water/sewer/trash, HOA fees. I do have the Appraisal districts letter. They have a 2014? Not sure on year...car. No other assets, property, CDs, IRAs,...no safety deposit box. or anything else of value. They do have 3 more whole term life insurance policies that do not have a cash out value to them. Do we list them or no? They are small...$3,000 and a couple $1000.
We'll get hold of the benefits worker for Area Agency on Aging...probably will fax her the info we have thus far and let her turn in the Medicaid claim for us. As a SSD Advocate of 28 years, I know there are "trick" questions that come up or repeat themselves. There done for a reason...but I'm certainly not savvy on the question of "Will they return to their home within 6 months?". Until we learn more of this RM (and where to even begin looking for what company had it? We're not seeing payments from it in bank statements.) we don't know how to answer that question. If we say "no", then the company can swoop in and take it quickly. But what if for some reason they DO Discharge Mom...She can not live alone 24/7, and if their home is taken away, there's no where for her to go. I'm certainly not leaving her at an unlicensed, unskilled home. So it leaves me wondering if that should be answered "unknown" instead of a flat "yes" or "no"....because it is al unknown. I read info tonight that some RM homes have up to a year before they foreclose on them?
So many questions...so little time. It's going on 2 a.m. It was 4 a.m. hitting the hay last night. Gotta go, but we'll be back. I gave my husband this site and he's created an account as well. Thanks again for you input, advice, encouragement, prayer, and probably some days, just a good swift kick in the pants could be necessary. We're not ones to procrastinate, but we're tired! May God bless y'all and hope you have a great week.
I've never dealt with a RM
SW likely did not get on filing for LTC Medicaid for them because at the time they were at NH still within mediCARE post hospitalization rehab benefit. Medicare would have been paying 100% of first 20/21 rehab days & at 80% for all days after that if still “progressing” in rehab. If SW had done app, application gotten kicked out as ineligible due to another coverage (mediCARE) being available. SW wasn’t being evil, just experienced imho.
Abt house, as others have said, RM is lynchpin on what must be done. You have to find out what’s what on RM & ASAP. Also if there is not a RM, check to see if there is any sort of mortgage. TX has a waiver if there’s a mortgage (more below).
Why? Well If there is a RM, imho realistically any idea or plans on family having your folks continue to keep home (which LTC Medicaid allows as exempt asset for thier lifetime) flat doesn’t make sense. RM are NOT, again NOT structured to ever get paid back by heirs. The only way I foresee a RM ever working is if it was LOC RM (Line of credit) done ages ago & LOC was not really drawn on and that home has increased in property value beyond huge from what assessed value RM was based on. Like 50k RM in 2000 with 2019 tax assessor value of 300k; that 50k with interest & fees probably closer to 100k+ owed now. If “hazards” (Insurance & all to 2019 requirements like TX wind pool if it’s coastal, NFIP / FEMA flood & private flood if over NFIP 250k) worked into her RM as an add-in, the amount needed to repay RM could be way beyond 100k. If it’s a HUD backed RM, family can repay RM at 90-95% of what’s owed but it has to be done in full in about 3-5 months & you have to submit paperwork to tender an offer with a source of funding. By & large, family can’t afford doing what is basically cash buy & figures don’t justify paying 95% of a loan that is maybe over value. RMs don’t care if u do it cause HUD will cover any loss should house not sell to cover all the RMs outlay. RMs are a racket, their legit fleecing imho. If banking doesn’t show $ in, the RM could have maxed payout long ago, but it’s racking up interest & fees.
Really you gotta find out if there’s a RM first & foremost & if any other securitized lending. Post us an update, ok.
Has anyone mentioned LTC Medicaid required co-pay?
if not, .... Medicaid Requires each to pay NH all SS$, pension or retirement less $60 ea. $60 is thier personal needs allowance. $120 is it from here on out for flexible $ for them. So they will have ziltch-nada-zero $ to ever pay anything “house”. So whatever costs - property taxes, utilities, insurance- has to get paid by family. And unless there’s a existing notarized agreement on this, $ you pay on house stuff cannot be repaid to you by them, as it’s considered gifting of moms assets to you & not allowed... like they will get ineligible. So if you pay $876.54 property taxes, you have to be chill that it’s not gonna be ever repaid to you, or your Bro, or Sis.
