What Happens to the Family Home When Both Spouses Need Long-Term Care

A Phone Call No Family Is Ready For

It was a Friday evening when Sandra called our office. She had just left the hospital where her father, Jim, had been moved to a rehabilitation unit after a fall.

Jim had been her mother Betty's primary caregiver for the past two years. Betty had Alzheimer's. She could not be left alone. And now Jim was in a hospital bed with a broken hip, facing weeks of rehabilitation — and possibly a nursing home stay of his own.

"What happens to Mom?" Sandra asked. "And what happens to their house?"

In nearly 30 years of practicing estate and elder law, that question — or some version of it — is one I hear more than almost any other. Most families have thought about what happens if one parent needs care. Almost none have thought through what happens when both do.

If you are reading this because you are in Sandra's situation, or because you are a couple who wants to understand what you are actually facing, I want to give you a straight answer. Not legal jargon. Not a lecture. Just what you need to know.

The Odds Are Higher Than Most Couples Realize

Here is a number that should get your attention. According to the U.S. Department of Health and Human Services, approximately 70 percent of Americans over the age of 65 will need some form of long-term care during their lifetime. A landmark 2019 federal report by researcher Richard W. Johnson — titled "What is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?" — put it plainly: "The prospect of becoming disabled and needing long-term services and supports (LTSS) is perhaps the most significant risk facing older Americans."

When you apply that 70 percent figure to a married couple, the math becomes sobering. The odds that at least one spouse will need care are very high. The odds that both will eventually need some level of care are meaningful — and far more common than most families have planned for.

The average length of care for a man is 2.7 years. For a woman, it is 3.2 years. But those are averages. Alzheimer's disease, Parkinson's, dementia, and other memory-related conditions routinely require five, seven, or ten or more years of care. The question is not whether this could happen to your family. The question is whether you have a plan when it does.

What Long-Term Care Actually Costs in 2025

Before we discuss the legal scenarios, it is worth understanding the scale of what we are talking about. The numbers from the 2025 Genworth Cost of Care Survey are not projections. They are the average costs families in Minnesota and Florida actually paid in 2025.

Minneapolis, Minnesota — 2025 Annual Costs

North Port / Southwest Florida — 2024 Annual Costs

Costs are rising faster than general inflation across every category. And when both spouses need care, the numbers multiply in ways most families have never modeled.

Scenario One: One Spouse in a Nursing Home, One Spouse at Home

This is typically the first scenario families encounter. One parent has a health event — a stroke, a fall, a diagnosis — and needs facility-level care. The other remains at home, still independent, and terrified about what this means for the family finances.

Federal Medicaid law provides real and meaningful protections here. The home is shielded while the community spouse — the one who remains at home — is living in it. Medicaid cannot force a sale of the home to pay for the care of the institutionalized spouse.

That is genuinely good news. But it is not the whole story.

The State Is Keeping Track

Every state that participates in Medicaid is legally required to pursue what is called estate recovery — the process by which the state seeks repayment for Medicaid benefits paid on behalf of a recipient after that person passes away.

Here is how it works in practice. The institutionalized spouse passes away. The state does not immediately come after the home because the community spouse is still living in it. But the state has been running a tab — tracking every dollar of Medicaid benefits paid. When the community spouse eventually passes away, the state can and does file a claim against the estate to recover those costs.

This means a family can lose the home — not because the community spouse ever received a single dollar of Medicaid benefits, not because they did anything wrong — but simply because the state is entitled to recover what it paid for the other spouse. The children who expected to inherit the family home may find it must be sold to satisfy that claim.

This happens to real families in Minnesota and Florida every year. And with the right planning done early enough, it is entirely preventable.

Scenario Two: Both Spouses in a Nursing Home With an Intent to Return

Sometimes both spouses end up in a care facility at the same time — but one of them expects to return home. Perhaps it is a rehabilitation stay following surgery. Perhaps the prognosis is uncertain. Perhaps one spouse is recovering while the other is receiving long-term care.

