Spouse in Nursing Home Raises Poverty Risk

When nursing home care uses up a widow’s savings, the federal Medicaid program will kick in and cover her bills for care. But it’s more complicated for couples.

If one spouse moves into a nursing home and the bills start piling up, the person who is still living in their home can face serious financial hardship and even poverty.

This is a significant risk facing the one in three married people in their early 70s whose spouse will eventually wind up in a nursing home, researchers at RAND found in a study on the financial impact on couples rather than individuals.

It’s not unusual to pay roughly $90,000 for a year for a semi-private in a nursing home, though many people have relatively short stays. A common misconception about Medicare is that it covers all nursing home bills. It does not. The program pays for just 100 days of care in a skilled nursing facility and only after someone has been in the hospital and needs more time for recovery or rehabilitation.

High-income retirees pay directly for care that doesn’t follow a hospital stay, because in most states Medicaid kicks in only after couples deplete all but about $3,000 in savings to cover the cost of the nursing home. There is one significant protection for couples under Medicaid’s eligibility rules: their home does not count as an asset as long as a spouse continues to live there.

But if an unlucky couple has high out-of-pocket spending due to a long stay in a nursing home, the researchers found that it increases the chances they will run through virtually all of their savings and become impoverished. While poverty is far less likely for higher-income couples, they are not immune.

The researchers followed nearly 2,000 older couples over two decades through a survey that asks individuals to report if they or a spouse is in a long-term care facility and how much it costs.

The average for the couples experiencing a nursing home stay was nine months, which racked up about $20,000 in out-of-pocket costs, according to the study. Not surprisingly, stays lasting more than 100 days – and past the period when Medicare might pay the bills – doubled the couple’s previous levels of out-of-pocket spending on medical care and greatly heightened the risk of falling into poverty.

Many things about retirement are impossible to predict, such as how long someone will live or whether they’ll need expensive cancer care. It’s also important for retired couples to remember that a costly nursing home stay may be in their future.

To read this study, authored by Péter Hudomiet, Michael Hurd, and Susann Rohwedder, see “The Lifetime Risk of Spousal Nursing Home Use and its Economic Impact on the Community-dwelling Spouse.”

The research reported herein was derived in whole or in part from research activities performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium.  The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA, any agency of the federal government, or Boston College.  Neither the United States Government nor any agency thereof, nor any of their employees, make any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report.  Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.