No parent wants to imagine their children fighting over an inheritance after they are gone. Sadly, family conflicts frequently arise, especially when a parent has gifted or loaned money to one child and not the others during their lifetime. Fortunately, incorporating a few precise provisions into your estate plan can dramatically minimize the potential for future disputes.

Clearing Up the Confusion Around Lifelong Gifts
When you financial assist one child during your life, their siblings may later argue that this child’s share of the remaining estate should be reduced. You can completely forestall these types of inheritance disputes by making your exact intent crystal clear in your estate planning documents.

Depending on your goals, your document can address lifetime gifts in two primary ways:

• The Equalizing Provision: You can explicitly state that your estate plan does not make any adjustments based on lifetime financial gifts. This leaves no room for interpretation, making it clear to all beneficiaries that everyone is to receive their designated share regardless of past assistance.
• The Specified Reduction: Alternatively, if you do intend for a lifetime gift to count against a future inheritance, you can specify the exact gifts that were made and explain that this child’s final share is being reduced accordingly.

The Trouble with Loans: Putting Verbal Agreements to Rest
Intra-family loans are another common source of litigation and resentment. Verbal loans are notoriously difficult to prove or track, which often leads to disputes over whether the money was actually a loan, a gift, or if it was already paid back.

To prevent these headaches, you can address outstanding loans in a number of structured ways based on your intent:

• Converting Verbal Loans to Gifts: You can include a provision stating that any outstanding verbal loans at the time of your passing are officially to be treated as gifts.
• Formalizing True Loans: If you have outstanding verbal loans that you do not want to become a gift, it is vital to formalize them in writing via a promissory note before you pass away.
• Treating Loans as an Inheritance Advance: If you want an outstanding loan balance to be deducted from a child's final inheritance, your estate planning documents can explicitly outline this mechanism.
• Requiring Written Proof of Forgiveness: To prevent a beneficiary from falsely claiming that you forgave their loan while you were alive, you can include a clause stating that any loan forgiveness must be documented in writing to be legally valid.

Intent is Everything: Work with an Expert
The absolute best defense against future family conflict is an estate plan that leaves zero room for guesswork. Verbal agreements and vague assumptions are what lead to fractured relationships and costly legal battles between siblings.
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Be sure to consult with an experienced estate planning attorney in your area. They can help you draft precise language regarding gifts and loans, ensuring your documents provide the exact guidance and protection your family needs.

Since the 1960s, Medicaid has provided vital health care coverage for low-income individuals across the United States. For millions of seniors, Medicaid offers a critical financial lifeline by helping to cover the staggering costs of long-term care services. Today, this joint federal-state program also benefits other qualifying populations with limited resources, including children and people with disabilities.

Qualifying for Medicaid
You might not foresee yourself applying for Medicaid in the future. Yet in reality, data from the U.S. Department of Health and Human Services shows that nearly 70% of adults turning 65 will require some form of long-term care during their lifetime. Because long-term care can be incredibly expensive, many families come to rely entirely on Medicaid benefits to cover these services.

Given these realities, it is crucial to understand how Medicaid eligibility works long before you actually need it. To qualify, you may need to take specific financial actions at least five years before submitting an application. This is because most state Medicaid agencies implement a five-year "lookback" period to review all your financial transactions leading up to your application date.

If you make certain uncompensated asset transfers, large purchases, or financial gifts during this lookback window, you could face a severe penalty period. These penalties can delay your eligibility, leaving you to wait months or even years before Medicaid will begin paying for your care.

The Asset Limit and the "Spend Down"
Because Medicaid is designed for individuals with limited financial means, applicants must meet strict income and asset thresholds. In most states, a single applicant is restricted to no more than $2,000 in countable assets to qualify for long-term care benefits.

If your assets exceed your state’s limit, you will need to "spend down" your extra resources on permissible expenses until you hit the threshold. Only after you have met this requirement—alongside all other clinical and financial criteria, will Medicaid step in to cover basic long-term care expenses.

Fortunately, not everything you own counts against you. Key exemptions typically include:

• Your primary home (up to your state's equity limit)
• One reliable vehicle
• Personal belongings and standard household furnishings

Depending on where you live, you can strategically use your excess assets to buy specific items that improve your comfort and daily life without triggering a penalty.

Important State Variations: Every state dictates its own exact income and asset limits, and these figures frequently adjust each year to reflect inflation. Furthermore, some states do not allow a standard spend down process; these are known as "income cap" states and follow an entirely different set of rules.

Legitimate Ways to Spend Down Your Assets
Medicaid applicants can generally reduce their excess assets in a variety of constructive ways. Paying off existing debt (like credit cards or outstanding medical bills) or prepaying for funeral and burial services are both widely accepted strategies.

You can also use surplus assets to purchase medical services, equipment, or health insurance premiums that aren't fully covered by Medicare. This includes items like:

• Hearing aids
• Wheelchairs, walkers, or canes
• Updated prescription eyeglasses and dental work

Beyond medical bills, you can often make lifestyle purchases that directly boost your quality of life. Here are seven tangible things you might be surprised to learn can legally qualify as a part of a Medicaid spend down:

• A New Vehicle: A reliable car or a wheelchair-accessible van to ensure you can get to medical appointments. (Note: Most states draw the line at luxury vehicles or recreational vehicles like RV campers).
• Personal Electronics: Upgrading your smartphone, laptop, tablet, or television to keep you connected with family and entertainment.
• New Clothing: Stocking up on everyday essentials, winter coats, sturdy shoes, or pajamas.
• Books and Subscriptions: Purchasing books, magazines, or ongoing streaming service subscriptions (like Netflix or Hulu).
• Towels and Bedding: Refreshing your linens. If you are transitioning to a long-term care facility, it is a good idea to check their specific rules regarding personal linens first.
• Comfort Furniture: Buying specialized furnishings for your living space, such as an ergonomic lift-chair recliner or an orthopedic mattress.
• Home Modifications: If you plan to receive care at home, your spend down can go toward modifying your residence for safety. Examples include installing wheelchair ramps, widening doorways, fixing faulty plumbing, or paving a smoother driveway walkway.

