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A Worried Son’s Dilemma for a Mom Who is Reluctant to Change

How to tend to an aging parent's finances and housing

Ramon Gonzalez, 56, with questions about his mother's finances
Trevor Paulhus; Jensen Larson; Shutterstock

The Problem

How do you plan for assisted living? After Clara Gonzalez, 87, had a few falls (nothing broken), that was the question from her son, Ramon, 56. Like so many family matters, this one is complicated. First, by location: Clara, fiercely independent, owns a condo in Orlando, Florida, with none of her three sons nearby. Second, by benefits: Ramon thought his mother could sell her place and use the expected $100,000 in proceeds to cover living costs. But he wondered whether that windfall would reduce her Medicaid and Medicare coverage or Social Security benefits.

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The Advice

Financial questions often open the door to questions that are not so financial at all. That became clear in a four-way phone call between Ramon, Clara, a Spanish-­speaking interpreter and me. While Ramon thought his mother should move right away to an assisted living facility in Georgia near one of his brothers, Clara disagreed. Maybe someday, she conceded, but for now she wanted to stay in Orlando.

This sort of disconnect happens all the time, says David York, an estate planning attorney and coauthor of Entrusted: Building a Legacy That Lasts. “[The son feels] guilt that he’s living his own life,” York says, and he worries about things going wrong for his parent. The result: Children jump to make a change that the parent doesn’t want. “Too often in my profession we’re about the how and the what without thinking about the who and the why,” York says.

In this case, he suggests the family figure out how to keep Clara safe and connected in a place where she wants to live — and provide reassurance to Ramon that she’s doing OK. Technology can help, says Kristen Hanich, director of research for broadband and health care at the market research firm Parks Associates. She suggested a passive monitoring system where home Wi-Fi can be used to detect if a parent isn’t moving around as is typical, or a smartwatch loaded with an app that can detect a fall and send an alert. York also suggested hiring a caretaker to do a wellness check a few times a week or looking into Meals on Wheels, which can provide a social experience as well as a healthy meal.

Turning to Clara’s financial future, Ramon was right to be concerned, but not about Medicare or Social Security; those benefits aren’t based on her current income or assets, so Clara will continue to receive them no matter her situation.​

Medicaid, which Clara is covered by along with Medicare, is a different story. Although rules vary by state, an individual receiving Medicaid is generally not allowed to have more than $2,000 in his or her name with the exception of certain assets, such as a prepaid burial, a primary residence and a car. If and when Clara is ready for assisted living, selling her home will provide her money she can combine with her Social Security to pay for a residence of her choice. Because having all that money in the bank will almost always disqualify her for Medicaid, she’ll have to pay privately if she needs to go into a nursing home, until she can once again pass the $2,000 asset test.

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The Outcome

When I last checked in, Ramon said Clara was still not ready to move. He’s crossing his fingers that her next incident will be minor — but still trigger her to agree to needed changes. He’s standing by to sell the house and use the money for assisted living in Georgia. Meanwhile, he was looking into more ways to keep Clara safe and connected in her current home.

Ramon is doing the right things, notes Joe Coughlin, director of the MIT AgeLab. The goal is what he calls “household resilience”: Recognizing that someday something will need to happen, and preparing in advance to deal with that situation.