Yes. And most families underestimate the risk.

In our experience, even households that have saved responsibly can see hundreds of thousands of dollars disappear within just a few years of extended care. Without a plan, it is not unusual for a lifetime of savings to be spent down far faster than expected.

What Long-Term Care Actually Includes

Long-term care is not limited to nursing homes. It includes:

• In-home care
• Assisted living
• Skilled nursing care

Each level comes with significant costs. In Ohio, nursing home care commonly ranges from $8,000 to $12,000 per month, depending on the facility and level of care. Higher-end facilities can exceed that. Assisted living is somewhat less, but still a major ongoing expense.

Many families assume Medicare will cover these costs. It does not. Medicare only covers short-term rehabilitation under limited circumstances. It does not pay for ongoing custodial care, which is what most people eventually need.

How Most Families End Up Paying

Because neither Medicare nor traditional health insurance covers long-term care, most families pay out-of-pocket until they qualify for Medicaid.

Ohio Medicaid can cover long-term care, but qualifying is not simple. It is a need-based program with strict income and asset limits. It also includes a five-year lookback period, meaning the state reviews financial transactions going back five years.

We often meet families who assume they can apply when needed, only to learn that prior gifts, transfers, or ownership decisions disqualify them or trigger penalties at the worst possible time.

Common and Costly Misunderstandings

Many of the problems we see come from misunderstandings about how the system works.

“I have a will or a revocable trust, so my assets are protected.”

A will does not protect anything during your lifetime. A standard revocable trust, while useful for avoiding probate, offers no protection from long-term care costs. We regularly see families who thought they were covered, only to find out too late that they were not.

“If needed, I can just gift assets to my children.”

The problem with that approach is timing. In Ohio, gifts made within the five-year lookback period can create a penalty period where Medicaid will not pay for care. That often leaves families paying privately right when funds are already under pressure.

“If one spouse needs care, the other will be financially protected.”

Many married couples assume this, but it is not how things typically work in practice. While Medicaid allows the healthy spouse to retain a portion of assets, we commonly see couples forced to spend down far more than expected when no planning was done in advance. The result can be long-term financial insecurity for the spouse who remains at home.

What Happens When There Is No Plan

In our experience, planning is often delayed until there is a crisis. What usually happens is a sudden event such as a fall, stroke, or dementia diagnosis. At that point, decisions need to be made quickly, often within days.

When that happens:

• The most effective planning strategies are no longer available
• Families are forced into reactive decisions
• Savings are spent down rapidly
• The focus shifts from protecting assets to simply covering immediate costs

We regularly see surviving spouses left with significantly reduced financial resources because there was no plan in place ahead of time.

In other cases, a family home that was intended to pass to children must be sold to pay for care.

What Changes When Planning Is Done Early

The outcome looks very different when planning is done in advance.

Instead of spending down nearly everything on care, we often see families:

• Preserve their home
• Protect a meaningful portion of their savings
• Qualify for Medicaid at the appropriate time
• Avoid crisis-driven financial decisions

This typically involves a combination of Medicaid planning strategies and properly structured irrevocable trusts, implemented early enough to work within the five-year lookback rules.

Timing is the key difference. Those who plan early have options. Those who wait usually do not.

The Overlooked Risk: Estate Recovery

Ohio also has estate recovery rules that many families do not anticipate.

After a Medicaid recipient passes away, the state can seek reimbursement for benefits paid. This often includes claims against the home if it was not properly protected.

We regularly see families surprised by this when a property they expected to pass to children must instead be sold to satisfy a Medicaid claim.

When Should You Start Planning?

If you are in your 50s, 60s, or early 70s, this is the window where planning is most effective.

Because Medicaid applies a five-year lookback period, planning strategies need time to work. Waiting too long can eliminate options entirely or significantly reduce what can be protected.

Final Thought

This is about understanding how the system actually works before you are forced to make decisions under pressure.

Once a health crisis hits, your options narrow quickly. Planning ahead allows you to make thoughtful decisions, protect what you have built, and reduce the financial and emotional strain on your family.

Schedule a Planning Meeting

If you are not sure how exposed you are to long-term care costs, the next step is to find out.

We regularly meet with individuals and couples who want to understand:

• What would happen if care were needed tomorrow
• How much of their savings are actually at risk
• What options are available to protect their home and assets
• Whether it is too late to do meaningful planning

In a short planning meeting, we can walk through your specific situation and show you what strategies may apply to you under Ohio law.

The difference between planning early and waiting is often hundreds of thousands of dollars.

If this is something you have been putting off, now is the time to get clarity. Join our Long-Term Care Seminar coming up on July 22nd, 2026.

Call our office or click this link to request an appointment today to start the conversation.