Question: My wife and I have cared for her mother at home with us for nearly two years after she suffered a stroke. When we saw that we could not handle this part-time and could not get my wife’s siblings to help, my wife stopped working to stay at home with her full-time. This meant her losing the ability to retire early.

Of late, my mother in law was diagnosed with dementia, and we just can't do it any longer. We tried to find a facility that would admit her, but because she only has $1,500.00 to her name and $720 per month in Social Security, the nursing homes tell us that there is an 18 month wait for a "Medicaid bed", and that they can’t take her unless my wife and I guarantee to pay for her care at more than $5,500 monthly. We tried to discuss splitting the costs with her brother and sister, but they are not interested, and my wife and I simply can’t afford to assume this cost. We are at our wit's end.

Answer: Yours is a prime example how long-term care can impact the family inter-generationally: Your wife stops work to care for her aged mother which, in turn, reduces your current family income and her chance for retirement which, in turn, obliterates your family’s retirement planning, passing responsibility on to your children should you require this type of care.

Oftentimes, the most difficult questions faced by families who care for disabled persons are if and when that individual should be admitted to a nursing home or other type of care facility. In addition to the personal conflicts surrounding these questions, there are a variety of legal, medical, and financial issues that must be considered.

If your mother-in-law had the funds with which to pay privately for her stay in a facility, there would be no obstacle to her entering a nursing home, regardless of the state of her health; however, for her stay to be paid for by Medicaid, rigid medical and financial requirements must be satisfied.

Based upon her assets as you describe them, she will meet the financial criteria; however, while she may be difficult for you to handle, your mother-in-law might not meet the requisite medical criteria. For this reason, before moving down the planning path too far, we suggest that you and your wife make sure that institutionalization is the appropriate option by having your mother-in-law's functional capacity assessed by a qualified geriatric care manager. Once a clear picture of her care needs has been made, you will be better able to determine the required level of care -- which might not be in a nursing home. If this is the case, there may be other options for you to consider not covered here because of space limitations.

But assuming she does meet the required medical level of care, your next hurdle is gaining her admission to a Medicaid-certified facility. While the Nursing Home Reform Act of 1987 (NHRA) is credited with bringing about nursing home regulation reform, Congress did not go far enough when it comes to situations like yours. While strengthening individual rights and to improving the quality of life and standard of care for nursing home residents, the nursing home admission process in most states is far from organized or fair. Since there are no centralized application procedures, in order to find a bed, you must visit a number of facilities, complete an application at each, and be placed on a waiting list for a bed.

Taking the NextStep: Because of space limitations, we will cover admission procedures and guarantee issues next week.