Long-Term Care Costs: Medicaid vs Private Pay, Plus Talking Money While Dating

Summary

NerdWallet’s Smart Money Podcast

Episode: Long-Term Care Costs: Medicaid vs Private Pay, Plus Talking Money While Dating
Date: February 9, 2026
Hosts: Sean Pyles, CFP® (A), Elizabeth Ayoola (B)
Featured Guests: Sarah Rathner (D, NerdWallet credit cards expert), Kate Ashford (C, Certified Senior Advisor)

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Episode Overview

This episode is a two-parter addressing complex, real-world money challenges:

• Part 1: Dives into NerdWallet’s recent study on money's messy role in dating, exploring dealbreakers and strategies for honest conversations.
• Part 2: Tackles a listener’s layered question about senior living payment models, how to build a budget for long-term care, and the nuanced path from private pay to Medicaid.

The Nerds give candid, practical advice and share relatable personal and research-backed insights, all with their signature mix of expertise and empathy.

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1. Talking Money While Dating: Dealbreakers, Honesty, and Making it Work

Study Highlights, Dealbreakers, and Real-World Impacts

(03:40 – 17:22)

• Credit Card Debt as a Red Flag:

  • 17% of Americans consider having any amount of credit card debt a dealbreaker (up from 10% last year).

    “More people are a little bit debt averse when it comes to finding a partner.” – Sarah Rathner [04:03]

  • But 50% have lied about their own financial situations.

• Lying About Finances:

  • The #1 dealbreaker: 54% say lying about your finances is unacceptable.

    “The biggest deal breaker of all in this study is lying about your finances. ...But 50% of Americans in a relationship have lied about their financial situation with their current partner.” – Sarah Rathner [04:09]

• Unexpected Red Flags:

  • 32% say living with roommates or family is a dealbreaker, though high-cost cities make this common.
  • “The important thing in the story is that [my husband] had his own bathroom ... that’s why I married him!” – Sarah [05:28]

• Why People Hide Purchases:

  • 18% admit to lying about purchases.
  • Many do so out of fear of judgment; 29% would break up over “unnecessary” spending.
  • Sometimes “financial infidelity” is driven by shame or emergencies (medical bills, repairs).

Navigating Money Conversations as a Couple

• Building Trust and Addressing Shame:

  • Couples should create a “judgment-free zone” to encourage honesty about finances.

    “The only way out is through. And it starts with creating a culture in your relationship where... you openly talk about money without fearing judgment from the other person.” – Sarah Rathner [09:16]

  • If money is weaponized as control, therapy may be needed.

• Financial Transparency:

  • Early, honest talks about money are crucial for healthy long-term relationships—even if 42% view it as a “red flag.”

    “You don’t have to bring your most recent tax return to your third date... but talk about money from the earliest stages.” – Sarah [16:04]

Cultural and Lifestyle Dealbreakers

(11:44 – 14:57)

• Other Common Dealbreakers:
  • Bad tipping (24%) is a big U.S. dating faux pas.
  • Expectations about paying for dates, work-life balance, and lack of savings or investments.
  • Asking to borrow money is touchy, especially early in a relationship.
  • Low credit score and not planning for the future can be concerning, but context matters.

“It’s not even just high standards…when you’re tying yourself, legally or for the long term, to another person, their ability to prepare for their future…also helps you prepare for your future together.” – Sarah [13:34]

Personal Reflections and Advice

(17:22 – 20:49)

• Would These Be Dealbreakers for You?
  • All three hosts lean toward flexibility—financial values matter, but circumstances differ.
• Best Practices for Money Conversations:
  • Start early, create safety to talk without fear, practice grace for yourself and your partner.

    “Judge others hopefully less than you judge yourself.” – Sarah [18:44]

  • You’ll never fully agree—but compromise, empathy, and clear agreements are crucial.

Personal Anecdotes

(19:38 – 20:49)

• Sarah and Elizabeth both mention relationships where mismatched financial habits contributed to endings, but money alone wasn't the only factor.
• Sean highlights the importance of equitability in relationships despite differing financial backgrounds.

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2. Senior Living Care Costs: Medicaid vs. Private Pay, Building a Budget, and Tough Conversations

Listener Question (Paraphrased)

(26:40 – 28:14)

• Listener’s father-in-law needs to move closer for health reasons, possibly into assisted or independent living.
• They’re comparing monthly payment vs. buy-in models, need a budget, and want clarity on Medicaid eligibility and transition.

Understanding the Landscape: Cost and Payment Models

(28:27 – 29:27)

• Regional Pricing: Costs can range from $4,700/month (AL) to $11,600/month (HI); local variance is also important.
• Assessing Needs: Room type, care level, add-on services (memory care, assistance with daily living), and annual increases all affect cost.
  • Resource: Genworth/CareScout Cost of Care Survey (by state, type of care).

How Do People Really Afford This?

(31:00 – 32:29)

• Most use a mix of Social Security, retirement accounts, savings, home equity (selling home or reverse mortgage), some have long-term care insurance or veterans’ benefits.
• Big Myth: Medicare does not cover long-term care.
• Note on Inheritance: “Your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.” – Kate [32:29]

Medicaid: The Safety Net and Its Complications

(32:29 – 34:49)

• To qualify, assets must be depleted—and the system checks for attempted “giveaways” (the five-year lookback).

  “Don’t try to trick the system because they’re one step ahead of you.” – Sean [32:52]

• Many seniors rely on family caregivers; only 3.5% of over-65s are in nursing homes/assisted living.

Payment Structures: Monthly vs. Buy-In Models

(35:30 – 37:14)

• Monthly: Like rent, covers base services; common for assisted living/nursing homes.

• Buy-in / CCRC: Continuing Care Retirement Communities require a large upfront deposit plus ongoing monthly fees, letting residents access increasing levels of care as needed.

• CCRCs generally want residents independent at move-in.

• Fun tangent: There’s a Jimmy Buffett-themed retirement community (Margaritaville) showing the lifestyle spectrum in senior living.

