What Happens When One Spouse Goes to a Nursing Home?

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Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

When a spouse goes into a nursing home, the experience can be very emotionally and financially disruptive. You may have questions about ensuring that your spouse receives good care, how to pay for their care, and how long they will be gone. 

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Laws that govern payment in nursing homes are complicated and driven by state requirements, which are based on federal guidelines. Nursing home care is the highest level of care available outside a hospital setting and, therefore, costly. Medicare does not pay for a nursing home, only for short-term rehab after a qualifying three-night stay in the hospital. 

Every state has different qualifying Medicaid criteria, and Medicaid is the primary source of payment for nursing home care. Whether your spouse qualifies for Medicaid will depend on where you live, as well as a very complicated asset and income criteria.

We will cover the basics for this article, but we recommend you speak with a Medicaid specialist or estate planning attorney to consider your options to protect your assets and pay for your loved one’s care.

What Can Happen To Your Money When One Spouse Moves to a Nursing Home?

The answer to what happens to your money when one spouse moves to a nursing home depends on where you live and your asset level at the time of the move. When your spouse moves to a nursing home, someone has to pay for their care, and whether they will qualify for Medicaid depends on several factors. If both you and your spouse’s assets and income are above a certain level, you may be required to pay out of pocket for all nursing home expenses. 

Assets

If your spouse has assets above the Medicaid limit, they will need to pay for their nursing home care. The Medicaid limit is state-dependent, but in general, the state only considers your spouse’s assets when determining whether they qualify for Medicaid. The idea is to protect your financial stability when a spouse goes to a nursing home. In general, a person who wants to be eligible for Medicaid can have no more than $2000 in assets (this amount might be higher in some states).

You may be able to keep a portion of your assets when your spouse goes into a nursing home, and your spouse may still qualify for Medicaid. The community spouse may be eligible to keep up to one-half of the couple's total assets up to a maximum of $130,380. Other states are more or less generous. 

Income, pensions, or Social Security payments for you and your spouse

Medicaid will not count the income of the community spouse when considering Medicaid eligibility. Only the income of the spouse going into the nursing home is used to determine whether they qualify.

Even if the community spouse is still working, they will not have to contribute to the cost of caring for the spouse in a nursing home if Medicaid covers them. In some states, however, if the community spouse’s income is above a certain level, they have to contribute to the cost of the spouse’s care.

If most of the couple's income is in the name of the nursing home spouse and the remaining spouse needs help with living expenses, they may be entitled to some or all of the monthly income that the nursing home spouse receives. The amount the community spouse is entitled to depends on what the Medicaid agency deems is appropriate for the community spouse. 

What about other assets?

CDs, stocks and bonds, savings accounts, and property that is not the primary residence can all be considered when determining Medicaid eligibility. There is also what is referred to as a five-year look-back period. You can’t transfer assets (to protect those assets from counting against you) into someone else’s name within five years of qualifying for Medicaid. 

Your home and other exempt assets

Fortunately, your home, regardless of value, is exempt from Medicaid eligibility. In other words, your home is not an asset when determining whether your spouse qualifies for Medicaid. Other exempt items are your vehicle, household items, prepaid funeral plan, burial plot, and life insurance policies that are not over a specific limit. 

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Who’s Responsible for Paying for Your Spouse’s Care Once They Enter a Nursing Home?

There are two primary sources of payment for a spouse entering a nursing home. Either you and your spouse are responsible for paying for nursing home care, or your spouse must qualify for Medicaid. Medicaid will pay for most services connected with nursing home care, but not all. There are some items and requests that may not be covered and are the responsibility of the resident. 

Tips for Maintaining a Relationship WIth a Spouse Who Enters a Nursing Home

When a spouse enters a nursing home, it can feel like a loss, and it is. Suddenly your friend and confidant are gone, and you might feel confused about how to maintain your relationship. You may also be feeling some relief, which is normal. You might have been the primary caregiver, and the stress and strain of caring for your spouse are now gone. And not all relationships are created equally.

