What Is a Trustee in Estate Planning?

A trustee is the person or institution appointed to manage a trust on behalf of beneficiaries of the trust.

Being a trustee is a significant responsibility. Those serving in this role must always act in the best interests of beneficiaries when carrying out their trust management duties, which include locating and protecting trust assets, investing assets prudently, distributing money and property to beneficiaries, keeping track of income and expenditures, and filing taxes.

When a trustee does not fulfill their duties, beneficiaries have the right to file a lawsuit against them. Trust litigation can have significant financial and emotional consequences, draining estate assets and damaging the relationships between the parties involved.

While a family member is often the first choice to serve in this position, to avoid potential conflicts of interest and disputes among heirs, a professional, independent trustee might be a better choice.

Trust Fundamentals

Most people have heard of trusts and have a basic idea of how they work. The inner workings of a trust, however, are complex and may not be as well understood.

Trusts are created by a document called a trust agreement (aka a trust deed or trust instrument). Some trusts are also created by a person’s will. There are three parties to a trust:

  • The grantor is the person who establishes the trust, funds it, and provides instructions about how to administer it in the trust document.

  • The trustee is the person the grantor names in the trust document to administer the trust. They can be an individual, such as a trusted family member, or an organization, such as a law firm or a financial institution. The trustee must voluntarily accept their position.

  • The beneficiary is the individual (or entity, such as a charity) whom the grantor specifies to receive assets from the trust. Trusts can have multiple beneficiaries.

Trusts can hold many types of assets, including financial assets like cash, stocks, bonds, and bank accounts, as well as real estate, life insurance, retirement accounts, personal property, and even things like business interests and digital assets.

The assets that are transferred into the trust become the property of the trust — they no longer belong to the grantor.

Trust property is subject to the trustee’s management and control, but the trustee doesn’t own the assets, either. Rather, they hold and administer trust property/assets for the benefit of a third party (the beneficiary/beneficiaries). A beneficiary only owns a trust asset once the trustee distributes it to them from the trust.

Duties and Responsibilities of a Trustee

Because trust assets do not belong to the trustee, they are not free to do whatever they want with the assets. They must follow the terms that the grantor specifies in the trust document, as well as certain trust laws.

Fulfilling the Grantor’s Wishes

Trusts are highly flexible and can contain detailed provisions about how to distribute money and property to beneficiaries. For example, the grantor may provide instructions that a beneficiary receives assets only once they reach a certain age, educational, or career milestone.

The conditions the grantor can place on distributions are virtually limitless. But whatever condition the grantor sets, unless the condition is illegal, uncertain, or against public policy, the trustee must follow it.

Enforcing a conditional gift from a trust can place a greater burden on the trustee because they will have to determine whether the beneficiary has satisfied a condition necessary to receive a gift.

If there is any uncertainty about a condition being met, this could cause tension between the trustee and the beneficiary. Anyone using trust-based conditional gifting should therefore make sure the trustee is up to the potential challenges of conditional gifting and other detailed trust instructions.

Fulfilling Fiduciary Duties

Although their duties are specific to the trust document, the types of assets held in the trust, and the trust’s purpose, a trustee also has what’s known as “fiduciary duties.”

These are legal duties that they must follow when managing a trust for the trust’s beneficiaries. They include the duties of care, loyalty, good faith, and neutrality.

Fiduciary duties require the trustee to manage the trust in a reasonable, good faith manner. They must put the interests of the trust and its beneficiaries above their personal interests.

Fulfilling Administrative Responsibilities

The most basic job of a trustee is to manage and administer trust assets, in accordance with the trust’s terms and purposes and in the interests of the beneficiaries. Typically, this includes the following responsibilities:

  • Identifying, collecting, and valuing trust assets

  • Managing investments of trust assets

  • Protecting the value of trust property

  • Distributing assets/payments to beneficiaries

  • Paying debts and taxes

  • Preparing and filing financial reports

  • Keeping a record of all transactions

  • Communicating with beneficiaries, answering their questions, and disclosing information to them

  • Making decisions as needed to fulfill the trust’s provisions

On this last point, many grantors give a trustee some degree of discretionary powers, such as the option to enforce a conditional gift provision.

While authorizing a trustee to use their discretion gives them some leeway to decide what to do — or not do — the trustee must not violate their duties or beneficiaries’ rights when making such decisions.

Failure to Fulfill Duties and Trust Litigation

Anyone who accepts the position of trustee needs to understand its significant responsibilities. Once they accept their position, they usually cannot step aside without the beneficiaries agreeing to remove or replace them. Often, trust agreements further stipulate that a trustee can only be removed for cause.

There could be grounds for removal if a beneficiary (or multiple beneficiaries) believes the trustee is not upholding their legal responsibilities. For example, they might suspect that the trustee is not making distributions per the grantor’s instructions, not disclosing information about trust assets, using trust assets to enrich themselves, or mismanaging assets.

