“I have lived my life caring for my family. I am now the sole caregiver for my husband of 40 years. I have been by his side almost 24 hours per day for the last year. We are blue-collar people. We have too much money to qualify for Medicaid and not enough money to pay out of pocket for assisted living facilities. We make ends meet. That’s about it.
His care needs are now more than I can physically and mentally handle. I am forced to place him in a care facility that will end up leaving me with $17 free money/month after paying for his care and my house expenses. I would have to retain an attorney to apply for medical financial assistance. I don’t think that $17 will get me very far with legal assistance.
I’m fearful of losing my home.
My husband’s mind is totally gone; he is barely able to walk with a walker. He doesn’t know who I am a lot of the time; he’s incontinent; he can’t communicate; his eyesight and hearing are impaired; he sits in a recliner day after day after day doing absolutely nothing. I now see how easily one can become homeless through no fault of their own. We must do everything possible to make sure our loved ones are safe, comfortable, and pain-free. I get that, but at the cost of some innocent victim known as a wife, who has given up everything for him short of her own life, why isn’t there some help for us? My life ended a year ago. It was a very nice life. I was happy, active, welcoming new great-grandchildren into the world, but now I can’t even go see them because I have to be here. Yes, I hired caregivers who come a couple of times a week. That’s a big expense.
Why do I have to lose everything and give up hope, knowing this could be the way things are going to be for months, years, …..
All I have ever done is put everyone first, and this is the result? Living this way sucks 😢”
The Reality: This Happens Every Day
This heartbreaking post, shared anonymously in a hospice and end-of-life Facebook group in mid-November 2025, reflects a devastating reality faced by countless families across America. This wife’s story isn’t rare or unusual—it represents what happens to families every single day when protective legal and financial measures aren’t established years before they’re needed.
Memory care facilities cost an average of $6,450 to $8,500 per month in 2025, depending on location and services. For many middle-class families like this one, they earn too much to qualify immediately for Medicaid but don’t have enough savings to pay privately for years of care. The healthy spouse—the community spouse—faces what experts call “spousal impoverishment,” left with minimal income while watching decades of savings disappear month after month.
These families experience overwhelming emotions: fear of losing their homes, anger at a system that seems to punish those who worked hard and saved money, helplessness watching a loved one’s mind deteriorate, and guilt about feeling resentful. Yet they did nothing wrong. They simply didn’t know that protections existed, or they didn’t understand that these safeguards must be put in place years—not months—before they’re needed.
What Could Have Been Different
Imagine if this family’s story had unfolded differently. With a Medicaid Asset Protection Trust established five or more years ago, this wife could have protected their home and a significant portion of their assets while her husband still qualified for Medicaid-funded memory care. She wouldn’t be facing $17 per month to live on. She could visit her great-grandchildren. She would have financial security instead of the terror of homelessness.
With the guidance of a life transition coach years earlier, they would have created comprehensive advance directives, established healthcare powers of attorney, and had honest conversations about their wishes for the future. When the diagnosis came, the family would already have had a roadmap in place, rather than scrambling to make impossible decisions during a crisis.
This alternative outcome wasn’t a fantasy. It was entirely achievable through advance planning with the right professionals. But the window of opportunity closes quickly, and for this family, that window had already passed.
Understanding Medicaid’s Five-Year Lookback Period
When you apply for Medicaid to help pay for long-term care, the state reviews all financial transactions from the past five years. This is called the “lookback period,” and understanding it is absolutely critical for protecting your family.
The lookback period exists to prevent people from giving away assets or transferring property right before applying for Medicaid benefits. If the state discovers you transferred assets during those five years—whether to children, other family members, or into certain types of trusts—you become ineligible for Medicaid for a calculated penalty period.
Here’s how this affects real families: If you transfer $100,000 to your children three years before applying for Medicaid, the state calculates how many months of care that money could have paid for. In many states, that might translate to 15-20 months of ineligibility—months when you need care but can’t get Medicaid to pay, and you’ve already given away the money that could have paid for it.
