A typical situation an older couple may face is that one of them has a serious medical event that puts them into the medical system for treatment, rehabilitation therapy, and then discharge to home. In a large number of those cases, the spouse going home needs help with the activities of daily living (ADLs) such as bathing, dressing, eating, toileting, and safely transferring from bed to chair. They may also need support with meal preparation, medication management and mobility around their home. From long experience a huge majority of those folks want to do it on their own, with help from their spouse, and believe they can do it. For many, that is not reality and increases the chances that both will end up needing help for long term care. Here are some thoughts.

Almost all families work hard through much of their lives to pay off their home mortgage, and have raised their families in that home. Most have a desire to leave that home to the children or at least have the children receive the value of it. They fear losing it to pay for long term care. Often that human desire is stated as “I don’t want my home to go to the nursing home.” There are several rules that are designed to protect the home, and in many cases, it is possible to save that value for the family.

Everyone should have a healthcare directive, also called a living will. It is a legal document that states your wishes if you should be in a life ending situation, with no hope of recovery, and don’t want extraordinary measures taken that can never return you to any meaningful form of life. Whether you are age 20, or 80, and have a normal quality of life, and are in a car accident and are bleeding to death, its common sense that you want the EMT’s to do all in their power to keep you alive. The saying “I don’t want anything” really means you don’t want extraordinary means taken to prolong life when there is no likelihood of returning to a decent quality of life. Here is a more complete explanation.

When a single person or a married couple decide to do estate planning, or asset protection planning, a key question is who to name as an Executor, Trustee, Power of Attorney, and Healthcare decision maker, called the Healthcare Representative. Let’s look at a typical married couple with children. Assume both are healthy and middle aged and their kids have no medical problems. They need standard powers of attorney so that each of them can sign for the other. But any older couple must consider that if one of them becomes incapable, or dies, a backup power of attorney is needed. That backup must have good judgment, be fair minded, and have the ability to handle financial matters. Let’s face it, some adult children simply do not have good financial skills or judgment. And in rare cases, they would not be fair to their siblings. That child should not be given a power of attorney, because finances could be mismanaged or siblings shortchanged. So the parents should choose as backup, children who are capable of handling the parents financial affairs, who have the parents’ welfare at heart, and who will treat their siblings fairly. If two or more children are to act, it should only be done if they would be cooperative.

The title of this article lists items that are in almost everyone’s house and from the time we learn to safely use them at age three or four, we don’t give them a thought. They are just part of our daily lives. But as we get up in age, those three items can become more dangerous to us than when we were toddlers. Most toddlers experience falls in their learning to safely use stairs, tubs, and rugs, and bruises and pain dissipate over hours or days and there is seldom long-term impairment. But when someone is 80, instead of 8, a broken bone, or dislocated joint, or concussion may not heal very well, or may incapacitate an otherwise self-reliant elder person to the point where they cannot stay at home. It’s our experience in aiding families get care for their loved ones that the single biggest reason for needing long term care, starts with a fall. Let’s be realistic, bones, muscle cells and that old brain just do not recover as fast, and sometimes not at all from the dreaded fall.

The five year rule is based on a federal law that is intended to prevent a long term care applicant for Medicaid, (Title 19), or a spouse, from giving away assets in order to qualify for payment for that care. It does not matter whether the sick spouse or the healthy spouse gives away the assets. It will create a period of time, called the penalty period, during which the state will not pay for the care. It is important to know that the penalty period does not begin until one of the spouses is in a nursing home, or has reduced their countable assets to the eligibility amount and is otherwise functionally eligible. The sick spouse is limited to $1600, and as of January 1, 2024, the healthy spouse can keep up to $154,140 of countable assets. The state doesn’t simply rely on what the applicant reports in the application. A caseworker will check the land records to see if a deed has been filed to transfer title. They will also see a social security number, check if the applicant and spouse have any bank or investment accounts, life insurance policies or annuities that have existed during that five year look back period. The Medicaid caseworker can look at any and all transactions to see if assets were given away. If there is a deposit in an account, the caseworker will ask where that came from if the source is not clear.