If a beneficiary suspects that a trustee has not met their legal obligations — whether those obligations are imposed by a trust document or under the law — the beneficiary could sue them.

Trust litigation can result in a trustee being held personally liable and ordered to pay back beneficiaries for financial harm. They can also be ordered to provide a full accounting of all trust assets and removed from their trustee position.

Types of Trustees and Whom to Choose

A close friend or family member, a third-party professional, or an independent trust company are commonly named as trustees. Co-trustees are also possible.

It is recommended that the grantor additionally name a successor, or backup, trustee. If a trustee is removed and no successor is named, the court could appoint someone new to the role.

Individual Child or Family Member

On the surface, an adult child who is responsible, trusted, and knows the family dynamics is a good choice for trustee. But a child — or any family member — may in practice not be the most appropriate person.

Being close to the family is a double-edged sword. Family relationships are complicated, and those complications could spill over into trust administration, especially in cases where trust beneficiaries are members of a blended family encompassing children from multiple marriages.

A person could be too close to make objective decisions, and even if they are acting objectively, their actions could be perceived as unfair or illegal, particularly if they are both the trustee and a beneficiary of the trust. And real or imagined wrongdoing on the part of a trustee can have the same outcome: trust litigation.

A Cautionary Tale: The Estate of Tony Bennett

A recent lawsuit over the estate of Tony Bennett illustrates why grantors should think twice before naming a child as trustee.

After the famed crooner Bennett passed away, his tangible personal property was supposed to be equally distributed among Bennetts’ four children from the family trust, with Danny, his oldest son from his first marriage, serving as trustee.

However, Bennett’s daughters from his second marriage, Antonia and Johanna, filed a trust lawsuit accusing Danny of mismanaging their late father’s assets, withholding information from them, and personally benefiting from the estate.

Antonia and Johanna requested a full accounting of Bennett’s assets and financial affairs. If the court finds that Danny violated his duties as trustee, the sisters could petition the court to remove Danny, and the court could replace him with an independent trustee.

Consider a Private or Professional Trustee

Bennett likely chose Danny as trustee because Danny had served as his longtime manager and was money savvy. Yet the lawsuit over the Bennett family trust shows how a parent might not fully think through the implications of one child acting as trustee for another child or children.

Nothing can bring out family disputes quite like money matters. The Bennett situation is a case study in how an independent trustee is sometimes a better option from the start.

An independent trustee that specializes in trust fund management, such as an attorney, advisor, or accountant, a private fiduciary from an independent trust company, or a corporate trustee from a financial institution like a bank, can bring an unbiased, outside perspective that helps to avoid family discord.

Grantors also need to consider that a child or other family member might have the right skill set to serve in this role but lack the necessary practical experience. In some instances, it might make sense to appoint co-trustees — one family member and one professional.

At a minimum, a trustee chosen from within the family should have a relationship with an estate planning attorney who can help them perform trust management competently, fairly, and legally.

(From Elder Law Answers)

Shielding Older Adults from Government-Impersonation Scams - from Elder Law Answers

Takeaways

  • Government agencies will not demand immediate payment by gift card, wire transfer, cryptocurrency, or cash. Nor will they ask for a Social Security number to “protect” benefits or determine eligibility.

  • Seniors and their families can reduce fraud risk by protecting personal information, verifying unexpected requests independently, and consulting someone they trust before taking action.

  • Report suspected fraud promptly, even if no money changed hands. If money or sensitive information was shared, contact the relevant financial institution and credit bureaus immediately.

Elder fraud has become a common form of financial exploitation across the country. Federal officials have estimated losses to be in the billions of dollars each year among older Americans, with government-impersonation schemes among the most reported types of fraud. For example, fraudsters may contact older adults and claim to be with the Social Security Administration (SSA) or the Department of Health and Human Services (HHS) while trying to extract information or money from them.

Scammers do not target older adults because they are less capable. They target this population because they may assume they have savings, established credit, and less familiarity with newer digital tactics. Awareness and preparation can make it harder for scammers to succeed.

How These Scams Work

Most impersonation and fraud schemes follow a consistent pattern, regardless of the specific story a scammer uses. It generally unfolds in four stages:

  • Pretend. The scammer claims to represent a trusted source, such as the SSA, the HHS’s Office of the Inspector General (HHS-OIG), a bank, or a well-known company. They may already have some of the potential victim’s personal information, which makes the approach feel legitimate.

  • Prize or problem. The scammer either offers something appealing, such as a benefit increase or a prize, or creates fear by claiming there is a serious problem, such as  a suspended Social Security number or a fraud alert on an account.

  • Pressure. They tell the person to act immediately, often to “avoid arrest” or “protect” their benefits or accounts, leaving little time to verify the claim.

  • Payment. The scammer requests payment or personal data through unusual channels, such as gift cards, wire transfers, cryptocurrency, cash delivered in person, or a Social Security or Medicare number provided “to confirm eligibility.”

