Medicaid Annuities: How Do They Work? (Part 2)

Let’s take another look at how you can use Medicaid annuities. Say you’re single and in the nursing home, and you have about $100,000 of “excess” assets. What can you do to qualify for Medicaid coverage of your nursing home expenses?

You can certainly give everything away, but that would cause you to be ineligible for Medicaid for many months—the so-called “penalty period.”

For example, if you gave away $100,000, to calculate the penalty period you must divide the amount of your gift by your state’s “penalty divisor,” which is based on the average cost of a nursing home in your state, and is usually set annually. So if your gift is $100,000, and the divisor is $5,000, then there’s a penalty period of $100,000/$5,000 = 20 months.

If you indeed gave away the full $100,000 to, say, your children, you’d be faced with no Medicaid coverage of your nursing home expenses for 20 months, based on our assumptions above. Well, who is going to pay for you for that 20-month period? That’s right, the kids! And it may well take the entire $100,000 you just gave them to cover your expenses for the penalty period, leaving the kids with nothing at the end! So much for that approach.

Instead, you should consider the “half-a-loaf” approach. Here’s how this works: Instead of giving away 100% and winding up with nothing for your family members as explained above, you give them 50% now and keep the other 50%. But if you stop there, you won’t qualify for Medicaid because you have too much money: remember, you can only have $2,000 in countable assets, not $50,000!

So you’d have to spend that $50,000 on your care, till it’s gone, and then you can apply for Medicaid. But at that point you would find out that the gift you made 10 months ago counts against you (as do all gifts you made within the last 5 years, as a general rule), forcing your kids once again to pay for you till the $50,000 you gave them is gone. Hmmm; not any better than the first approach…

But wait, there’s another twist in this that must be followed for it to work. Since the penalty period only starts running if you are otherwise eligible for Medicaid but for the gift penalty, you must make the $50,000 you kept “disappear,” somehow. No, hiding it and lying to the Medicaid workers is not what I had in mind. That will only get you a huge fine and some time in prison; the food in the nursing home will start to look good to you in comparison!

The trick is to take that $50,000 you kept and purchase a Medicaid annuity, as described in Part 1. Then you should immediately apply for Medicaid. You won’t qualify, because of the gift you just made, but since you are now broke, the penalty will start running. That means that you must somehow cover your own nursing home expenses for the next 10 months. That’s where the annuity comes in: hopefully you purchased one that will pay you enough each month to cover your monthly expenses just for the penalty period. Ideally, the annuity payments stop at the exact moment that your Medicaid eligibility starts. Result: your children have an extra $50,000 they would not have had, had you done nothing. (And you stayed out of prison!)

Now, folks, this sounds simple, but let me warn you: Don’t try this on your own, without competent legal advice! There are a number of details that I omitted, for simplification, and the rules of each state vary on exactly how this can be implemented. Nonetheless, it can be a powerful technique to save your family many thousands of dollars, in the right circumstances.

NOTE: For more information on this topic and other Medicaid planning techniques, see my book “How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets” (2008 Second Edition available here: www.MedicaidSecrets.com).

Medicaid Annuities: How Do They Work? (Part 1)

In order to qualify for Medicaid, a single individual cannot have more than $2,000 in countable assets, and a couple cannot have more than $106,400. Any excess must be either spent down till it’s gone (not generally the best alternative), gifted (which causes a costly period of Medicaid ineligibility), or converted to a non-countable asset. Such a non-countable asset is a “Medicaid annuity.” Here’s how it works.

An annuity is a regular stream of payments back to you, in exchange for a lump sum of money. They can be either private (made between you and a family member) or commercial (made with an insurance company). Medicaid only allows commercial annuities.

For example, if you are a male, age 70, you could transfer $50,000 to an insurance company in exchange for a monthly annuity payment of $400, guaranteed for your life, no matter how long you lived. But what if you died unexpectedly after two years? The annuity payments would stop. Most people do not like that, and therefore will typically purchase the annuity with a “guarantee period” of at least a certain number of years.

