Plan · Scenarios

Family scenarios: how different paths can unfold

These scenarios are not advice. They are illustrations to help you see the tradeoffs between different ways of paying for and arranging care — especially over time. They can be used as starting points for discussion with your family and trusted advisors.

The numbers and timelines here are simplified. Real situations will vary by state, health needs, family, and resources.

Scenario 1: Medicaid spend-down

In this path, a person pays privately for care until savings and countable assets drop below the Medicaid threshold. Once eligible, Medicaid becomes the primary payer for long-term care in a nursing facility.

• Often involves selling or spending down assets over time.
• Gives access to care when private funds are gone, but with fewer choices.
• May trigger estate recovery after death, depending on the state.

Scenario 2: Family-supported hybrid

Here, family members contribute time, money, or both — for example, helping with housing costs, sharing caregiving, or paying for additional in-home support so that a move to a facility can be delayed or avoided.

• Can preserve more independence and flexibility, especially early on.
• Requires honest conversation about what each person can realistically sustain.
• Benefits from written expectations so one person is not silently carrying the load.

Scenario 3: Using home equity as part of the plan

In this path, home equity might be used — for example through a sale, downsizing, or other tools — to fund care needs for a period of time, with Medicaid as a possible later step if funds are eventually exhausted.

• Can increase the years of flexibility and choice earlier in the plan.
• May reduce the value of the estate passed to heirs.
• Needs careful review with professionals to understand tax and legal implications.

Using scenarios in your own planning

Rather than trying to copy any scenario exactly, you can use them to ask:

• Which parts of each path feel acceptable to me?
• Which parts would I strongly like to avoid?
• What would my family need to understand now, while there is time to plan?

These questions can help you and your family move from “we’ll figure it out later” to “we have at least a shared direction and some boundaries.”