Be Medicareful

The New York Times Magazine
THE WAY WE LIVE NOW
THE ETHICIST by Randy Cohen

My mother has Alzheimer's disease and her doctor has warned me that she soon will need to be placed in a nursing home. Several years ago, her lawyer advised me to transfer her assets to my name so that she could qualify for Medicaid and I could inherit her money. This is perfectly legal, and according to other people in the same situation I've spoken to, it is widely done. But is it ethical? -G.O.

Perhaps it is calling this "transferring assets" that gives it a sinister tone; if you think of it as a mother offering her child a gift, albeit one you enact on her behalf, it couldn't be more ordinary or more benign.

Indeed, Federal law allows her to give $675,000.00 over her lifetime free of Federal taxes. Furthermore, for your mother to do so deprives no one else of health care. Federal and state governments finance Medicaid for all who are eligible.

Just as you are required to pay your taxes but not to toss in a bonus payment, your obligation here is to obey the law, including the laws governing power of attorney, and to use your mother's money in her best interest. You have no ethical obligation to drive her into poverty.

With long-term nursing home care costing as much as $8,000.00 a month, an expense not borne by Medicare, many older people quickly run through the savings of a lifetime. Others avoid destitution by giving some of their money to their children. There are other solutions. You might consider long term care insurance, which can allow your mother to preserve her savings. Or you might emigrate. Nearly every other Western nation has found a way to provide for its elderly citizens without making them paupers. Or you could encourage Congress to emigrate until it can design a more humane health care system.

But if you decide to stay here, don't wait for the last minute to make your plans.

"The Government can look back over a three-year period, and any money transferred can still be counted toward Medicaid eligibility," says Jeffrey Abrandt, a partner in Goldfarb & Abrandt, a law firm active in elder law and health care law. "The legal obligations are complicated and changeable. It's certainly an area where you should consult a lawyer."