Why It Is Key to Work with an Elder Law Attorney
The rules governing Medicaid eligibility are notoriously complex and vary heavily by zip code. Before making any significant financial moves, it is essential to consult with an experienced elder law attorney in your area.
An attorney who specializes in Medicaid planning can safely structure your spend down, protect your hard-earned savings, ensure your spouse is taken care of, and help you avoid accidental penalty periods. As a bonus, legal fees are generally considered a permissible spend down expense.

Whatever paths you choose, ensure you keep every single receipt and detailed piece of documentation. Clear records are your best defense if state evaluators raise questions during the application process.

​If you’re receiving care through a skilled nursing facility, home health agency, or outpatient rehabilitation center, there may come a day when your provider hands you a form titled “Notice of Medicare Non-Coverage,” or NOMNC. Don’t panic, but don’t ignore it either. Here’s what it means and what you can do.

What Is an NOMNC?
An NOMNC is an official notice that your Medicare-covered care is ending. Your provider, whether that’s a nursing facility, home health agency, hospice, or comprehensive outpatient rehabilitation facility, is required by law to give you this notice at least two days before your Medicare-covered services end.

The notice is meant to protect you. It tells you when coverage will end, why, and, most importantly, that you have the right to appeal.

Why You Might Receive an NOMNC
Providers issue an NOMNC when they believe your condition no longer meets Medicare’s coverage criteria. Medicare generally covers skilled care, meaning care that requires the expertise of a nurse or therapist. Once your provider determines you no longer need that level of care, they’re required to notify you that coverage is ending.

This doesn’t necessarily mean your care was inappropriate or that Medicare will agree with the provider. It simply means the provider has made a judgment call that Medicare coverage no longer applies.

What You Should Do

• Read the notice carefully: The NOMNC will include the date your coverage ends and a brief reason. The notice will also include information about the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), which is the independent organization that handles Medicare appeals for these situations.
• Decide whether to immediately appeal: You have the right to request a free, expedited review by the BFCC-QIO. If you appeal before your coverage ends, you generally won’t be billed for the disputed services while the review is pending. That protection alone makes filing an appeal worth considering.
• Appeal quickly: You must contact the BFCC-QIO listed on your notice by noon of the day before your coverage ends. You can typically reach them by phone; the number will be printed on your NOMNC. Call it as soon as possible.
• Get a written statement from your provider: After the BFCC-QIO notifies your provider that you appealed, your provider must give you a “detailed explanation of non-coverage” (DENC). This gives you their specific clinical reasoning, which can help you and the reviewer understand the case.
• Talk to your doctor: Your physician may be able to provide documentation supporting continued care. The BFCC-QIO reviewer will consider medical evidence, so your doctor’s input can matter.

What Happens After You Appeal?
Generally, the BFCC-QIO will give you a decision by the close of business the day after it gets the information it needs to make a decision. If the reviewer agrees coverage should continue, Medicare keeps paying. If they side with the provider, your coverage ends, but you can still request a second-level appeal by a Qualified Independent Contractor.

Receiving an NOMNC can feel alarming, especially while you’re recovering from an illness or surgery. But the notice is also your opportunity to push back if you believe the decision is wrong. Act quickly, use the appeal process, and don’t hesitate to involve your doctor and family in the decision.

A dementia diagnosis can feel like a door closing. But for the millions of people living with Alzheimer’s disease and related dementias, as well as for their family members and friends, a growing movement in care is pushing back against that narrative. The message: a diagnosis does not define a life.

Seeing the Whole Person
Traditional approaches to dementia care have often focused on what is lost, such as memory, independence, and cognitive function. That can leave people feeling like their future has been decided for them.

As explained in a webinar led by the National Alzheimer’s and Dementia Resource Center (NADRC), a more compassionate and effective approach turns that lens around. Palliative care (specialized medical care focused on comfort, symptom relief, and quality of life) and person-centered care models begin with a simple but powerful premise: a person living with dementia is still a full human being with emotional needs, spiritual beliefs, physical health, social connections, and family relationships that matter deeply.

Rather than addressing solely what is wrong, this approach asks questions like “What is important to you? What brings you joy? What do you still want to accomplish?” The answers vary widely from person to person, and that’s the point.

Care built around individual goals and strengths not only looks different from a one-size-fits-all plan, but the outcomes are also better.

What Person-Centered, Palliative Dementia Care Looks Like
Person-centered care is a philosophy woven through every interaction, from medical appointments to daily activities at home. It is built around the individual’s routines, values, and goals, not just the diagnosis, and addresses several interconnected areas of a person’s life:

• Emotional well-being. Dementia can bring fear, grief, frustration, and social isolation. Acknowledging and validating these feelings, rather than minimizing them, helps people feel seen and reduces anxiety.
• Spiritual life. For many people, faith, meaning, and purpose are central to identity. Honoring spiritual practices, rituals, and beliefs provides comfort and continuity, even as one’s memory changes.
• Medical care. Comprehensive medical support includes not just treating the disease but also managing pain, monitoring medications, and addressing other health conditions that affect quality of life.
• Physical health and activity. Movement, nutrition, sleep, and sensory engagement all affect mood, cognition, and function. Modified exercise, meaningful activities, and time outdoors can make a significant difference.
• Social connection. Human beings need one another. Peer support groups, where people with dementia meet others who truly understand their experience, can help reduce isolation and foster resilience, humor, and hope.
• Family and caregiving relationships. Dementia affects entire families. Caregivers can benefit from education, support groups of their own, and practical tools for navigating the emotional and logistical demands of the role.
  

