If your parents live in Connecticut, you live in Pennsylvania and your brothers and sisters live in California and New York, chances are you may have had "the conversation" discussing with your parents where they might live if one of them needs long term care.
It is not just a question of whether they might leave home, but also what supports and funding are available and, if a continuing care retirement community is involved, what are the terms of the contract.
Also, the questioner needs to know differences between states and, even within a state there can be dramatic differences depending on whether the area is rural, suburban or metropolitan. Private availability, taxes and government and private programs vary. States can differ dramatically when it comes to long term care regarding availability, quality, government benefits, retirement communities and cost.
If you are nearing retirement and you open an attractive brochure advertising a senior community with golf courses and swimming pools in North Carolina, you might reasonably hesitate before signing on with your spouse because you do not know what options are available if you need some serious care. Is it a life care contract? If so, it might need to be examined in detail to determine your options. What happens if you want to move back to be near the kids or if you run out of money?
If you are a "snowbird" and live most of the year in Florida and return to Pennsylvania during the summer, are you better off eventually to live full time in Florida or in Pennsylvania? If you are in a private residence, Florida has a very generous homestead exemption for property taxes.
These questions are faced every day by ordinary people that are largely ignored by planners and they do make a huge difference. I discovered some years ago there are firms on the border between the U.S. and Canada that specialize in planning whether Americans who commute to their vacation homes in Canada should move or stay based on financial considerations.
Along these lines some years back I co-authored a book titled "The Medicaid Program: Interstate Planning Opportunities in Pennsylvania and Delaware" addressing just one issue - the difference in Medicaid programs between two adjoining states. With our office close to the borders with both Delaware and Maryland, it helps to know differences in availability and cost of services.
If you live in Pennsylvania and receive long term care services and supports here, whether in a nursing home or at home under the Medicaid Waiver Program, your spouse's retirement funds - IRA, 401(k), 403(b) or similar - (not yours), are exempt for Medicaid regardless of the amount. However, if you cross the bridge to New Jersey they are counted and would be spent down as part of the Medicaid spenddown. The difference to the couple could mean hundreds of thousands of dollars lost or saved.
Delaware, and, for that matter, New Jersey, have Medicaid availability for assisted living/personal care. Not so in Pennsylvania.
Pennsylvania has strict income limitations preventing many from receiving "at home" services and supports. It is possible you would be better able to qualify for at home Medicaid waiver in Delaware.
California is very open in its interpretation of the Medicaid gifting rules. Pennsylvania allows $500 total (not per recipient) per month without penalty but does have a Medicaid gift and annuity strategy if properly used. New Jersey counts gifts in any amount
After participating in a conversation with other elder law attorneys years ago in Georgia following a national conference, I was able to conclude I would not recommend clients move to Iowa for long term care.
So what is the answer? Our office researches the laws in other states and connects with other elder law attorneys in areas where clients expect to move. This is one time among many when it pays to belong to a national organization, the National Academy of Elder Law Attorneys (NAELA) to further relate to other elder law attorneys who concentrate in this field across the U.S. Whenever and wherever you move - or if you decide not to - there are answers and we are prepared to research and provide them.