Elder Law Update

Approximately 53 million Americans provide unpaid care to another adult, and providing adequate care to a loved one requires over 24 hours per week on average, according to the Caregiving in the U.S. 2020 Report by the National Alliance for Caregivers and AARP. However, caregivers often devote so much time and energy to caring for a loved one that they neglect to take adequate care of themselves. This has become so prevalent that “caregiver burnout” is now a common term. Caregiver burnout is characterized by physical, emotional, and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. Many caregivers even feel guilty if they spend time on themselves rather than on caring for their elderly or ill loved one.


If you are a caregiver in your family, you need to recognize the difficulty of what you are undertaking and be aware of the signs that you may be trying to do too much. Ask yourself the following questions to determine if you are approaching burnout:

  • Are you exhausted even after a full night’s sleep?
  • Do you seem to catch an unusually large number of colds?
  • Do you feel like your whole life revolves around caregiving, but you don’t get any satisfaction from it?
  • Are you always tense or feel like you’ve lost the ability to simply relax?
  • Are you increasingly impatient with the person in your care?
  • Have you lost interest in activities you once enjoyed?
  • Do you have anxiety about the future?
  • Do you often feel helpless, sometimes even hopeless?

If you answered yes to some of these questions and you didn’t feel this way until you began serving as a caregiver, you may be approaching burnout. You need to start caring for yourself.

First, understand that what you are feeling is not unusual. Caregiver burnout is much more common than you might think. This should come as no surprise given the number of Americans serving as caregivers and the amount of time and energy required to provide adequate care.


Here are some steps you can take if you believe you might be suffering from caregiver burnout:

  • Learn as much as you can about your loved one’s illness and how to care for it.
  • Recognize your limits and take a more realistic approach to how much time and effort you can give your loved one. Be sure to express those limits to doctors and other family members.
  • Learn to accept how you feel about the responsibilities of being a caregiver, including emotions such as anger, fear, resentment, guilt, helplessness, and grief.
  • Talk to people about your feelings. Confiding in friends and family members can provide a sense of relief and help you overcome feelings of isolation.
  • Ask for help! Needing help doesn’t mean you are a bad caregiver. It just means that you can’t do it alone and that it’s completely okay.

This last step is particularly important. You are not alone, and support is available from people who understand what you are going through and can help you cope with the stress. You need to do whatever it takes to avoid a sense of isolation. You can find support groups within the community, online, through your physician, and from organizations associated with the health problem of the loved one under your care. Your local chapter of AARP, as well as agencies such as Family Caregiver Alliance, are good places to start seeking help.


For an elderly person to be eligible for nursing home care, assisted living, adult foster care, or in-home care from Medicaid, they must have limited income and low assets. To prevent applicants from simply giving away their resources to relatives or friends in order to qualify for Medicaid, there is a “look-back period.” This is a set period of time prior to the individual’s application during which the Medicaid administering agency reviews all the financial transactions that the applicant has made.

If someone violates the Medicaid look-back period, he or she will be penalized by becoming ineligible for Medicaid for a certain period of time. This period is known as the penalty period and is calculated by dividing the dollar value of the transferred assets by either the average monthly or daily private patient rate of nursing home care in the state where the person resides. This calculation uses a penalty divisor or private pay rate that increases annually in accordance with the rising cost of nursing home care. It is important to note that there is no maximum limit to the penalty period. What happens if you are subject to the look-back period? The answer can be rather complex.


If a person who is applying for Medicaid has given away, transferred, or sold their assets, such as money, homes, cars, artwork, etc. for less than the actual market value, they will face penalties. Even if they have made informal payments to a caregiver without a written agreement, it can still be considered a violation during the look-back period. Additionally, if the applicant's spouse has transferred assets, it can also result in a Medicaid penalty for the applicant. The penalty period is imposed because these assets could have been used to pay for long-term care expenses, but were instead given away or transferred.


The majority of states, 49 out of 50, have a look-back period of five years (60 months) for Medicaid eligibility. California is an exception with a 2.5 year (30 month) look-back period. The look-back period starts from the date when the applicant applies for Medicaid. For instance, if a person submits their Medicaid application on July 15, 2022, the look-back period would begin on that day and extend back five years to July 15, 2017 (or in California, 30 months back to January 15, 2020). All financial transactions between these dates would be subject to review.


Thankfully, there are several exceptions and exemptions to the Medicaid eligibility rules that can benefit families facing challenging circumstances. These exceptions allow applicants to transfer assets to certain parties and to employ specific spend-down strategies without incurring a penalty.


Navigating your long-term care planning options can be complicated, but with proper planning it is possible to protect your assets against the transfer penalty. Even if you have already made asset transfers in the last five years (or 30 months in California) and will be applying for Medicaid soon, we may still be able to protect a portion of your life savings.


Pasadena Law Group