The Power of Support Groups
One of the most practical and powerful resources available to both people with dementia and their caregivers, according to the webinar presenters, is peer support groups. These gatherings, whether in person or virtual, offer something that professional care alone cannot: the knowledge that you are not alone.

For people living with dementia, support groups provide a space to share experiences, exchange coping strategies, and simply enjoy social connection with others who understand what they are going through. For caregivers, they offer a lifeline in the form of a place to receive encouragement, learn new skills, and speak honestly about the exhaustion, grief, and love that define the caregiving experience.

What Supporters Can Do
Friends, family members, and professional caregivers can play an essential role in helping someone with dementia live their life to the fullest. Some of the most meaningful things supporters can do include:

• Listen without rushing. Give the individual time to express themselves. Patience communicates respect.
• Focus on what they can do, rather than on what they can’t do. Celebrate preserved abilities and interests rather than emphasizing limitations.
• Stay connected. Regular visits, phone calls, or simple shared activities maintain the relationship and reduce isolation.
• Ask the person what they want. Involve the person who is living with dementia in decisions about their life as much as possible.
• Take care of yourself first. Caregiver burnout is real. Seeking your own support is not a luxury — it is a necessity.
• Learn and prepare for the future. Understanding the stages of dementia and what to expect helps families plan proactively and reduces crisis-driven decision-making.

Resources
The following organizations offer resources, education, and support for individuals living with dementia and those who care for them.

For People Living With Dementia and Their Caregivers

• Alzheimer’s Association. The largest voluntary health organization in Alzheimer’s care, support, and research. Offers a 24/7 helpline (800-272-3900), local support groups, care consultations, and an extensive online resource library.
• Alzheimer’s Foundation of America. Provides education, support services, and a free memory screening program. Reach its national toll-free helpline at 866-232-8484.
• Alzheimers.gov. The federal government’s central resource for information on Alzheimer’s and related dementias, including finding local services, caregiver resources, and clinical trials.
• Caregiver Action Network. Provides education, peer support, and resources for family caregivers.
• AARP Caregiver Resource Center. Offers tools, guides, and a helpline (877-333-5885) to assist family caregivers with planning, communication, and self-care.

Specialized Programs

• NADRC. Offers free webinars, toolkits, issue briefs, and resources for individuals, caregivers, and community organizations. Resources include guides on person-centered care, faith-based dementia programs, and support for people living with dementia.
• Riverside Health Martha W. Goodson Center. Offers comprehensive, person-centered memory care services, including free Memory Care Navigation, caregiver support groups, a GUIDE model program for eligible patients, and an e-Learning Resource Center.
• Eldercare Locator. Connects older adults and caregivers with local services including transportation, meals, respite care, and support groups. Contact trained staff by phone or text at 800-677-1116.
  

A dementia diagnosis means a change in life, not the end of life. With the right support, the right mindset, and access to the right resources, people living with dementia can continue to find meaning, connection, and joy. The goal of strengths-based, person-centered care is not to deny the challenges of the disease. It instead seeks to ensure that the whole person, not just their diagnosis, remains at the center of every decision, every relationship, and every day.

Summer is officially rolling into town, bringing longer days, backyard barbecues, and the perfect excuse for families to get together. Whether you are packing up for a cross-country road trip, heading to a family reunion, or stepping in to care for an aging parent while their primary caregiver takes a well-deserved vacation, summer is a season of movement.
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While most of us focus on packing bags and booking hotels, summer travel also highlights an important reality: health emergencies can happen anywhere, at any time. To ensure your family is protected no matter where your travels take you, here is an essential legal checklist to consider before you hit the road.

​1. The "Out of Town" Healthcare Directive
If an aging parent experiences a medical emergency while traveling outside of Kansas or Missouri, who has the legal authority to talk to doctors or make medical decisions?

• The Legal Check: Ensure your loved one has an updated Advance Healthcare Directive and a Durable Power of Attorney for Healthcare. Without these executed documents, out-of-state hospitals may hesitate to share critical information or allow family members to make urgent care decisions, causing agonizing administrative delays.

2. Don’t Forget the HIPAA Release
Due to strict federal privacy laws, medical professionals cannot disclose health status or treatment options to anyone, even a spouse or adult child, without explicit authorization.

• The Legal Check: A standalone HIPAA Authorization form ensures that designated family members can get immediate medical updates from doctors, whether they are at a hospital across the country or checking in from back home.

3. Check Medicare and Insurance Boundaries
If you are traveling across state lines or internationally, your healthcare coverage might not automatically travel with you.

• The Legal Check: Standard Medicare covers care anywhere in the U.S., but if your parent relies on a Medicare Advantage Plan (Part C), their network of doctors and hospitals might be strictly local, restricting coverage to emergencies only when out of network. Before leaving, review the plan's out-of-area rules so you aren't surprised by catastrophic out-of-pocket bills.

4. Planning a "Caregiver Respite" Vacation?
If you are an adult child stepping in to care for a parent so their primary caregiver can take a summer trip, or if you are hiring temporary home health aid for the week, you need the legal green light to manage daily affairs.

• The Legal Check: Ensure you have access to a Financial Power of Attorney in case you need to manage bank accounts, pay unexpected care bills, or coordinate with pharmacy benefits while the primary caregiver is unreachable.

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Before You Leave: You don't need to carry stacks of legal paperwork on vacation. We highly recommend keeping digital copies of your estate plan, Powers of Attorney, and insurance cards securely on your smartphone or in an encrypted cloud drive so they can be produced instantly in an emergency.

If your summer plans involve gathering with family or traveling out of state, take a moment to ensure your legal safety net is securely in place. We are always here to help you review, update, or establish these essential protections before you depart.

Have a wonderful, safe, and memorable summer!

If you’re caring for an aging parent, you’re probably juggling more than you ever expected: appointments, bills, siblings’ opinions, and the constant worry of “What happens if something goes wrong?”

