Long-Term Care Planning

Nursing home care in New York City is among the most expensive in the nation. As of 2024, the average semi-private room in a New York City skilled nursing facility costs between $14,000 and $18,000 per month, with private rooms in premium Manhattan facilities often exceeding $20,000 monthly. At these rates, a couple's entire life savings can be depleted within two to three years of one spouse entering a nursing home. Home care through the New York Medicaid CDPAP (Consumer Directed Personal Assistance Program) or traditional home health aide services can also run $8,000 to $12,000 monthly for round-the-clock care. Long-term care insurance premiums have risen sharply in recent years, and many New York residents who purchased policies years ago find that coverage is insufficient to meet today's costs. This financial reality makes proactive long-term care planning — ideally beginning five or more years before care is anticipated — essential for New York City families. Russel Morgan, Esq. works with clients throughout Manhattan, Brooklyn, Queens, the Bronx, and Staten Island to develop strategies that preserve assets while ensuring access to quality care.

Long-term care planning is a proactive, advance strategy undertaken years before nursing home care is needed — typically five or more years ahead — allowing full use of Medicaid's 60-month look-back period to maximize asset protection. When assets are transferred to a Medicaid Asset Protection Trust or otherwise repositioned more than 60 months before a Medicaid application, there is no penalty period and no look-back exposure. Proactive planning allows New York residents to protect the family home, investment accounts, and other significant assets from nursing home spend-down entirely. Medicaid crisis planning, by contrast, refers to emergency planning undertaken when a person is already in — or about to enter — a nursing home without prior preparation. Crisis planning employs different tools: spousal asset transfers, Medicaid-compliant annuities, exempt asset conversions, and in some cases spousal refusal. While crisis planning cannot protect assets with the same efficiency as advance planning, an experienced elder law attorney can still preserve a substantial portion of the estate even at the crisis stage. Morgan Legal Group is expert in both approaches and tailors strategy to each client's timeline and circumstances.

Medicare provides only limited, short-term coverage for skilled nursing facility care in New York and does not cover custodial or long-term nursing home care. Medicare will cover 100% of SNF costs for days 1–20 following a qualifying inpatient hospital stay of at least three days (not just observation status), subject to strict "skilled care" requirements meaning the patient must require and receive daily skilled nursing or therapy services. For days 21–100, Medicare imposes a significant daily copayment (approximately $200 per day in 2024), after which Medicare coverage ends entirely. After day 100, or whenever the patient no longer requires skilled care, Medicare coverage ceases. At that point, the patient must pay privately, use long-term care insurance proceeds, or — if asset and income limits are met — qualify for Medicaid. This stark reality is why long-term care planning is critical: Medicare will not protect New York families from the financial devastation of extended nursing home costs. Medicaid, not Medicare, is the primary payer for long-term custodial care in New York's nursing homes, and qualifying for Medicaid without first losing all of one's assets requires proactive legal planning.

Yes — with proper planning. New York law provides several mechanisms to protect the family home from nursing home spend-down and Medicaid estate recovery. The most powerful tool is the Medicaid Asset Protection Trust (MAPT): an irrevocable trust into which the home is transferred at least 60 months before a Medicaid application. Because the grantor relinquishes ownership of the home to the trust, the home is not a countable asset for Medicaid eligibility purposes once the look-back period has run, and it is not subject to Medicaid estate recovery since it does not pass through the probate estate at death. A life estate deed is a simpler but somewhat less flexible alternative: the homeowner retains a "life estate" — the right to live in and use the property for life — while transferring the remainder interest to children or other beneficiaries. New York law also exempts the home from Medicaid spend-down while the community spouse lives there, while a child under 21 resides there, or while a blind or disabled child of any age resides there. Russel Morgan, Esq. evaluates each client's specific home ownership situation — including New York City co-op apartments, condominiums, and multi-family properties — and recommends the most appropriate protection strategy.