Helping Families Navigate the Financial Challenges of Age Transitions

Month: March 2025

When political values collide with Mom’s Need for Care: One Reader’s Crisis of Conscience. 

"I find myself in a very conflicted position. I am 62 years old. I am a politically conservative person who has long believed that entitlement programs were a big part of this country's problems, and that Medicaid especially is responsible for creating a dependency on the government. Here's my situation: My 91 year old mother has depleted the savings that she and my dad worked to build, paying for care over the past five years. In five years, we have paid almost $400,000 between full-time sitters or nursing home care. Now she's out of money and the nursing home staff is telling me to apply for Medicaid for her. I could bring her home, but that would mean either me or my wife would have to quit our jobs or cut back on hours, and neither option is a good one. I can't afford to pay for her care out of my own pocket without severely impacting my own retirement, yet that's always been my belief - that families should take care of their own and not depend on the government. I'm in a real quandary as this goes directly against my beliefs, but I don't know what to do. I am an only child so there is no other family who can help."

First, you have my deepest respect for honestly confronting this clash of values that you have described. My personal opinion is that there may not be such a collision of values as you think. You seem to have taken personal responsibility for the care of your aging mother for the past five years, ensuring that the savings that your parents worked hard to accumulate have been used for her care in the best way possible. The fact that you feel conflicted about filing for Medicaid sounds less like a political view than a desire to continue that responsibility. You are certainly not alone as more aging parents from all political persuasions will likely need Medicaid’s assistance, and I want to gently challenge your belief that such programs only perpetuate government dependency.  

Medicaid's Founding and Purpose

Medicaid was established in 1965 as part of the Social Security Act, with the purpose of providing health coverage to low-income individuals and families. Initially targeted at families receiving cash assistance, the program has since expanded to cover a broader population, including pregnant women, children, elderly adults, and individuals with disabilities. As of 2023, Medicaid covers over 83 million Americans, making it the largest source of health coverage in the United States. Medicaid is jointly funded by the federal and state governments, with total spending exceeding $600 billion annually. The program plays a crucial role in ensuring access to healthcare for millions of Americans who might otherwise be unable to afford it. 

Criticisms of Medicaid

However, the cost and expansion of Medicaid have raised concerns among political conservatives. They argue that the rising expenditures place a significant burden on federal and state budgets, potentially diverting funds from other essential services. Additionally, some conservatives believe that the expansion of Medicaid encourages dependency on government assistance rather than promoting self-sufficiency.  

Furthermore, well-documented cases of Medicaid fraud and abuse have contributed to a negative perception of Medicaid among many, but especially among more conservative Americans.

Reconsider Your Conflict

When people with conservative beliefs about personal responsibility face the need for help, such as caring for an aging parent without savings, they may encounter a conflict. Their value of financial independence clashes with the necessity to use government programs like Medicaid, which they previously saw as fostering dependency.  

But is this really a moral and ideological dilemma that forces you to reconsider your beliefs in the light of your responsibilities and the stark financial realities you are confronting? The prevailing theme expressed by your beliefs seems to be taking responsibility, and you could consider that getting Medicaid support for your mother during what is likely the last remaining years of her life IS taking responsibility.   

Applying for Medicaid does not negate the commitment to caring for your aging mother. Instead, it acknowledges the practical realities of the high costs associated with long-term care. By securing financial assistance, you are ensuring that your mother receives the best possible care, which is a responsible and loving act. Rather than creating dependency and irresponsibility in you, here are three things getting Medicaid for your mother would allow you to do.

  1. Maintain Active Involvement: Even with Medicaid support, you can remain actively involved in your mother’s care. Regular visits, advocating for her needs, and staying informed about her health and well-being demonstrate your ongoing commitment and responsibility. 
  2. Focus on Quality of Life: By alleviating the financial burden through Medicaid, you can focus more on enhancing your mother’s quality of life. This might include spending more meaningful time with her, engaging in activities she enjoys, and ensuring she feels loved and supported. 
  3. Preserve Financial Stability: Seeking Medicaid assistance can help preserve your financial stability, allowing you to continue fulfilling other responsibilities and maintaining your independence. This approach ensures that you can care for your mother without compromising your own well-being and future. 

So let yourself off the hook. You haven’t compromised your values, but perhaps you can see others in a more compassionate way. How many other Medicaid recipients value personal responsibility, but circumstances gave them few options but to accept the safety net that Medicaid offers? It’s ok to support Medicaid reform in order to make it more fiscally sound and free from fraud and abuse while also acknowledging its value to those who need it most. 