The critical timing means protection must be in place at least five years before needing Medicaid. Most people don’t plan five years ahead for a health crisis they hope will never come. That’s exactly why this planning must happen sooner rather than later.
Important note: State rules vary. While most states use a five-year lookback, California currently uses a 30-month period (though this is being phased to align with federal requirements), and New York has specific differences in how penalties are calculated. Always consult with an elder law attorney in your state to understand the specific rules that apply to you.
Medicaid Asset Protection Trusts Explained
What Is a Medicaid Asset Protection Trust?
A Medicaid Asset Protection Trust (MAPT) is a legal arrangement where you transfer ownership of assets to a trust, protecting them from being counted when you apply for Medicaid. Think of it as moving your assets into a protected safe that Medicaid can’t touch, while still allowing you to benefit from them in specific ways.
Once created, a MAPT is irrevocable, meaning you cannot change or cancel the trust. This permanence feels scary to many people, but it’s precisely what makes the trust work—because you no longer legally own the assets, Medicaid doesn’t count them when determining your eligibility.
How MAPTs Protect Your Family
The trust involves three key parties:
Grantor: You, the person creating the trust and transferring assets into it
Trustee: Someone else you choose who manages the trust (often an adult child or professional trustee)
Beneficiary: The person who inherits the assets after your death (often your children)
Assets that can go into a MAPT include your home, other real estate, savings accounts, investments, and certain other property. Importantly, even though you no longer legally own your home after transferring it to the trust, you can still live in it for the rest of your life. If the home generates rental income or your investments produce returns, you can receive that income.
The trust also provides estate recovery protection. In many states, Medicaid can place a claim on your estate after death to recover the costs of care provided. Assets in a properly structured MAPT are protected from these recovery efforts, preserving your legacy for your children and grandchildren.
The Cost of Protection vs. the Cost of Not Planning
Establishing a MAPT typically costs $2,000 to $12,000, depending on your location, the complexity of your estate, and the attorney you work with. This might seem expensive, but consider the alternative:
Memory care costs $6,450 to $8,500 per month on average. Over just two years, that’s $154,800 to $204,000 in care expenses. If one spouse needs care for five years—not uncommon with dementia—the total reaches $387,000 to $510,000. For most middle-class families, this completely depletes everything they’ve worked for, leaving the healthy spouse impoverished.
The $2,000-$12,000 investment in a MAPT protects potentially hundreds of thousands of dollars in assets and ensures the community spouse can maintain their quality of life.
The Role of Life Transition Coaches
What Life Transition Coaches Do
Life transition coaches are healthcare professionals—often registered nurses, social workers, or certified end-of-life doulas—who guide families through major health transitions. Unlike your doctor or nurse, who provides medical care, life transition coaches coordinate and support the bigger picture of your healthcare journey.
They help with creating advance directives (documents explaining your healthcare wishes), living wills, healthcare powers of attorney, and medical decision-making. They facilitate difficult family conversations about preferences and values. They help you think through questions like: What does quality of life mean to you? Under what circumstances would you want life-sustaining treatment? Who do you trust to make decisions if you cannot?
How They Help Before Crisis Strikes
The relationship aspect is crucial. When you establish a connection with a life transition coach while you’re healthy, they learn about your values, fears, hopes, and family dynamics. Then, when a health crisis occurs, you already have a trusted guide who understands your situation and can immediately provide support.
Life transition coaches bridge the gap between medical providers and legal professionals. They often work collaboratively with hospice teams, palliative care providers, and elder law attorneys to ensure comprehensive planning.
Creating Living Wills and Power of Attorney Documents
A living will specifies what medical treatments you would or wouldn’t want if you became unable to communicate your wishes—things like resuscitation, breathing machines, feeding tubes, and other life-sustaining measures. A healthcare power of attorney (also called a healthcare proxy) names someone you trust to make medical decisions for you if you’re incapacitated.
