Question: My wife was diagnosed with Alzheimer’s Disease three years ago and, while her deterioration was rather slow for a period of time, it suddenly has become very rapid. Because we always promised each other that neither of us would allow the other to be placed in a nursing home, I am wearing down and am unable to care for her at home any longer. My wife needs assistance with every activity from dressing to eating. Since we have no family to help me, I started sending her to adult day care, but her condition has worsened to the point that they will not take her any more. We have limited assets and funds. Her doctor tells me that she is near the late state of the disease. I don’t know where to turn for help.

Answer: Like hundreds of thousands of others in your situation, there are no easy or encouraging answers to your dilemma. Since there is no national nursing home insurance program similar to Medicare (which only covers short-term treatment stays in a nursing facility), most folks pay privately for long-term care until they become eligible for Medicaid. Because Medicaid is a needs-based welfare program, to be eligible, you and your spouse must become “impoverished” based upon the program guidelines which vary from state to state within rules imposed by federal law.

Assuming your wife will qualify medically – and it appears she will, and assuming you qualify financially for Medicaid, you may want to look at waiver programs in your state which can provide in-home assistance. If that is not an option, then a nursing home placement is your only other choice.

But because nursing homes can discriminate in the admissions process (that is, unless your wife is hospitalized for at least three overnights and sent to a facility for rehabilitation under Medicare, which is unlikely), your wife will have to begin her stay as a private pay resident. The nursing home will review your income and assets to determine whether your wife will be accepted. This is a difficult and confusing time; however, assuming she is admitted, at upwards of $4,000 per month, without proper planning, your assets can be wiped out very quickly. By “proper planning,” we mean planning for a way to assure that your wife receives appropriate care and to assure that you are protected from impoverishment.

Basic Medicaid eligibility rules do not allow an applicant -- whether single or married – to have more than $2,000 in "countable" assets. “Countable" assets generally include all belongings except for (1) clothing, furniture, and jewelry; (2) an automobile; (3) the applicant's principal residence; and (4) other assets that are considered to be unavailable for acceptable reasons.

Because transfers between spouses do not result in disqualification, if your wife signed a durable power of attorney with appropriate gifting provisions, it is a good idea to transfer all assets out of her name into yours, including any interest she may have in the residence.

Taking the NextStep: If planning has not been accomplished before a diagnosis of Alzheimer’s, once diagnosed, it is imperative that both spouses sign durable powers of attorney with gifting provisions, durable health care powers of attorney, and wills. The will of the spouse who has not been diagnosed should contain a special needs trust in order to assure the best care possible. Decisions about how to pay for nursing home care are both difficult and frightening. As always, we suggest that you contact an elder law attorney to assist you in the planning process as early as possible.