In this scenario, the home may still be considered a protected asset under Medicaid rules. The intent to return is a recognized legal standard in both Minnesota and Florida. As long as one spouse genuinely expects to return, the home retains its protected status.

But the Medicaid estate recovery lien still applies. The home being temporarily protected during the care period does not erase the state’s right to recover benefits after both spouses have passed. Families in this scenario are often relieved when they learn the home is protected — and do not realize that a recovery claim is still building in the background.

Scenario Three: Neither Spouse Can Return Home

This is where the stakes become highest — and where the most families are caught without a plan.

If neither spouse is realistically expected to return home — because of advanced dementia, significant physical decline, or a permanent placement in memory care — the home loses its protected status under Medicaid rules entirely.

When no community spouse is living at home and neither spouse has a realistic intent to return, Medicaid treats the home as what the rules call an available asset. That means it must be spent down toward the cost of care before Medicaid will pay a dollar.

For families in this situation, the home they spent a lifetime building must often be sold — quickly, under difficult emotional circumstances, sometimes while both parents are still alive and in facilities.

Minnesota vs. Florida: The Rules Are Different — and the Differences Are Significant

One of the most important — and most misunderstood — planning issues I encounter involves families who live in Florida but still own property in Minnesota, or who are considering a move from one state to the other as their care needs grow. The Medicaid rules in these two states differ in ways that can have a profound impact on what can be protected and what cannot.

Minnesota: Enhanced Estate Recovery

Minnesota has what is known as enhanced estate recovery. This means the state’s recovery rights are not limited to assets that pass through the probate process. Minnesota can reach assets held in a revocable living trust — even though those assets pass outside of probate.

This is a critical distinction that catches many families off guard. A revocable trust is a cornerstone of most estate plans — and rightly so. But in Minnesota, placing your home in a revocable trust does not protect it from Medicaid estate recovery. The enhanced recovery statute reaches beyond probate, and the state can still file a claim against the home even if it is held in a revocable trust.

To genuinely protect a home in Minnesota from Medicaid estate recovery, it typically must be placed into an irrevocable Medicaid Asset Protection Trust — a specialized legal structure that, when properly funded at least five years before a Medicaid application, removes the home from the reach of both Medicaid asset rules and estate recovery.

Florida: A Narrower But Still Consequential Recovery Approach

Florida takes a more limited approach. In Florida, Medicaid estate recovery generally applies only to assets that pass through the probate process. Florida also imposes an equity limit — if the home’s equity exceeds a certain threshold, it may not qualify for protection.

For Florida residents, a properly structured revocable living trust can be an effective tool for keeping the home outside of Florida’s Medicaid estate recovery process, because assets in a revocable trust typically pass outside of probate in Florida.

But that protection applies to the Florida home. And that is exactly where many families with ties to both states make a very costly mistake.

The Snowbird Trap: When Your Northern Property Is Left Exposed

I see this situation regularly in my practice, and it is one of the most important planning issues facing families with connections to both Minnesota and Florida.

A couple establishes Florida as their primary residence. They claim Florida’s homestead exemption. They work with an estate planning attorney and put their Florida home into a revocable trust. Their Florida plan is solid.

But they still own the lake cabin up in Minnesota. Or the family home where they lived for thirty years before they moved south. And that property — because it is located in Minnesota — is governed by Minnesota law. Including Minnesota’s enhanced estate recovery rules. And, because it is not homestead property, it is also subject to spenddown requirements even if you are a Florida resident.

The revocable trust that works well for the Florida home does nothing for the Minnesota property. I have worked with many families who had done careful, thoughtful planning for their Florida assets and had no idea the cabin was completely exposed. It was not from a lack of caring. It was simply not knowing that the two properties are governed by two fundamentally different sets of rules.