Refundable Buy-Ins and Making the Right Choice

(37:14 – 38:12)

• Refunds vary—partial/full, declining over time, or none; always read the fine print.

• Example: Kate’s grandfather got most of his buy-in back after leaving shortly post-move-in.

• Choosing Best Model:

  • Consider care needs, expected longevity, access to step-up care, and family support.
  • Use services like A Place for Mom to match needs and options.
  • Longevity is an “educated guess”:
    Average need (claims data): 2–4 years for men, 3–6 years for women, but huge individual variation.

Planning Under Uncertainty & Family Dynamics

(40:11 – 41:31)

• Model various scenarios—don’t assume averages apply.
• Start conversations early and revisit often. Normalize the topic to reduce stigma and stress.

  “If you normalize talking about it, it becomes less taboo and weird and depressing. ...Just talk about it like any financial planning topic.” – Kate [42:08]

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The Medicaid Application Process: Overview and Resources

(42:23 – 44:01)

• State-Specific, Asset- and Income-Based: Rules and applications differ.
• Where to Start:
  • State Medicaid office
  • Local Office on Aging (eldercare.acl.gov)
  • MedicaidPlanningAssistance.org
  • Certified Medicaid Planners or elder law attorneys (fees vary; worth it for complex cases)
• Some facilities accept “private pay” with seamless Medicaid transition when assets run out.

“There are folks out there called certified Medicaid planners. ...I didn’t need anything beyond the free consultation, so no harm in calling.” – Kate [43:39]

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Key Quotes & Memorable Moments

• On financial transparency in relationships:
  “You don’t have to bring your most recent tax return to your third date... but talk about money from the earliest stages.” – Sarah [16:04]

• On money shame and honesty:
  “The only way out is through. It starts with creating a culture in your relationship where... you openly talk about money without fearing judgment from the other person.” – Sarah [09:16]

• On spending down assets for senior care:
  “Your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.” – Kate [32:29]

• On Medicaid planning pitfalls:
  “Don’t try to trick the system... they’re one step ahead of you.” – Sean [32:52]

• On normalizing tough conversations:
  “If you normalize talking about it, it becomes less taboo and weird and depressing. ...Just talk about it like any financial planning topic.” – Kate [42:08]

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Useful Timestamps

• Talking dating dealbreakers: [03:40 – 17:22]
• No Spend/Friction Spend challenge check-in: [20:50 – 24:08]
• Listener question (senior care): [26:40 – 28:14]
• Senior living cost and payment breakdown: [28:27 – 41:31]
• Medicaid process and resources: [42:23 – 44:01]

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Takeaways & Actionable Advice

For Couples:

• Start money talks early.
• Focus on underlying values and context, not just financial “scores” or red flags.
• Practice empathy—both for yourself and your partner.
• Don’t let shame stagnate honesty or growth.

For Planning Senior Care:

• Research local costs carefully—huge state and facility variation.
• Build a realistic budget using a mix of all available resources.
• Understand payment models (monthly vs. buy-in, refundability, care escalation).
• Don’t count on Medicare for long-term care (but do explore VA, LTC insurance, and family home equity).
• To qualify for Medicaid, assets must be depleted—and you can’t sidestep the lookback rules.
• Begin family conversations early and revisit regularly.

Helpful Resources Mentioned:

• Genworth/CareScout Cost of Care Survey
• A Place for Mom
• MedicaidPlanningAssistance.org
• Eldercare Locator: eldercare.acl.gov

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NerdWallet’s Smart Money Podcast delivers practical, nuanced financial wisdom—whether you’re dating or gearing up for the realities of senior living.

Transcript

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BILT cards are issued by Column NA, Member, FDIC, pursuant to license for MasterCard International, Inc. Shawn, do you ever sit down and think about who's gonna care for you when you become a senior?

[A]

I think about this, but it's often not when I'm sitting. Usually when I'm out on a nice long run. I think about what's gonna happen to me in my old age. And I'm hoping that my husband will be the one caring for me. That or a robot. Or maybe both.

[B]

A robot? We have to talk more about that later.

[A]

Yeah, they'll be here any day now.

[B]

I personally hope that my loved ones will take care of me, but nothing is guaranteed, you know? And for that reason, I am stashing away as much money as I can in a high yield savings account. Now, this episode, we're going to go more into detail about paying for senior care.

[A]

Welcome to NerdWallet's Smart Money podcast, where you send us your money questions and we answer them with the help of our genius nerds. I'm Sean Pyles.

[B]

And I'm Elizabeth Ayola. During this episode, we are going to answer a listener's question about paying for senior care.

[A]

But first, it's the month of Love, and we have a new study about dating deal breakers to speak with you all about. Spokesperson and credit card writer Sarah Rathner is with us to talk about the study. Hey, Sarah.

[C]

Hey.

[D]

Great to be here.

[B]

Let's get right into it Now, I had fun looking through this study because there were so many juicy details and I love some relationship drama. So, Sarah, tell us what some key findings from the study were.

[D]

Yeah, one thing we found was that 17% of Americans think that a partner with any amount of credit card debt would be a deal breaker. And that's up from 10% last year. So more people are a little bit debt averse when it comes to finding a partner. But the biggest deal break, deal breaker of all in this study is lying about your finances. 54% said that is a hard pass. But on the other side, 50% of Americans in a relationship have lied about their financial situation with their current partner.

[A]

I'm wondering how much Projection is going on in these answers because 17% of people wouldn't date someone with credit card debt. A lot of people have credit card debt. And also a lot of people are just giving little white lies now and again about their finances. So let's have some great people.

[D]

Ah, rules for thee and not for me.

[A]

Yeah, exactly. So did any of the findings in the study surprise you, Sarah?

[D]

Besides how many people are flat out liars who expect the world of their partners?

[C]

Yeah.