This checklist is designed for adult children and family caregivers who want to get ahead of a crisis. You don’t need to do all 10 things this week, but every item you check off can save time, money, and stress later.

Note: Laws and forms vary by state. This article is general information, not legal advice. An elder law attorney can help you choose the right documents for your parent’s situation and state.

1. Make Sure a Durable Power of Attorney Is in Place
A durable power of attorney (POA) is a legal document that lets your parent name someone to manage finances if they can’t.

The key word is durable: it means the POA stays valid even if your parent loses mental capacity. A regular (nondurable) POA generally does not.

• What to do now: Locate the document and confirm it’s signed and complete. If there is no POA, act quickly while your parent can still sign. Ask whether the POA is effective immediately or only after a doctor determines incapacity (sometimes called a “springing” power of attorney). Either can work, but the “right” choice depends on your family and your parent’s preferences.
• What can happen without it: You may have to go to court to get a conservator or guardian appointed,  a process that can be slow, expensive, and stressful.

2. Locate (or Create) a Health Care Proxy
A health care proxy (sometimes called a health care power of attorney or medical power of attorney) names the person authorized to make medical decisions if your parent can’t speak for themselves.
This is separate from a financial POA, which gives a trusted individual the authority to act on your behalf with regard to financial decisions and transactions. Most families need both.

• What to do now: Find the document (or ask your parent’s doctor’s office if it’s in the chart). If it doesn’t exist, ask an attorney about the correct form for your state. Make sure the person named knows they’ve been chosen and understands the role.
• Family reality check: If different relatives assume they’re “in charge,” hospitals can end up in the middle of a family dispute.

3. Find the Living Will (Advance Directive)
A living will (often part of an advance directive) tells doctors what your parent does and doesn’t want if they’re incapacitated.
It commonly covers decisions about:

• CPR (resuscitation)
• Life support (ventilators)
• Feeding tubes

This is not a “giving up” document. For many families, it’s a gift. It reduces impossible guesswork and helps loved ones honor what your parent would want.

• What to do now: Locate it and confirm it reflects your parent’s current wishes. Give a copy to your parent’s primary care physician and keep one where it can be found quickly (not locked away where no one can access it).

For a clear federal resource on advance care planning, see the National Institute on Aging’s tip sheet on advance care planning.

4. Confirm Health Insurance Portability and Accountability Act (HIPAA) Authorization Forms Are Signed
Many caregivers are surprised by this: HIPAA privacy rules can prevent a doctor’s office or hospital from sharing information with family members — including adult children — unless the patient has given permission.

• What to do now: Ask your parent’s doctor’s office and main hospital system whether a HIPAA release is on file that names you (or another trusted family member).
• Why it matters: This is especially important in nonemergency situations, when you’re calling for updates, test results, or care planning.

For federal guidance on health information privacy, check out this consumer-friendly overview.

5. Know Where the Will Is and Whether It’s Current
You don’t need to read your parent’s will today, but you should know:

• A will exists (or doesn’t)
• Where it is stored
• Who drafted it (if anyone)

Red flags that may mean it needs updating:

• The will was written before a major life change (remarriage, divorce, death of a beneficiary)
• Your parent moved to a new state
• Their assets changed significantly

Also remember: a will only takes effect after death. It doesn’t help you manage a medical or financial crisis while your parent is alive.

6. Check Beneficiary Designations on Key Accounts
Some assets pass directly to named beneficiaries, outside the will. Common examples include:

• Retirement accounts (like IRAs and 401(k)s)
• Life insurance policies
• Payable-on-death (POD) or transfer-on-death (TOD) bank and brokerage accounts

Outdated beneficiary designations (an ex-spouse, a deceased relative, or “we’ll fix it later”) can create serious problems.

• What to do now: Ask your parent to review beneficiaries with their financial advisor or elder law attorney. If your parent has a trust, make sure beneficiary designations match the overall plan — this is a common place where plans unintentionally conflict.

7. Gather Key Financial and Account Information
You don’t need full access to everything right now, but you do need enough information to act fast if there’s a hospitalization, a scam, or an unpaid bill.
A practical “starter list” includes:

• Bank and investment accounts
• Insurance policies (health, life, long-term care)
• Social Security and Medicare information
• Mortgage, credit cards, and other debts
• Basic monthly budget (income sources and major bills)

Store these in a fireproof home safe, a password manager, or as a secure shared document that your family agrees on.

If you’ve been named to manage money for someone else (or might be soon), these caregiver-friendly guides are worth bookmarking.

8. Understand Your Parent’s Medicare and Insurance Coverage
Care decisions often get forced by coverage realities. A little knowledge now can prevent expensive surprises later.
Start with these basics:

• Does your parent have Original Medicare or a Medicare Advantage plan?
• Do they have a supplemental (Medigap) policy?
• Do they have a long-term care insurance policy?

Then ask practical questions:

• What happens after a hospital stay — what rehab or skilled nursing coverage exists, and what are the limits?
• What home care is covered (and what isn’t)?
• What’s the out-of-pocket exposure if a longer care need develops?

If your parent might eventually need Medicaid, it’s important to know that planning in advance can matter. Medicaid rules are complicated and timing can be critical.

A key starting point is understanding transfer rules. See Medicaid’s asset transfer rules.

9. Have a Real Conversation About Care Wishes
When families avoid these important conversations, the “default plan” becomes:

• A rushed decision during a hospital stay
• A family argument
• A choice your parent wouldn’t have wanted

Ask the following questions while your parent is still doing okay:

• Where do you want to live as you age (home, with family, assisted living, nursing facility)?
• Who do you want making decisions if you can’t?
• Are there medical treatments you would refuse?
• What does a “good day” look like to you — and what would you consider unacceptable?
• How to frame it: “I want to honor your wishes and reduce stress later — can we talk while things are calm?”

Start small; one 20-minute conversation is better than waiting for the “perfect time.”

