Have you ever considered what would happen to all your assets in your properties if either one of you had to go into a nursing home? I don't think many of us do, The government is pretty efficient in drawing down your assets in that case. (remember that you don't have to be older, certain diseases/accidents can land one there,)

this is from a financial site perhaps to give you something to think about,..

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The average nursing home now costs about $110,000 a year per person. Many people still think Medicare will pay for them to stay in a nursing home, if they end up needing to. As Kaplan points out, it won’t, except in very narrow circumstances (such as skilled nursing care for a couple of months after discharge from hospital). The only federal program that will pay for nursing-home costs is Medicaid, and it will only do so once you have spent nearly all your own assets and income and are effectively broke.

Here’s the twist. When it comes to making sure you’ve spent nearly all of your own assets first, Medicaid will consider a married couple as a unit, but an unmarried couple as two separate people.

So if, say, Bill and Betty are married, and Bill has to go into a nursing home, Medicaid will demand the couple run through nearly all their money — Betty’s as well as Bill’s — before it starts chipping in.

“As a married person, some of Betty’s income might be required to pay for Bill’s nursing-home bill,” Kaplan writes. “If Bill and Betty were not married, however, none of her income would be subject to this mandatory contribution requirement.”

Naturally there are some allowances — the Medicaid law is not to render Betty destitute — but they are not extensive. They generally include the primary residence if the spouse is still living there; a single car; a prepaid burial plot; and something called the “Community Spouse Resource Allowance,” or CSRA, which varies from state to state, rises to a maximum of $137,400, and is supposed to be enough for the remaining spouse to live on.

“There is no concept comparable to the CSRA for couples who are not married, and accordingly there is no limit on how much an unmarried partner can keep,” Kaplan writes.

He continues: “Assume that Bill in the preceding example has $100,000 in financial assets beyond the ‘exempt resources’ … while Betty has $600,000 of such assets. Assume further than Bill needs to apply for Medicaid long-term-care benefits, so his and Betty’s combined nonexempt resources are $700,000. In this case, all of those assets would need to be spent on Bill’s care until only $137,400 (at most) remains. But if Bill and Betty were not married, Bill would be required to spend down his $100,000 to $2,000, while Betty’s $600,000 of financial assets would be completely unaffected.”

I went through this with both of my parents. You do NOT want to end up in a nursing home that has patients on Medicaid. You ONLY want to go to a facility that is private pay. Yes, it's ridiculously expensive but the average nursing home stay is between 1 and 2 years. So you spend $200,000 on your own care. Well worth it to be a nice facility with a private room, activities, etc.

My dad dementia and fell at home. After his hospitalization he was transferred to a medicare paid facility for rehab. Medicare will pay for 60 days after a hospitalization. It was a nightmare. He was in a tiny shared room where residents spent most of their day. We couldn't get him out of there fast enough.

Marriage penalty. It's always been a thing - like with income tax.

I've heard of people getting a divorce and splitting assets in a situation where there is a need for one to go into a nursing facility.

While it is something to consider, here's some statistics from a study that the national institute of health did a few years ago:

The study was of 1890 nursing home residents who died between 1992 and 2006.

The median age of entering a nursing home was 83

The median length of stay was 5 months

The average length of stay was 14 months

53% died within 6 months of going in

The longest stay was 121 months

75% expired within 20 months

Statistically, 40% of us will die in a nursing home

I agree with you, JR.

My mother went into a nursing home 3 years ago and is still there. She is beating the statistics. I informed her about the state having claim on her house when she dies. She said that wasn't right and I replied "what's not right about it? They are paying your bill hear." She has lived on welfare or charities most of her life, if not all of her life and thinks they are stealing from her.

