Q. My husband recently entered a nursing home and it appears he will be there for the long term. It is very expensive and I am concerned that we may lose our home and savings. Is there anything that we should do at this time?
A. Yes. The first step is to take a deep breath. Then, approach your concerns systematically. Here are my recommendations:
1) Ensure Good Care: Make sure that he is getting good care. Frequent visits and interaction with staff can be very helpful. If you desire a professional evaluation, you might hire a geriatric care manager for an assessment of his needs. Visit www.caremanager.org or phone 520-881-8008.
2) Review Health Directives. Review your Advance Healthcare Directives to make sure they are current. Discuss with your husband’s doctor signing a Physicians-Order-for-Life-Sustaining- Treatment (“POLST”), a relatively new form which increases the chance that your husband’s end-of-life wishes will be honored
3) Consider Medi-Cal Subsidy: Consider applying for a Medi-Cal subsidy to help with the cost. Many couples are surprised to learn that they can qualify: if your combined savings do not exceed $115,640, your husband can qualify. Your home and certain other items are exempt and are not counted against this resource ceiling. If your assets exceed this amount, planning options are still available but you will need professional guidance. To learn more, visit our website to download a free copy of the “Consumer’s Guide to Medi-Cal Planning”.
4) Change Community Into Separate Property: If your husband qualifies for Medi-Cal, take steps to protect your home and other assets from Medi-Cal “recovery”. Here, it is usually wise to change community property into your separate property. An elder law attorney experienced in Medi-Cal planning can help.
5) Change Your Will or Trust: Likewise, consider changing your own will or trust to avoid a direct bequest to him. Remember, while on Medi-Cal your husband cannot have more than $2,000 in his own name; the balance must remain in your name. If you were to predecease him, your bequest to him would likely put him over the resource ceiling and end his subsidy.
To avoid this result, consider a plan which leaves everything to your children if they are trustworthy or, alternatively, to a Special Needs Trust (“SNT”) for your husband’s benefit. The SNT is a special trust created to hold assets for a person receiving Medi-Cal. The assets are deemed owned by the trust, but are available to supplement your husband’s needs in a manner that does not jeopardize his Medi-Cal benefits.
5) Revise Powers of Attorney: Make sure your Powers of Attorney (“POA’s”) coordinate with your trust (many do not), eliminate any requirement of doctor certification of incapacity so that his POA is immediately effective, and add Medi-Cal planning, expanded gifting and “self-dealing” powers in order to help you manage and preserve assets for your family. Also, make sure that his POA is “durable”, so that it legally survives if he loses capacity.
If your husband is not capable of signing new documents, there is a court procedure that can help. The judge’s order takes the place of your husband’s signature.
After attending to the above, you will have gone a long way toward assuring good care, financial security and peace of mind for both you and your husband.