Hollywood Cases Highlight the Benefits of Long Term Care Trusts.

When planning for long-term care, many individuals focus on purchasing insurance or setting aside assets to cover future expenses. However, financial abuse and mismanagement can derail even the best-laid plans. A long-term care trust offers a structured, protective approach to ensuring that funds are used appropriately, especially when an individual is no longer able to manage their own affairs.

What Is a Long-Term Care Trust?

A long-term care trust is a standby revocable trust designed to provide financial oversight for an individual’s long-term care needs. While the settlor (the person creating the trust) is capable, they retain control over the trust assets. However, the trust includes springing provisions—legal language that allows a successor trustee to step in and take over management if the settlor is deemed incapacitated.

The trust can own various assets, including long-term care insurance policies, life insurance policies with long-term care riders, and liquid assets designated for care-related expenses. Once the successor trustee takes over, they are responsible for filing insurance claims, paying expenses from the trust, and managing trust assets to ensure care needs are met.

Lessons from the John Amos and Mickey Rooney Cases

One of the most compelling reasons to consider a long-term care trust is to prevent financial exploitation, as tragically illustrated in the John Amos and Mickey Rooney cases.

John Amos, a well-known actor, who died in 2014, has been called a victim of elder financial abuse by his adult children, each claiming that the abuse was perpetrated by the other. 

Mickey Rooney, another famous actor, provided powerful testimony before Congress about the financial abuse he endured in his later years. Rooney described how he was isolated, financially exploited, and left without access to his own money. His testimony shed light on the widespread issue of elder financial abuse and the devastating impact it can have on an individual’s dignity and well-being.

A long-term care trust may have helped prevent such abuse by placing financial oversight in the hands of a designated trustee rather than leaving assets vulnerable to manipulation by infighting siblings or self-serving outsiders. With a properly structured trust, all care-related expenses are managed transparently and according to predefined terms, reducing the risk of unauthorized withdrawals or misuse.

Key Benefits of a Long-Term Care Trust

  1. Ensures Funds Are Used for Care Needs
    By designating a trust to own long-term care policies and other assets, funds are explicitly earmarked for care expenses. This prevents potential misappropriation by well-meaning but financially strained family members.

  2. Streamlines Insurance Claims and Payments
    Managing long-term care insurance claims can be overwhelming, especially when a person is already facing health challenges. The trustee, as the legal owner of the policy, handles all paperwork, ensuring that claims are filed correctly and benefits are used as intended.

  3. Protects Against Financial Exploitation
    With a structured oversight system in place, there is a clear fiduciary duty to manage funds appropriately. The trustee must follow the trust’s terms, keeping records and providing transparency that minimizes opportunities for fraud or undue influence.

  4. Reduces Family Conflicts and Burdens
    Family members often struggle with decisions about paying for care, especially when different parties have competing financial interests. A long-term care trust provides clear guidelines, removing ambiguity and reducing potential disputes.

  5. Offers Continuity and Professional Management
    If a person becomes incapacitated, the transition of financial management is seamless. The springing provision allows for immediate oversight by the successor trustee, avoiding court intervention or delays that could disrupt care.

Selecting the Right Trustee: The Case for a Professional

Perhaps the most critical decision when establishing a long-term care trust is choosing the right trustee. While some individuals select a family member, this can create conflicts of interest, emotional strain, and potential mismanagement. Instead, using a professional trustee—either an institutional trustee (such as a bank trust department) or an independent professional trustee—offers significant advantages:

  • Objectivity – A professional trustee is neutral and bound by fiduciary duties, making decisions based on the trust’s terms rather than personal interests.

  • Expertise – Managing long-term care expenses requires financial, legal, and insurance knowledge that a professional trustee brings to the table.

  • Accountability – Unlike family members, professional trustees are legally required to keep records, report transactions, and manage funds prudently.

  • Reliability – Professionals are available long-term and will not face personal circumstances (such as illness or financial hardship) that might interfere with management duties.

A long-term care trust is a powerful tool for ensuring that assets are managed effectively, claims are handled properly, and financial abuse is prevented. By structuring the trust with springing provisions and selecting a professional trustee, individuals can safeguard their care needs and provide peace of mind for themselves and their families.

In a world where financial abuse and care mismanagement are real threats, a well-crafted long-term care trust offers a practical, protective, and proactive solution. Whether planning for yourself or helping a loved one, considering this option is a smart financial move that can make all the difference when it matters most.

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