Protecting the Minnesota Property

To protect a Minnesota property from Medicaid estate recovery, it typically needs to be placed into an irrevocable Medicaid Asset Protection Trust — funded well in advance of any Medicaid application. The five-year clock starts when the property goes into the trust. The earlier it is done, the more protection is available.

What If Your Parents Move Back to Minnesota for Care?

This scenario catches families off guard more than almost any other. Your parents are living in Florida, have structured their plan under Florida law, and then — as their health declines and care needs grow — they decide to move back to Minnesota to be closer to family.

The moment they establish Minnesota residency and apply for Medicaid in Minnesota, they are subject to Minnesota’s Medicaid rules. It does not matter that the plan was built around Florida law. If Minnesota is where they live when they apply for benefits, Minnesota’s enhanced recovery rules apply — to everything.

For any family with connections to both states, the plan must account for both sets of rules from the beginning. Not after a move has already happened.

What Can Be Done: Planning Strategies That Protect Families

The good news — and there is genuine good news here — is that there are proven legal strategies to protect the family home and life savings even in the two-spouse care scenario. The key is timing. These strategies work best, and in some cases only work, when put in place years before a crisis arrives.

Medicaid Asset Protection Trusts

An irrevocable Medicaid Asset Protection Trust is one of the most powerful tools available for protecting a home from nursing home costs and Medicaid estate recovery. When properly structured and funded at least five years before a Medicaid application, the assets inside the trust are no longer counted as available and are not subject to estate recovery. Parents can continue living in the home during their lifetimes, and the home is preserved for the next generation.

Spousal Protections Under Federal Medicaid Law

When one spouse is in a nursing home and the other remains at home, federal law provides meaningful protections for the community spouse — including the right to retain a portion of the couple’s countable assets and a minimum monthly income. Understanding and proactively planning around these protections can significantly improve the financial outcome for the spouse who remains at home.

Understanding the Difference Between Revocable and Irrevocable Trusts

A revocable living trust is a cornerstone of most estate plans and serves important purposes — avoiding probate, managing assets during incapacity, providing for a smooth transition to heirs. But in the context of Medicaid planning, particularly in Minnesota, a revocable trust does not protect assets from estate recovery. Only an irrevocable Medicaid Asset Protection Trust — properly structured and funded well in advance — provides that protection.

Multi-State Planning for Families With Ties to Both States

For families with assets in both Minnesota and Florida, the plan must be designed with both states’ rules in mind. A plan built exclusively around Florida law may protect the Florida home but leave a Minnesota property entirely exposed. Comprehensive planning means no asset in either state is left behind — and it requires working with an attorney who is licensed and experienced in both jurisdictions.

Why Timing Is Everything

The single most consequential mistake families make is waiting until a parent is already in a crisis before seeking legal help. By that point, many of the most effective strategies are no longer available because of the five-year look-back period. Families who call us when planning could still be done almost always have more options than they expected. Families who call us in the middle of a crisis rarely do.

Even if your parents are in their early seventies and in good health today, the time to create a Medicaid Asset Protection Trust for the family cabin or the out-of-state property is now. Not after a diagnosis changes everything. Not after a fall sends one parent to a rehabilitation facility. Now.

The five-year clock starts when the trust is funded. Every year that passes without a plan is a year that could have been working for your family.

Frequently Asked Questions

Does the home have to be sold if both spouses go into a nursing home?

Not automatically, and not always. If one spouse remains at home, the home is protected while that community spouse lives there. If both spouses are in a facility but one has a genuine intent to return, the home may retain protected status. If neither spouse can return home, the home may be treated as an available asset and could need to be sold before Medicaid will pay. The outcome depends heavily on the specific facts and which state you are in.

Does a revocable living trust protect the home from Medicaid in Minnesota?

No. Minnesota has enhanced estate recovery, which means the state can pursue recovery against assets held in a revocable trust — not just assets that pass through probate. To protect a home from Medicaid estate recovery in Minnesota, the property typically must be placed into an irrevocable Medicaid Asset Protection Trust, funded at least five years before a Medicaid application.