A genuine call from the SSA or HHS-OIG will never ask a beneficiary to wire money, purchase gift cards, send cash, or disclose a Social Security number. That single rule can help older adults avoid most government-impersonation scams.

Practical Steps for Protecting Personal Data

Protecting personal information is often more effective than trying to recognize every new scam. Scammers’ tactics change constantly, but their goal remains the same: getting access to personal information or money.

Safeguard Your Most Personal Information

Personal information can be pieced together from public records, social media, data breaches, and previous contacts. Protecting key details makes it harder for scammers to create convincing requests.

  • Do not share sensitive information. Never provide a Social Security number, Medicare number, bank account information, or online-account password to an unsolicited caller, texter, or email sender. Caller ID can be spoofed, so a government agency’s name or number does not prove that the contact is legitimate.

  • Protect important documents. Store Social Security and Medicare cards securely at home rather than carrying them daily. Shred documents containing account or benefit numbers before disposing of them.

Check With the Official Source

Always verify unexpected requests through contact information you find yourself, not through a phone number, link, or website supplied by the person who contacted you.

  • End the conversation. Hang up on unexpected calls claiming to be from the SSA, HHS-OIG, or the Medicare program. Then call the agency back using a number found independently on their government website.

  • Monitor your accounts. Create an official my Social Security account to track benefit statements and catch unauthorized changes.

Pause and Talk With Someone You Trust

Scammers use urgency, isolation, and secrecy to prevent people from evaluating a request or seeking advice.

  • Treat pressure as a warning sign. Legitimate agencies do not demand immediate action or ask beneficiaries to keep a conversation confidential from family members.

  • Ask for help without fear or blame. Talk with a trusted family member, friend, or caregiver before sending money or sharing information in response to an unexpected request.

Create a Family or Caregiver Fraud-Prevention Plan

Families can reduce the risk of government-impersonation scams by agreeing in advance on how to handle unexpected calls, texts, and requests involving benefits or personal information.

  • Choose a trusted contact. Agree on whom the older adult will call before sending money, sharing personal information, or responding to an urgent matter. This could be a family member, friend, caregiver, attorney, or other trusted advisor.

  • Create a family code word. A code word can help relatives confirm that an urgent call or text is genuine, especially when a scammer pretends to be a grandchild or another family member.

  • Set up account alerts. With the account holder’s permission, consider enabling notifications for large withdrawals, unusual purchases, password changes, or transfers to new recipients.

  • Review important information together. Make sure contact information is current with banks, credit card companies, insurers, and government agencies. Knowing how to reach these organizations through official channels can make it easier to verify a suspicious request.

Open, respectful conversations can reassure older adults that they can seek help without fear of blame or embarrassment.

Limit Digital Exposure

Scammers can use information posted online to make impersonation attempts seem more personal and believable. Basic digital precautions can reduce the amount of information available to them.

  • Handle messages carefully. Avoid clicking links or downloading attachments in unsolicited messages, even if they appear to come from a government agency or familiar company.

  • Review privacy settings on social media accounts. Scammers often mine public posts for details, birthdays, family names, and routines that they can use to make impersonation attempts more convincing.

If You Encounter a Scam

Report suspected scams promptly, even if you recognized the fraud before sharing information or sending money. Reports can help investigators identify patterns, warn the public, and shut down schemes.

  • Social Security-related scams. Report online or call the SSA OIG Fraud Hotline at 1-800-269-0271.

  • Medicare, Medicaid, or other HHS program fraud. Report fraud attempts through the HHS-OIG Hotline.

  • General fraud reports. File with the Federal Trade Commission.

If you believe you have already shared sensitive information or sent money to a scammer, contact your bank or credit card company immediately to limit further loss. Consider placing a fraud alert or credit freeze with the major credit bureaus.

The Rule That Can Prevent Most Impersonation Scams

No legitimate government agency will ever ask someone to move money to “protect” it, demand payment in gift cards or cryptocurrency, or ask for a Social Security number to determine benefit eligibility. Older adults and their families can help prevent fraud by verifying unexpected contacts and seeking advice before acting.

How Do I Give Gifts to My Grandchildren?

Gifting assets to your grandchildren can help them get a good start in life — it can also reduce the size of your estate and the tax that will be due upon your death. You can accomplish this in different ways.

 

How Do I Give Gifts to My Grandchildren?

Gifting assets to your grandchildren can help them get a good start in life — it can also reduce the size of your estate and the tax that will be due upon your death. You can accomplish this in different ways.

Outright Gifting

Perhaps the simplest approach to gifting is to give the grandchild an outright gift. You may give each grandchild up to $19,000 a year (in 2026) without having to report the gifts. If you're married, both you and your spouse can make such gifts. For example, a married couple with four grandchildren may give away up to $152,000 a year with no gift tax implications. In addition, the gifts will not count as taxable income to your grandchildren (although the earnings on the gifts, if they are invested, will be taxed). Just remember that any gift can interfere with Medicaid eligibility.