According to the Medicaid rules, a male age 70 has a life expectancy of 12.8 years. So you cannot purchase an annuity with a guarantee period that exceeds 12.8 years without causing a period of disqualification from Medicaid. So let’s stick with 12.8 years to be safe. Because you are guaranteed payments for the longer of your life expectancy or 12.8 years, the monthly payments will be lower. In this example, they drop from $400 to $354 per month.

So why would anyone do this? What if you are in a nursing home and have $50,000 too much in the bank. You could purchase one of these annuities and immediately qualify for Medicaid without having to spend down the $50,000. The $354 will have to be paid to the nursing home each month, and Medicaid will pick up the difference. Under new laws that became effective Feb. 8, 2006, the state will have to be named as the beneficiary of the annuity up to the amount of Medicaid benefits it paid on your behalf, during your lifetime.

If you live to your full life expectancy and then die, the annuity payments will stop, and the state will be unable to receive any reimbursement. But what if you happen to die after 2 years? In that case, the annuity payments will continue for the balance of the guarantee period, but must first go to the state until your Medicaid “bill” is fully paid. After that, if any payments are still to be made, they can pass to your family members.

So if the Medicaid “bill” is for two years’ of Medicaid coverage, it could easily be in the amount of $96,000 (assumes $4,000/month). Since that exceeds the value of the annuity, the state will receive all of the remaining payments and your family will get nothing.

As you can see, using the entire amount of excess funds to purchase a Medicaid annuity for a single individual rarely makes sense. However, in order to be sure, you simply must “run the numbers”: how much money is there to invest in the annuity? What is the age of the nursing home resident? What is the expected life expectancy of the resident? Once you know those factors, you can try different scenarios and see whether or not it makes sense to purchase the annuity. If not, then other Medicaid planning techniques should instead be considered.

NOTE: For more information on this topic and other Medicaid planning techniques, see my book “How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets” (2008 Second Edition available here: www.MedicaidSecrets.com).

Common Law Marriage: Be Careful!

Back in the early days of our country, when justices of the peace and clergy were harder to find and the population more spread out, there arose the concept of a “common law” marriage. The basic idea was that if a man and a woman held themselves out to the community as married, and considered themselves to be husband and wife in all their dealings with the public and themselves, then the law would recognize them as such.

At the present time, only about a dozen states still recognize a common law marriage formed under their own laws. However, under the U.S. Constitution’s “full faith and credit” provision, a common law marriage valid in any one of these dozen states will be recognized as a legal marriage in all of the other states.

Unfortunately, because there is no piece of paper to point to, whether a couple will be recognized as married for purposes of state law (and hence federal law, which follows state law on this determination) is a facts and circumstances test.

Here are some of the factors that judges have looked at in making a determination that a couple were married at common law:

• living together
• holding themselves out as married to the general community
• exchange of wedding rings
• attending holiday celebrations and family gatherings together
• traveling together
• filing income taxes marked as married individuals
• completing medical records as married
• sharing domestic responsibilities

Here are some factors that weighed against a couple being considered in a common law marriage:

• the female’s reference to her partner as her “boyfriend” or “partner” to emergency medical personnel
• failure of one partner to indicate she was married when applying for a mortgage
• holding themselves as married only to a small circle of friends and co-workers but not the general community

Because tax returns are signed under the penalties of perjury, they are particularly persuasive to a court in making this determination.

Why is this important? There are many legal consequences, rights, and responsibilities that depend on a determination of marital status. For example:

• A surviving spouse is entitled to a certain percentage of a deceased spouse’s estate if the spouse died with no will; if declared to be unmarried, that surviving “spouse” gets nothing.
• A surviving spouse is entitled to a certain percentage of a deceased spouse’s estate if the spouse had a will but omitted or left little to the other “spouse”; this is called an “elective share” and could be as much as 50% of the deceased spouse’s estate.
• With larger estates, only a legal spouse can claim the unlimited marital deduction, saving thousands of dollars in estate taxes.
• Only legal spouses can file income taxes as “married filing jointly.”
• Only a legal spouse would have certain rights and access to medical records under federal and state laws.
• Only a legal spouse is entitled to the Social Security payments of a deceased spouse.

