Let’s be honest — no one dreams of picking out a nursing home. But when the time comes, whether for yourself or someone you love, making the right choice can mean the difference between peace of mind and panic mode. The good news? With a little planning (and maybe a friendly estate planning attorney in your corner), you can make the process far less stressful — and even empowering.

1. Start Early — Like, Now

The best time to look into nursing home options is before you actually need one. When you’re not in crisis mode, you can tour facilities, ask questions, and weigh your options without feeling rushed. Waiting until a hospital discharge with only 48 hours to find a bed? That’s like apartment hunting with your eyes closed — in the rain.

2. Make a “Must-Have” List

Not all nursing homes are created equal, and what works for one person might not work for another. Start by thinking about what’s truly important. Ask yourself these questions:

1. What level of care is needed? (Assisted living, memory care, full skilled nursing?)
2. Is the facility close to family and friends who’ll visit often?
3. Are there nearby hospitals and specialists in case of medical needs?
4. What’s the social vibe like — do they offer activities and events?
5. Are religious or cultural needs taken into account?
6. What’s the staff-to-resident ratio? And do the staff actually stick around?

Proximity really matters — especially for maintaining relationships, making regular visits easier, and staying connected to the local medical community. Being closer to familiar people and places can make a huge difference in someone’s emotional and physical well-being.

You can also use tools like Medicare’s Nursing Home Compare (Medicare’s Nursing Home Compare) to check out ratings, inspection reports, and staffing details.

3. Go See It for Yourself (and Maybe Pop in Unannounced)

Those glossy brochures? Lovely. But a real-life visit — especially a surprise one — tells you much more. Is it clean? How does it smell? Do the residents seem happy and well cared for? How do staff interact with them? Trust your gut, your nose, and your instincts.

4. Understand the Cost — and How You’ll Cover It

Sticker shock is real. The median cost of a semi-private room in a nursing home is now over $11,000 per month. Here’s how most people handle the cost:

Long-Term Care Insurance: If you have it, now’s the time to dust off that policy. Just make sure it covers the type of care you’re considering — and note any waiting periods before benefits kick in.

Medicaid: Yes, Medicaid covers nursing home care — but it’s income- and asset-based. The rules are tricky, and mistakes (like giving away assets too late) can delay eligibility. Early planning helps you protect assets and avoid headaches.

Private Pay: Without insurance or Medicaid, it’s out-of-pocket. That can drain savings fast. It’s smart to understand what you’re agreeing to — and what other resources may be available.

5. Talk to an Estate Planning Attorney (Hi, That’s Us!)

This isn’t just a financial decision — it’s a legal one, too. We can help you navigate Medicaid eligibility and protect your assets, legally. We will also review your long-term care policy, prepare or update your powers of attorney and healthcare directives, read the fine print on those confusing admissions agreements, and set up trusts or other planning tools to minimize risk.

We’re not here to sell you anything — just to make sure your legal ducks are in a row and your choices are respected.

6. Watch for Red Flags 🚩

Some things should raise your eyebrows — and possibly your blood pressure:

🚩Facilities that demand a family member personally guarantee payment

🚩Vague or missing cost breakdowns

🚩A history of health and safety violations (check those inspection reports!)

🚩High staff turnover or negative online reviews from families

Choosing the right nursing home isn’t easy — but it can be

Choosing the right nursing home isn’t easy — but it can be manageable, and even empowering, when you’re prepared. A little early planning, some solid research, and the right support can help you make a decision that brings peace of mind to the whole family. Click below to schedule a meeting with a qualified Rhode Island estate planning attorney.

Nursing homes are really expensive and it is no wonder people are terrified about how to pay for long term care. The fear is not misplaced. The average nursing home will cost you about $10,000 per month. The average nursing home stay is 18 months. For the majority of Americans, this will quickly drain your life savings. But can this catastrophe be averted? The answer is yes – with proper planning, you can prepare an estate plan designed to protect your assets from nursing home costs.

Because long term care is so expensive, the majority of Americans rely on Medicaid to pay for care costs.

What Is Medicaid And How Does It Work?

Medicaid is a partnership between the state and federal governments to provide medical benefit assistance to people, including those over age 65, who have financial need.

In order to be considered to have financial need, when you go into a nursing home and go on Medicaid, you cannot have more than $4,000 (in Rhode Island) in “available” resources.

Available Resources

Some resources don’t count, such as your primary home and the car used for your regular transportation.  Other assets such as vacation homes, rental properties, business assets and other investments will be counted toward your resources.

The Lookback Period

Assets that cannot be used for your benefit, such as those in an irrevocable living trust, don’t count either. However, In order to be fully protected your assets must be transferred into the MPT at least 60 months (5 years) before you apply for Medicaid. Transferring assets within the lookback period are subject to a “clawback” which means you will have to spend the equivalent amount of the value of the transferred asset before Medicaid will kick in. This is known as the penalty period and something you will want to avoid.

Not all living trusts are the same

There are two kinds of trust – the revocable trust and the irrevocable trust. . In this article, I will discuss only the irrevocable type, because that is what you will need to protect your assets from long term care costs. This Irrevocable Living Trust, sometimes referred to as a Medicaid Protection Trust, is a complicated legal instrument designed to protect your hard earned wealth from being depleted for your care. But this is not just any old irrevocable trust. The language used is very specific, and very restrictive, in order to shield the assets.

How The MPT Protects your Assets

The purpose of the Medicaid Protection Trust is to remove the assets from your control, so they are no longer available to you, under any circumstances, to pay for your long term care. Unlike a revocable living trust, where you can make changes to your trust and withdraw assets at your discretion, once you place assets in the Medicaid Protection Trust they must stay there.

So you may ask, why can’t I just give my assets to my children or grandchildren and qualify for Medicaid? The reason is this: giving away assets in order to avoid paying creditors (including medical care and nursing homes) is considered a fraudulent transfer. But not all gifts or transfers are fraudulent. If the gift or transfer was made well in advance, it will be ignored.

The Dreaded Medicaid Lien

“I don’t want the state to take my house when I die.”

This is one of the top five concerns our estate planning clients bring to us. It seems really unfair–a lifetime of work and savings to pay off a home you intend to leave to your family, only to lose it in the end. But that is how the Medicaid Lien works.  If you require long term care in a nursing home, after you pass away the state will attach your estate assets and expect to be paid back for the money spent on your care. This often means that your home must be sold and the proceeds handed over to the state, not your children or grandchildren. Not only your home but all other assets in your estate are subject to the lien. Because care is so expensive, it is not unusual for the lien to exceed the total value of the estate. Sounds unfair, right? That may be, but it is the current state of the law.

Protecting Your Assets From The Nursing Home Is Possible, And An Experienced Estate Planning Attorney Can Help

If you’re concerned about protecting your assets from nursing home costs, the time to act is now. At Jill Santiago Law Offices, we specialize in crafting personalized estate plans, including Medicaid Protection Trusts, to safeguard your hard-earned assets. Don’t leave your financial future to chance—proper planning can make all the difference for you and your loved ones. Click the link below to schedule a consultation, and let us help you navigate the complexities of estate planning with confidence.