Should there be a HELOC or regular mortgage, TX has a waiver they can file for file for to have that paid from copay for a period of time. Last I looked it was 6 mos, so you gotta get house sold by then. Waiver doesn’t cover taxes or insurance. It’s for mortgage, as it keeps house from being foreclosed on. Theory is it gets sold, $ from sale then gets used to private pay for NH then once at 3k in assets max, they can then be eligible for LTC Medicaid. Not all states do this waiver but TX does & house must have a MLS listing, no FSBO nonsense.
yeah it’s a harsh limited set of choices.
if it’s got a RM, personally I’d walk on dealing with it totally. Mail the keys.
On their RM...their daughter passed away back in 2005. She has insurance policies that bought them this nice little home and a car. We want to keep the utilities, taxes, & HOA dues paid up in case the SNF wants to discharge Mom. She'd have no where to go if they did that! She was in only 14 days and they were trying to discharge her last weekend (by her mentally unstable self (delusional with Parkinsons, Delirium, etc.) because her Humana Medicare stopped paying them. The SW was trying to send her to an unlicensed home. So we're afraid of them dumping her somewhere (we were not notified last week...we just happened to call and was told that the day before.) We also were not giving the info about the appeal process. That's a battle for another day. Right now, we're trying to get everything aligned for a state medicaid app.
So this morning, we've began putting in calls to County Clerk's office to try to find what lender had that reverse mortgage. Do you know how we can do that?
They have very little in their bank account. Stimulus checks were just put in...how long do we have to spend that down? They have an older car, the house with a RM (we have NO info on the lender, etc.) and they had 1/2 dozen whole life policies, 3 of which had $7000 cash out value. At the advice of Area Agency on Aging Benefits rep, my husband set up a burial/funeral trust (I may not be using the right jargon) with the cash policies so they won't go against them. The other 3 whole life policies have no cashout value. Are they to be listed on the app as well? I know term doesn't, but since this is whole life...but no cashout value...it's a bit confusing.
Also, there is the question on the app "Will you be moving back to primary home within 6 months?". Or something to that affect. How to answer that? Who knows? If we say no, then the house will definitely have to go. If we say yes, does that hurt their app approval?
Just at your convenience, we'd appreciate your input. Thanks!
LTC Medicaid will want the entire policies submitted at some point in the approval application process. Term policies do NOT require a cash out, so please please PLEASE make sure it’s actually whole life & not Term. For my mom, the caseworker had a ? on this for her application & I sent over a on letterhead letter from a broker who held a TX insurance broker license to state he reviewed it and it was Term. If it’s an older policy - my moms was.... like almost 30 pages Double sided, legal length too - it may not be exactly clear as to if term or whole life & the caseworker doesn’t have time or training how to review older policies. But it does matter, term can actually be beyond its face value - my moms was & by quite a bit - but that does NOT need to be a factor for Medicaid. For term, it’s only the “face value” that counts. TX does have a max “face value” for Term, so if it’s Term it has to be under the state max; it will be somewhere in the policy as to face value.
if it’s whole life, I’d suggest that you via email contact the insurance co to ask what’s needed for the cash out to be done. Could take few days or weeks. Whatever the case, imho, you gotta be ready the day $ comes in to go and use it to pay thier funeral preneed if that’s how y’all have decided is best use of $. Most FH know the LTC Medicaid rules as to the max value of a preneed allowed by TX Medicaid. I did not have to deal with this for my mom as she had a preneed done & parents bought a vault before dad died in the 1980’s (she outlived him by over 3 decades). Even with these, there were still all sorts of funeral & burial costs. You gotta pay attention to the details, it’s hard but try not to let your emotions get ahead of your purse or wallet. Maybe take a more pittbullie bad witch friend with you. For my MIL, the sons did a cremation, way simpler and under 1k, and then waited till VA could schedule free cremains earthing. But I digress, you have to have a plan at the ready to spend whole life $. The day $ deposited into thier account, it’s considered “income” that month. All states have an income max for LTC Medicaid. For individuals usually abt $2100 a mo; for couples it’s abt $3800 a mo. Look at TX DADS website for the exact amount and then compare it to what your folks get each month from SSA $ and all other monthly income, like a pension or retirement. If thier income goes over the Medicaid ceiling for a couple for LTC Medicaid and stays that way, they will be ineligible for LTC Medicaid. One time $ that comes in if it gets spent totally is income that month but not counted by Medicaid but if it sits in their bank account to the next month it then become an “asset” for Medicaid. You might want to wait till like 2nd of the month to actually deposit the check, comprende? So that whole life $ has come in & move out to a legit & ok for Medicaid payee & done before end of the month. It’s deposited & spent, so it doesn’t flow over into the next month. Again Comprende? Funeral preneed is legit, but $ to you & family is not.
