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The recent outpouring of support for the victims of the earthquake in Haiti highlights a question often asked about gifting and charitable contributions as it relates to Medicaid.  For example, last week Mary called me to ask whether it is OK for Mom to make a charitable contribution to help

Jane called because she was flat out of money and desperate.  Dad had been in a nursing facility for almost 4 years now.  He had spent down his money and Jane had paid the $11,000 per month expense after that, until she was tapped out of her home equity line

Mary’s husband Joe, passed away several years ago but she continued to live in the home where they had raised their family.  Mary was now struggling with the effects of dementia.  But she wouldn’t hear of it when her children talked about moving her to a safer environment.  So they

I could hear the panic in Mary’s voice. Her husband Joe’s health had been steadily declining for years and Mary has been his primaryworriedcouple caregiver. But last week he fell at home, breaking his hip, and now he’s in a subacute facility. The recovery process hasn’t gone well, in part because of Joe’s age and partly because of the toll that Alzheimer’s has taken on his mind. Mary is now facing the prospect of either long term care at a cost of $11,000 per month or, in an effort to keep the cost down, trying to bring him home and provide much of the care herself, supplementing it with a few hours of home aide assistance. “Joe never wanted to talk about long term care and so we never did plan for this,” she tells me. It’s a classic scenario and one that, so often, is more damaging to the wife than the husband. How so? Mary’s situation is a typical one. At 72, she’s 6 years younger than Joe. Add the fact that women have a longer life expectancy than men and chances are that the husband will need long term care first. And if the couple haven’t planned for it, they’ll likely spend most of their savings on his care. Mary and Joe have $400,000 of assets plus their house. Without any guidance Mary could be left with as little as $109,000 and the house before the State will help pay for Joe’s care.