Does a revocable trust protect the home in Florida?

It can — but only the Florida home, and only from Florida’s estate recovery process. Florida limits recovery to assets that pass through probate, and a properly structured revocable trust keeps assets outside of probate. However, this protection does not extend to property located in another state, such as a Minnesota cabin or lake home, which is governed by Minnesota’s rules.

What happens to the surviving spouse's income and assets when one spouse goes into a nursing home?

Federal law protects the community spouse — the one who remains at home — from complete impoverishment. The community spouse is entitled to keep a portion of the couple’s combined countable assets (the Community Spouse Resource Allowance) and a minimum monthly income. The specific amounts vary by state and are adjusted periodically. An elder law attorney can help you understand exactly what protections apply in your situation and how to maximize them.

Is it too late to protect anything if both parents are already in a nursing home?

Not necessarily. Even when both spouses are already in care, there may be options depending on the specific situation, the assets involved, and the states where they live. Crisis Medicaid planning is more limited than planning done in advance, but it is rarely the case that nothing can be done. The most important step is to speak with an experienced elder law attorney immediately rather than assuming all options are gone.

What is Medicaid estate recovery and when does it apply?

Medicaid estate recovery is the legal process by which a state seeks repayment for Medicaid benefits paid on behalf of a recipient after that person passes away. In most states, recovery is triggered after the death of both the Medicaid recipient and the community spouse. The state files a claim against the estate — which can include the family home — to recover the benefits it paid. The scope of recovery differs by state: Florida limits recovery to probate assets, while Minnesota’s enhanced recovery reaches beyond probate to assets held in revocable trusts.

A Final Word From Chuck Roulet

Why I Practice Elder Law

I watched my grandparents lose everything to a nursing home — their homes, their savings, and ultimately their dignity — because at the time, Minnesota was not following federal law. My grandfather, a WW II veteran, wept when he learned everything, including the small home he inherited from his brother, was gone. Thankfully, MN has now been forced to follow federal law. Florida has been following federal law for many years.

That experience shaped the way I practice law. In nearly 30 years, I have helped hundreds of families protect their homes, their savings, and their peace of mind — even when the diagnosis had already arrived. I have also sat across from families where it was too late to do everything we could have done earlier.

I do not want that to be your family's story.

The families who come to us early — even after a diagnosis, even when they think it might be too late — almost always have more options than they expected. The families who wait rarely do.

If you would like to schedule a consultation to discuss your own planning, call us today at (941) 909-4644 for our Florida office or at (763) 420-5087 for our Minnetonka, Minnesota office. Or you can fill out the contact form on this page and a member of our team will reach out to you to you to schedule.

If you would like to discover more, here are two additional resources for you:

Download your copy of "Save Our Home: How to Protect Your Home and Life Savings From Long-Term Care and Nursing Home Costs". Click here to download your copy.

Join us in my upcoming masterclass where I reveal strategies I use with my private clients to help them protect their home and savings from long-term care costs. Click here to sign up.

Join us in my upcoming masterclass where I reveal strategies I use with my private clients to help them avoid probate, save on taxes, protect the money they leave for their kids in the event they get divorced and much more. Click here to sign up.

About the Author

Chuck Roulet is an estate and elder law planning attorney at Roulet Law Firm, P.A., with offices in Minnetonka, Minnesota and Venice, Florida. He is licensed in both states and has nearly 30 years of experience helping families protect their homes, life savings, and legacies. He has been interviewed by USA Today, Live Life Large, CNN, The Epoch Times, and other national media, is the author of several books including The Florida Snowbird Guide, and teaches continuing education to attorneys, financial advisors, and government professionals across the country.

This article is for informational purposes only and does not constitute legal advice. Please consult with a licensed attorney regarding your specific situation.