I've purchased run down properties from people's estates as they were being placed into elder care housing. I explained to these families if they sell, pay income tax and then invest their proceeds in interest bearing bank accounts, they would loose half of their money in fee's/taxes and then earn only 3 or 4 percent if lucky. On the other hand if they sell me their run down properties, as is, and finance the sale (carry back the note), then this would be an installment sale and delay most of their taxes. For the first 15 year of a loan, most of the proceeds would be interest and they would pay income tax and not the recapture/long term capital gains or State taxes.

you keep your assets in a well run partnership FLP. Don't keep much cash in your own name When or if you go into a nursing home you are allowed to keep some funds. The trick is to keep enough funds to get into private care facility. When your funds get to a threshold amount they have to stop taking from you. HERES the best part once you get your funds down they CAN'T EVICT YOU.

This is how it goes. you get admitted to adult care for say 30 days. Your money runs out and you go from adult care to the nursing home--- now the gov't picks up the tab.

When it is time to go into a nursing home, OWN the nursing home.

Many of us have some substantial assets or cash. Some have many rentals.

It seems to me a good idea to, somewhere along the timeline in our investment career, to perhaps invest in a nursing home or two. Or at least something which will throw off enough money to pay for all of this.

Here's an example: the VA operates many hospitals and clinics throughout the country. Many of these clinics are in leased buildings with long term leases paid by the govt. Such a building was for sale a couple years ago for $625K with about 1800 sq feet of unoccupied space and about 4000 sq ft of space occupied by the VA clinic on a long term lease at 108K/yr NNN. Payments were about $4300 month Principal and interest on 600K at 6 percent for 15 yrs. (About 52000 year).

Slam dunk for me. Get some HELOC on other places, 25K cash and a loan. The VA clinic then decided to lease the additional 1800 square feet for a higher total. Govt pays the bill.

Post offices also rent places. In my area,the State Housing people are also leasing about 2400 sq ft in a local mall. Sometimes, finding deals like this can make a difference.

MikeA, thank you for that detailed explanation. That is the answers I was looking for. Where were you able to get this information?

Ken, that is most likely exactly what that is, however, how would you be able to buy the property without it triggering the lean?

Richard, that is very smart. Own the nursing home.

When I tried to research it a year or so ago, I read that it is a Federal law that the states have to try and get reimbursed. As it should be, IMO.

Great thread HOLLIS; thanks for posting this!

In the nice private care facilities here, even some not so nice ones, you need to have funds to pay for more than a month. The care facilities want to see enough for at least 2 years before any govt funds kick in.

We saw this when moving my Mom from Senior Living to Asst Living. Then, if she needed a higher level of care, she would perhaps need to move to a nursing home. That's a lot of moves and readjustments for someone reaching 90+.

When I need care, I'd like to be somewhere who has all levels of care and a rehab facility on the grounds. Yep, will cost a fortune. We all need to be looking into the options out there for us and planning accordingly.

My almost 90 year old Grandmother is in Florida with dementia. She has a full time live in caregiver I think the total cost including keeping her house is around $200k a year. Her estate is worth 2-3 million. She earned the money she can use it, it won't last more than 2-3 years.

Mike A.

There are several different levels of care facilities in most states. What they are called varies but the basic thing is it goes from minimal care to full on care where the patient is bedridden with full time nurses on staff. Prices vary by the level of care.

You're right about some people creating smaller facilities and I know some who have done that, especially if they have a larger, newer home. Here the levels start at "adult day care" where the people can sign themselves in and out at will and there is minimal supervision.These come as either 6 or 12 occupant levels. The larger number has some extra requirements, like fire sprinklers that the lower number does not. Some people just go with the lower number (6 or less) and the money from this pays for the entire house and land.

6x6,

I expect to pay for my own nursing home care. Houses will be sold to pay for it. I expect that one house will pay for the entire thing, but you never know what the future brings.

My heir is onboard with that and he doesn't care if it is all spent because he was raised to take care of himself and he has money of his own that he earned himself.

