Judd Matsunaga
The government knows it can’t pay for long-term care for the baby boomer generation. So, the government is making it harder to qualify for Medi-Cal. One day soon, the government is going to shift the financial burden of LTC off the public sector and onto the private sector. “How?” you might ask. By forcing workers to buy long-term care insurance, i.e., privatizing long-term care.
In other words, workers will get their paycheck and look at the deductions. They’ll see the standard deductions, e.g., federal and state taxes, Social Security, Medicare. But soon, they’ll see another deduction for long-term care insurance. It’s already happening in Washington. California and several other states are already writing laws to do the same. But the problem is that the state-sponsored long-term care insurance isn’t any good.
So, if there’s no more Medi-Cal (Medicaid in other states), and you don’t want to end up in a state-run facility, what should you do? I asked the very same question to Tony Chicotel, senior staff attorney for California Advocates for Nursing Home Reform. Chicotel is at the top of the long-term care community, often asked by legislators for his comments and recommendations on the law. Here’s what he said: “HAVE A BUNCH OF DAUGHTERS.”
Why daughters? Parents are better off having daughters if they want to be cared for in their old age, suggests a new study by the American Sociological Assn. (www.asanet.org). “Daughters provide as much elderly parent care as they can. Sons do as little as possible,” says study author Angelina Grigoryeva, PhD. “This suggests that sons pass on caregiving responsibilities to their sisters.” Sons tend to reduce theirs when sisters are present.
Historically, caregiving has been socially expected of women. In the U.S., a 2020 report presented by the National Alliance for Caregiving and the AARP Public Policy Institute shows that the majority of caregivers (61 percent) are still female. Daughters tend to provide more hours of care per week and are more likely to be the sole caregiver or the main provider in a caregiving team (https://tinyurl.com/5ff6mtn4).
According to Psychology Today (March 18, 2025), caregiving remains gendered, with women continuing to take on most unpaid caregiving. In some families, caregiving is shared among siblings, with one child taking the lead but others contributing. Research shows that daughters are more often the primary caregivers for aging parents than sons, though the picture is more complex than a simple “daughters always” rule.
Although caregiving can create stronger bonds within a family, it can also create stress and emotional fatigue. Forty-two percent of those surveyed described caregiving as stressful but manageable. Much of the stress comes from trying to balance multiple responsibilities, including work, personal needs and the needs of each aging parent. Balancing work, family life, self-care and caregiving is a challenge.
In addition to the time that adult daughters put into caring for their aging parents, this role has a significant impact on various aspects of everyday life, such as work. Six in 10 caregivers are employed at some point while providing care, and the majority of working caregivers report having to make workplace accommodations, such as cutting back their hours, turning down promotions and taking time off. Higher-hour caregivers (who are predominantly female) are most likely to report these kinds of negative impacts on their careers.
In many cases, something must give, and family caregivers often choose to put their professional aspirations on hold by quitting or retiring early. This decision can financially hamstring the entire family. In addition to the immediate reduction in household income, caregivers who stop working lose out on months or even years of earnings, benefits and work credits for retirement programs like Social Security and Medicare. Giving up a job has a lasting impact on one’s current financial situation and plans for one’s own retirement and care.
When all siblings in any given family cannot contribute an equal amount of time to caregiving, some seek financial support to equalize contributions, i.e., money instead of time.
An article in ElderLawAnswers says that “32 percent of respondents earning $150,000 or more think that a sibling should contribute money if they can’t contribute time” (https://tinyurl.com/3ccwasxn). This may indicate a growing awareness that time, labor and emotional energy have value.
Now, if you are the primary caregiving child (son or daughter), here’s my advice:
First, make sure your parent updates their Powers of Attorney, both for assets and for health care. Even if you got it from an attorney, banks are taking the position that the Patriot Act (Federal Law after 9-11) gives banks the discretion to not honor a state legal POA. Some banks won’t honor POAs that are more than three to five years old. If you’re not sure if the bank will honor them, take it to the bank and ask them. Also, make sure your aging parent gives you an “immediate” power and not a “springing” power.
Second, since mom and dad probably want to stay at home and “age in place,” see if you can get any kind of public financial assistance. In California, In-Home-Supportive-Services is the only public program that will pay for “at-home” care. If the government can keep seniors at home, it saves money by not paying for their care at a 24/7 nursing home. IHSS is run by the county and is available for low-income people only.
Third, in order to qualify for IHSS, you first have to get Medi-Cal (Medicaid in other states). In California, Medi-Cal is a “needs-based” program, i.e., you have to qualify. This is as opposed to Medicare, which is called an entitlement. As a U.S. citizen, you are entitled to get Medicare at age 65, even if you’re a multimillionaire. Not so with Medi-Cal, i.e., there’s an “Asset Test.”
Fourth, make sure your parents’ Living Trust is up to date. Many trusts that were created 20 years ago have handwritten cross-outs and handwritten changes that are not legally enforceable. Also, if parents own a home, make sure the home is still in the name of the trust. Occasionally, a homeowner will refinance, and the lender will take the home out of the trust but never put it back in. This is important for two reasons. One, to avoid the court process called Probate, a legal nightmare. Second, to avoid a State Recovery Claim.
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
Past “Legal-Ease” columns may be viewed here.