Ask Chuck: Struggling to pay for senior care

Dear Chuck,

My husband has Alzheimer’s.  Should I use my retirement to fund his care? It will go quickly due to his medical bills, and I won’t be able to leave my daughters anything. An alternative is to have him go on Medicaid should I pass away first.

Struggling with Senior Care

Dear Struggling with Senior Care,

I am very sorry you are having this painful trial. It would be so helpful to have more information related to your ages, your daughters, and your comprehensive financial picture. Regardless, I will do my best to give you counsel and point you to some helpful resources. Please consider me just one source, and seek the counsel of more trusted advisors.

Financial programs for Alzheimer’s patients

Over 5.5 million Americans are affected by Alzheimer’s disease and dementia. Some require 24-hour supervision, which drains funds and caregivers. The cost, worldwide, of dementia care is nearly one trillion dollars. Supposedly, mid-to-late-stage Alzheimer’s patients commonly qualify for Medicaid benefits; but because the program is handled by each state separately, benefits vary by location. It pays only if income and assets are below certain levels. The following options are worth looking into and are explained more fully at the website: Paying For Senior Care.com:

• Medicare Advantage Programs.
• Medicaid and HCBS Waivers and Alzheimer’s Care.
• Nonprofits and Foundation Assistance.
• State Assistance Programs.
• VA Assistance.
• Respite Care.
• Reverse Mortgages.
• Life Insurance Conversions.
• Assistance or Medications.
• Alzheimer’s Care Loans.

If not yet 65, your husband may qualify for Social Security disability benefits.

I do not know your situation, but you may benefit emotionally and financially by continuing to work. Caring for yourself is vital to avoid becoming overwhelmed or discouraged. Join a support group or start one in your church or community. Make a list of those you can call on when needed. Notify neighbors of your situation.

Next steps

• Hold a family meeting to discuss the situation. Be open and transparent.
• Get legal and financial documents in order. See estate planning for dementia.
• Research community resources. The Eldercare Locator may provide help.
• Research long-term care. Ask for recommendations from trusted individuals, family, and friends. My wife’s aunt was well cared for in a small facility run by Mennonites outside a major city. Think outside the box and seek your options before they are actually needed.
• Research hospice care. Medicare covers this.
• Helpful website: Nine tips for caring for a spouse with early onset Alzheimer’s.

Learn how to protect your assets when your husband needs additional care. Here’s an article on protecting them for your spouse should you die first. Planning for the future and end-of-life care is important for all stewards to implement sooner rather than later.  

According to alz.org, the health and long-term care costs for people living with Alzheimer’s and dementia are projected to reach $360 billion in 2024. This does not include the value of informal caregiving. Medicare and Medicaid are expected to cover 64% of the total cost. Out-of-pocket spending is an estimated 25%. For more detailed information see the link above.

Your daughters’ needs

Consider giving an early inheritance. You will experience the joy of blessing your girls and alleviate some of your concerns about the unknown future needs of your husband. Just make sure you have enough funds set aside for your future care so as not to be a burden for them. Some gifts impact Medicaid eligibility. The federal government has a five-year look-back period in which the transfer of assets is scrutinized. I cannot overemphasize the importance of knowing all the details before you take any steps. You might consider consulting with a professional Medicaid planner or talking with someone your church or a trusted individual recommends. At the very least, do some careful research. 

Another option is to pay off your home mortgage, do repairs and maintenance, and eliminate outstanding debt. From what I have read, this does not violate the look-back period. The benefit is that it makes your home more comfortable and marketable when it comes time to sell or pass it on to your daughters. Again, study the look-back-period rules and loopholes well.

Remember to meditate on the promises of God. He knows your pain, and He is near to all who call upon Him.

“Listen to me, O house of Jacob, all the remnant of the house of Israel, who have been borne by me from before your birth, carried from the womb; even to your old age I am he, and to gray hairs I will carry you. I have made, and I will bear; I will carry and will save” (Isaiah 46:4, ESV).

I’d like to invite you to join a free Crown Bible study on the YouVersion app. We have several devotionals regarding money and stewardship that will help bring God’s Word into your daily life and provide some much-needed encouragement during this difficult time.