Sometimes it’s actually better not to be determined to be married. For example, a healthy spouse’s own assets must be “spent down” on a disabled spouse residing in a nursing home, before Medicaid coverage of the nursing home costs will be allowed. If the couple is not married, then only the nursing home partner’s assets are counted, protecting an unlimited amount of assets of the healthy partner.

As you can see, important monetary and other benefits turn on the legal determination of whether there was or was not a common law marriage. In most cases there are benefits to the spouse; in some cases there are disadvantages. In any case, this should be thought through by the couple so that they do not get caught unaware! If in doubt, the couple should go downtown and sign that little piece of paper indicating they are officially married. That would end all questions!

Setting Up a Special Needs Trust for a Disabled Relative

Many of us have a family member or close relative with a disability. We’d like to leave a portion of our estate to help this family member but are unsure how best to do this. Should we just make an outright gift? What about a trust? Let’s take a look at some of the options.

The simplest method of assisting the family member is an outright gift, either during lifetime or via our will. However, if the disabled individual is already receiving government benefits such as SSI (Supplemental Security Income) or Medicaid, additional assets could cause them to become disqualified from those programs. On the other hand, some programs such as SSDI (Social Security Disability Insurance) are not “means tested,” i.e., are not affected by the assets or income of the recipient.

Since a person may not need to receive “means-tested” benefits today but may require them in the future, the safest route is to leave them your gift inside a trust. The trustee of the trust will hold your money, invest it, and distribute it to your intended beneficiary as needed, without causing disqualification from government benefits.

Such a trust is called a Special Needs Trust or Supplemental Needs Trust, since it is designed to supplement—and not replace—government benefits. It can be created today and funded with money or other assets now. Such a trust is called an “inter vivos” trust. You can serve as the trustee or permit someone else to serve as trustee; the trust can be revocable or irrevocable; and you can retain power to change the ultimate distribution of the trust assets or not. All of these decisions affect the income tax and estate tax treatment of the trust. If you choose to make the trust irrevocable, then it will have its own federal tax i.d. number and can be set up to be taxed either to you, the trust itself, or to the beneficiary.

You can also set up the trust within your will, to be funded upon your death. Such a trust is called a “testamentary trust.” In this case, you will not have a separate trust document, since the terms of the trust will be contained within the will itself.

Because the rules of each state vary as to whether the terms of the trust will cause or not cause disqualification, you really must work with an experienced estate planning or elder law attorney to draft this trust for you. The attorney will be familiar with both the federal and state programs that might be of benefit at some point to your family member, what the rules are under both federal and state benefits laws, how trusts work, the different income and estate tax ramifications of each trust option, and how best to achieve your objectives.

Examples of distributions that will not cause the beneficiary to lose or have reduced government benefits:

• new car
• attorney/accounting services
• alternative health treatments
• TV, DVD player
• public transportation pass
• camera
• computer hardware, software, internet fees
• courses and classes
• dental work not covered by Medicaid
• fitness equipment
• musical instruments
• non-food grocery items
• physician specialists not covered by Medicaid
• utility bills
• physical therapy not covered by Medicaid
• vacations

The above is by no means an exhaustive list, but is only intended to give you some idea of what your gift via trust can be spent on to make your family member’s life so much better, without causing disqualification. As you can see, your gift will have wide-ranging benefits for your family member and will improve their quality of life for many years.

Wills for a Second Marriage

“I’m concerned that if I died first, and I just left all my assets to John, that he could get remarried or simply decide for whatever reason not to leave my boys anything upon his death.” Sarah’s heartfelt concern is shared by many individuals who are in a second marriage, where children can be his, hers, and theirs. Taxes are not the issue; protecting one’s legacy so that at least some portion of it stays “on your side” is the goal. How can this be achieved while still benefiting the second spouse?