[D]

So one thing that we found was interesting was that 32% of Americans said it's a deal breaker if their partner lives with roommates or family members. And that totally surprised me because I spent my 20s and early 30s in a high cost of living city. I lived in D.C. and most people I knew had roommates before they ended up with a significant other that they lived with. My husband had three roommates when we met. And the important thing in the story is that he had his own bathroom in his house and he kept it clean.

[A]

So, yes.

[D]

Yeah, I knew he was marriage material because I didn't have to share a bathroom with his roommates and deal with that.

[B]

Oh, my gosh. I'm not gonna lie. In my 20s, I have dated people with roommates. But in my 30s, it actually is a deal breaker for me because I don't want to go over and see a roommate.

[A]

So I get that. But it depends on the city you're living in, too. Like, if someone's living in New York or LA or Atlanta, Miami, places that have high rent, you might just want to have a roommate or two so you can save more money for other things. Like, they might be able to take you out to more dates if they're saving more money by not spending as much on rent. So I'm okay with that.

[D]

Yeah. And honestly, as long as one of you has your own place.

[B]

You get some privacy sometimes.

[D]

There you go.

[A]

I will say not having your own bedroom would be a deal breaker.

[D]

100%. Yes, 100%.

[B]

Maybe you shouldn't be dating if you don't have your own bedroom. Just saying.

[A]

Okay, so I saw a data point in the study that 18% of Americans currently in a relationship say that they've lied about purchases. Why do you think people are lying about where they're spending their money, Sarah?

[D]

I mean, you just don't want the other person to judge you. Like, we found that 29% of people think it's a deal breaker when their partner spends money on things that they think are unnecessary. So you're already judging Your partner.

[A]

Everyone's so judgmental. Yeah.

[D]

So judgmental. And then. So then you don't want to that to turn back around on you and your partner to say, hey, I can't believe you spent 200 bucks on this thing that I think is frivolous, and that makes you a bad boyfriend or girlfriend. It's just like, you know, we're all just judging each other too harshly, I think. But, I mean, it's okay to judge. Like, you should talk about money, and, like, if somebody has spending habits that give you pause, then you should consider that as you move forward with them. But I think we could all just, like, have more conversations about things and understand each other's ways of thinking before we rush to judgment.

[A]

Yeah, let's have some radical transparency about where you're spending your money and maybe some grace about how your partner is spending their money. As long as all the bases are covered. You know, you're paying your rent, you're paying your utilities, putting some money away in your retirement and savings accounts, and then beyond that, have fun.

[B]

That's it. I mean, as we're talking, I'm like, well, maybe a good first date. Okay, that's too early. Maybe third date, practice. It's like, hey, let's look at each other's. I don't know, wherever you shop basket or what you've bought over the last five months, it feels intrusive. Yes. But it will give you an idea of what you spent. And then if they judge you, you know that that's not the right person for you. Okay, so there you go.

[A]

It's a good litmus test.

[D]

Oh, my God. That's like looking through somebody's search history. You really don't.

[A]

I don't know.

[D]

You're gonna find some stuff you don't want to know about another person.

[A]

I agree.

[B]

Not saying I would do it. Just an idea. So what are some of the things that people are hiding?

[D]

I mean, it could be shopping sprees. All those, you know, online shopping carts that they're actually clearing out and buying everything Amazon purchases. Who knows? It could be sending money to a family member or a friend to help them out financially. I mean, they could be supporting a secret second family. In that case, you should run. That's. I don't normally tell people point blank, like, hey, don't be in this relationship, but if they have a secret second family, I think you should do yourself a favor and get out. You know, it's not just frivolous spending. A lot of times people end up in credit card debt because of things like medical bills, things that aren't your fault, unexpected expenses that you have to deal with, car repairs, home repairs, things like that. So it's not just like buying random stuff online. It's also using money to solve a lot of, like, life's major problems.

[A]

When people lie about their finances, a lot of the time, it can come from a place of shame and feeling like maybe you messed up or that your partner wouldn't understand why you did these things with your finances. But recovering and being honest about your finances is a really important step to re establishing that deeper trust in your relationship in general. So how can people begin to be more on the mend and recover from any sort of financial infidelity, as they call it?

[D]

Yeah, I mean, the only way out is through. And it starts with creating a culture in your relationship where not only do you openly talk about money, but you openly talk about money without fearing judgment from the other person, because that's what allows you to feel comfortable being honest. And so when you have something to say that's hard to talk about, if you feel like you could talk to your partner about anything and they might not agree with you, but at least they'll listen to you, then you're more likely to open up about what's going on for you financially. If they judge you, if they start a fight with you, if they make you feel in any way psychologically or physically unsafe when it comes to talking about your money, I mean, that should be a sign that relationship might not need to go somewhere, you know what I mean? So you need to use these money conversations almost as a way of judging not your partner's spending habits, but your ability as a couple to talk to each other about these things.

[A]

Right. A lot of times money can be used as tool to play out power dynamics in a relationship that can develop in unhealthy ways over time. And if you are in a place where you feel like you can't talk about money, or one of the partners is the one that's enforcing spending in kind of strict or maybe unhealthy ways, it might be a good idea to talk with a couples therapist, perhaps a financial therapist, to really resolve these issues and get to a place of that mutual trust again.

[D]

And I will tell you, if you think that the solution to the problems you have as a couple when it comes to money communication is to move in together to save money money, to get married for the tax benefits or to have a baby because you want to have a baby, I'M here to tell you that those things will make your life more complicated and make it harder to get out of a bad relationship. So have these conversations early and often before you take serious steps in your relationship to further entangle your lives.

[B]

Yeah, and just one more thing on that that I was thinking is it can also be hard to be honest with your partner about your finances if you feel shame yourself. So there's one on one part, you being afraid of your partner shaming you, but then on the other part, there's you being ashamed of your own spend. So I think it's important to address any shame that you have around your spending and your finances so that you can also feel more comfortable sharing with your partner as well. All right, so let's pivot to deal breakers now. I was surprised that someone being a bad tipper was a deal breaker. I'm from the uk we don't tip over there, so that is not a deal breaker for me. So 24% of respondents said so. Now, what are some other financial deal breakers that you came across in the survey, Sam?

