The sentence families repeat to me, almost word for word, is this: they told us Medicare is done paying.
Their father is not better. He has Alzheimer’s, and he is not going to get better. He was in the hospital after a fall, then in a rehabilitation facility for a few weeks, and now the coverage has stopped while the need has not. Someone at the facility is asking the family what they want to do next, and the answer apparently costs more per month than most mortgages in Woodland Hills.
I have explained this to West Valley families since 1990, and I have never found a way to make it sound fair. What I tell them is this. If it were a heart attack, Medicare would cover it. But it’s Alzheimer’s.
The line is not about how sick your parent is
This is the part almost no one knows until they are standing in it. Coverage does not follow the seriousness of the diagnosis. It follows the kind of care.
- Skilled care is medical treatment delivered by licensed professionals. Wound care, IV medication, physical therapy after a stroke or a broken hip. It is temporary by design, aimed at recovery, and Medicare pays for a limited period of it.
- Custodial care is help with daily living. Bathing, dressing, eating, toileting, and supervision so a parent does not walk out the front door at two in the morning. It requires no medical license, and Medicare does not pay for it.
A heart attack produces the first kind of care. Alzheimer’s produces years of the second kind and very little of the first. That is the whole gap. Your father can be profoundly, permanently ill and still not qualify for a single covered day, because what he needs is a person rather than a procedure.
What that means for a family in the West Valley
Skilled nursing care in Los Angeles County runs between $10,000 and $14,000 a month. Not for a few weeks of recovery. For as long as it lasts, which with Alzheimer’s is usually measured in years.
Long-term care insurance, where a family has it, is often more limited than they expect, and cognitive conditions are frequently restricted or excluded outright. So most families do what anyone would do. They pay out of pocket, and they keep paying until there is nothing left to pay with. That is how Alzheimer’s care costs in California quietly consume an estate that took a lifetime to build.
What actually closes the gap
Medi-Cal is California’s program for covering long-term skilled nursing care once a person meets the eligibility requirements. The rules are strict. They also come with a set of planning tools that, used correctly, protect far more than most families believe is possible. Our Medi-Cal planning page walks through how that works.
Two things families consistently get wrong, and both of them cost money:
- The lookback clock does not start when you make a gift. The 30-month lookback is triggered by the date the Medi-Cal application is filed. A transfer made three years ago is not automatically safe, and a transfer made last month is not automatically fatal. It depends on when the application goes in.
- Medi-Cal can only recover from probate assets. Assets held in a properly funded living trust are protected from estate recovery. Families who assume the state will take the house regardless are often protecting nothing and giving up a great deal.
The one thing not to do
Do not transfer the house to the children.
I say this more than almost anything else in my practice, because it is the advice families get from friends, from neighbors, and occasionally from professionals who should know better. The home is an exempt asset for Medi-Cal eligibility purposes. Transferring it does nothing to help your parent qualify. What it does do is trigger a Proposition 19 reassessment that your family will pay for every year they own the property. We cover the right approach on protecting your home from long-term care costs.
Timing is the whole game
Families who come in before a crisis, while a parent is still managing day to day, almost always protect everything. Families who come in during a crisis do the best they can with the time they have. Both conversations are worth having. They are just very different conversations, and only one of them is entirely within your control.
Key Takeaways
- Coverage follows the type of care, not the severity of the illness. Alzheimer’s requires custodial care, which Medicare does not pay for.
- Skilled nursing in Los Angeles County runs $10,000 to $14,000 a month, and long-term care insurance often restricts cognitive conditions.
- Never transfer the family home to protect it. It is already exempt for Medi-Cal, and the transfer triggers a Prop 19 reassessment.
Have the conversation before the facility has it for you
If a parent has been diagnosed, or you have just been told Medicare is finished paying, the useful next step is understanding what is actually protectable and what the timing allows. A first conversation is straightforward, and it costs nothing.
Call 818-292-8160 or schedule a consultation. We serve families throughout Woodland Hills, Calabasas, Tarzana, Encino, West Hills and the broader West Valley.