Protecting Your Gifts

But you may have some misgivings about making outright gifts to your grandchildren. There is no guarantee that the money will be used in the way you may have wished. Money that you hoped would be saved for educational expenses may instead be spent on a fact-finding mission to Fort Lauderdale. Fortunately, there are a number of options to protect against misuse of the funds:

  • You can pay for educational and medical costs for your grandchildren. There's no limit on these gifts, meaning that you can pay these expenses in addition to making annual $19,000 (in 2026) gifts. But you have to be sure to pay the school or medical provider directly.

  • You can make gifts to a custodial account that parents can establish for a minor child.

  • You can transfer money into a TRUST established to benefit a grandchild.

  • You can reduce your taxable estate while earmarking funds for the higher education of a grandchild through the use of a 529 account.

  • You can use other gift vehicles like IRAs and savings bonds.

 

(From Elder Law Answers)

 

Call our office at 803-980-1199 to schedule an appointment! We can help you set up Trusts for you grandchildren!

What Is a Life Estate?

The phrase “life estate” is sometimes mentioned when discussing estate and Medicaid planning, but what does it mean?

A life estate is a form of joint ownership that allows one person to remain in a house until their death when it passes to the other owner.

Elder law attorneys use life estates to help their clients with:

  • Avoiding probate

  • Passing their house on to their children without having to give up the ability to live in it

  • Medicaid planning

  • Who Owns the Property in a Life Estate?

    With a life estate, two or more people each have an ownership interest in a property, but at different periods of time.

    The life tenant is the person holding the life estate. They possess the property during their lifetime. The remainderman (the other owner, such as a senior’s adult child) has a current ownership interest; however, the remainderman can't take possession until the death of the life tenant.

    What Are the Benefits of Life Estates?

    During their lifetime, the life tenant has full control of the property as well as the legal responsibility to maintain the property. The life tenant also has the right to use the property, rent it, and make improvements as they see fit, but they can’t sell or mortgage the property without the agreement of the remainderman. So, it may be easier to refinance, if necessary, before developing the life estate.

    If the property is sold, the proceeds of the sale are divided between the life tenant and the remainderman. If sold, the life tenant may receive a lesser share of the proceeds, as the shares are determined based on the life tenant’s age at the time – the older the life tenant, the smaller their share.

    Upon the death of the life tenant, the house will not go through probate. In other words, the ownership of the house will pass automatically at that time to the remainderman. In addition, because the property is not included in the life tenant's probate estate, it can successfully avoid Medicaid estate recovery.

    Estate Taxes

    Although the property will not be included in the probate estate, it will be included in the taxable estate.

    Currently, those with extremely high net worth need to be concerned about the potential of having to pay an estate tax. As of 2025, if the size of the estate is larger than $13.99 million, the property may be subject to estate taxation.

    Wait, What Is an Estate Tax?

    An estate includes everything that an individual owns, from their real estate and vehicles to their bank accounts and stocks. After an individual passes away, their estate may be subject to an estate tax – also often called a “death tax.” The IRS calls it a tax on your right to transfer your property at your death. Again, as mentioned above, your estate will be required to file an estate tax return only if your entire estate is valued at more than $13.99 million.

    Medicaid Eligibility

    Be aware that transferring your property and retaining a life estate can trigger a Medicaid ineligibility period if you apply for Medicaid within five years of the transfer. Purchasing a life estate should not result in a transfer penalty if you buy it on someone else’s home, pay an appropriate amount for the property, and live in the house for more than a year.

    For example, a senior who can no longer live in their home might sell it and use the proceeds to buy a home for themselves, their son, and their daughter-in-law. The father would hold a life estate, and the younger couple would be the remaindermen. Alternatively, the father could purchase a life estate interest in the children’s existing home.

    Assuming the father has lived in the home for more than a year and paid a fair amount for the life estate, the purchase of the life estate should not be a disqualifying transfer for Medicaid. Just be aware that there may be some local variations on how this is applied, so check with an estate planning or elder law attorney.

    If you want comfort knowing exactly what will happen to your home upon your death, a life estate may be a great option. An attorney can help you find out if a life estate is appropriate for your situation. Then a legal strategy is necessary to transfer property while qualifying for Medicaid benefits.

    To find out if a life estate is the right plan for you, find an estate planning attorney near you.

    Further Reading

    The rules regarding estate planning, including life estates, can be complex. Regulations can vary by state and your unique circumstances. To learn more about the various aspects of estate planning, take a moment to check out the following articles and Q&As:


    Created date: 09/23/2016 - Elder Law Answers

When to Hire a Home Care Service for an Older Adult

For seniors and their families, hiring a home care service can support independence for the older adult while reducing stress on the family unit. A home carer can assist with activities of daily living (ADLs), like bathing, dressing, preparing meals, chores like laundry and dishes, medication management, and transportation to and from appointments and outings. Skilled caregivers who are qualified nurses can also provide medical care for those with more complex medical needs.

