Alzheimer's and Dementia, Elder Law, estate planning, Long Term Care, Medicaid

The Burden of the Caregiving Spouse

By Rick Law, Medicaid crisis planning attorney and estate planner at the Elder Law firm of Law Elder Law in Western Chicagoland in IL. An often overlooked aspect of Alzheimer’s disease is the burden placed on caregiving spouses, who often need care themselves later. We once had a client whose husband had Alzheimer’s disease and eventually needed long-term care beyond what his wife could provide. Despite the husband’s macho declaration that he would put a gun to his head before ever going to a nursing home, the sad truth is that his wife would be the one to bear the burden caused by his long-term-care needs and her own aging challenges. The husband and wife in this example are frugal people who worked hard all their lives. They live on two Social Security checks, his modest pension, and minimal investments. They are able to pay their bills and enjoy simple luxuries—until the out-of-pocket expenses of long-term care begin to drain what they worked a lifetime to save. The wife selflessly provides in-home care for her beloved husband, but eventually the day will come when her strength is not enough to pick him up or keep him from wandering away from home. On that day, it might be a doctor, a discharge planner, or a police officer who looks into her eyes and speaks the harsh truth: “I’m sorry, ma’am. You can’t take care of him by yourself anymore.” This poor woman will then face a nightmare as she walks the eldercare journey with a frail and declining husband. First, she will learn that neither Medicare nor their health insurance provides any payment for home healthcare costs. Later, when her husband must be relocated to a long-term care facility, she will discover that neither Medicare nor Medicaid supplemental insurance will pay the facility’s $3,000 to $8,000 monthly cost. Quickly, she also will discover that Medicaid is not available because she has “too much money.” Her husband’s care will be offset by Medicaid only if she and her husband meet stringent income and asset limitations. If they have assets over $109,560, they will be forced to “spend down” their life savings, which Medicaid defines as “excess assets.” When all excess assets have been spent on her husband’s medical care, then Medicaid will also control her monthly income. In Illinois, she will be restricted to $2,739 per month from the couple’s joint income. If she has more income than this of her own not counting her husband’s income, the state (again, Illinois) will seek a support amount from her to contribute to the payment of his care. Later, when her husband dies, she will receive more bad news. She may lose all or half of his pension, and as the “survivor spouse” she loses one of the two Social Security checks. She has spent nearly all of their assets to provide for her husband’s care, and now she can’t even afford to live in her own home. The nightmare of long-term care will leave her impoverished and will steal her independence after she has spent many years providing for his care. She will not have the luxury of a spouse who will serve her as she served him. No one will be there to dutifully care for her at home and to delay the day that she must move to a long-term-care facility. She will not have the financial resources that he had, because Medicaid called them “excess nonexempt assets” and she spent those assets paying for her husband’s care. As a single person, she will not be provided with assistance by the Medicaid system until she has become impoverished to the point of a paltry $2,000 or less in total assets. The indignity committed against her does not stop there, for now she must sign over all her income to the nursing home as well, except for a miserly personal-needs allowance of $30 per month, which is not enough to get her hair done much less to pay for personal items and replace clothing that is worn or that does not come back from the laundry at the nursing home. The loving wife who faithfully cared for her husband is now out of money and out of options. She is alone—and living the nightmare of long-term care in America. Too many families needlessly lose everything they have.  Don’t let that be you.  If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100.  Your first consultation is absolutely free.  We’ll let you know what steps you need to take, right now, to protect yourself and your family.  Call now, because when you’re out of money, you’re out of options! Sincerely, Rick L. Law, Attorney, Estate Planner for Retirees. Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine,, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future.  Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.  Call 800-310-3100 for your free consultation now!