It is never too early to proactively talk about estate planning. I have family meetings with my clients and their children while my clients are in their 50s, so they are young and healthy still. It is always hard to talk about these things when we are in a crisis mode and stress levels as high. If you have done some estate planning of your own, that is a great place to start to bring up the subject. 

Here are some topics to consider:

• Do they have a power of attorney
• Do they have an advance health care directive
• What are their wishes regarding end of life decisions 
• To they have a trust or will
• Are they willing to share a 'location list' of where they have accounts and/or important documents. 

This is a good start!

Your dad would need to sign a new power of attorney (POA) to transfer the authority to you (or back to you) and revoke the prior POA(s). 

It sounds like, however, he may be suseptiable to undue influence. So possibly his girlfriend could get him to sign another POA again and it becomes difficult to stop that, which is when some people turn to the court to get a conservatorship or guardianship. However, you would need to show your dad cannot manage his finances himself and he sounds very active.

You could transfer and ensure all of his assets are in his trust, including the bank accounts, since the POA only controls non-trust assets. 

Medicare is a federal insurance program paid out of Social Security deductions. All persons 65 or older who have made Social Security contributions are entitled to the benefits, as well as persons under 65 with disabilities who have been eligible for Social Security disability benefits for at least two years, and persons of any age with end-stage renal disease.

Medicare does not pay for all medical expenses, and usually must be supplemented with private insurance ("medigap") or consumers can enroll in an HMO plan that contracts with Medicare. After 3 days of prior hospitalization, Medicare will pay up to 100% for the first 20 days of skilled nursing care. For the 21- 100 days, the patient will pay a co-payment. The premiums and copayments are increased every year. There will be no Medicare coverage for nursing home care beyond 100 days in any single benefit period.

It should be noted that Medicare only pays for “skilled nursing care,” does not pay for “custodial care” and the average stay in a nursing home under Medicare is usually less than 24 days. Thus, few can look to Medicare to pay for any substantial nursing home costs.

If you have any clear evidence of elder financial abuse by someone, you should report it to adult protective services and the police. However, it sounds like you are just noticing some irregular charges. It also sounds like you have tried to speak with your mom about this. You might want to bring up a time where you had and issue with fraudulent charges and how you handled it or a story you had heard so mom is not as embarrassed. 

Do you have a durable power of attorney for mom? If so that document might allow you to access her accounts and review the charges. If mom does not have this document in place it would be a good idea to see an attorney to draft one. This will allow you to manage mom's finances in the event she cannot. 

From a legal stand point there a some key documents your grandfather should consider putting in place:

A medical power of attorney, which nominates someone to make medical decisions;

A financial power of attorney, which appoints an agent to make medical decisions; and 

Determine whether, depending on the types of assets your grandfather has, if he needs to have a Will or a Trust.

Certain accounts and assets can pass at death via a beneficiary designation. I'd encourage your grandfather to check all accounts for this option. 

As difficult it may be, I'd also encourage your grandfather to think about end of life decisions and be as specific as possible regarding health directives. 

Typically Medicaid rules, which vary state to state, allow the well spouse to maintain an amount of what would otherwise be available assets for qualification purposes at the time you apply for Medicaid. Assets acquired after the spouse is institutionalized are not protected and will be counted at the time of the application. You would want to see what amount is allowed in your state.  Since it sounds like your husband is not yet institutionalized, at least a portion, if not all, should be protected. 

This is a great opportunity to be proactive. There are a couple essential documents to start with. The first two deal with incapacity: the power of attorney and advance health care directive. Each nominates a person or persons to handle your parents' financial and medical decisions during periods on incapacity. If your parents already have these documents, they should be updated every 5 years or so to ensure they are not outdated. I just reviewed a power of attorney that only went into effect upon incapacity and incapacity was defined by not one but two doctors and the children had to agree. Practically this would be difficult and could lead to delays. So it is important to review the terms. 