[D]

Yeah, well, these respondents were US based, so we have our firmly entrenched tipping culture here. And in the US There is a circle of hell reserved for bad tippers and they have to wait tables for eternity. So in the United States, where you're paid less than minimum wage to wait to wait tables and you're supposed to make it up in tips. So can't say I necessarily agree with the practice, but it is what we have going on here. So tip your servers, everyone, and tip.

[A]

Them well if you can.

[D]

Yes. And so another deal breaker we found, and this has to do with going out to places where you might have to pay a tip, is when your partner typically expects you to pay for dates, it turns out a lot more people would actually rather share the costs a little bit more evenly. And another interesting one, 17% consider it a deal breaker when the other person works a lot. Yeah. Oh, yeah, that one surprised me because obviously there's a lot of pressure to be successful in your career and make a lot of money, but not at the expense of spending time with your loved ones.

[A]

I think it goes to show that time is love and the more time you spend together, the better your relationship is going to be. Sometimes it's best to close that laptop. Just spend time with your loved ones.

[D]

Yes. Come home and spend quality time together. And a couple other deal breakers we found people don't like when their partner asks to borrow money from them and they don't like, yeah, I know that's a deep one.

[B]

I think it depends on the stage of the relationship. Right?

[D]

Yeah. If you haven't been dating for very long, that's, you know, probably don't ask. If you've been together for a much longer time, you can potentially work out a deal because you know the person a lot better and there's that trust. But, you know, it can still be a really touchy subject. And people also do not like when a person has no savings or doesn't invest for their future, whether it's investing for retirement or other purposes or when somebody has a low credit score.

[A]

So I guess be on your best behavior financially at all times if you want any sort of love in this country because people have high standards.

[B]

Oh, my goodness, that sounds so harsh.

[D]

I mean, it's not even just high standards. I think it's the recognition that when you're tying yourself legally, potentially legally, or for the long term to another person, their ability to prepare for their future is. It also helps you prepare for your future together because if you're with somebody who maybe has never invested at all for retirement and you're going to be with them for several decades, eventually that's going to catch up with both of you and you're just not going to have as much money available to be financially secure in your retirement. And so people are thinking long term, is this something that's going to impact our ability to meet our shared goals as a couple? And it could be.

[A]

You want to see that people's behaviors as well are, you know, built in trust and forward planning and all of those things that will give you a secure life later on. But at the same time, a lot of people are dealt circumstances that are outside of their control that may make it so they don't have retirement savings. And I think it's okay if you're dating someone and they're in a completely different financial situation than you, and you love them very much, you can make it work because that's what love is. You'll make it work.

[B]

That's it.

[D]

Yeah.

[B]

And then I think it's important to differentiate, you know, financial values from life happening. Right. So I think maybe a lot of people here are, you know, basing these deal breakers on assuming that if a person has a low credit score, they have debt, that their financial values don't align or aren't good, quote unquote. But that's not necessarily true. Sometimes life is happening. It takes time to get to know what their true values are.

[A]

Yes, yes.

[D]

You Know, Sean, you talk about making it work and, you know, if you are in a relationship with somebody that is in a tough, really, you know, tough financial situation, they haven't had the ability to save much. Maybe they're living paycheck to paycheck. They don't have savings for retirement or other goals. Making it work with them is not burying your head in the sand as a couple. Making it work is talking about it and coming up with some sort of plan that makes sense for the two of you going forward. So you can still set joint financial goals together, but in a way that honors where both of you are and where both of you hope to be. You don't want to, oh, my partner has like, six figures of credit card debt.

[B]

La, la.

[D]

Whatever. No, let's talk about it. Let's talk about how we can, you know, move towards some sort of progress and what does progress look like realistically, rather than just ignoring the problem.

[A]

So I'm loving the grace and thoughtfulness that we're all bringing to this conversation here. I think that we would all be great partners to anyone based on what we've just been talking about, obviously. That said, Sarah, would any of these be absolute deal breakers for you, the topics we've just been discussing around debt, credit score, all of that?

[D]

Oh, I mean. Well, I'll throw out another stat from the survey that I disagree with. So we asked folks a bunch of questions about different things they would consider to be red flags. 42% said talking about money early in a relationship would be a red flag for them. Nope. I just. I think that I'm in good company here in saying that I disagree with this. You don't have to bring your most recent tax return to your third date or anything like that, but talk about money from the earliest stages of your relationship, even if it's just asking somebody, like, how do you like to spend your time? Do you like to travel? What was your family like growing up? Asking these sorts of questions can teach you a lot about that person without, you know, asking them to tell you how much they make in a year. So, you know, if they have expensive hobbies, if they travel extensively, if they talk about, oh, my family's vacation houses, plural, you could get a pretty good idea of what kind of lifestyle this person lives without actually asking about money.

[A]

Yeah, I think that points to how we're often talking about money when we're not talking about money. If you're on a first date and the person who took you out just goes and picks up the check without saying anything. That's a little conversation about money right there and who's spending it and what they want from the relationship. But eventually you want to get to the point of being explicit. And I would say do it sooner than later.

[B]

Yeah.

[A]

Okay. So, Elizabeth, you're up next.

[B]

Any deal breakers? You know what I started this conversation with? Like, yeah, most of these are deal breakers for me, but now that we're at the end of the conversation, I think I have more flexibility, especially with the nuance that we've discussed. But still, a lot of these things are deal breakers for me. But I would definitely say working a lot is not a deal breaker because I know how to keep myself busy. And then I guess it depends on how we define a lot as well. And a low credit score isn't either. And I think along those lines, debt isn't either, depending on how low the credit score is and how much debt it is.

