You were proceeding as if you had all the time in the world. And then, suddenly, life happens and you realize that you don't.

And you panic.

You are the person in the family who takes care of everyone, your parents, your children, your spouse. Then one day your mother falls, or your father has a stroke out of the blue, and suddenly you have to figure out who is going to take care of them and where they are going to go.

Your first instinct may be to bring Mom or Dad home and take care of them yourself. You rearrange schedules. Family members pitch in. You try to make it work.

But sometimes you realize that Mom or Dad needs more care than your family can realistically provide. Maybe they cannot be left alone safely. Maybe they need help transferring from the bed to a wheelchair, assistance throughout the night, or skilled nursing care.

So you begin looking at nursing homes, and then there is sheer shock. You see the price. In Washington, D.C., and Maryland, a private nursing-home room can cost approximately $14,500 per month. And now another question becomes urgent:

How are we going to pay for this?

Unfortunately, this is often when families first begin thinking seriously about long-term care planning.

Medicare May Not Be the Answer You Thought It Was

Many families are surprised to learn that Medicare does not simply pay indefinitely for nursing-home care.

Medicare may cover qualifying skilled nursing and rehabilitation services for a limited period, but it generally does not provide an unlimited benefit for the ongoing custodial care many older adults require.

Once that coverage ends, families may be faced with paying privately, qualifying for Medicaid or another available benefit, finding appropriate care in the community, or using some combination of resources. That is why planning before a crisis can be so important.

Medicaid Planning Is About Having Choices

When we talk about Medicaid long-term care planning, we are not telling you to sell or transfer your assets simply to make yourself poor enough to qualify for Medicaid.

That is not the objective. Nobody wants to plan to go into a nursing home. But everyone should have a plan in place if there comes a time when significant long-term care is needed. That plan might involve remaining at home with appropriate assistance, using your own resources for the care or living arrangements you prefer, qualifying for Medicaid or other benefits, protecting certain assets when appropriate, or some combination of these options.

The point is not to make yourself poor. The point is to understand your choices while you still have choices to make.

Planning Early Can Preserve More Options

Timing matters because Medicaid has rules governing assets and certain transfers. Something that seems harmless, giving money to your children, adding someone's name to a deed, or transferring a home, can create unintended eligibility problems later, leaving your loved one without sufficient resources to pay for long-term care and unable to qualify for Medicaid-paid care during a penalty period.

Depending upon the family's circumstances, proper planning might involve the family home, how assets are titled, long-term care insurance, a Medicaid Asset Protection Trust (MAPT), a Medicaid- compliant annuity, or other lawful planning strategies.

But these tools are not right for everyone, and D.C. and Maryland administer their Medicaid programs separately. The appropriate strategy depends upon your circumstances, your goals, and when you begin planning.

And if the crisis has already happened, don't assume it is too late. There may still be lawful planning options available. Don’t panic. What you should not do is begin transferring property or moving money because a friend said something worked for her mother or because you found a strategy on the internet.

What Decision Is Right for Our Family?

This is the question that matters most.

What does Mom or Dad want? What level of care do they actually need? Can they safely remain at home? Is living with or near family an option? What can the family realistically provide? What benefits and resources are available?

And what about their assets? Are we trying to preserve something for the next generation, or does Mom or Dad need those resources now to maintain the best possible quality of life?

Wanting to care for a parent at home and being able to safely provide the level of care that parent needs can be two very different things.

The objective is not simply to get Mom or Dad's assets below a particular number so that Medicaid will pay for their care. The objective is to use everything in our legal toolbox, the law, available benefits, family resources, and Mom or Dad's own resources, to develop a plan that is right for the family.

Plan Before the Decisions Are Made for You

No one knows whether a fall, stroke, diagnosis, or other health event will happen next month, five years from now, or never.

But families can prepare for the possibility. Planning early gives you time to understand the potential cost of care, evaluate Medicaid and other benefits, consider appropriate asset-preservation strategies, and decide how your resources can best be used to provide the care and quality of life your loved one needs. For D.C. and Maryland families, long-term care planning is not simply about protecting money.

It is about preserving options before a crisis takes those options away.

If you are beginning to think about long-term care for yourself or someone you love, or if life has already happened and you are suddenly forced to figure out what to do next, we can help you understand your options and develop a plan that makes sense for you and your family.

Source: CareScout, 2025 Cost of Care Survey. The reported 2025 median annual cost of a private nursing-home room was $173,740 in Washington, D.C., and $173,375 in Maryland. Actual costs vary by facility, location, level of care, and other factors.