“Dad’s in a nursing home. What can we do to protect my mother? I don’t want her to be destitute.”
Nursing homes cost a lot of money, so when one spouse requires long-term care, the other spouse often worries about his or her ability to meet expenses. To make matters worse, often the spouse who requires long-term care first is the husband. And, for the current generation of older Americans, the husband was the breadwinner and continues to receive most of the income.
“Will my mom get to keep any of dad’s income or will the nursing home take it all?”
The fact that there are so many myths surrounding long-term care and Medicaid – the only government program that pays for long-term care – doesn’t help the situation. Compound those myths with the fact that a family is faced with one of the most significant crisis situations that a family can confront – the long-term care needs of a husband/parent – and you have a blend of myth and emotion that could cause the calmest person to jump out of his skin.
What are the rights of the spouse who is left behind in the community? The wife may be fortunate since it is not she who requires long-term care, but is she really the lucky one? Will there be any money on which she can live, or must she now rely on family members for her support?
Before the husband qualifies for Medicaid, nothing for the wife will change – with the exception of her need to pay the monthly nursing home bill, which could be as high as $8,000 a month. That bill aside, the husband will still receive his Social Security and pension income, and the wife will still receive her income. The wife will probably have to apply most of that income, and some of the couple’s assets, to the nursing home bill, but no one “takes” either the husband’s or wife’s monthly income away.
Frequently, a client will come to see me with the firm belief that the nursing home or the State takes their income from the moment the husband enters the home.
If the husband eventually qualifies for Medicaid, the amount of the husband’s income that the wife will get to keep depends on the amount of her monthly expenses are and the amount of her own income. No one, by the way, takes the wife’s income.
The maximum amount of the husband’s income that the wife can keep is $2,175. Let’s assume that the husband has Social Security and pension income totaling $1,500 per month and that the wife has Social Security income of $500 per month. Let’s further assume that the wife has “shelter expenses” (rent, mortgage, real estate taxes, utilities) totaling $636 per month.
Given these facts, the wife will retain $1,152 of the husband’s income. I arrive at this figure because Medicaid law says that the wife can keep up to $1,452 as a “basic living allowance,” in order to pay for items such as food and clothing. From the $1,452 figure, the wife’s income of $500 is subtracted. Medicaid also allows the wife to keep as an “excess shelter allowance” those shelter expenses that exceed $436, so in my hypothetical, that’s $200.
Together, in this example, the basic living allowance and the excess shelter allowance equal $1,152, so that’s how much of the husband’s income the wife can retain, after the husband qualifies for Medicaid.
Balancing the needs of both spouses can be challenging when care enters the picture. Protections exist to prevent complete financial disruption, but how those protections apply depends on the details. Understanding that balance can help avoid unintended hardship.