It is very hard to envision the way life will be when you reach a certain age that is in the future. You can make assumptions, but you may find that things are very different than you imagined. As an elder law firm, we know this all too well because of our experiences with clients.
How Likely Is It?
A lot of people know that there are those that require living assistance, but they assume that it is a small minority. In fact, 70 percent of people that are attaining senior citizen status will need help with their day-to-day needs.
Some of these folks will be able to rely on family members and friends to provide a bit of assistance for free, but others are not in this position. There are also those who have willing family members, but the level of care needed is beyond their capabilities.
Long-Term Care Costs and the Medicare Problem
From a financial perspective, you may not worry about long-term care costs because you know you are going to qualify for Medicare when you are a senior.
Unfortunately, Medicare does not pay for custodial care. This is the type of care nursing homes provide, and in-home health aides administer custodial care as well.
A full-time home health aide in the Manhattan, NY area will cost about $80,000 a year. The median annual charge for a private room in a NYC nursing home is nearly $170,000.
Length of Stay
Just under half of people who need paid long-term care get the assistance for less than a year, and 40 percent are in the one-to-five-year range. Thirteen percent of individuals that are paying for long-term care accumulate the bills for more than five years.
These numbers can get disturbingly large, and married couples can be forced to deal with two different sets of long-term care bills
The Medicaid Solution
Medicaid will pay for long-term care if you can gain eligibility, and there is a Home and Community-Based Services Waiver that covers in-home care. The latter can be the preferred course of action for a wide range of people for a number of reasons.
First and foremost, the comfort and familiarity of home is extremely important for many seniors. This is true in a general sense, and a move into a nursing facility can potentially cause disorientation, anxiety, and depression.
There are aging in place home modifications that can be made to adapt the surroundings to the physical limitations of a senior with mobility challenges.
Medicaid Eligibility
Since Medicaid is a need-based program, there is a $30,182 asset limit, but an applicant’s home is not a countable asset. However, Medicaid is required to seek reimbursement from the estates of deceased beneficiaries. So, a lien could be placed on a home that is owned by a beneficiary.
Fortunately, there is a very effective solution in the form of an irrevocable, income-only trust. If you implement this nursing home asset protection strategy, you convey your home and income-producing assets into the trust well before you need long-term care.
The income will allow you to maintain your lifestyle, and the home will no longer be in your personal possession. Legally, it will be the property of the trust.
If you fund the trust at least 60 months before you apply for Medicaid, the assets in the trust would not count. In New York, there is a 30-month look-back for Community Medicaid, but it has not been implemented at the time of this writing
Your home would be protected since it is owned by the trust, so this can be a turnkey solution if you act in advance.
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- Are You Prepared for Long-Term Care Costs? - August 15, 2026
- How Often Should I Review My Estate Plan? - August 1, 2026
- What Happens When an Executor and a Beneficiary Disagree? - July 15, 2026
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