Also I’d suggest that you get 3 binders going 1 for each Medicaid paperwork and then 1 for all joint banking, insurance etc. Yes you’ll have to xerox to the individual binders. But each of them have thier own paperwork for application & the renewal that will be required in 2021. Being organized will help keep your sanity. TX Medicaid for my mom took 5 1/2 months but she had medical “at need” issues. TX seems to get applications done in 4 mos.
Because of this try to get them into a NH that does “Medicaid Pending”. Otherwise NH may heavily press on family for a refundable deposit done. They can’t make you do this, but family does it rather than go to the not quite so cute NH. Once they clear Medicaid, you can get them moved lateral to another NH closer or better. Best of luck
Regarding their old MDs, if they go onto LTC NH Medicaid, the facility will likely be participating in a Medicaid MCO (Managed care organization) for the medical services. TX moved over to MCO system abt 4 years ago and now done in some way in all counties. My mom was on LTC Medicaid AND on hospice by then, so hospice (Medicare benefit) directed her health care. But if she’d hadn’t been it would be whichever MCO group her NH affiliated with. The MCO list of MDs, PAs, etc will be the closed system of providers for them and whatever hospitals and clinics that MCO is affiliated with. I know it’s all a lot of info hitting you right now. The takeaway is The day’s of them going to see ophthalmologist over in say Sugarland and then their old internists in a League City or a specialist up at MD Anderson is probably all over with once in a NH. It will be the medical director affiliated with the MCO that is now running thier chart and what is done. What is in the hospital discharge report for thier ICD-10 codes is what’s going to guide what services they need initially at the NH. There should be a “care plan” meeting set for about 4-6 week mark for them. This meeting is super important. You want to write your ? & concerns down so you’re ready for the meeting. Again, the 1st one is quite important. Try to have a friend or family member be there just to take notes.
This is for NH, aka Skilled Nursing Care, right? & for both, right?
Here's where problems came in. While still in isolation, our Mom gained strength and mobility. She super smart and witty. Hides her delirium well during times with doctors (I'm an old mental health caseworker and saw how well people with chronic mental illness can hide their illness for short periods of time.) The problem is, Mom did such a good job, Medicare quit paying and they were trying to give her an accelerated discharge after the Dr. at NH said she only needed 6 hours of care a day. She thinks she's at an airport...or lately, a "fancy hotel" for goodness sakes. Someone has "stolen her bags" and Pop's wallet. She's moving back to her childhood home to see her dad some days (she's 82...he's long gone), but not to worry...because the medical staff and doctors have agreed to all move with her!
So HOW can we get this changed? We're stressing to the nurses to please document her delusional thoughts and behaviors and we believe they are. We tried filing an appeal (not that the NH offered that info and when we brought it up the day before they were going to remove her, the SW told us "you have til noon"...20 minutes! We got it done...but then had a call last Sat. to say that the appeal was denied and to call Humana. Humana said we would need to have the Dr. that admitted her there for services to extend her therapies. He was a Dr. at the hospital she was discharged from to NH and we have left numerous messages in his various offices around Houston and my husband faxed him with details of what was needed. Crickets.
It is overwhelming trying to know that we're keeping up the battle and getting things in place financially...all the while being worried about them giving her the "boot". Ombudsman kept ensuring that "they can't just kick her out". But lo and behold, that's what almost happened last weekend. The SW who said that there are NO Medicaid pending homes...well her Admin of the home asked my husband if they would consider LTC where they are...Medicaid pending. Worried much about them almost discharging her to an unlicensed home? We just want them well and safe while we take care of the financials. We know the nursing staff is doing a wonderful job, but we don't trust the SW and her staff as far as we can pick them up and throw them.
But if their in Houston / Ft. Bend area, a good firm is going to likely be $7500 for a couple to become a client. Ft Bend is wealthiest co in TX. There’s more demand than CELA NAELA attys in the area. That’s why I asked what county they were in.
Plus if already in a NH and done Medicaid LTC application, the “snapshot” day that Medicaid uses is already affixed, there's no window to move and realign assets. If they have filed LTC Medicaid application, the vibe I've gotten is usually law firms won’t do the initial “free” consultation as the dye is cast so to speak. TX is very much property rights state but if there’s a RM, all things you might do with property (Lady Birds, MERP exclusions, Testamentary Trust) isn’t options as RM controls that asset. If it’s actually that it’s just they have an old car, very little $ in bank and a house with a RM, and they have gotten DPOA & MPOAs done at the facility they are in now, I Personally just don’t see what an elder law atty can do for them.