Both my parents have passed, but my mom did live in a Medicaid facility for some time. Us kids (me, brother, sister) visited often and engaged the staff, asking lots of questions, taking in snacks and thank you cards etc. My sister is a doctor so she conversed with the staff often on medication issues. We believe our mom got better care and the staff was more accountable due to our interactions with them…they made sure she was fed properly and that her clothes were always clean, etc. instead of giving my mom money, which would be taken by the state, we took her gifts and necessities. We took her socks, sandals, pajamas, extra healthy foods like fresh fruit, toothbrushes, deodorant, vitamins, and much more. During visits we would comb her hair and make sure the staff had let her/helped her shower, fed her on time,etc. I agree that Medicaid facilities are not as nice, but we shopped around and found the best one.

One other strategy that MIGHT work if a loved one lives alone in a certain city with no friends would be to move to another state with lower cost private facilities. For example, let’s say you live in Iowa where private nursing homes cost $60k per year, but your mom has lived in New York all her life where nursing homes cost $95k per month. Let’s say your mom lives alone and now needs a nursing home. Could you move her to Iowa and thus get her a nicer facility? Once you are in a nursing home where you rarely leave the building, I don’t think it matters much where you live other than the TV channels you watch and weather.

this post went 180 in answering.

How to protect your assets is NOT buy buying a nursing home???

you think rentals are regulated-- you have no idea about regulations until you own a nursing home. NOT A CLUE.

Well, I was going to post some deep thoughts on this, but I'm just going to say that after the nursing home nightmare with my mother, I would never wish the miserable experience on others, especially not myself.

Trusts are supposed to stop the asset seizure, or did.

Since my cancer in 2018, I've sung my death song and spent much time contemplating the meaning of life, sitting on the red cliffs of Sedona and listening to the wind at the Medicine Wheel in Wyoming. I have done most of what I set out to do. I am content, my life has mattered.

To die in a tiny room in some heartless facility, tended by strangers would make my life a travesty.

When my time comes, all I ask is give me a gun, a fast horse, and a head start! ;)

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Hubby's mom (90+) is in Independent Living in a CCRC (Continuing Care Retirement Community). The buy-in was $440,000, 90% refundable if she were to leave.

They don't take Medicaid. But - she is guaranteed first preference over outsiders when/if she needs Assisted Living or Memory Care. The $400,000 that she would get back when vacating her Independent Living cottage, plus her investments of around the same amount, and her SS/husband's pension would support her completely for maybe 5 years. The community's Benevolence fund would then kick in to supplement the SS/pension money - she will never have to leave the place until she is called Home.

For anybody considering getting onto the business of operating nursing home, I highly recommend extreme caution.

As mentioned above the care is not always good as the lawsuits can be plentiful as a result.

Residents needing more care than others are frequently the ones who do not receive necessary care.

Big time liability issues and insurance has got to be massively expensive.

6X6,

We have been watching a house next to one of ours for 12 years. It's the same situation: resident is in a nursing home and can't sell without having to pay her own bill.

That house has been maintained for 12 years now! Grass cut, power on... no one living there.

Hollis - Please read MYOB 11/13/22 post he is correct. How do I know? I have studied Nursing Home care and how to pay for it

for the last 11 years. I have spoke to Nursing home managers - Elder Care lawyers - families who have been thru a love one with Dementia and on and on.

from extensive research and experience.

#1 Get them in home (their home) care-- like meals on wheels. it gets someone there every day to look in on them.

#2. One time a day 8 to 1pm or 11 to 5 in home care like home instead company. They come in and get them up or ready for bed - prepare meal if needed. This gives the family a break that there not sitting all day like a baby sitter.

#3 Once it gets to the point of needing someone regularly but not a live in get them into an adult care facility-- close to you that has a nursing home side. Adult care they take care of themselves but someone is there on duty to be sure they aren't in danger and to take their meds.

#4 when you need more care-- like a nursing home-- almost every place that has nursing home has an adult care connected to it and even if there's a waiting list for the nursing home if your already in their adult care you go to the front of the nursing home list.

