With any life-changing event, it’s important to clarify that no one experience will be the same. Medical conditions, financial aspects, and family dynamics will be unique for each family that deals with a long-term care crisis. As I share my family’s ordeal after my parent’s horrific car accident, I do so simply in the hope that you, your parents, and those you love will come to understand that, however small the risk of a life-changing event may be, the emotional stress and financial repercussions for all individuals involved are unacceptable. To avoid this emotional and financial carnage, I hope you and your loved ones will see the need to take action now while reasonable and financially sound choices are still available to you. Learn from our mistake.

Please understand that sharing the story of how my parents miscalculated this risk is painful and agonizing. I could never have fathomed the nightmare we went through without seeing it, living it, and being consumed by it. Not only were we dealing with the emotional trauma of seeing a loved one bedridden, unable to breathe on her own, and requiring countless procedures, but also the emotional stress of trying to figure out the financial implications and how this would work in the future.

Multiple family members were at risk of huge financial implications. I risked losing the building that housed my business. Another family member was at risk of losing the property she had called home for over thirty years. Sharing Mom’s story could be misinterpreted as airing the family’s dirty laundry of financial planning failure, but the true purpose is to share what we learned the hard way and while under extreme duress.

As the months progressed after the accident, we began to realize that Mom’s recovery process would be slow and could take years. She had been confined to a bed for months; the daily goal of physical therapy was often simply to have her sit up on the side of the bed. Our greatest hope was that she could get off the ventilator and breathe on her own, but we knew the longer she was on the ventilator, the less likely she could breathe without assistance.

The business side of the medical industry was also becoming clearer. A common statement we heard from hospital administrators was “discharge is always a part of the initial conversation, so a plan can be put into place for what comes next”. On multiple occasions, hospital administrators reminded us that a hospital is not a long-term care facility, but where does one go to receive specialized care outside a hospital? The level of care Mom needed required a 24/7 respiratory technician, ongoing monitoring, and regular review by a physician. The only option is skilled nursing facilities, and the stepdown in care from a hospital to a nursing home is shockingly drastic.

Failing to recognize the business side of the medical industry is naïve. While I don’t advocate for a socialized healthcare system, I have seen the negative side of our medical system for the individuals who are really injured or really sick. Options are limited for those who, like my mom, require a high level of care. Unfortunately, the only solution is financial capital. A family must first spend all their financial capital to cover the expenses. When available financial resources are exhausted, an application for Medicaid can be made; however, this comes with the potential loss of options for where and how this care is provided. The shocking, yet true, fact is that money talks in the medical industry. Expenses are either paid by insurance, out of pocket, or Medicaid when the family exhausts their funds and become destitute.

Mom was covered through Medicare and a medical supplement policy. Although I do not have any expertise on medical supplement insurance, I was told throughout the process that Mom had one of the best plans you could purchase in the state of Ohio. However, as we approached four or five months after the accident, we were often reminded of both the maximum hospitalization days and the lifetime reserve days remaining. In the state of Ohio, Medicare covers up to 90 days for in-patient hospitalization with an additional 60 days lifetime reserve for a total of 150 days. Medicare does not cover 100% of the hospitalization cost, even during this 150-day allotment, but medial supplement or gap insurance kicks in to cover the patient’s co-pay (at various levels depending on coverage).

In our experience, the stepdown in care from a hospital setting to a skilled nursing facility was a wide gap. In addition, the level of care offered by skilled nursing facilities varied from one facility to another. While one member of the family would stay with Mom during the day at the hospital, another family member would visit facilities to assess the level of care provided. We were often greeted by members of the admission department with a disclaimer that we needed to be “accepted” to the facility and a list of financial documents required in order to be consider for admission.

Medicare does not pay for long-term care, but will pay up to 100 days of skilled nursing care when admittance is within 30 days from a hospitalization of three days or more, when rehabilitation has been prescribed, and the patient is improving through rehab. Most individuals only use 30-45 days of this rehabilitation coverage through Medicare as they either fully recover and can return to their home, or plateau in their rehab progress such that improvement through rehabilitation can no longer be demonstrated.