[A]

Yes. And why they got into debt, because I think about that, too. Some people get into debt again because they have a hard time just making money sometimes, or some happens in their life where they have to, you know, have an expensive car repair, and any number of those things can get you into debt. But if it becomes symptomatic of a deeper trust issue in the relationship, that could be a deal breaker.

[B]

That's it. And I've put in so much hard work to get my finances to a decent place. And again, I know we're all starting at different places and all the different phases of our life, but I would just want to make sure, even if I am compromising, the person, again, has similar financial values to me so they don't derail my finances.

[A]

Yes.

[B]

So, Sarah, what are some ways to approach conversations about money within romantic relationships? As we've discussed earlier, it can be awkward, it can be uncomfortable to talk about, but it's definitely necessary. So what are your thoughts?

[D]

Yeah, I mean, we talked a little bit about this earlier, but just creating that culture of safety in talking about hard things, especially when it comes to money, but other stuff, too, within your relationship and give the other person the level of understanding you hope that they would have with you. We talked so much about how judgmental people are of other people, when in fact they are just projecting because they're judging themselves for the same things. So understand others as hard as you understand yourself and judge others hopefully less than you judge yourself. How about that? Make that your goal, because you're not always going to agree about money. You're two different people. You were raised in different households, you have different lives and you're merging those lives together. You're never going to totally be the same person. You're never going to totally agree. But if you can talk about it and come to work, agreements about things and negotiate and compromise, then those are all good signs for the health of your relationship.

[A]

Yeah, that's applicable across so many parts of a relationship. Compromise, communication, kind of to wrap things up. I'm wondering if either of you has ever broken up with someone or avoided dating someone because of the state of their finances.

[D]

I've never broken up with somebody because of money. There have been times where like a relationship I was in ended for other reasons. And then thinking back on it, I realized that we were also incompatible financially. But there were also other incompatibilities that came to the forefront sooner and ended the relationship for me.

[B]

Similar to Sarah, it wasn't the sole reason, but it was a big reason for two relationships I can think of. So one was a complete spendthrift and anytime any money came in their hand they had to just buy something new and shiny. So very difficult to plan and save with them. And the other one just didn't like working. So just like to, you know, that's tough.

[A]

It makes it hard to have money when you're not working like that.

[B]

Exactly. So I, I was footing the bills and that, that was a bit rough too. So.

[A]

Yeah, yeah.

[B]

What about you, Sean?

[A]

No, I haven't. I feel like I've been lucky. I, I've dated plenty of people where we had very different financial circumstances and we always find a way or have found ways to make it equitable. And that's what's important to me at the end of the day.

[B]

Wonderful.

[A]

This was a great chat, Sarah. We're going to keep you around for just a second longer as Elizabeth and I do a check in on how our no Spend Friction Spend challenges are going for the month of February. Quick recap for listeners who maybe didn't catch last week's episode. We're doing a month long challenge where Elizabeth is not spending money on non essentials. Is that correct, Elizabeth?

[B]

That is correct.

[A]

And I am adding friction to my finances where each week I'm doing something different. Last week I didn't buy anything online. This week I'm just using cash, which is already off to a rocky start. So let's look back. First, Elizabeth, how did your week go?

[B]

Actually, you know what, it went pretty good. Like I said, the brick has been helping me. I did, I was on Zara, you're Breaking your phone.

[A]

Yeah.

[B]

Yes, yes. For those who don't know what a brick is exactly, just to help me, you know, restrict social media apps or whatever I don't want to use. But I was on Zara just window shopping. I didn't buy anything, and I don't know, I feel like I should be penalized for going to Whole foods and spending $167 on groceries. It just. This broke my heart.

[A]

You're buying like two sweet potatoes for that amount of money.

[B]

I left with two bags. That was it. That was it. But that's an essential. So I guess to answer your question, I think I did good this week. I didn't buy any non essentials, just food.

[A]

Well, I'm proud of you for not buying anything from Zara, even though you did tempt yourself with some window shopping. I know.

[B]

How's yours going, Sean?

[A]

Mine went okay until the last part of the week where I. I've been getting my greenhouse set up to start seeds for the spring and going into summer. And I realized that these seeds I bought for some oriental chrysanthemums. If you guys don't know what those are, just Google them. They look like whipped cream on a stem. They're incredible. I bought these seeds and they're kind of hard to find. And then naturally I immediately lost them in my house and cannot locate them. So I was on a tear of rectifying my own forgetfulness, I guess, and bought like $60 worth of seeds from Etsy, which may not be real because a lot of the photos looked semi AI generated. Etsy is kind of like a aces pool of AI slop nowadays, turns out, anyway, so I just spent money in a fit of wanting to have these seeds. But beyond that, I didn't buy anything else online and I feel okay about that.

[B]

So it sounds like you get a B then, Sean, or is this A?

[D]

Yeah, that's C for chrysanthemum.

[A]

Thank you. I love it. Is it any better that I knew I shouldn't have been doing it, or does that make it worse?

[B]

Sometimes that's the thrill, you know.

[A]

Well, Sarah, I am wondering if you have any thoughts on how we did or what would you do differently in our case?

[D]

Oh, for no spend. Oh, well, I mean, I think the idea of doing things like bricking your phone and introducing friction are both great. One thing I would say is, you know, like, let's say your credit card numbers are saved on retailers, websites where you shop often. Just go ahead and unsave them, make it so that you have to manually enter your credit card number every time.

[A]

It's a great way to memorize it. And then you can't unsave it from your brain. Yeah, don't do. That's my issue.

[D]

I've done that in the past. Don't do that. But. Or like just put stuff in your cart and then commit to leaving it there for like 48 hours. And half the time you forget. You forget that you even put something in there. You don't go back and check. So those are all tricks that I play on myself that are really helpful.

[A]

It's all about little games for yourself to get you to spend or not spend or save or not save. Well, thank you, Sarah for coming on and chatting with us today. It was great.

[D]

Thanks for having me.

[B]

Up next, we're going to speak to a nerd about paying for senior care.

[A]

But first, listeners, you know what's up. Send us your financial questions.