TX property taxes are either all due Jan 31st, or back half of 50/50 due end of June, or qrtly with next due end of June. & there is no leeway. If it’s not paid, it gets posted within days on collector or district website. The RMs seem to scan for these as they can seize the property for noncompliance for terms of mortgage. The “we buy houses” outfits pounce on these too. RMs seem to be especially ruthless for TX real estate.
The RM will get whatever paperwork to the parents or DPOA to get the house transferred. The kids will have to clear the house of stuff or RM will hire a company to do this & they work fast. The DPOA can probably force the RM to get a mobile notary over to the NH, if DPOA wants to be pitbullie on this. I just don’t see spending $ on atty. & I’m all for using atty, as legal issues not a DIY project, but you have to have assets to work with.
we asked them to put in for medicaid in case needed ( the hospital wanted us to get hospice- they all thought he had only a short time to live ( thanks to a statement from a neighbor who called the ambulance)
To be honest, it is scary sometimes how little some people in the medical field (and that includes the SW) know about cognitive issues like dementia. As for the Humana (probably a misnomer for that place!) rejection, they ARE aware of the virus and the impact on medical staff, right? Probably why you are not hearing back from the doctor...
To me, here’s what I kinda see as “the” decision that needs to be thought thru. Mil went into SNF in April, followed quickly after by FIL. Your FIL definitely needs SNF and has a nice fat medical chart to show he’s “at need” medically for TX LTC Medicaid.
BUT.....
for MIL, she’s showing that she is much better & has actually gotten evaluated and is facing discharge from SNF, right? SW tried to get her placed in a facility not in Wharton Co but in adjacent co. It wasn’t a SNF but lesser level of care, right?? Was it a board & care place, these are a grey area for licensing, some are quite good but stay small so not regulated; pretty low costs. But I digress..... so what right now is MIL “need”? Is she definitely not “at need” for SNF/ NH? If so, finding a place that will take Medicaid for her will likely be quite difficult. TX LTC Medicaid is mainly all abt paying for SNF/NH. To have Medicaid pay for AL or MC, it would need a waiver by Medicaid & a facility that participates in waiver program. The cockup in this is that TX waiver programs are so narrow & limited that it really isn’t an option, or the place is a scary sketchy. Medicaid funding LTC for skilled nursing care is required by the feds. Waivers don’t have to happen.... unless a state prioritizes them. TX kinda doesn’t.
So if mil isn’t medically at need for a SNF, but is AL, how is that going to be paid? I’m guessing that there’s no $ for this from their income / resources and it’s not feasible for the kids to pay.
Would it be feasible for MIL to return home & for family to figure out a way to do caregiving in home? If so, MiL would become a “community spouse” for how Medicaid looks at thier $. CS is hugely different than both in a NH situation. If that RM is ok on her continuing to live there, she can stay. She can apply for MMNA / CSRA (are needs allowances). What they do is allow for a waiver of FIL required mo. Income copay to the NH to instead be “waived” and go to her as a CS. TX does MMNA and it’s pretty high max, like $2800 a mo. Think of it as kinda like alimony. So in theory, if he got $2900 a mo & she needed $2800, $2800 waived to her and NH would only get $40 a mo. as TX has $60 a mo personal needs allowance. She has to show she needs the $ which I’m sure y’all can pull from their bills. There was someone on this site whose dad only paid the NH $35 a mo as the mom had high RXs and utilities so needed almost all his income. Atty are good for CS situations if that’s the plan.
it might be that once mil is not doing for FIL 24/7 that she will be quite fine at home with family perhaps staying there thru this summer. In this plan, she files for MMNA, keeps her own SS$, keeps all the whole life $ & any other $ as TX allows for CS to have abt $128k in assets (excluding house) & stays living in the RM home. Then reevaluate this Fall. She sounds like one you actually like to be around, which is rare. Then in Sept, if she needs her medical chart updated to clearly show “at need” for a SNF (so she can get LTC Medicaid), you have time to get this built up. FIL stays in NH during all this. You can look around for another NH too for the both of them. TX Medicaid allows for a lateral move from 1 NH to another; I did it for my mom within the first year to a much better facility. It’s a bit of a ballet to do but can be done with planning.
if RM is actually way way under 160k, maybe $ back if it gets sold. I personally wouldn’t spend a penny on house (other than what RM requires) unless u know 4 sure RM can be cleared with real profit. Remember any $ family outlays cannot be repaid from a house sale as proceeds from sale is parents assets; if it’s done, Medicaid can view it as “gifting” and both become ineligible.
Alot is dependent on if both into NH or if it’s NH/CS. 2 very different paths for medical and financial requirements for Medicaid imho.