As the skilled nursing facilities assessed Mom’s condition, they looked closely at my parent’s financials to assess our ability to pay for care once Medicare stopped. We learned this fact several months before Mom was released from the hospital, and quickly concluded this was way above our ability to navigate the system. Since my parents never secured a long-term care policy to pay for this care, we opted to hire experts to help us review our options.

Taking all of my parent’s finances into account, they were considered land poor. They owned two properties apart from their residence, one that housed my business and a second property where a family member resided. Apart from these properties, the remaining capital was needed to cover living expenses for the remainder of my father’s life.

Again, every individual circumstance is unique; available capital and capital needed to fund long-term care is unique. Replace my parent’s land ownership with a family farm, family business, or asset promised to the next generation.

Whatever the specifics may be for you and your family, know that a long-term care event will require tough decisions made under duress, and the decisions you make today were ones that should have been made yesterday.

From the moment the car accident occurred, a time clock started for my family. We didn’t realize it until weeks and months later, but we were in a race to protect what we could of my parent’s finances while also putting together a plan to provide care for Mom.

Replace car accident with a cognitive diagnosis like Alzheimer’s, a fall down a flight of stairs, or a major medical event that forever changes the course of life for the one who needs care. Think of the impact for family members who now find themselves thrust into crisis.

Believe me when I say the impact is multi-generational.

My kids suffered through missed opportunities, emotional turmoil, and disruption of the family schedule. My siblings and I had two choices. The first choice was to stand by our parents, make them both a top priority, and go all in. The second choice was to walk away. We made the first choice and went all in. Please know that if you should ever become the one who needs care and your loved ones go all in, they will suffer as will those they love.

Working with experts in the field of planning for long-term care cost, we decided our best option was to position our parent’s assets so that Mom could qualify for Medicaid. This decision required the family to make several hard decisions with respects to land ownership, as we couldn’t simply transfer ownership to someone else. A reasonable sale and exchange of goods was required for the asset to no longer be included by Medicaid. Since my father recovered from the accident and returned to his home, their residence was protected from becoming a countable asset. I decided to purchase the land where my business was housed. The property another family member called home would be included as a countable asset, so my father took out a mortgage to drive down the equity in that property. Cash value in life insurance policies was also a countable asset, so we had to surrender those insurance policies. Only one car is allowed to be excluded as a countable asset, so we sold vehicles my parents owned and kept a classic car as the one vehicle that could be excluded. Even burial plots my parents purchased decades ago were considered countable assets, so they were sold at current fair market price in order to be excluded. I wish I could convey to you the time, effort, and distress that each of these decisions required.

All the capital generated, including investments and savings in our parent’s bank accounts, was used to purchase a Medicaid single premium immediate annuity. This tied up my parent’s assets for a two-year period while the annuity slowly repaid principal to my father, but allowed both the funds used to purchase the annuity and payments received from the annuity to be excluded.

As you can imagine, the process was tedious and involved collection of financial statements and records for the seven years preceding the car accident, securing of titles to land and vehicles my parents owned, and securing other documentation needed for the Medicaid application.

Looking back on what my family endured, I’m certain this account does not fully express the impact my parent’s car accident had upon the entire family. Advance long-term care planning will never take away the tears, pain, and suffering of witnessing someone you love in need of care, but so much of the financial hardship, sleepless nights, and agonizing decisions could have been avoided by advance long-term care planning. If you are the one who needs care, know that your loved ones who make the choice to be all in will hurt and suffer with you.

Advanced long-term care planning can limit the emotional stress, concern, and worry of navigating the financial aspects. If you don’t have a plan to fund a long-term care event, those you love will be forced to design a plan that will always be flawed, difficult, and less than ideal.

While no single solution will ever cover the multitude of possibilities, please recognize the potential carnage your family could experience if you don’t have a plan in place. Once you recognize how severe this impact will be upon the ones who love you, even a small possibility of risk becomes unacceptable. Advanced long-term care planning is not just for you, it is also for those who love you and would make the choice to be all in for you.