Michael H. Marks is an elder law attorney practicing at Marks Elder Law with offices in Squirrel Hill and Monroeville. Send questions to Michael@marks-law.com or visit www.marks-law.com.

Jerry and Lisa needed help to deal with Jerry's advancing dementia and increasing cost of care. They were terrified they would lose everything. Jerry and Lisa had done well for themselves. They owned their home, they had CDs and bank accounts and some investments. They also each had IRAs and life insurance.

Then things got worse for Jerry. There came a time when Lisa could no longer take care of Jerry at home; his dementia had progressed to the point that he needed to go to a nursing home. Lisa was staggered when she began researching the cost of nursing home care.

She quickly learned that Medicare, that they had always relied on, would not pay for Jerry to be in the nursing home permanently – for "long-term care" – but would only pay for short-term, temporary nursing home care. Then the nursing home began bill them at the rate of $320 a day, or almost $10,000 per month. At that rate, all their assets, including their house, would be gone within a few years. Jerry could easily remain in the nursing home far longer.

It was at this point that Lisa visited our office in Squirrel Hill. Elder law to the rescue!

With no long term care insurance, the only viable choice was to have Jerry enrolled in Medicaid. Jerry needed Medicaid to pay for his long-term care in a nursing home, or their life savings and retirement nest egg would be gone pretty quickly. But Medicaid has strict rules on financial eligibility so we got to work on lawful, allowable asset protection strategies. Otherwise, Medicaid wouldn't even begin to pay for Jerry in the nursing home till after they had spent most of their own money on Jerry's care.

First, I helped them spend some of their money on things they needed or could use anyway, like prepaid funerals, upgrading the car that Lisa drove every day to see her husband, and other transactions that would protect value for them (but not mess up our plan for Jerry's Medicaid) under the rules.

Next, we identified specific assets that Lisa would be allowed to keep, because she was Jerry's wife still living at home in the community – her "Community Spouse Resource Allowance."

Finally, I helped them put all their remaining money that wasn't already protected – the money that Medicaid told them they had to spend at the nursing home first – into a very specialized kind of annuity, a "Medicaid Qualified Spousal Immediate Annuity." I helped Lisa transfer the rest of her cash and liquid assets – excess “available resources” according to Medicaid - into a stream of future payments, thereby making Jerry eligible for Medicaid. All the money was returned to Lisa in monthly payments over the ensuing months, for her to keep. I also guided them in removing Jerry as an owner or beneficiary where appropriate or required.

I was able to save them virtually everything they owned. They ended up paying the nursing home privately for only a short period of time. They kept many, many, many times the amount of my fee that without the right advice, they would have lost.

By the way, they kept their home for Lisa, too.

When Jerry passed, Lisa and the kids were heartbroken, but she was financially secure. I couldn't havebeen more proud of the help that I provided.

I was able to help them make sure that Jerry (andLisa) would get the care they needed and still save a ton of money for the