[D]

Maybe you don't know how to navigate finances with your partner, and this episode has taught you that there's a lot you don't know yet. That's cool. Or you need tips on paying down debt. Whatever your money question, we nerds are here to help. Leave us a voicemail or text us on the nerd hotline at 901-730-6373. That's 901-730-N E R D. You can.

[A]

Also send us an email at podcastnerdwallet.com or leave us a comment on Spotify or YouTube. Okay, let's get to this episode's money question. That's up next. Stay with us. The following is a paid sponsorship, not an endorsement by NerdWallet's editorial team. Today's episode is sponsored by Bilt.

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[A]

We're back and answering your money questions to help you make smarter financial decisions. This episode's question is a long one, so Elizabeth and I are going to split up reading it. Hi nerds, I'm a longtime listener of this podcast and really appreciate all the information you share. Here is something I'm not sure you have tackled. My father in law currently lives alone out of state, but this is not a good setup for him long term as he is starting to have health issues that could change his ability to care for himself at any time. We are looking at how we can have him move closer to us into an independent assisted living situation. He has some liquid assets that he has saved for his retirement as well as a pension and Social Security for income. We've looked at a couple of places and they vary widely in their payment structure and levels of care that they offer. Some seem to be based solely off a monthly payment, while others have a buy in model where you pay a lump sum upfront but then have lower monthly fees going forward. Some of these buy in models are partially refundable.

[B]

We would like to build a budget to help him understand what type of living situation he could afford and for how long. Can you help us understand the pros and cons of these different types of payment models? We think he has enough funds to enable sufficient time at an independent or assisted living facility, but there could be a time when he needs to transition to a nursing home where the costs then skyrocket when his money runs out. I know that you can apply for Medicaid to pay for the cost of a nursing home. Can you talk a bit about what this process looks like and how we can prepare for it all the best. And our listener signs it Senior living is confusing. Listener. I second that.

[C]

And I third that.

[B]

Oh, hey Kate. So we have today with us to help us answer this question, nerd Kate Ashford, who is a certified senior advisor. Welcome back to Smart Money.

[C]

Hi guys. Happy to be here.

[A]

Hey Kate, good to have you. As always, we love bringing you on for the most technical topics. So let's just get right to it. Start by laying the groundwork for how much our listeners, father and law, or really anyone in this situation, might expect to pay for senior living care. So the challenge here is that it's pretty much universally expensive, but that the costs really vary so much depending on where you live. So I looked into some numbers here and in Alabama the monthly cost is about $4,700 a month. Meanwhile in Hawaii, the cost is over $11,600 a month or about $7,000 more each month. So given that, it seems like our listener first needs to figure out how much the typical cost could be where they're living or maybe where the father in law is currently living and also how much money is available to cover these costs right now. So in a sense that's a pretty typical cost of living budgeting challenge. Are there any other unique factors that folks should think about as they're considering their budget for assisted living?

[C]

Sure, Sean. So first I would really want to point people toward the Genworth and Care Scout cost of care survey. It's something they put out every year here. It's got numbers for all sorts of care from home health aides to assisted living, nursing homes, adult daycare. And you can dig in by state, which is really helpful because as you mentioned, data really is different depending on where you live. And it can also be different by locality. I mean New York City, very different from upstate New York. But this will give you a general sense and it's a good starting point. And then once you're looking into your local prices, please know that that there are different fees for different room types. So what is this person's father in law hoping to have or living situation? A single room, a shared room. Some places have apartments, even two bedroom apartments. If it's going to be a shared living space, there's memory care. And then of course there's a base rate versus an all in cost at most of these facilities. A base rate might include things like meals or light, housekeeping, social activities, transportation to doctor's appointments. But then there are probably add ons like help with activities of daily living like getting dressed, higher level care tiers as someone's needs increase, there generally is extra money for things like memory care. And then each year there's probably an annual increase in these prices. Just like anything else, your rent goes up. Rent goes up in these places as well. So you should budget for that and model different length stays. So there are a lot of variables and it's kind of a, a complicated starting point, but. But there you go.

[B]

Sounds pretty complicated. But our listener's question seems to basically be how do I pay for senior living care? But it could just as easily be how can anyone afford senior living care with how expensive all of these prices are you guys just mentioned? So how do people typically gather the funds for this? Are people using their retirement funds? Are they using Social Security? Are they using cash savings? And I imagine that people have to get creative here in terms of paying for it, right?

[C]

Absolutely, Elizabeth. I think it really is an all hands on deck situation. If you have the money somewhere, I think you're using it. So people are certainly using Social Security for these expenses, their personal savings, retirement accounts for sure. I mean, this is what that money is for, right? You're in your retirement years, so definitely pull from those accounts. Home equity. Some people will sell their home and use that equity toward long term care or a reverse mortgage if there's a situation where you're trying to stay in the house and have in home care. Some people have long term care insurance, some people are veterans and there are some veterans benefits that are available to folks who have served at certain times or in certain places. So contact the VA if you have questions. I would note that Medicare does not cover long term care, so that's not an avenue to go down. And there's this sense as people are contemplating this decision that they don't want to spend down their assets because they're trying to leave a nest egg to their heir. But I would say that your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.

[A]

And once you do spend on those assets, it'll be easier to qualify for Medicaid. Although be careful when you're trying to qualify for Medicaid, you have to have a very small amount of assets to qualify. And there is what's known as a five year look back. So if you just try to deplete all of your assets, give them to your loved ones, that's going to be looked into and found and you can be fined and punished for that. So don't try to trick the system because they are one Step ahead of you. You.

[C]

They're definitely watching out for that.

[A]

Yes, yes. So ahead of this conversation, I scoured a lot of Reddit threads, as I love to do. And I was trying to figure out how random people on the Internet just handle this affordability question when it comes to senior care. And I did see a lot of suggestions about depleting your assets to qualify for Medicaid, or getting roommates, or even moving to a less expensive country. And looking through these threads, it was frankly pretty depressing. And I think it really highlights how little support our government provides seniors, especially depending where you live, since some programs are state run. So, Kate, do you think that these threads I was reading are actually representative or was it just an especially bleak corner of the Internet?