The goal is generally to benefit the surviving spouse while guaranteeing that upon that spouse’s death, whatever is left will pass in accordance with the wishes of the first spouse to die. There are a number of ways to do this.

Contract to Make a Will. First, it is possible for both spouses to have wills that leave everything to the surviving spouse but then divide between both sides of the family that cannot be later changed, based on a written contract signed by both spouses. The risk is that the surviving spouse may remarry, get sued, or get divorced. In any of those situations, the will may continue to be unchanged, but the assets may becomed depleted by the time the spouse dies.

Testamentary Trust for the Spouse. A better alternative is to insert a trust within your will, for the surviving spouse (this can also be done within a living trust). The surviving spouse can be the sole beneficiary of this trust, but there will be limits on the distributions, so that the surviving spouse cannot withdraw all the trust assets, defeating the plan. The spouse would generally be entitled to all the trust income plus discretionary distributions of principal for maintenance and support or at least medical emergencies.

Having someone other than the spouse as the trustee—or at least as a co-trustee with the spouse—adds further protection. Upon the spouse’s death, the trust divides among your children or however you want it to pass. The main advantages of this approach are as follows:

• your spouse has no ability to alter your intended distribution of assets following your spouse’s death
• if your spouse remarries your assets are protected against claims of a divorcing new spouse
• if your spouse remarries the new spouse will not be able to demand a portion of your assets as an “elective share” (see below) upon your spouse’s later death
• creditors of your spouse cannot touch the trust assets during your spouse’s lifetime or after death

Elective Share. Any of the above solutions must take into consideration the “elective share” statute of your state. That law guarantees a certain percentage of your estate must pass to your surviving spouse, no matter what your will says. That percentage varies from state to state, but is generally between 1/3 and 1/2, and some states pro rate the percentage depending on how long you’ve been married. A pre-nuptial or post-nuptial agreement can override this statute, as can a properly worded contract to make a will.

When is a Person Too Incapacitated to Sign a Will, Trust, or Power of Attorney?

As an elder law attorney I am frequently faced with adult children who realize that they simply have to take over for an aging parent. Maybe the parent is falling behind on bills or has trouble dealing with the medical establishment. It is always hard for a “child” to become the caretaker of the once-powerful and dominant parent.

Unfortunately, the parent may be reluctant to sign a power of attorney empowering the child to make legal decisions for the parent, since that act is frequently seen as an admission that the parent may actually need such help. Combine that with the child’s reluctance to bring up the subject for fear that it may anger the parent, and you have a recipe for procrastination. Hence the all-too-common situation where the attorney has to decide if a parent (or spouse) is too incapacitated legally to sign a will, trust, or power of attorney.

Let’s start with wills. Many people are surprised to find out that a person with Alzheimer’s or under a guardianship may still be legally competent to sign a will. That’s because under the laws of most states, a person is legally competent to sign a will if at the time of the signing he or she meets the following tests:

• knows the natural objects of his bounty (i.e., is aware of his spouse and children, if any)
• comprehends the kind and character of his property (i.e., knows approximately his net worth and what kind of assets he owns)
• understands the nature and effect of his act (i.e., realizes that it is indeed a will he is signing, and what that means)
• is able to make a disposition of his property according to a plan formed in his mind

Thus, the lawyer must meet with the parent or spouse and try to discern the above. In some cases, the lawyer may decide that the individual is too incapacitated and thus the lawyer must refuse to prepare a will.

A slightly different test is involved for signing a power of attorney. Here, the individual must be capable of understanding and appreciating the extent and effect of the document, just as if he or she were signing a contract. Thus, the parent may be competent to sign a power of attorney, but not competent to sign a will.

A trust is sometimes deemed to be more like a contract than a will, so that the necessary mental capacity needed to sign a trust may be less than that needed to sign a will. Recognizing that in today’s world living trusts are most often utilized as “will substitutes,” some recent state statutes have made the test for a trust the same as that set forth above for a will.

