On August 1, 2016, Ohio changed its Medicaid regulations regarding the treatment of the home. Federal and State Medicaid laws recognize that the family home is often times the largest asset of an individual, and Medicaid rules account for the reality that the family home is critical to the well-being of a spouse, a child, or other family members. Still, the changes in the law make protection of the house even more difficult and cumbersome. Now more than ever, early planning involving the relatively simple act of transferring the home into an irrevocable trust can ensure that the home will remain in the family for generations, regardless of the need for long-term care.

Medicaid defines the “Home” as any real property in which an individual has an ownership interest and is the individual’s principal place of residence. A “principal place of residence” is the home to which a person would intend to return if they were absent, like in the case of a stay in a rehab facility or a nursing home.

Generally, the family home that is considered the principal place of residence by an individual or a married couple is an excluded resource, regardless of value. However, the new rules state that the home is no longer considered to be the principal place of residence and will be countable if the individual does not intend to return home. However, the rule states that a “temporary” absence from the home does not affect the exclusion of the home as

Many of my clients are caregivers. They are often caregiving for their children with disabilities or for their elderly parents. Others are more distant relatives who have taken it upon themselves to care for their loved one. Although their situations vary greatly, I see many recurring themes. I see strength, compassion, and selflessness on a grand scale. I see struggle, grief, and a unique optimism that finds joy in the little moments. I would like to touch on some of those struggles and offer some solutions and hope.

Society fails to recognize the great sacrifices made by caregivers across the country. Approximately 34.2 million people in the United States are caregivers for an adult age 50 or older, according to a 2015 AARP report. About half are caring for a parent. Some caregivers retired early, reduced their hours to part-time, or quit their jobs entirely to care for their loved one. Unpaid family caregivers contribute $470 billion worth of care to the US economy. What I personally find the most frustrating is that this sacrifice is assumed by society and often goes unthanked and unrecognized. Caregivers often feel a sense of duty to sacrifice their careers, their time, and often, their own health. This results in martyrdom of our most kind and deserving citizens. Not only should we as a society better appreciate and care for our caregivers, but we must support caregivers in caring for themselves.

There are a few different ways to get support as a caregiver.

For years, I have been helping people complete durable powers of attorney for healthcare, living wills, and do-not-resuscitate (DNR) orders. Collectively, these documents are called “advance directives.” They give directions about the care desired in advance of the need for that care. Advance directives allow you to select whether or not you want your healthcare providers to stop giving you “life-sustaining treatment” when you are in a “permanently unconscious state” or a “terminal condition.” Additionally, a living will and a DNR order allows you to tell healthcare providers and emergency medical service providers that you do not want to have CPR given to you in those cases when your heart has stopped beating (cardiac arrest).

Inevitably these questions come up during my discussions with people about their advanced directives: “What if my health care providers are making a mistake?” “How can someone stop a mistake from being made?” The answer is that there are checks and balances built into the laws that control how your advance directives operate. Let me explain.

First, I think it’s important to make sure you understand the meaning of some of the terms in your advance directives. A “permanently unconscious state” means, that to a reasonable degree of medical certainty, determined using reasonable medical standards, your doctor and one other doctor who has examined you, determine that you are irreversibly unaware of your environment and you have a total loss of cerebral functioning. In a permanently unconscious state you have no capacity for pain or