The second two are a Will or a Trust and three documents would deal with a passing. Depending on what types of assets your parents own and other factors, one or the other might be more appropriate. It helps to discuss these options with an estate planning attorney. 

This would be a great idea! I find it helpful when speaking to parents to let them know you've just gone through the same process. So if you have done a budget for yourself, show it to your dad. If you have not done a budget for yourself, your should! Also it is important to put together an asset inventory so that you know where assets are located. 

I cannot comment about if there is a specific New York law, but I agree that this is a health issue. 

Here are a few things to consider:

1. Does your husband have a valid Advance Healthcare Directive for his father? If so, review what sorts of powers that document gives him. 

2. Consider speaking to the social worker at the facility regarding this issue.

3. Consider speaking to a geriatric care manager who can counsel regarding ways to approach your father in law regarding this issue.

It would certainly be very difficult to force your father in law to shower. Maybe they staff would give him a sponge bath instead. Many seniors have a fear of showering because they are concerned about falling. Perhaps your husband can address this fear with his father. 

In California, you do not have to sell your home to qualify for Medicaid as long as you have an intent to return to the house. However, Medi-Cal (California's Medicaid program) can recover against your estate after you pass, including outing an estate claim against the equity in your home. 

You will want to speak to an elder law attorney about your state's specific laws and legal ways (such as irrevocable trusts and irrevocable life estates) to protect the home after you pass. 

This is a very interesting question. You always want to review the contract you/your dad signs with the nursing home regarding collections and their policies to make sure you are clear on what they can or cannot do to collect outstanding bills. In my experience, the nursing home does not use peronal items in the resident's home as collateral. Again, review the contract carefully. If you are not sure about the terms - ask. You do not need to sign it "as is" if you are not comfortable with it. 

An Elder Care Attorney can guide families through this process.  The process begins with a review of any Estate Planning Documents your grandfather may have (and if they don’t have any it is time to make sure they do). Estate planning documents would include Powers of attorney, medical directive, a Will and a trust, if appropriate. It is important to update the documents to make sure that your grandfather has a plan for what happens when you don’t die but need long term care.  A long term care plan will prepare for the inevitable need for long term care, making sure plans are in place so that your grandfather can qualify for public benefits such as Medicaid and Veteran’s Benefits.  Long Term Planning is designed to leverage and protect assets.  The goal is to make sure that as the family travels this road that your grandfather is able to get the care they need and that their money lasts until the end of life.  The road can be long and there will be many choices along the way: Can grandfather stay at home with caregivers?  Which Assisted Living is best?  Does grandfather need Skilled Care? How can we pay for this?  What do we do next? An elder care/law attorney can help with these decisions and the choices are not the same for each family, which is why you would want to work with one that creates a relationship with the  clients and their families that starts with updating their planning while they can continue to provide advocacy and guidance along the way.

As you know, Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. Each state has different rules about eligibility and applying for Medicaid. I would suggest calling your state Medicaid program to see if you qualify and learn how to apply and you might also consider consulting an elder law attorney in your state.

Under CT Title 19, if you are on Medicaid, you will probably have to spend your monthly pension, Social Security, or other income to pay for your nursing home. What is not clear from my initial reading of the statute is whether giving gifts is a permissible way to "spend down". Clearly medicial bills are, but what else? This what you need to find out. 

You are allowed to keep some money each month:

§  $60 for personal needs. (****I am not sure what the definition of personal needs is but perhaps, the elder could perhaps give gifts from this amount)

§  Support for your spouse or other dependent living at home.

§  Health costs that Medicaid does not cover.

§  $90 each month for a single war veteran or the spouse of a deceased war veteran.

§  Some expenses for your home if you will go back within 6 months, including rent or the mortgage.

Again, since each state's programs are different, I would suggest that you call your state Medicaid program and ask them for their definition of personal needs and see if gifting is included in personal needs.