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6 Long-Term Care Planning Scenarios

By Harry S. Margolis

The major challenge in doing advance long-term care planning is that we don’t know the future. When we meet with an older couple who is concerned about long-term care costs, any of the following scenarios could play out during their lives:

  1. Neither spouse ever needs long-term care.
  2. One spouse needs care while the other is healthy.
  3. One spouse passes away and subsequently the surviving spouse needs long-term care.
  4. While one spouse is getting care the “healthy” spouse passes away.
  5. One spouse gets care, passes away, and subsequently the surviving spouse assistance.
  6. Both spouses need care at the same time.

These scenarios only scratch the surface, since the planning steps one would take may be different depending on whether it’s the wife or the husband who needs care, since one may have more or less of the couple’s income or may own a large retirement account that can’t be easily moved to the other spouse. And when we talk about long-term care, it may be at home, in assisted living or in a nursing home, or all three in succession.Timing can also be an issue, since MassHealth planning often involves transferring assets which can cause five years of ineligibility for benefits.

The planning steps that would be optimal for one situation may be inadvisable for another, or at least not the best plan. So, the goal of long-term care planning is to put the clients in the best position for a number of different outcomes without putting them in a worse position for any of them, if possible. At the same time, the plan must be consistent both with their estate planning goals and their plans for their lives while their healthy. It makes no sense to transfer all of a couple’s assets into an irrevocable trust, for instance, if it would make it difficult for them to make ends meet or take vacations they enjoy.

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