[C]

It does sound like a bleak corner of the Internet, but it also sounds like a representation of a lot of people being confused and stressed because they're in situations where they don't have a lot or maybe anything at all saved and they're not sure how to swing the cost of this care because it's expensive and Social Security isn't going to cover it all the way. And Medicaid is confusing and it really can feel bleak. For sure. The majority of people are not leaving the country. There's something like 61.2 million people in the U.S. over age 65. And I went looking. There are something like 670,000 people getting Social Security abroad. So that's 1%. It's teeny. Roommates are not the cure all. Maybe you can set up kind of a golden girl situation.

[A]

Ah, that's the dream.

[B]

I always love those. I came across an Instagram post a couple of years ago of elderly women who did that. They all bought a huge house and just lived together. And I thought, how cool is that?

[A]

That is my go to comfort show. I would love to live in that reality.

[C]

Oh yeah, who wouldn't want to be in the Golden Girls again? Those ladies were all in good health and no one there was looking for long term care. So if you're talking about someone who needs care, it's a slightly more complicated equation. So generally it's hard and it's costly. And in a lot of cases, older adults are getting by with family caregivers. Sometimes they're moving in with them, sometimes our caregivers are moving in with the older adults because really there's only a small percentage of the over 65 folks are in assisted living or nursing homes. It's only about three and a half percent, actually.

[A]

Oh wow. That's a lot less than I thought it would be.

[C]

Yeah, it is.

[B]

And when I think about it, Kate, because I do know many people who are in the sandwich generation currently and having to take in their parents. Well, not having to choosing to take in their parents. I don't know many people who have or anyone who has their parent in assisted living care or a nursing home.

[C]

I think for as long as people can, they try to get by with family or some situation where they don't have to go someplace else that isn't home.

[B]

Well, our listener mentioned two payment structures, monthly payments and also a buy in structure. So Kate, can you outline how these work typically?

[C]

Sure. So you're basically looking at two setups here. Facilities with monthly payments. It's exactly like it sounds. You're paying rent, there's a monthly fee that covers a certain base level of services. That's the typical setup for assisted living facilities. And nursing homes. Buy in facilities are generally things like continuing care retirement communities. You might hear them called CCRCs. And those are the places that offer different step up levels of living. So they'll have an independent living location, assisted living and skilled nursing kind of all on one campus. And as you need more care, you kind of step up in housing. And those usually require an upfront lump sum like a big deposit and then an ongoing monthly fee. And those can be a really good option for certain people at certain times of their lives. It's worth noting that you must be healthy enough to live independently when you move into a ccrc. They're not looking for folks that are moving in and going immediately to assisted living. They're looking for folks who can live independently for a while and exist in that community for a few years.

[A]

This might be totally out of left field, Kate, but have you heard about Margaritaville?

[C]

I have not heard about Margaritaville.

[D]

Wait, wait, wait, wait.

[A]

Living facility. I believe it's in Florida and it's for folks who love Jimmy Buffett and Margaritaville and you can live there and live your Margaritaville dream in your older years. So that's a little bit less focused on the healthcare side of things and more the lifestyle side of things. But I think it shows that there's a huge range of options available and some might be more fun than others.

[C]

For sure, that does sound more fun than many options. Gotta say.

[A]

Okay, well, well, continuing on with the important and listener focused part of this conversation, they said that they could potentially get a refund for the buy in structure. How would that work?

[C]

So I just want to mention up front this depends. Rules vary by facility. So in general you can sometimes get a refund, but not always. Make sure you read the paperwork. You might find that a CCRC will refund some or all of your buy in money if you move out within a certain period of time. Some are refundable on kind of a declining scale over five years.

[D]

Years.

[C]

Some are partially refundable, some are fully refundable. Read the contract so you understand the terms. My grandparents actually bought into a CCRC in the early 2000s and then my grandmother passed away kind of unexpectedly pretty soon after they moved in. But my grandfather left the community and got a lot of his buy in back because they weren't there for very long. So that is a thing you can get out of those arrangements if the contract says you can.

[B]

Certainly a silver lining there.

[C]

Yes.

[B]

How can people determine which might be best for their family situation? Because we know this varies according to your situation. Does it involve some morbid estimation of how long your loved one might live or need this kind of care?

[C]

Kind of. Yes, it, it does. I mean, this is going to depend on your older adult, right? So if you've got someone who needs a lot of help or you've got someone who just needs some companionship and meals and light housekeeping, those folks are going to have, have different timelines. There are services out there like a place for mom where you can call in to describe your loved one's needs and what they're hoping to get out of the care they're looking for. And they can point you toward the facility that best fits it in your area at your price point. So it's kind of a nice resource if you are looking for someone to talk to about that and you're, you're doing some longevity calculus. If you have a more independent older adult who's moving into assisted living, they're probably going to need it for longer than someone who's really ill and moving into skilled nursing. More or less. In terms of averages. I actually spoke to someone. I talked to Bill Comfort, who is a long term care insurance specialist in North Carolina, and he gave me some data from the perspective of long term care insurance claims that cover this kind of care and how long those claims are paid out on average. So how long is someone getting these claims paid? Keeping in mind that long term care insurance doesn't typically pay until someone needs help with at least two activities of daily living. So dressing, bathing, eating, or continual supervision for safety. If someone is cognitively impaired, that number is a little skewed because about 40% of claims last less than a year because people are quite ill. But if you give a little leeway for that, the advice for men is generally to expect probably two to four years, and for women, expect three to six. As your kind of basic starting point, a financial planner can help you run longevity numbers. Your family doctor might be willing to give you a timeline, although in my experience, not always. It's really. It's a big educated guess.