Life transition coaches guide you through completing these documents thoughtfully, not just checking boxes. They help you understand the medical scenarios you’re planning for, facilitate conversations with family members who might be affected, and ensure your documents reflect your true wishes.
Why You Need Both: Elder Law Attorneys and Life Transition Coaches
These two professionals serve complementary but distinct roles:
Life transition coaches focus on personal wishes, healthcare decisions, care coordination, and emotional support. They help you clarify what matters most to you and document your healthcare preferences.
Elder law attorneys handle legal protections, asset protection, trusts, estate planning, and navigating complex Medicaid rules. They create the legal structures that protect your financial security.
Many life transition coaches maintain referral relationships with trusted elder law attorneys and can connect you with the right legal professional for your situation. This team approach provides comprehensive protection—both for your healthcare wishes and your financial security.
Who Needs This Protection (Everyone 18 and Older)
Young Adults: Why Starting Early Matters
If you’re between 18 and 40, you might think end-of-life planning is something for your grandparents, not you. But unexpected accidents and illnesses don’t follow age rules. Traumatic brain injuries from car accidents, unexpected cancers, and strokes (which are increasing among younger adults) can suddenly require long-term care.
At 18, every adult needs basic advance directives: a living will and a healthcare power of attorney. These ensure that if something happens, someone you’ve chosen can make medical decisions rather than leaving it to chance or family conflict.
Middle Age: The Critical Planning Window
Ages 40 to 65 represent the ideal planning window. You likely have accumulated assets worth protecting. Statistically, your immediate risk of needing long-term care is still relatively low, giving you time for the five-year lookback period to pass. You’re typically still healthy enough to make clear decisions and handle the planning process without the pressure of an immediate crisis.
This is when consulting with an elder law attorney about a Medicaid Asset Protection Trust makes the most sense. It’s also the perfect time to establish a relationship with a life transition coach and create comprehensive advance directives.
Older Adults: Act Now, Not Later
If you’re 65 or older, there’s genuine urgency. Every year that passes increases your risk of needing long-term care. More importantly, every year that passes is one less year toward completing the five-year lookback period.
If you’re 65 and establish a MAPT today, you’ll meet the lookback requirement at 70. If you wait until 70, you won’t be protected until 75. Those five years could make the difference between protecting your home and losing everything.
Long-Term Care Isn’t Just About Dementia
Automobile Accidents and Traumatic Brain Injuries
A serious car accident can result in a traumatic brain injury requiring years of specialized care. A 45-year-old involved in a severe collision might need long-term residential care for decades, slowly draining family assets year after year.
Strokes and Heart Attacks
Strokes can cause sudden disability requiring immediate and ongoing nursing care. Someone who survives a major stroke at 62 might need intensive support for 10, 15, or 20 years—far longer than most families can afford to pay privately.
Progressive Diseases Beyond Dementia
Multiple sclerosis, ALS (Lou Gehrig’s disease), and Parkinson’s disease are progressive conditions requiring increasing levels of care over many years. The wife in our opening story faces exactly this situation—her husband’s Parkinson’s combined with dementia has created care needs she can no longer manage alone.
The Hospice Paradox: When Six Months Becomes Years
Here’s something most people don’t understand: Someone can be eligible for hospice care (with a prognosis of six months or less) but actually live for years with ongoing recertifications.
Hospice patients with dementia have an average length of stay of 95-123 days, but many live much longer. Some patients are recertified multiple times because, while they continue to decline, they don’t decline fast enough to meet the six-month prognosis. During these extended hospice stays, families still face significant costs for housing, basic care, and medications not covered by hospice.
We cannot know when or how we might need long-term care—only that the risk increases with each passing year. Planning ahead protects us no matter what health challenge we face.
What Happens Without These Protections
Spousal Impoverishment
Federal spousal impoverishment rules were enacted in 1988 to prevent the exact situation faced by the wife in our opening story. However, these protections are limited. In 2025, the community spouse (the one still living at home) can typically keep between $74,310 and $154,140 in assets, depending on the state. Many states only allow the lower amount, half of the couple’s combined assets, up to the limit.