The mental capacity to sign the document should not be confused with the physical ability to sign one’s name. The law will permit a person to sign an “X” (known as a “mark”), that, so long as properly witnessed, will suffice just the same as a signature. In addition, if even a mark is not possible for the individual to make, then the individual can direct someone else to sign on his or her behalf.

Of course, the best advice is not to wait until it may be too late, but to have those conversations with family members while they are still competent and able to comprehend exactly what they’re signing and why.

My Spouse Has to Go into a Nursing Home…How Much Can I Keep?

Most people know that in order to qualify for Medicaid coverage of a long-term stay in a nursing home, the nursing home resident cannot own more than $2,000 in cash or other “countable” assets. But if you’re married, and one spouse is going into a nursing home and the other is remaining “in the community” (i.e., continuing to reside at home), how much can the so-called “Community Spouse” retain? That amount is determined by a combination of both federal and state Medicaid laws. (Note that for these purposes it doesn’t matter whether assets are titled in the sole name of the nursing home spouse, the Community Spouse, or jointly in both names.)

The basic rule is that the Community Spouse can retain 50% of all of the countable assets of both spouses, based on what they own when the other spouse first enters the nursing home for a continuous period of at least 30 days.

However, the most lenient states permit the Community Spouse to retain the first $104,400 of the couple’s combined assets (this figure changes annually, to keep up with inflation); if their assets exceed twice this amount (i.e., $208,800), then the Community Spouse can only protect 50%. So if the couple’s total assets are, say $150,000, since $104,400 is greater than 50% of $150,000, the Community Spouse can protect $104,400.

Most of the other states only permit the Community Spouse to protect one-half of the total amount of the couple’s assets, with a ceiling of $104,400 and a floor of $20,880. So if the couple’s total assets are under $20,880, the Community Spouse can retain it all; if their total assets are between $20,880 and twice that amount (i.e., $41,760), the Community Spouse retains $20,880; if between $41,760 and $208,800, the Community Spouse retains half; and if over $208,800, the Community Spouse retains $104,400. All clear now??? No? Well, some examples may help….

Examples:

1. Assume a couple has total assets of $30,000. Half of that is $15,000, which is less than the “floor” amount, so the Community Spouse can protect $20,880; the balance must be “spent down” before the nursing home spouse can qualify for Medicaid.

2. If the couple’s assets total $100,000, then the Community Spouse can protect the full 50% amount: $50,000.

3. If the couple’s assets total $300,000, the Community Spouse’s protected amount is limited to $104,400.In each of the above cases, once the Community Spouse’s share is set aside, the nursing home spouse can keep $2,000, and the balance must be eliminated somehow before the nursing home spouse can qualify for Medicaid.

So what do you do with the “excess” assets over the limits discussed above? The Medicaid folks will tell you that you must “spend down” the excess assets, and if it’s a small amount, that’s certainly the simplest way to qualify.

Another alternative is for the couple to simply give away the excess, but that will cause a period of disqualification from Medicaid eligibility for the nursing home spouse.

The couple could convert some or all of the excess from “countable” to “non-countable,” e.g., buying a new car, improving the house, purchasing a Medicaid annuity, etc.

Finally, many of these options are quite technical and require the skills and advice of an experienced elder law attorney. Unless you’re an attorney “in the trenches” on a daily basis, it’s easy to miss a recent state Regulation or Agency Letter and make a mistake that will wind up costing you $1,000s!

 To read more examples and get into more of the details just touched upon above, and to find out if you live in a “50%” or “100%” state, be sure to pick up a copy of the 2008 Revised Edition of my book, “How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets“ (available here: www.MedicaidSecrets.com).

I Don’t Have a Will - Do I Really Need One?

A common question estate planning and elder law attorneys often get asked is “Do I really need a will?” (The next question is always, “How much does it cost?” but we’ll discuss that another day!)

Most people would assume that an estate planning attorney would always answer “Yes, of course,” but such is not the case. Many people simply have no need for a will. But let’s take a look at why you may indeed want to have a will.

