I agree with the poster who suggested calling Hospice for an evaluation of your mother. They do provide wonderful care-- and it is covered by Medicare or most insurances. There is generally a trade off-- if insurance is covering Hospice, they will not cover visits to the E/R. So it is a big decision. But it is probably the right decision in your mother's case.

As for long term skilled nursing care-- this is a note just on the financial realities, which are brutal.

Medicare generally cover the first 100 days of long-term skilled nursing care if the patient qualifies by medical need. Health insurance will only cover medical treatment not long-term skilled nursing care or residential care.

After the 100 days of Medicare coverage, if the patient needs to remain in the nursing facility, the patient will be required to "spend down" all of their assets and resources to a certain point (essentially, a few grand). If they hope to recover and return to their house, they can keep their house, but the local county department of social services (DSS) which administers Medicaid will place a lien on the home so that when it is eventually sold, DSS will be reimbursed to the fullest extent they are legally permitted to be reimbursed out of the sale proceeds.

In NY, the local DSS will look back FIVE YEARS into the bank accounts, real property, stocks, trusts etc. of the patient. They will penalize any improper gifts within that time frame. So, if two years before going into a nursing home, a resident gives away their house to their children, or makes gifts of $10K to each of 5 grandchildren, Medicaid will not cover their nursing home stay for however many months that equals the value of those gifts.

That is called a Medicaid sanction. There are certain allowable expenditures, depending on the rules of your state (for example, a prepaid burial account up to a certain maximum dollar amount).

It is a horrible reality that for many people who require skilled nursing home care, at a rate of $5,000-$8,000 per month, this will absolutely wipe out an average person's life savings within one to three years-- and eliminate any chances for the patient's children to inherit that nest egg they spent their lifetimes building.

The good news is is once your parents are technically destitute, Medicaid will begin covering the cost of care, (less their monthly pension and social security checks).

I see a problem for the LW if she is relying upon the parents' social security checks to make her own mortgage payment.

This happens when caregivers leave their jobs to care for their parents and spouses full-time. It is difficult to re-enter the work force, and when the parents go into nursing homes, their monthly pension and social security will be paid to the nursing home (this is a difficult situation but is not nefarious-- the nursing home IS after all, providing room, board and 24 hour skilled care to the patient while the patient is residing there).

The LW will then need to find other means to pay her own expenses.

The legislature is tightening the rules on Medicaid spending more and more, in anticipation of the baby boomer generation entering their senior years.

The legislature really wants to encourage people with nest eggs to purchase long-term care insurance. It is expensive, but will allow people to protect their savings if they want to leave a financial legacy to their children.

Also, irrevocable trusts made five years before entering a nursing home will not be sanctioned by Medicaid.

I say all this because this scenario that the LW finds herself in is not an exceptional circumstance.

People in their 50s and 60s who are healthy, who have worked their whole lives to create a decent nest egg and want to keep it should purchase long-term care insurance. The premiums are expensive, but might be worth it depending on how much money you have in the bank. I know this is the last thing that anyone wants to think about as they enter into retirement, a new expensive fixed expense, but it is just par for course.