10. Connect With an Elder Law Attorney Before You Need One Urgently
Elder law attorneys focus on the issues families face as parents age, including estate planning, Medicaid planning, and long-term care.

Even a single consultation can reveal risks you didn’t know were there (or confirm that you’re in good shape). Finding help before a crisis means you’re not scrambling under pressure.

What If You’re Already in a Crisis?Many families only discover these legal gaps when they’re already under stress.

Keep in mind that some steps may still be possible. For example, a person can sometimes sign new documents if they still have the legal capacity to understand what they’re signing.

If it’s too late to sign key documents, families sometimes must pursue guardianship through the court to get legal authority.
Start with what you can do today:

• Gather documents and account information.
• Ask doctors’ offices about HIPAA authorizations.
• Get a legal consult so you know your options and your timeline.

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When you’re overwhelmed, progress beats perfection. One document found or one form signed can make tomorrow easier.

For most Americans, the plan goes something like this: work hard, save diligently, pay off the house, and pass something on to the kids. This quiet promise at the heart of the American Dream is that a lifetime of effort can translate into security for you and the next generation.

A study published by the Roosevelt Institute in April suggests that for most Americans, that promise is being broken — not by bad luck or poor choices, but by the crushing, largely unseen cost of long-term care.
The report lays out a stark picture: The long-term care system in the United States isn’t just failing older Americans in their final years but systematically draining the wealth of middle- and lower-income families and making it nearly impossible for the next generation to get a financial foothold.

What Is Long-Term Care and Why Does It Cost So Much?
Long-term care refers to the ongoing help people need when they can no longer fully care for themselves. It can encompass home health aides, adult day care programs, assisted living facilities, and nursing homes.

Over half of Americans aged 65 will need long-term services and supports in their lifetime, and one in five of those adults will need care for more than five years. This is not a fringe issue; it is, statistically speaking, a near-universal part of aging in America — and the costs are staggering.

In 2025, the national annual median cost of in-home, long-term care was about $80,000. The annual cost of community and assisted living ranged from $25,000 to $74,000, and nursing home care was between $115,000 and $129,000 per year.

Meanwhile, the median household income for Americans aged 65 and older is approximately $57,000, meaning a single year in a nursing home can cost more than twice what a typical senior household earns in a year.

Why are prices so high? Over the past two decades, long-term care costs have risen sharply as the over-65 population has grown rapidly.

Demand for long-term care services is increasing as American adults age, but the industry has long had problems attracting and retaining workers. Long-term care workers often face low pay and poor working conditions, with 36 percent living at or near the poverty line, which makes recruiting and retaining staff difficult. When demand outpaces supply, prices rise — and have been rising for years.

Why the System Leaves the American Middle Class Exposed
You might assume that government programs like Medicare and Medicaid would provide a safety net. However, the reality is far more complicated and far less generous than most people realize.

Medicare, the federal health insurance program for adults 65 and older, provides only short-term skilled nursing or rehabilitation care after a qualifying hospital stay. It does not cover ongoing assistance with daily activities like using the bathroom, eating, or getting in and out of bed. For the millions of Americans who need help with these basic tasks for months or years, Medicare offers essentially nothing.

Medicaid does cover long-term care but only after a family has nearly run out of money. To access Medicaid long-term care, adults must fall below income and asset thresholds that vary by state. As of mid-2025, monthly income limits range between $967 and $2,901 for a single individual and asset ceilings are generally around $2,000 in most states. In other words, a person must spend down their savings to near-poverty levels before the government steps in to help.

This leaves many middle-class Americans in a difficult position. They have too much money to qualify for Medicaid, but nowhere near enough to comfortably afford years of private care. After the onset of care needs, middle-class individuals face permanent wealth reductions to just 42 percent of their original levels and lower-income individuals realize reductions to just 11 percent of their original levels. However, the top quartile of earners eventually recover 94 percent of their assets.

Even families who consider themselves financially comfortable are not immune. Among upper-middle-class couples with lifetime earnings over $4.75 million, nearly half will spend down their assets paying for long-term care and eventually enroll in Medicaid if they require long-term care for five years or more.

The Ripple Effect on the Next Generation
Much has been made in recent years about the so-called “Great Wealth Transfer,” the enormous sum of money that Baby Boomers are expected to pass down to their children and grandchildren. The Roosevelt Institute’s findings puncture that narrative for most families.

The spend-down process required to qualify for Medicaid leaves little to be passed on to younger generations. This interrupts the potential for building generational wealth after what is often a lifetime of work and saving, perpetuating cycles of wealth inequality.

The consequences ripple outward in another way, too: through the unpaid labor of family caregivers, who are overwhelmingly women. In 2021 alone, unpaid caregivers provided an estimated $600 billion in economic value, often at the expense of their own career growth and retirement savings.

When someone steps back from their career to care for an aging parent, sacrificing promotions, raises, and retirement contributions, the long-term financial cost to them and their family can be enormous. So, the care crisis doesn’t just affect the person receiving care, it spreads.

Long-term care is not just an individual health issue; it is also a structural driver of wealth inequality. By maintaining a system that depends on unpaid family caregiving, provides public support only after families have nearly exhausted their savings, and allows private, profit-driven companies to capture rising care costs, the U.S. effectively penalizes aging.

What Families Can Do
While systemic change is needed, there are practical steps that families can take to reduce their exposure:

• Plan early, before a crisis hits. Long-term care insurance exists specifically to cover these costs and is most affordable when purchased in your 50s, before health conditions make premiums prohibitive or coverage unavailable. Hybrid life insurance policies that include long-term care riders are another option worth exploring with a financial advisor.
• Have the hard family conversation. Discussing aging, care preferences, and finances before a health crisis is uncomfortable but is far less painful than making those decisions under pressure. Who will provide care? Where will funding come from?
• Understand what Medicare actually covers. Many families are blindsided when they discover how little Medicare pays for custodial care. Knowing the limits in advance allows you to plan accordingly rather than scramble when a crisis arrives.
• Learn the Medicaid rules in your state. Medicaid planning rules vary by state. An elder law attorney can help family members understand what assets are protected (a primary home, for instance, often is) and how to plan ahead within legal boundaries.
• Don’t assume the “Great Wealth Transfer” will apply to you. If your parents haven’t accounted for long-term care in their financial planning, a significant portion, or all, of what you expected to inherit may go toward care costs. Adjusting your own savings strategy accordingly is prudent.