First, only in a will can you name the person(s) whom you would prefer to handle your estate after your death. Such person is called the “Executor” in some states, the “Personal Representative” in others. In any case, this person is the one who files the original will in court (usually with the help of an attorney), gathers and protects all your assets, pays all your debts, files the estate tax return (if necessary), and distributes your property in accordance with your directions as set forth in the will.

With no will, someone still has to go to court to get the legal authority to deal with your property and do the same tasks as the Executor, but this time it is up to the probate court judge who that person is. Since you left no indication whom you wanted, a battle could ensue. A will solves that problem, since it is rare that the court will not appoint the person(s) you named as Executor in your will.

The second big reason to have a will is if you wish to distribute your property in a way that differs from the default rules of your state. Every state has a statutory will, essentially, for those who did not write their own will. This scheme of distribution is called “intestacy” (”testate” means will, so “intestate” means with no will). For example, most state intestacy laws say that upon your death all of your money, assets, and real estate pass to your surviving spouse, if any, then in equal shares to your children, outright.

So a good reason to have a will would be any of these reasons:

• You don’t want to leave everything to your spouse.
• You want to leave more to one child than another.
• You have minor children and want to hold back their access to your money until they are at least age 25 or 30.
• You’d like to leave $10,000 to your alma mater or your church or temple.
• You want to “cut out” one of your children.
• You’d like to leave money to a family member in a way that is protected against lawsuits, creditors, and divorcing spouses.
• You’d like to leave a small sum to each of your grandchildren or a daughter-in-law.
• Your parents are living, you have no spouse or children, and you want your assets to go to your siblings and not your parents.

So who does not need a will, then?

• Your estate is relatively small and you’re happy with how your estate would be divided and distributed under your state’s intestacy laws.
• You’ve completely avoided probate by using “P.O.D.,” “T.O.D.,” joint ownership with right of survivorship, a trust, or beneficiary designations on all your assets.
• You’re content having all your assets be immediately distributed to your heirs, regardless of their age or ability to handle money.
• You’re not overly concerned with who will handle the affairs of your estate after your death.

Finally, before you consider the cost of a will, consider the real cost if your wishes were not carried out because you needed a will but did not have one. Sometimes even the simplest will is better than no will at all!

Doesn’t Medicaid Exempt $12,000 per Year Gifts?

Many people are aware that there is some exemption for gifts, but the details are a little hazy. Usually it goes something like this, “I thought there was a $10,000 per person exemption for gifts, so there would not be a Medicaid penalty. No?”

First of all, the client is confusing a gift tax exclusion with a Medicaid gift exclusion.

Under federal gift tax rules, a “taxable” gift is made whenever one person makes gifts to another person of money or equivalent that exceed a total of (currently) $12,000 per year. (For many years this figure was pegged at $10,000, hence the confusion; now the exemption increases every few years to reflect inflation.) So making two gifts of $7,000 to the same person within the same calendar year will push you over the limit. But making one gift of $7,000 on December 31 and another the next day on January 1 does not push you over the limit, since the second gift is in the next calendar year. The “clock” is reset to zero every January 1, so to speak.

So what difference does it make if the gift is a “taxable” gift? It only matters if a person’s lifetime taxable gifts will eventually exceed $1,000,000! And no client who is even thinking about applying for Medicaid is going to have that kind of dough. So as a practical matter it only means that there is an obligation to file a federal gift tax return if your gifts to one person in a calendar year exceed $12,000.

If you are married and one spouse makes a gift of, say, $20,000, to one person, by filing the federal gift tax return the couple can consent to “split” the gift. That way, each spouse is treated as having made a $10,000 gift, so neither will have made a taxable gift. Note that a federal gift tax return must be filed in order to split the gift; the fact of marriage alone will not affect the result.

Finally, note that only Connecticut, Louisiana, North Carolina, and Tennessee still impose their own separate state gift taxes. The rest of the states have no state gift tax, so if you live outside those four states and you’re under the federal limit, you’re all set.

