There are two ways to make sure my sister keeps the house. Either she buys it from my mom for fair market value, or we immediately set up an intervivos trust to hold the house in my sister's name and then wait at least five years before applying for Medicaid. In other words, it would have been better to have set up that trust right after my dad died in late 2008. The only way to keep the house while receiving Medicaid assistance wouled be to keep my mom living in the house. And then after she dies, Medicaid can force us to sell the house so they can recoup the money they spent. The only way to protect the house from that scenario is to have a trust set up to hold the house in my sister's name (or mine) at least five years before applying for Medicaid. Five years ago, my mom was still very much in denial about memory problems, so she wouldn't have agreed to the trust. And there is no great advantage to my sister buying the house, because then she would be right back to making regular house payments while struggling with her credit card debt. She would be better off just living with my mom without house payments and paying off the credit cards and then saving some money. Besides, this house isn't that special to our family. My family has moved a lot over the years. I went to three different grade schools. My sister went to four different high schools. To the extent that we think of any place as the family home, it was the house that we lived in for 9 years when we were kids, and our family moved out of that house a long time ago.
If anybody can see this through to the end, it's my sister. She is a very experienced nurse. She helped my mom care for my dad during his last year, when he was dying of cancer, and she helped my grandmother during the final year of her life. Her only serious issue with handling our mom is the rare occasions when our mom gets violent. My sister now has a theory that the violent behavior might be tied to a specific medication that my mom has been taking for almost a year now, so she is going to see about getting the dosage adjusted.
The other thing that I noticed while talking to my sister last night is that I need to be talking to her more often, to give her a chance to vent about everything. We were just normal siblings growing up, until the family moved away while I was in college. Since then, my sister has idealized me, kind of like one of those anime girls that swoons over her "big brother." So whenever I call her, it seems to be a big morale boost for her. I can do that much right now, and then hopefully the ongoing crisis at work will get resolved soon, freeing up my time and money to help her.