A System That Needs Reform
Individual planning can only go so far. The Roosevelt Institute’s report is ultimately a call to recognize long-term care as a systemic policy failure, not a series of individual misfortunes.

The result of the current system is a force shaping who gets to grow old with security and who bears the financial cost of care. Wealthier Americans can absorb the costs and recover; most others cannot.
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Other wealthy nations have approached this problem differently, such as through public long-term care insurance programs, stronger workforce investment, and universal coverage models. The U.S. has long treated elder care as a private responsibility. The Roosevelt Institute’s data show the price that ordinary Americans pay for that choice: a lifetime of savings wiped out, and a next generation left with less of a foundation than it might otherwise have had.

Rick and Mary Williams had happily lived in their home in California for 22 years but began to question whether it was the right place for them to grow old.

That question sits at the heart of Senior Spaces, a new television series that follows real older adults as they navigate one of life’s most emotionally charged crossroads: deciding where and how to live the next chapter of their lives.

Hosted by Bryan Devore, a Seniors Real Estate Specialist (SRES), the show airs on the Senior Lifestyle Network, KUSI News in San Diego, and on YouTube. Senior Spaces is not a renovation show, a real estate competition, or a retirement fantasy but an honest look at the intertwined mix of love, loss, practicality, and hope that shapes one of the most significant decisions aging adults and their families will make.

Difficult Decisions
By 2030, all baby boomers will be over 65, making seniors the fastest-growing segment of the American population. Millions of families are asking a question previous generations rarely faced: What happens when staying at home becomes complicated?

The answer differs for everyone. Whether to age in place, downsize, join a 55-plus community, or move into a nursing or assisted living facility depends on health, finances, family proximity, social connection, and personal values around independence.

The decision rarely arrives cleanly. Often, it follows a fall, a diagnosis, the loss of a spouse, or a slow accumulation of moments when managing the house stops feeling manageable. By then, the emotional and practical weight can be overwhelming.

The Four Paths: Understanding Your Options

Aging in Place
For many older adults, remaining in one’s home is not just a preference but a deeply felt need. The home holds memories, identity, and routine. Aging in place can be a rich and workable option but living independently requires honest planning.
Common challenges include:

• Physical accessibility. Stairs, narrow doorways, and bathrooms not designed for mobility challenges can become serious safety hazards.
• Isolation. Without social infrastructure, aging at home can lead to loneliness, which research links to cognitive decline and poor health outcomes.
• Home maintenance. Upkeep can become exhausting or unaffordable.
• Caregiver burden. Family members stepping in to help may experience significant emotional and physical strain.
• Emergency response gaps. Living alone without reliable access to help is a real and underappreciated risk.

Resources for aging in place include the AARP HomeFit Guide, the National Aging in Place Council (NAIPC), and Area Agencies on Aging (AAA), which connect seniors with local services including transportation, meal delivery, and in-home care.

Downsizing or Relocating to a New Home
Some seniors choose to downsize to a smaller, more manageable property. This path can unlock home equity, reduce maintenance burdens, and open a new chapter of life in a community that fits better.

Common challenges include:

• Letting go of decades of belongings, a home where children were raised, and a familiar neighborhood can be emotionally challenging.
• Simultaneously buying and selling real estate is stressful at any age; navigating the process later in life adds complexity.
• Adjusting to a new living environment and community and starting over socially in a new place takes energy and time.
• Getting the market timing right can create financial pressure.

Working with an SRES can make a significant difference. These professionals are trained to understand the unique financial, emotional, and logistical dimensions of senior transitions.

Moving to a Senior Living Community
Active adult communities, 55-plus neighborhoods, independent living communities, and continuing care retirement communities (CCRCs) offer a range of options for seniors who want the independence of their own home or apartment within a community designed for their life stage.

Common challenges include:

• Cost. Entry fees and monthly charges for CCRCs and independent living communities can be significant and vary widely.
• Giving up a sense of home. Trading a house full of personal history for an apartment or condo requires psychological adjustment.
• Navigating the options. The spectrum from active adult communities to independent living to memory care is broad; finding the right fit requires research.
• Waitlists. High-quality communities often have long waiting lists, making early planning essential.

A Place for Mom and Caring.com are two popular online tools that help families research and compare senior living communities. Many communities also offer trial stays, which can ease the transition and help seniors make informed decisions.

Assisted Living and Nursing Home Care
When daily living activities such as bathing, dressing, managing medications, and eating require consistent support, assisted living and skilled nursing facilities provide round-the-clock structured care. For seniors with dementia or complex medical needs, these settings offer safety and specialized attention that home environments often cannot.

Common challenges include:

• Cost of care. Assisted living averages $6,200 per month nationally and a semi-private room in a nursing home can exceed $9,000 per month.
• Quality variation. The quality of care varies from one facility to the next, making thorough research and visits essential.
• Emotional difficulty. For seniors and families, the transition to a care facility often carries grief, guilt, and a sense of finality that deserves acknowledgment.
• Advocacy. Family members often must serve as active advocates to ensure their loved one receives attentive, respectful care.

The Long-Term Care Ombudsman Program helps residents of care facilities resolve complaints and understand their rights. Medicare’s Nursing Home Compare tool provides inspection reports, staffing data, and quality ratings for facilities nationwide.