What about Medicaid? Unfortunately, the general rule is that there is no exemption of any kind for a gift when figuring Medicaid penalties. If you give away $50,000 to one person or $10,000 to five people, it’s all the same. The Medicaid folks simply tally up the total amount of gifts made within the last five years and divide by the average cost of a nursing home in your state to come up with the number of months of Medicaid ineligibility, starting on the day you apply.

Indeed there are exceptions for gifts to a spouse, or to a trust for a blind or disabled child, or of a gift of your home to certain people, etc. But for run-of-the-mill cash gifts to family members, be aware that any gifts you made within the five-year period prior to applying for Medicaid may well come back to haunt you, causing a period of Medicaid ineligibility.

How To Choose A Good Nursing Home

With nursing homes costing anywhere from $3,500 to $10,000 per month (depending on your state), and with the average stay about 2 1/2 years, the total cost of a typical stay in a nursing home can be between $100,000 and $300,000. However, family members should not focus only on the cost but also on the care of their parent or spouse. How do you go about finding a good nursing home, one which will properly care for the emotional as well as physical and medical needs of your family member?

A good place to start would be the Consumer Reports Nursing Home Guide (you can find this online). This in-depth site is completely independent of the nursing home industry and can be relied on for giving you objective information. Here you can learn not only what to look for in evaluating nursing homes, but also review a state-by-state “Quality Monitor” that lists recommended homes and those to avoid. These lists are far from complete, but the general information on the site is very helpful.

Medicare itself has published a four-page checklist on its excellent website www.Medicare.gov that you would take with you when visiting a nursing home. One of the most important items on the list is whether or not the facility is “Medicaid-certified.” Most people don’t realize that many nursing homes do not accept Medicaid; if you think you may be applying for Medicaid at some point, then you probably should start out placing your family member in a Medicaid-certified facility, so that once your private pay money stops you won’t have to move your family member, which can be very traumatic.

Another great resource is the Nursing Home Inspector at www.CarePathways.com, where for a small fee you can search their database of over 44,000 nursing homes and obtain detailed information about the performance and characteristics of every Medicare/Medicaid certified nursing home in the US.

Finally, you should check out the free reports available at www.MyZiva.net. MyZiva.Net claims to be a free, objective and easy-to-use nursing home resource for prospective residents, caregivers and healthcare professionals that can help you find and compare nursing homes. You simply enter the zip code of the area you are considering, and a comprehensive chart pops up from which you can link to reports on the facility’s main focus, survey results, quality measures, and staffing. You can also check several facilities you are interested in and obtain a side-by-side comparison.

In all cases, you will have to follow-up any online research with phone calls to the facility and finally an in-person visit. Try to get a tour that takes you “behind the scenes.” Does the staff look harried? Are the hallways cluttered? What about the food? You might consider having a meal there, yourself, with the residents. Bring your checklist and don’t be shy about asking tough questions.

Moving a loved one to a nursing home can be an emotionally draining experience not just for the one having to move there, but for the entire family. A spouse of 65 years, separated for the first time; a parent who’s always been there for you, that you now must take care of; the solid father and grandfather who now looks shriveled and worn–all these can exact an emotional toll on the family. Accordingly, you want to do your best job in locating a facility that you can feel confident about, and that will be a comfort and aid to your spouse or parent during the remaining years of their life. Hopefully the resources discussed above will assist you with that task.

A recent additional resource, The Baby Boomer’s Guide to Nursing Home Care, explains the many laws protecting nursing home residents and provides advice on obtaining the best nursing home care possible. It is intended for use by residents and their family members and friends, but also is a worthwhile reference for nursing home operators, attorneys, social workers, and others with a personal or professional interest in nursing home care.

For a different point of view on nursing home placement, see There’s No Place Like (a Nursing) Home: 4 Powerful Steps That Will Change Your Life.

Selecting a nursing home for a loved family member can be a very difficult decision. However, once you are armed with the information from the above resources you should find this burden to be much less onerous. In any event, good luck!