#5 if you wait to be placed into a facility that facility could be 80 to 90 miles away from family. Better to check out the adult care-- strip down the accounts of who ever is going into the facility to the bear minimum.

#6 there is a rating gov't system for nursing homes find the ones in your immediate area and go visit-- READ the comments. Talk tot he facility director of admissions and lay out your plan to them.

#7 JUST LIKE LL'S-- THESE HOMES NEED BEDS FULL. KEEP THAT IN MIND-- FULL IS HOW YOU MADE MONEY IN NURSING HOMES.

Agree 100% that no one should try to make themselves look poor to get charity. Medicaid is poor people care. It's not there so you can pass on your property to your kids: if you need Medicaid, there shouldn't be any property to pass on to kids other than personal property / family heirlooms.

I've read that the last 6 months of our lives are typically more expensive than the last decade of our lives. Possibly, for the uncreative who just throw their hands up in the air and expect someone else to deal with it.

For $200/day, you can get someone to hang out at a home and take care of most basic chores. That's only $6000/month.

Licensed healthcare workers are on call in case of emergency.

Plenty of ways to stay at home and deal with this for half the cost or less of the nursing home. Sitting around in a wheel chair playing bingo all day doesn't really stir my imagination.

Along the lines of LTD's post, I really don't want to linger anywhere. I'm thinking a cabin on a lake somewhere rustic. Or up in the Mountains. Colorado has cabins on lakes in the mountains!

My MIL in Illinois had a beautiful 3400 square foot condo in Park Ridge but it was getting to be too much for her after her husband died 2.2 years earlier. So she sold and moved into a Brookdale Independent Living situation.

And now after almost 4 years there, she is getting low on funds. Her condo could have been a cash cow for her as a highly desirable home in a highly desirable suburb if she had rented it out. But of course she would not have listened to us.

Sure Sid We, my wife and I, worked 40 yrs to give our hard work to a nursing home owner-- or worse the gov't.

Myob, I know you and I don't share the same philosophy on some things, and this appears to be one of them. Here's how I see the situation.

No one is GIVING their assets to the nursing home owner/the Govt. They are PAYING for a service that they DESIRE TO RECEIVE. No one is forcing anyone into a Medicaid nursing home. They can figure out an alternative means of care if they don't want to pay for it. I'm not sure why a person with plenty of assets to pay for care would want to go to a Medicaid Nursing home anyway. Two of my family members have gone into such places. They're short-staffed, cut corners, and are generally considered the "Class C/D" of nursing homes. Not the way I want to live out my final days just so my kids can party when I'm gone with the money I bequeathed them.

Regarding estate planning, we use a Revocable Trust to ensure things don't get tied up in probate, but that doesn't make us look poor on paper. Our plan is to pay for our care and still have plenty to left over so that we can do what the Bible says a good man does: "Leave an inheritance to our children..." part of which is a legacy of wisdom starting with Finance Rule #1: Never put your financial well-being in the hands of the Govt.

No we don't always-- that's because you never believe me when I say I'm right!

I've worked in nursing homes -- my sister has owned a nursing home for 30 years. My family members have been in nursing homes.

Again here is the secret. There is a gov't site that rates nursing homes-- you can read all the + and - of these homes.

You find one with the highest rating that's close to you that has an Adult care pay as you go-- AKA your a private pay. Nursing homes love private pays. REMEMBER you have already checked this place out. There's a nursing home side to the adult care facility. They check out your accounts to be sure you can pay private charges. Most often people don't stay in the private side to long-- enough to get 30 days residency. Now you run out of money AND you get bad enough to have to go into a nursing home. You get first dibs on a bed and when you run out of funds they have to keep you and allow you to get on medicare. Guess what? yea that's right your still at the nursing home you wanted.

As with anything as you get older you gotta plan--

As far as what the conditions are: if you or your relative go to a place 80 miles away-- your sunk. If you go to a place 3 or 5 miles away-- they the staff never know when your going to POP in.