What Senior Spaces Brings to the Conversation
What sets Senior Spaces apart from other housing or lifestyle programming is its commitment to showing the full picture, with its uncertainty, second-guessing, and surprises. In the pilot, Rick and Mary’s story unfolds in ways that challenge assumptions about what seniors want and what ultimately feels right.

The show treats older adults as thoughtful, complex people making consequential decisions, not as a demographic to be managed or a problem to be solved, a meaningful framing in a culture that often sidelines the voices of people in later stages of life.

The show goes beyond square footage and market value. It explores the emotional landscape: the attachments people carry, the family conversations that don’t always go as planned, and the relief that often follows a decision everyone was afraid to make.

Starting the Conversation Early
One consistent insight from senior housing specialists, geriatric care managers, and social workers: families who navigate these transitions best are those who started the conversation before a crisis hit.

That means asking while everyone is still well: What matters most about where you live? What would have to change for you to consider a move? What does a good day look like at 80? These conversations aren’t always comfortable, but they’re far less painful than making the same decisions mid-crisis, without consensus and against a deadline.

Resources such as the National Institute on Aging and ElderCare Locator can help families identify local resources and care managers. Those managers, now often called Aging Life Care Professionals, specialize in comprehensive care planning and navigating complex housing decisions.

The Human Side of a Practical Decision
The question of where to live later in life is not purely logistical. For most people, a home is not just shelter, it is a repository of identity, a symbol of independence, and a place where the self feels continuous across time. Leaving it, even for something better, involves a form of grief.

This dynamic makes Senior Spaces valuable viewing not just for seniors, but for the adult children, spouses, siblings, and friends who stand alongside them during their later-life transitions. Watching someone else move through the process can make it easier to imagine walking the same path yourself.

The show also offers a quiet but important message: there is no shame in needing more support, wanting community, or choosing safety over sentiment. These are not failures of aging but acts of wisdom.

Rick and Mary’s story, like so many others, does not end with a simple answer. It ends with a decision that feels right, not because it was obvious, but because they thought it through together with honesty and care. That is the kind of conversation Senior Spaces is trying to make easier for everyone watching. And in a country where millions of families are wrestling with the same questions, that matters more than most people realize.

Nursing home costs continue to climb, leaving many older Americans concerned about how to afford long-term care without exhausting their life savings. Since private health insurance and Medicare rarely cover extended stays, and long-term care insurance can be prohibitively expensive, millions rely on Medicaid.

While Medicaid is often seen as a "payer of last resort" that requires "spending down" assets to qualify, proactive planning can help seniors qualify while still retaining a portion of their estate.

The Growing Need for Long-Term Care
The likelihood of needing professional care is high: approximately 70% of people turning 65 today will eventually require some form of long-term support. Furthermore, about 40% of 65-year-olds will spend time in a nursing home.

While the average stay is roughly 16 months, costs can exceed $250 to $300 per day in many states. This means a typical stay can easily surpass $150,000, a figure that is unsustainable for most families without a strategic plan.

Medicaid Planning Strategies
To qualify for Medicaid, individuals generally must meet strict asset limits, often as low as $2,000. However, certain assets, such as a primary residence and one vehicle, are typically exempt.

Effective planning often involves converting "countable" assets into "exempt" assets. It is crucial to navigate the five-year lookback period, during which Medicaid scrutinizes past asset transfers to ensure they weren't made solely to qualify for benefits.

1. Medicaid Asset Protection Trusts (MAPTs)
A MAPT holds assets for a set period, after which they transfer to beneficiaries. Once assets are in the trust, they are no longer considered part of your estate for Medicaid purposes.

• Benefit: You may still benefit from the assets (e.g., living in a home owned by the trust).
• Caveat: Transfers into a MAPT trigger the lookback period, making this most effective when established years before care is needed.

2. Life Estates
A life estate allows you to transfer your home's ownership to a beneficiary while retaining the right to live there for the rest of your life.

• Benefit: Removes the home's value from countable assets and can protect it from Medicaid estate recovery.
• Caveat: Like trusts, these are subject to the lookback policy and involve a loss of some control over the property.

3. Promissory Notes
In some states, you can lend money to a family member via a formal promissory note. This converts a lump-sum asset into a stream of monthly income.

• Benefit: Can reduce the immediate asset total.
• Caveat: This is subject to heavy scrutiny by Medicaid agencies and depends entirely on the borrower's ability to repay.

4. Strategic "Spend Downs"
Directly spending money on exempt items can help meet eligibility requirements while providing immediate value. Examples include:

• Paying off existing debts or mortgages.
• Making necessary home repairs or modifications.
• Prepaying funeral and burial expenses.
• Purchasing a more reliable vehicle.

Spousal ProtectionsIf only one spouse requires nursing home care, Medicaid rules allow the "community spouse" (the one remaining at home) to keep a specific amount of income and assets to prevent them from falling into poverty.

Because Medicaid laws vary significantly by state and are subject to frequent changes, it is highly recommended to consult with an elder law attorney or a specialized financial planner early in the process.

Imagine opening your mailbox and finding a letter that says your Medicare Advantage plan won’t be available next year. No negotiation, no appeal, just a notice that your insurer is leaving, and you need to figure something out before January 1.

That’s what recently happened to tens of thousands of older adults in Vermont, and it’s becoming an increasingly common reality across the country.

Vermont: A Cautionary Tale
Nearly the entire Medicare Advantage market in Vermont collapsed heading into 2026. According to a recent study, about 92 percent of Vermont’s Medicare Advantage enrollees were forced to disenroll after insurers exited their areas. By February 2026, only about 21,000 Vermonters, roughly 12 percent of the state’s eligible adults, remained enrolled in a Medicare Advantage plan.

Vermont’s situation is an extreme version of a trend playing out nationally. Estimates suggest that roughly 10 percent (around 2.9 million) Medicare Advantage enrollees in standard HMO and PPO plans faced forced disenrollment for 2026. For context, from 2018 through 2024, the average annual rate was just 1 percent.