Any assets above that protected amount must be “spent down” on care before Medicaid will help. For couples who saved $300,000 over their lifetimes, the community spouse might keep only $74,310 while the remaining $225,690 pays for care. Once that’s gone and they qualify for Medicaid, the healthy spouse may be left with a monthly income as low as $2,000 to $3,000 to cover all housing, food, medical, and living expenses.
Loss of Family Homes
Without a MAPT, families often must sell their homes to pay for care. Generational properties that parents hoped to leave to children are liquidated to cover months or years of memory care costs. Even if the home is protected while the community spouse still lives there, after both spouses pass away, many states can pursue estate recovery to reclaim Medicaid costs, taking the home that was supposed to be the children’s inheritance.
Depleted Savings and Retirement Funds
The retirement savings that were supposed to provide security and comfort in later years vanish, spent on long-term care. There’s nothing left to pass to children and grandchildren. The financial legacy a couple worked decades to build disappears in just a few years of care costs.
Family Conflict and Caregiver Burnout
Without clear advance directives and planning, family members often disagree about care decisions, financial choices, and who should bear the caregiving burden. One sibling feels others aren’t helping enough. Family members argue about whether to pursue aggressive treatment or focus on comfort—disagreements about money—who should pay for what—create lasting rifts.
The primary caregiver, often a spouse or adult daughter, experiences severe burnout. They sacrifice their own health, relationships, careers, and well-being to provide care. Like the wife in our opening story, they become isolated, exhausted, and hopeless.
The original Facebook post perfectly captures what happens without these protections: “I now see how easily one can become homeless through no fault of their own”. This isn’t a rare tragedy. This is the predictable outcome when families don’t plan ahead with the right professionals.
Take Action Today: Your Next Steps
The family in that Facebook post couldn’t change their situation. But you can change yours. Here are the specific steps to take now:
1. Connect with a life transition coach to establish a relationship and begin advance care planning.
Life transition coaches help you think through your values and preferences while you’re healthy.
They guide you through creating advance directives that truly reflect your wishes.
This relationship provides support when health challenges arise.
2. Create or update your living will and healthcare power of attorney with your life transition coach’s guidance.
These documents ensure your healthcare wishes are known and followed.
They prevent family conflict during medical crises.
They should be reviewed annually if you’re healthy, quarterly if you have a chronic illness.
3. Request a referral to an elder law attorney from your life transition coach.
Life transition coaches often maintain networks of trusted elder law attorneys.
This referral ensures you work with someone experienced in Medicaid planning.
4. Schedule a consultation with an elder law attorney to review your assets and discuss whether a MAPT is appropriate for your situation.
The attorney will evaluate your specific financial situation.
They’ll explain how a MAPT would work for your circumstances.
They’ll help you understand the costs and benefits for your unique situation.
5. If recommended, establish your MAPT as soon as possible to start the five-year lookback clock.
The sooner you act, the sooner you’re protected.
Remember: waiting means the clock hasn’t started.
6. Review and update your plans regularly as your life circumstances change.
Life transitions, health changes, and family situations evolve.
Your planning should evolve, too.
These steps are acts of love and protection for your family. They’re not about pessimism or fear—they’re about responsibility and care. Planning ahead means your family won’t face impossible choices during a crisis.
It’s never too early to plan, but it can be too late. The best time to establish these protections was five years ago. The second-best time is today.
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At present, no official organization oversees end-of-life doulas (EOLDs). Remember that some EOLDs listed in directories may no longer be practicing, so it’s important to verify their current status.
End-of-Life Doula Schools
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Remember that there is currently no official accrediting body for end-of-life doula programs. It’s advisable to conduct discovery sessions with any doula school you’re considering—whether or not it’s listed here—to verify that it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school offered a solid foundation for launching your own death doula practice.
