‘How does a family work this out?’ Shouldn’t my mom’s husband of 34 years pay for her long-term care — or is this the kids’ responsibility?

Answer: The “who should pay” conversation is tricky, so it’s hard to give a blanket, one-way-or-the-other answer. “When negotiating this topic, families should look at the ability to pay,” says certified senior adviser Dharam Khalsa at Mirador Living. “I work mostly with families in the San Francisco, California area and in many cases, the adult children earn much more than their parents ever did. And they had this opportunity largely because of the sacrifices their parents made. In these cases, it’s fair for the adult children to pitch in and I’ve seen it happen many times.”

But generally speaking, the parent or patient requiring long-term memory care is financially responsible for the cost of expense. “The burden often falls on the caretaking spouse to coordinate and figure things out. It’s also common for adult children to assist their caretaking parent, however they have no obligation to contribute,” says attorney Russell Reynolds, partner at Reynolds & Reynolds. 

In some cases, parents who benefited tremendously from real estate appreciation might consider using the proceeds from selling their home to cover memory care expenses, says Khalsa.

For senior living placement operator Brett Koenig at Senior Living Search Partners, one thing he says he’s learned is that what’s right for one family isn’t always right for another. “It’s worth considering whether the spouse themselves may need some assistance soon as well. This is why it’s so important to have these conversations ahead of time. Have a plan. If finances are a concern, there are options like long-term care insurance that can help families handle the costs, but only if they plan ahead,” says Koenig.

It might be helpful to have your mom’s husband and you and your sibling meet with an elder law attorney. “They can help understand your options and how to coordinate long-term care insurance benefits and assistance programs to protect your parents’ assets as much as possible. A financial planner doesn’t have this expertise,” says Reynolds.

Know, too, that your mom might qualify or eventually qualify for assistance programs under Medicaid, depending on available income and resources after exemptions or exceptions, including needs of the caretaking spouse, says Reynolds. “If a physician has assessed a spouse with a high risk or new diagnosis of memory disorder, it’s a good idea to see an elder law attorney as soon as possible. The elder law attorney can help determine how much time you have for eligibility if assets require reorganization,” says Reynolds.

Though Medicare is certainly useful, it can’t be the only solution you rely on. “It may cover limited stays in a skilled nursing facility after hospitalization under specific circumstances; it does not provide coverage for long-term care, assisted living facilities or retirement homes. It may in some cases cover medically necessary medical care rendered there by a licensed professional, but not the costs associated with living in such a facility,” says Whitney Stidom at eHealth. 

To better understand the complexities surrounding Medicare, Medicare Advantage and Medicare Supplement, working with a licensed insurance agent can pay dividends. “Enrolling in Medicare can be an overwhelming and complex process, given people on average have over 40 Medicare Advantage plans to choose from. In addition, many beneficiaries struggle to understand the differences between various kinds of Medicare coverage and how it may impact their out-of-pocket costs,” says Stidom.

While working with a financial planner can’t directly help answer who should pay for your mom’s care, having a comprehensive financial plan in place can give you a better understanding of how much you might be able to contribute to her care. What’s more, having input from an adviser can help you save for your own care down the road, so that you don’t find yourself in a similar position as your mom.

In your case, working with a fee-only fiduciary adviser will ensure you’re engaging with someone who is putting your best interests ahead of their own. Look for a CFP who offers hourly or project-based services and can create a holistic financial plan to guide your financial life based on your risk tolerance and time horizon. Hourly planners tend to charge between $200 and $500 per hour while project-based advisers cost $1,500 to $7,500 depending on the scope of the project. (Looking for a financial planner too? This free tool from our ad partner SmartAsset can match you to advisers, as well as sites like CFP Board and NAPFA.)

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