When an older adult needs help with daily activities, this support can be invaluable. As an alternative to assisted living, a home care service can help people age in place in their homes, which many older adults would prefer. In fact, AARP reports that 75 percent of adults 50 and older want to remain in their homes as they age.

An Alternative to Family Caregivers

Many seniors rely on family members such as their spouses and grown children to provide unpaid support. Family caregivers may struggle to balance their own personal responsibilities and care for their loved one, leading to stress. According to Cleveland Clinic, an estimated 60 percent of caregivers say they experience burnout, a state of physical, mental, and emotional exhaustion.

Meanwhile, older adults receiving care from a loved one may wrestle with feeling less independent, especially when the caregiver is their child.

Even having an in-home care person come a few times a week can afford family caregivers more time to meet their own needs and do things they enjoy. The older adult may also be more receptive to professional help from someone outside the family unit.

Care Costs

While in-home care has many benefits, it comes at a cost.

In some states, home- and community-based service (HCBS) waivers provide Medicaid funding for in-home care. These programs have stringent medical and financial requirements. Medicare may also cover some home care services for certain medical conditions if the older adult meets specific requirements. In either case, individuals who do not meet these requirements may need to turn to private care options.

As of 2024, the median cost of private in-home care in the United States ranges was about $6,000 a month. Caregiver qualifications, services offered, and location can affect rates.

Skilled nursing care provided by an in-home health aide is more expensive, with the monthly median cost nationwide approaching $6,500. Licensed nurses can provide medical care at home, including medication administration and wound care.

Most families seeking help with caregiving for an aging loved one must take cost into consideration. However, often just as important is knowing when it may be the right time to hire a home care service.

When to Hire a Home Care Service

When an older adult needs help with activities of daily living such as bathing, dressing, and preparing meals and prefers to age in place, it may be time to hire a home care service. Here are some indications that it may be time to consider in-home care for an aging loved one:

  • The older adult is having trouble with daily tasks. Signs that may raise concerns include a less clean home, infrequent bathing, and social withdrawal. The individual may seem sad, apathetic, or have lower energy.

  • The older adult does not want help from family members. They may be more receptive to care from a neutral third party.

  • Family caregivers are feeling overstretched and exhausted. They may even be experiencing personal health challenges worsened by caregiving stress or want more time for themselves, their work, or other responsibilities. Hiring a professional caregiving service can free them up.

  • In-home care is the older adult’s preference over other long-term care options and is medically appropriate. While many seniors prefer to age in place, other long-term care options come with benefits like increased social opportunities or more affordable round-the-clock medical care. Be sure to consider the various benefits and drawbacks of different care options before making a decision.

When choosing a home care agency, you may also want to research whether the agencies you are considering are certified by an accrediting body. The independent nonprofit Community Health Accreditation Partner is one such organization.

Related Reading

Helping You Age Safely, Independently, and with Peace of Mind

Growing older doesn't mean you have to navigate life's challenges alone. York County offers valuable resources designed to help older adults remain healthy, independent, and connected to their communities. At Khaled Elder Law, we believe that planning for the future includes knowing about the services available today.

One of the most important needs as we age is access to nutritious meals. Proper nutrition helps maintain strength, supports overall health, and can improve quality of life. Fortunately, several programs in York County are available to help.

Home-Delivered Meals (Meals on Wheels)

For seniors who are homebound or have difficulty preparing meals, home-delivered meal programs provide nutritious meals delivered directly to the home. These meals not only offer proper nutrition but also provide regular wellness checks and friendly visits that can help reduce feelings of isolation.

Congregate Meals

Many local senior centers offer congregate meal programs where older adults can enjoy healthy lunches while spending time with friends and neighbors. These gatherings encourage social interaction, reduce loneliness, and create opportunities to participate in other activities offered by the centers.

Nutrition Education

Healthy eating needs can change with age. Nutrition education programs provide seniors with helpful information about balanced diets, managing chronic health conditions through nutrition, and making healthy food choices that support long-term wellness.

Who May Qualify?

Many of these services are available to adults age 60 and older. Eligibility requirements may vary depending on the specific program, but staff members are available to help determine which services best fit your needs.

Where to Start

If you or a loved one would like to learn more about meals and nutrition programs, contact:

Rock Hill Senior Citizens Center
917 Standard Street
Rock Hill, SC 29730
Phone: (803) 327-6694

Catawba Area Agency on Aging
2051 Ebenezer Road, Suite B
Rock Hill, SC 29732
Phone: (803) 329-9670

Planning Beyond Today

While community resources can provide valuable support today, having a comprehensive estate plan helps ensure your wishes are protected for the future. Whether you're planning for long-term care, creating powers of attorney, or establishing a living trust, proactive planning gives both you and your loved ones peace of mind.

