Choosing Medicaid to Pay For a Nursing Home

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Many lawyers who do estate planning spend a lot of time helping where they can to arrange for elderly people to qualify for Medicaid. Depending on the requirements in your state, various things must be done with money to qualify a person for Medicaid. The idea is to “preserve assets” or protect the elder from having to spend money for care when the elder can qualify for Medicaid and get the state to pay for care. We’re not talking about folks who are truly poor and have no assets.

What’s wrong with this picture? I challenge those urging and assisting elders who own expensive homes and have plenty of money to get on Medicaid to explain in detail what care the elder will qualify for, once eligible for Medicaid. When a lot of help is needed, the only choice is a nursing home. Does anyone want to purposely impoverish him or herself for the privilege of living in a nursing home?

I have worked in nursing homes. I’ve been an aide, a staff nurse, and a charge nurse in nursing homes with most or all of the beds for Medicaid residents. I have also sued nursing homes on behalf of neglected elders. I don’t recommend it as a choice unless that is the only alternative.

Why do I say this? It is clear to me, and to any lawyer who has sued nursing homes for neglect of an elder that nursing homes can be unsafe places. The elder’s new “home” in such a facility is usually like a hospital room. It may be shared with one, two, or as many as three other residents. There is no privacy. It can be quite noisy, and it isn’t going to feel very homey.

Sometimes a nursing home is the best place, because the level of nursing care the elder needs simply can’t be given in any other setting, or the elder can’t afford around the clock care at home. However, there are those who have been persuaded to choose a nursing home so that their money can go to their heirs, and not be spent on quality care at home. This exists, ignoring the fact that the rate of depression in nursing homes is about 80% of the residents.

Until we get rid of the hospital model of how a nursing home should be, and focus our resources on making such homes into pleasant places to live, I think choosing to legally hide one’s assets, give them to heirs, and get the forced choice of Medicaid-paid care, we are short-changing our elders.

This opinion will undoubtedly anger some estate planning attorneys, as well as the adult children who can’t wait to get their hands on the money Mom or Dad is giving up to “protect their assets”. Protect them from what? From actually ensuring that a parent has quality of life in his or her own home for as long as possible by paying for good help on their own?

I hope some lawyers with a conscience and a true understanding of what Medicaid will buy for the elder will urge older people to take care of themselves first and worry less about what their adult children are going to inherit. In too many instances, the price of a generous inheritance is sacrificed quality of life in the parent’s last years or months.

To learn more about how to choose a good nursing home, see our booklet How to Choose a Nursing Home, filled with practical tips to help take the fear out of the process. Note the Tips section at the end to empower you to be a good consumer when the time comes that you must make this choice for your aging parent.

Carolyn L. Rosenblatt, RN, BSN, Attorney,

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