Why Is This Happening?
Medicare Advantage, often called “MA,” is the private insurance alternative to traditional government Medicare. Insurers receive payments from the federal government to provide your Part A and Part B benefits. For years, many MA plans attracted seniors with enticing extras like dental, vision, and hearing benefits, often at low or zero monthly premiums.

But those attractive benefits came with a financial reality that is now catching up with the industry.

Rising medical costs have squeezed insurer profit margins significantly. At the same time, the federal government has tightened oversight of how insurers calculate patient health risk scores, which is a key factor in determining how much the government pays the plans.

As a result, insurance companies are cutting benefits, shrinking service areas, and in some cases pulling out of markets entirely. UnitedHealthcare, the largest MA provider in the country, is on track to lose between 1.3 and 1.4 million Medicare Advantage members in 2026.

The drastic drop in MA enrollment in Vermont was partly driven by state-specific factors. The state’s health care landscape is dominated by a single large health care system, making it hard for insurers to negotiate favorable rates.

Vermont is also one of the most rural states in the country. Research shows that rural beneficiaries are disproportionately affected by plan terminations. While rural residents make up 14 percent of typical Medicare Advantage enrollees, they represent nearly 23 percent of those whose plans were terminated in 2025. Idaho, Wyoming, and South Dakota also each saw disenrollment rates of at least 40 percent in 2026.

Vermont may be more canary than outlier. When plans exit a market, their less healthy and more costly enrollees get pushed into whatever plans remain, thus potentially making those remaining plans less profitable, triggering further exits, in a process that could continue to spread.

What This Means for People With MA Plans
Medicare Advantage now covers more than half of all Medicare-eligible Americans (over 34 million people). The program’s rapid growth over the past decade was fueled by aggressive marketing, generous extra benefits, and zero-premium plans that made traditional Medicare look comparatively spartan.

But the current pullbacks mean many of those extras are disappearing. Across the country, MA plans are reducing dental and vision benefits, raising copays, and narrowing their networks of doctors and hospitals. Some major hospital systems have also cut ties with Medicare Advantage insurers in 2026, citing frustrations with prior authorization denials and slow reimbursements. This means that even seniors who keep their plans may find that their preferred doctors or hospitals are no longer covered.

The broader picture reveals an MA market in the process of a painful correction, with seniors caught in the middle.

What to Do If You Lose Your Medicare Advantage Coverage
If your Medicare Advantage plan terminates, you won’t fall off a coverage cliff. You will automatically revert to Original Medicare (Parts A and B), which covers hospital care and medical services. However, Original Medicare alone doesn’t include prescription drug coverage, so you’ll need to act to avoid a lapse.

Read Your Termination Letter and Save It
When your Medicare Advantage plan exits your area, the insurer must notify you in advance, typically by September 30 for changes taking effect January 1. The letter should tell you when your current coverage ends and what your options are. Keep this letter; it may be useful if you have to prove you qualify for a Special Enrollment Period (SEP) or other protections.

Use Your Special Enrollment Period
If your Medicare Advantage plan terminates through no fault of your own, you typically qualify for an SEP. An SEP gives you extra time to:

• Choose a different MA plan (if available), or
• Return to Original Medicare and pick a Part D plan.

If you receive notice that your plan will not renew, you generally have from October 15 through the end of February of the following year to select a new plan or switch to traditional Medicare. Don’t wait until the last minute; the earlier you act, the less you risk a gap in coverage.

Consider Your Three Main Paths

• Pick a new Medicare Advantage plan. If there are other MA plans in your area, compare your options using Medicare’s Plan Finder tool. Compare plans by your medications, doctors, and budget.
• Switch to Original Medicare + Part D. Traditional Medicare with a standalone Part D prescription drug plan to cover your medications gives you more flexibility in choosing doctors. However, consider whether you need supplemental (Medigap) coverage to help with deductibles and coinsurance.
• Consider Medigap if you’re leaving MA. In some situations, losing your MA plan can trigger “guaranteed-issue” rights for certain Medigap policies. This means you may be able to buy a policy without medical underwriting, so insurers cannot deny you coverage or charge you more based on health conditions. This window is time-limited, so act quickly.

Protect Your Prescription Drug Coverage
This is urgent: If you go 63 days or more without creditable prescription drug coverage, you may face a Part D late enrollment penalty. That penalty can last as long as you have Part D. When you switch plans, make sure drug coverage is in place and continuous.

Verify Your Doctors and Prescriptions Are Covered Before You Commit
Before enrolling in any new plan, confirm that your primary care doctor, specialists, and regular medications are covered under the new plan’s network and formulary (drug list). Do not assume; call the plan directly or check through the Medicare Plan Finder tool.

Get Free, Unbiased Help
Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased Medicare counseling. These counselors can help you compare plans and avoid missing any deadlines. Find your local SHIP at shiphelp.org or call 1-800-MEDICARE (1-800-633-4227).

Keep Records of Everything
Hold on to termination letters, enrollment confirmations, and notes on any communications with your insurer or Medicare. If billing errors or coverage disputes surface during a transition, documentation is essential.

The Bigger Picture
What’s unfolding in Medicare Advantage plans is a collision between decades of rapid expansion and the financial realities of covering an aging, higher-need population against a backdrop of government payment adjustments and tightening regulatory oversight.

For now, the program remains, in many parts of the country, robust. But Vermont shows what can happen when the economics stop working for insurers in a given region. Seniors in rural areas, in markets dominated by a single health system, or in states already seeing significant plan exits should pay especially close attention to their coverage as each annual enrollment period approaches.

The annual open enrollment window is when most Medicare beneficiaries can make changes for the following year. Use this window to compare different plans in your area and switch if that makes sense. Even if your plan isn’t ending this year, it’s worth reviewing your coverage each fall. Benefits, networks, and premiums can change, and what worked this year may not be the best option for next year.