Question: My father has been failing mentally for a year or so, but much more lately. He and my mother are in their mid-70’s. Other than his memory problems, he is in good health and so is she. In order to preserve resources, someone suggested that he sign over to her all of his assets, but then we read that if he did, there would be problems with the Medicaid "look-back" if he goes into a nursing home during the next three years. But Dad does not think he has memory problems and believes that Mom can continue to care for him. We read your column religiously and would appreciate you telling us the best thing to do.

Answer: Avoiding the "disinformation" glut is one of the biggest challenges facing elderly persons and their families who are trying to develop a plan for long-term care. And often, families must face the question of the elder's needs versus his desires. No one wants to be in a nursing home, but some folks need to be in a nursing home. The elderly person’s perception of his or her health, and the ability of the family to care for him or her, may be very different from the true facts.

For these reasons alone, we believe it is essential that the family first identify the team of professionals who will be able to assist them in this process. In our view, the most important cog in this wheel is an experienced elder law attorney who can help the family correctly identify and assess, and then appropriately address, the issues as early in the planning process as possible.

That said, a word about transfers of assets: Based on current law, there are several types of transfers by potential Medicaid applicants that can be made without incurring a period of ineligibility, the first of which is transfers between a husband and wife. This means that one spouse can transfer to the other any transferable asset without incurring a penalty. Therefore, as part of a long-term care plan, your father can transfer to your mother all of his interest in their bank accounts, real estate, automobiles, and the like. Assets that cannot be transferred between spouses – or for that matter, to anyone else – include IRA’s, 401k’s, and other accounts that contain pension funds.

Other transfers by a potential Medicaid applicant that will not result in a period of ineligibility include the transfer of a principal residence to (i) a minor or disabled child, (ii) a child of the applicant who has resided in the principal residence for at least two years before the applicant is admitted to a nursing home, and who provided care to the applicant that helped the applicant stay at home, or (iii) a sibling of the applicant if the sibling has an ownership interest in the house and has been residing there for at least one year prior to the applicant's admission to the nursing home.

There are also transfers for full and adequate consideration that don’t result in a period of ineligibility. For example, if your father sells you his automobile for fair market value, the sale will not result in a disqualification.

And finally, transfers made solely for a reason other than to qualify for Medicaid will not result in a period of ineligibility so long as strict proof is presented. (This exception to the transfer-of-assets rules is often very difficult to establish, since Medicaid generally presumes that transfers were part of a plan to qualify for benefits.)

Because long-term care planning may involve the elderly person giving up control of assets that he or she earned or inherited, we believe that no transfer should be made unless it is part of a comprehensive plan developed by knowledgeable professionals who are able to accurately assess the situation, understand the goals, and develop a plan that is best for the family.