At Khaled Elder Law, we're committed to helping families navigate every stage of aging with confidence and compassion.

Need guidance? Contact Khaled Elder Law at (803) 980-1199 or visit www.jklawfirm.net to learn how we can help you plan for whatever the future holds. Yolanda Thornton, Certified Elder Care Coordinator, assists with identifying the care needs for the client, provides support, advocacy, education and referrals to varied resources. Schedule that appointment to learn more about this particular service of Khaled Elder Law, Life Care Planning.

How to Respond to a Notice of Medicare Non-Coverage (NOMNC)

Takeaways

  • An NOMNC is a required notice that Medicare-covered services are set to end soon — not a bill.

  • You can request a free, expedited appeal, but you must act fast.

  • To avoid being billed while the review is pending, file by noon the day before coverage ends.

  • Involve your doctor quickly; documentation can support continued coverage.

  • If your appeal is denied, a second-level appeal may still be available.

If you’re receiving care through a skilled nursing facility, home health agency, or outpatient rehabilitation center, there may come a day when your provider hands you a form titled “Notice of Medicare Non-Coverage,” or NOMNC. Don’t panic, but don’t ignore it either. Here’s what it means and what you can do.

What Is an NOMNC?

An NOMNC is an official notice that your Medicare-covered care is ending. Your provider, whether that’s a nursing facility, home health agency, hospice, or comprehensive outpatient rehabilitation facility, is required by law to give you this notice at least two days before your Medicare-covered services end.

The notice is meant to protect you. It tells you when coverage will end, why, and, most importantly, that you have the right to appeal.

Why You Might Receive an NOMNC

Providers issue an NOMNC when they believe your condition no longer meets Medicare’s coverage criteria. Medicare generally covers skilled care, meaning care that requires the expertise of a nurse or therapist. Once your provider determines you no longer need that level of care, they’re required to notify you that coverage is ending.

This doesn’t necessarily mean your care was inappropriate or that Medicare will agree with the provider. It simply means the provider has made a judgment call that Medicare coverage no longer applies.

What You Should Do

  • Read the notice carefully: The NOMNC will include the date your coverage ends and a brief reason. The notice will also include information about the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), which is the independent organization that handles Medicare appeals for these situations.

  • Decide whether to immediately appeal: You have the right to request a free, expedited review by the BFCC-QIO. If you appeal before your coverage ends, you generally won’t be billed for the disputed services while the review is pending. That protection alone makes filing an appeal worth considering.

  • Appeal quickly: You must contact the BFCC-QIO listed on your notice by noon of the day before your coverage ends. You can typically reach them by phone; the number will be printed on your NOMNC. Call it as soon as possible.

  • Get a written statement from your provider: After the BFCC-QIO notifies your provider that you appealed, your provider must give you a “detailed explanation of non-coverage” (DENC). This gives you their specific clinical reasoning, which can help you and the reviewer understand the case.

  • Talk to your doctor: Your physician may be able to provide documentation supporting continued care. The BFCC-QIO reviewer will consider medical evidence, so your doctor’s input can matter.

What Happens After You Appeal?

Generally, the BFCC-QIO will give you a decision by the close of business the day after it gets the information it needs to make a decision. If the reviewer agrees coverage should continue, Medicare keeps paying. If they side with the provider, your coverage ends, but you can still request a second-level appeal by a Qualified Independent Contractor.

Receiving an NOMNC can feel alarming, especially while you’re recovering from an illness or surgery. But the notice is also your opportunity to push back if you believe the decision is wrong. Act quickly, use the appeal process, and don’t hesitate to involve your doctor and family in the decision.

Additional Reading

For additional reading on topics related to Medicare, check out the following articles:

Living Your Best Possible Life After a Dementia Diagnosis

Takeaways

  • A dementia diagnosis changes life — it does not define it. A strengths-based approach helps people living with dementia keep purpose, identity, and dignity at the center of care.

  • Person-centered, palliative dementia care looks at the whole person. It supports emotional well-being, spiritual needs, physical health, medical comfort, social connection, and family relationships — not just symptoms or decline.

  • Support groups are a practical, high-impact resource for both patients and caregivers. They reduce isolation, provide real-world coping strategies, and create a space where people can speak openly and feel understood.

  • Supporters can make day-to-day life better with simple, consistent actions. Listen patiently, focus on preserved abilities, stay connected, include the person with dementia in decisions, and keep routines and meaningful activities in place.

  • Caregivers need to find support, too — and planning helps. Preventing burnout and learning what to expect (including future decision-making needs) can reduce crisis-driven choices and strengthen the whole care network.

A dementia diagnosis can feel like a door closing. But for the millions of people living with Alzheimer’s disease and related dementias, as well as for their family members and friends, a growing movement in care is pushing back against that narrative. The message: a diagnosis does not define a life.