Your relationship might change over time as one person becomes more frail and dependent. Now, with this new phase, you will need to pivot again to keep your relationship strong and loving. 

Visit

Nothing takes the place of a personal visit. And this can be hard on you, especially if your spouse has dementia. It isn’t easy to see your spouse suffering or asking to go home. During the COVID-19 pandemic, visits to nursing homes were prohibited. There are many stories of how hard this was on both the resident and the families. 

Scheduling visits is a good way to ensure that you don’t let too much time go by. A personal visit will help your loved one feel cared for.  Bring adult children or grandchildren along. The other advantage of a visit is the opportunity to assess the care your spouse is receiving. 

Touch

Everyone needs touch, and when your spouse is in a nursing home, the contact they receive can be impersonal and task-oriented. Loving touch makes a connection that few other gestures can. Physical contact is especially crucial for people who have dementia. Bring some lotion and offer to put some on your spouse’s hands or massage their neck and back.

Be encouraging

It can be demoralizing to be in a nursing home. Depending on your spouse’s condition, they may never come home. But that doesn’t mean that you can’t reinforce positive mental and physical health efforts. Quality of life, regardless of how much time is left, is worth fighting for every day.  

Bring gifts

Bringing thoughtful gifts can make someone feel cared for. Consider flowers or cut herbs to liven up your spouse’s space. Earbuds and music are other great ideas, especially considering that your loved one probably shares a room with another resident. Blocking out noise is a challenge, and music can help. If your spouse has dementia, family photos can be comforting reminders—place photos on the bedside stand or the walls.

Ask what your spouse needs

Sometimes we forget the obvious! Ask your spouse what they need and want to be more comfortable. You might be surprised at the answer. Your assumptions about what is important to your spouse could be upended, and that is OK.

Tips for Making Sure Your Spouse Receives Good Care in a Nursing Home

Before you decide on a nursing home, there are questions to ask a nursing home so you can make an informed decision. To make sure your spouse receives good care in a nursing home, you have to be a detective, care manager, and advocate rolled into one. It is a part-time job that will require time and effort. 

Use your eyes

What you see will tell you a lot about the care your spouse is receiving, and that means opening your eyes to the details. Pay attention to cleanliness in the room and the hygiene of your spouse.

If continence is an issue, ensure that your loved one is changed frequently. When someone is bed-bound, sores can become a serious health concern. Either your spouse needs to be repositioned, or they need to have an alternating air mattress. 

Attend all care plan meetings

Nursing homes are required to hold patient care plan meetings every three months. These meetings are a perfect opportunity for you to get updates on your spouse’s care and voice concerns. If you are notified that the care plan meeting is at a time you are unable to attend, ask for a reschedule so that you can participate in person.

Try not to be deterred by how fast the meeting goes, and make sure you get all of your questions answered. Attend to any to-do tasks assigned to specific staff and make sure you follow up with that person later. 

Complain politely and to the correct people

You have heard the phrase, “You can catch more flies with honey,’' which means you are more likely to get what you want by being nice. However, don’t be afraid to make formal complaints to state agencies if the identified problems are not rectified to your satisfaction. 

Also, try to make formal complaints to the correct people who can do something about it. Complaining about the food to a server or complaining about care issues to an aide is unlikely to help. Go directly to a supervisor and the executive director if necessary. Having a calm and positive demeanor will help, and follow up with a written summary of your complaint and action steps.

Consider additional help

If finances allow, consider hiring a private caregiver to tend to your loved one. There are several advantages to this idea. First, you can designate specific tasks for the caregiver to do that you don’t have time for, like massage, personal care, and stimulating activities like games or watching movies. Secondly, a caregiver is another set of eyes and ears to report any concerns.

What Happens When One Spouse Goes to a Nursing Home

When your spouse goes to a nursing home, you will be juggling emotions, finances, and your loved one’s needs. Reach out for help from an estate planning attorney and friends and family for support and guidance. At the center of the storm is your spouse, so keep them front and center and in your heart. 

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