[A]

It sounds like it'd be really hard to pin down this exact number even if you are working with a financial planner, because part of it comes down to your family history as well and how long people tend to live, what sort of illness you might have, and it just makes it hard to really know what's what. So how do you think people can best navigate this?

[C]

That it's incredibly specific. I think you have to model for all the scenarios. I think you have to decide, you know, if my loved one beats the odds and lives for another 20 years, could we manage that or, you know, what the numbers look like if that happens, you just have to build that into your equation.

[B]

I just want to say these sounds like such difficult decisions to make, number one. And also, as I'm listening, I wish we started learning about this earlier on in life. Right. Because it seems like. Like it'd be a lot more stressful to have to make that decision in the moment. Whereas if you learn about it early, which is what we're hopefully doing through this podcast and sharing the information, you can start thinking about it and planning for it, you know.

[A]

Yeah. And beyond learning about it and hearing about it on a show like this, it's also really important to have these conversations with your family. And Kate, something that you and I have talked about before is how this isn't just a one conversation thing. It's something that you need to continue to bring up because covering all this ground at one time is just overwhelming and stressful and not really feasible. So take it a little bit at a time and just try to make a plan, but do have that conversation.

[B]

Don't shout at me. This is making me sad. Both of my parents are still alive and honestly, we've not had this conversation and luckily they're both healthy and independent, but they're aging and that might not always be the case.

[A]

So add this to your to do list, Elizabeth.

[C]

Ah, I'm sad a little bit at a time.

[A]

Yeah. And hey, I mean, for me, I feel more empowered by this. This is something that I need to be talking about my parents with and I think, think in order to avoid feeling sad later, you talk about it now. Right. Like what do they want? Given all that could happen, how can you best make sure they have the later in life care that they would like to have while also making it feasible financially for everyone involved?

[C]

I feel like if you normalize talking about it, it becomes less taboo and weird and depressing. It's just, you're just talking about it the way you would talk about any financial planning topic. Right. It is something that comes out up for everybody. So.

[A]

Yeah, reduce the stigma around it.

[C]

Yeah.

[A]

Well, let's pivot now over to Medicaid because our listener seems like they might want to be taking advantage of that for their father in law once their assets are depleted. So Kate, can you run us through quickly the Medicaid application process and again how you qualify for it?

[C]

Absolutely. I feel like my answer to all of your questions today is it depends.

[B]

Welcome to the finance world.

[C]

Yeah, and Medicaid is kind of like that. It's administered by state, the rules vary by state, so it's, it's kind of hard to generalize. And there is no central process. So that's super helpful.

[B]

Right.

[C]

In the most general sense. Qualifying for Medicaid as an older person is going to be income based. You typically must have income and assets below a certain level. That's going to depend on your state. There are people in your state who are going to have information about this. So I encourage people to call and ask. Easiest place to start is your state Medicaid office. You can probably find [e-mail], although that site is a little bit, little hard to navigate. So you can also just google your state Medicaid office and go from there. Your local office on Aging is a good place to go. You can find [e-mail] you can find the one closest to you. There's also a website called MedicaidPlanningAssistance.org it's a site from the American Council on Aging. It's got a lot of information on Medicaid. And then if you really are just like, I don't know what to do, this feels complicated. There are folks out there called certified Medicaid planners. You can talk to them. They do cost money. They may offer a free consultation to get a sense of your situation and whether they can help you. I actually did this when I was working on something for my mom a couple of years ago and it was helpful and I didn't need anything beyond the free consultation so no harm in calling.

[A]

Do you recall what the person's fee may have been if you did decide to go ahead and hire them?

[C]

It was a few thousand. But keep in mind, I'm in the Westchester, New York City area, so everything is a few thousand out your door.

[A]

Is a few thousand dollars over there.

[C]

Exactly. If you're in a really prickly situation, you might want to call an elder law attorney. I, actually, speaking of Reddit, saw a story of someone that moved their father to a state where he could qualify for Medicaid if his assets were structured in a certain way and that worked for them. So sometimes the upfront cost for this might be worth it. And keep in mind, a lot of facilities will accept private pay and Medicaid and can transition your loved one to Medicaid when they've depleted their assets. So that is something to keep in mind, too. They could move in on private pay and be transitioned to Medicaid later at some facilities.

[A]

Yeah. What I'm hearing from all of this is that there are a lot of resources and people that can help you navigate this. You're not alone in figuring this all out.

[C]

Absolutely.

[B]

Kate, do you have any other advice for our listener or anyone else dealing with this process for their loved ones?

[C]

As Shawn mentioned, there are so many resources out there. I'm a big fan of asking people I know for advice. If you know anyone who knows anyone who might have information that's helpful, reach out to them. I think people want to be helpful and they're happy to speak to you. When I was working on things with my mom a couple of years ago, I spoke to friends of friends who were geriatric nurses and acquaintances who were going through similar things with their parents and people in Facebook groups and generally anyone who would talk to me for 10 minutes. So it's stressful. So take your time. It's not worth rushing. Ask those questions and take care of yourself because, again, it's hard.

[A]

Yeah. Good advice. Kate. Thank you so much for coming on and talking with us.

[C]

Yeah, thank you for having me again.

[A]

And that's all we have for this episode.

[C]

If you want the nerds to help you answer your money question, call or text us your questions at 901-730-6373. That's 901730, nerd. You can also email [e-mail] or you can leave us a comment on Spotify or YouTube.

[B]

We love your company, so we want you to join us next time when we talk to a couple about how they're planning for retirement in an age gap relationship. Follow Smart Money on your favorite podcast app that is Spotify Apple Podcasts iHeartRadio to automatically download new episodes.

[A]

Here's our brief disclaimer. We are not your financial or investment advisor. This interview info is provided for general educational and entertainment purposes and may not apply to your specific circumstances. Circumstances.

[B]

This episode was produced by Tess Viglund. Hilary Georgie helped with editing. Nick Karisami mixed our audio and we want to say a big thank you to all of our editors for all of their help.

[A]

Until next time, turn to the nerds.

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