Seeing the Whole Person

Traditional approaches to dementia care have often focused on what is lost, such as memory, independence, and cognitive function. That can leave people feeling like their future has been decided for them.

As explained in a recent webinar led by the National Alzheimer’s and Dementia Resource Center (NADRC), a more compassionate and effective approach turns that lens around. Palliative care (specialized medical care focused on comfort, symptom relief, and quality of life) and person-centered care models begin with a simple but powerful premise: a person living with dementia is still a full human being with emotional needs, spiritual beliefs, physical health, social connections, and family relationships that matter deeply.

Rather than addressing solely what is wrong, this approach asks questions like “What is important to you? What brings you joy? What do you still want to accomplish?” The answers vary widely from person to person, and that’s the point.

Care built around individual goals and strengths not only looks different from a one-size-fits-all plan, but the outcomes are also better.

What Person-Centered, Palliative Dementia Care Looks Like

Person-centered care is a philosophy woven through every interaction, from medical appointments to daily activities at home. It is built around the individual’s routines, values, and goals — not just the diagnosis — and addresses several interconnected areas of a person’s life:

  • Emotional well-being. Dementia can bring fear, grief, frustration, and social isolation. Acknowledging and validating these feelings, rather than minimizing them, helps people feel seen and reduces anxiety.

  • Spiritual life. For many people, faith, meaning, and purpose are central to identity. Honoring spiritual practices, rituals, and beliefs provides comfort and continuity, even as one’s memory changes.

  • Medical care. Comprehensive medical support includes not just treating the disease but also managing pain, monitoring medications, and addressing other health conditions that affect quality of life.

  • Physical health and activity. Movement, nutrition, sleep, and sensory engagement all affect mood, cognition, and function. Modified exercise, meaningful activities, and time outdoors can make a significant difference.

  • Social connection. Human beings need one another. Peer support groups, where people with dementia meet others who truly understand their experience, can help reduce isolation and foster resilience, humor, and hope.

  • Family and caregiving relationships. Dementia affects entire families. Caregivers can benefit from education, support groups of their own, and practical tools for navigating the emotional and logistical demands of the role.

The Power of Support Groups

One of the most practical and powerful resources available to both people with dementia and their caregivers, according to the webinar presenters, is peer support groups. These gatherings, whether in person or virtual, offer something that professional care alone cannot: the knowledge that you are not alone.

For people living with dementia, support groups provide a space to share experiences, exchange coping strategies, and simply enjoy social connection with others who understand what they are going through. For caregivers, they offer a lifeline in the form of a place to receive encouragement, learn new skills, and speak honestly about the exhaustion, grief, and love that define the caregiving experience.

What Supporters Can Do

Friends, family members, and professional caregivers can play an essential role in helping someone with dementia live their life to the fullest. Some of the most meaningful things supporters can do include:

  • Listen without rushing. Give the individual time to express themselves. Patience communicates respect.

  • Focus on what they can do, rather than on what they can’t do. Celebrate preserved abilities and interests rather than emphasizing limitations.

  • Stay connected. Regular visits, phone calls, or simple shared activities maintain the relationship and reduce isolation.

  • Ask the person what they want. Involve the person who is living with dementia in decisions about their life as much as possible.

  • Take care of yourself first. Caregiver burnout is real. Seeking your own support is not a luxury — it is a necessity.

  • Learn and prepare for the future. Understanding the stages of dementia and what to expect helps families plan proactively and reduces crisis-driven decision-making.

Resources

The following organizations offer resources, education, and support for individuals living with dementia and those who care for them.

For People Living With Dementia and Their Caregivers

  • Alzheimer’s Association. The largest voluntary health organization in Alzheimer’s care, support, and research. Offers a 24/7 helpline (800-272-3900), local support groups, care consultations, and an extensive online resource library.

  • Alzheimer’s Foundation of America. Provides education, support services, and a free memory screening program. Reach its national toll-free helpline at 866-232-8484.

  • Alzheimers.gov. The federal government’s central resource for information on Alzheimer’s and related dementias, including finding local services, caregiver resources, and clinical trials.

  • Caregiver Action Network. Provides education, peer support, and resources for family caregivers.

  • AARP Caregiver Resource Center. Offers tools, guides, and a helpline (877-333-5885) to assist family caregivers with planning, communication, and self-care.

Specialized Programs

  • NADRC. Offers free webinars, toolkits, issue briefs, and resources for individuals, caregivers, and community organizations. Resources include guides on person-centered care, faith-based dementia programs, and support for people living with dementia.

  • Riverside Health Martha W. Goodson Center. Offers comprehensive, person-centered memory care services, including free Memory Care Navigation, caregiver support groups, a GUIDE model program for eligible patients, and an e-Learning Resource Center.

  • Eldercare Locator. Connects older adults and caregivers with local services including transportation, meals, respite care, and support groups. Contact trained staff by phone or text at 800-677-1116.

