My favorite part of being a Financial Concierge is forming lasting relationships with my clients. Part of the skill set for helping people over so many years is being able to adapt to their changing needs. Recently I had the opportunity to help someone apply for Medicaid.

When I first met this woman she owned a condominium; had a good pension; and enjoyed a cash stream from an IRA in addition to her Social Security benefits. She also had a lot of money put away and had been paying for a long-term care insurance policy.

Gradually she realized she was having memory problems, and was eventually diagnosed with early onset Alzheimer’s disease.

So we built a team for her consisting of her attorney, a care manager, a dear friend of hers, and myself. She has no children and no family. As her disease progressed, her need for care grew. In an effort to keep her home as long as possible, we hired a 24/7 caregiver. When the money ran out, my client was forced to sell her condo and move into an assisted living facility. There she still had the comforts of home, with her own furniture and decorations.

Alzheimer’s continued its course within my client until she could no longer be cared for at the assisted living facility because her needs were so many. So it became our task to move her into a nursing home. By this point most of her assets had been exhausted and her long-term care benefits had ended. She was facing the prospect of being unable to pay for a bed in a nursing home, and she had nowhere else to go.

That’s when the team began to prepare an application for Medicaid. Medicaid will pay for nursing home care when an individual can no longer afford to pay for her own care — and the financial requirements are stringent, allowing each person to have only $1,600 or less in assets. Getting to that $1,600 is called the Medicaid spend-down.

Case Study: The Medicaid Spend-Down By Judy HeftWith enough money for only a few weeks’ worth of care, the team found my client a good nursing home facility. We knew that by getting into a good facility as a self-paying patient, my client would be able to stay in that facility even after her assets were completely wound down and she became a Medicaid beneficiary. That’s because some private facilities have “Medicaid beds” — but usually you have to already be a self-paying resident before becoming a Medicaid enrollee.

Although my client will end up on Medicaid, her pension and savings enabled her to live as high a quality of life as possible for many years before they were exhausted. Even more important, being able to self-pay got her foot in the door at a well run, private facility. I think the moral of the story is not to get discouraged by how expensive long-term care is, but to realize that every penny you save for it will help you — even if it’s just to get your foot in the door.