A Final Word

A dementia diagnosis means a change in life, not the end of life. With the right support, the right mindset, and access to the right resources, people living with dementia can continue to find meaning, connection, and joy. The goal of strengths-based, person-centered care is not to deny the challenges of the disease. It instead seeks to ensure that the whole person, not just their diagnosis, remains at the center of every decision, every relationship, and every day.

For additional reading on topics related to dementia, check out the following articles:

TV Show Explores Senior Housing and Long-Term Care Options

Takeaways

  • Senior Spaces is a new TV show that follows older adults making real housing and care decisions.

  • Most families weigh four paths: aging in place, downsizing, joining a senior living community, or moving to assisted living or nursing care.

  • The best choice depends on health, finances, support network, and what independence means to the senior.

  • Starting the conversation before a crisis helps families make clearer decisions.

Rick and Mary Williams had happily lived in their home in California for 22 years but began to question whether it was the right place for them to grow old.

That question sits at the heart of Senior Spaces, a new television series that follows real older adults as they navigate one of life’s most emotionally charged crossroads: deciding where and how to live the next chapter of their lives.

Hosted by Bryan Devore, a Seniors Real Estate Specialist (SRES), the show airs on the Senior Lifestyle Network, KUSI News in San Diego, and on YouTube. Senior Spaces is not a renovation show, a real estate competition, or a retirement fantasy but an honest look at the intertwined mix of love, loss, practicality, and hope that shapes one of the most significant decisions aging adults and their families will make.

Difficult Decisions

By 2030, all baby boomers will be over 65, making seniors the fastest-growing segment of the American population. Millions of families are asking a question previous generations rarely faced: What happens when staying at home becomes complicated?

The answer differs for everyone. Whether to age in place, downsize, join a 55-plus community, or move into a nursing or assisted living facility depends on health, finances, family proximity, social connection, and personal values around independence.

The decision rarely arrives cleanly. Often, it follows a fall, a diagnosis, the loss of a spouse, or a slow accumulation of moments when managing the house stops feeling manageable. By then, the emotional and practical weight can be overwhelming.

The Four Paths: Understanding Your Options

Aging in Place

For many older adults, remaining in one’s home is not just a preference but a deeply felt need. The home holds memories, identity, and routine. Aging in place can be a rich and workable option but living independently requires honest planning.

Common challenges include:

  • Physical accessibility. Stairs, narrow doorways, and bathrooms not designed for mobility challenges can become serious safety hazards.

  • Isolation. Without social infrastructure, aging at home can lead to loneliness, which research links to cognitive decline and poor health outcomes.

  • Home maintenance. Upkeep can become exhausting or unaffordable.

  • Caregiver burden. Family members stepping in to help may experience significant emotional and physical strain.

  • Emergency response gaps. Living alone without reliable access to help is a real and underappreciated risk.

Resources for aging in place include the AARP HomeFit Guide, the National Aging in Place Council (NAIPC), and Area Agencies on Aging (AAA), which connect seniors with local services including transportation, meal delivery, and in-home care.

Downsizing or Relocating to a New Home

Some seniors choose to downsize to a smaller, more manageable property. This path can unlock home equity, reduce maintenance burdens, and open a new chapter of life in a community that fits better.

Common challenges include:

  • Letting go of decades of belongings, a home where children were raised, and a familiar neighborhood can be emotionally challenging.

  • Simultaneously buying and selling real estate is stressful at any age; navigating the process later in life adds complexity.

  • Adjusting to a new living environment and community and starting over socially in a new place takes energy and time.

  • Getting the market timing right can create financial pressure.

Working with an SRES can make a significant difference. These professionals are trained to understand the unique financial, emotional, and logistical dimensions of senior transitions.

Moving to a Senior Living Community

Active adult communities, 55-plus neighborhoods, independent living communities, and continuing care retirement communities (CCRCs) offer a range of options for seniors who want the independence of their own home or apartment within a community designed for their life stage.

Common challenges include:

  • Cost. Entry fees and monthly charges for CCRCs and independent living communities can be significant and vary widely.

  • Giving up a sense of home. Trading a house full of personal history for an apartment or condo requires psychological adjustment.

  • Navigating the options. The spectrum from active adult communities to independent living to memory care is broad; finding the right fit requires research.

  • Waitlists. High-quality communities often have long waiting lists, making early planning essential.

A Place for Mom and Caring.com are two popular online tools that help families research and compare senior living communities. Many communities also offer trial stays, which can ease the transition and help seniors make informed decisions.

Assisted Living and Nursing Home Care

When daily living activities such as bathing, dressing, managing medications, and eating require consistent support, assisted living and skilled nursing facilities provide round-the-clock structured care. For seniors with dementia or complex medical needs, these settings offer safety and specialized attention that home environments often cannot.

Common challenges include:

  • Cost of care. Assisted living averages $6,200 per month nationally and a semi-private room in a nursing home can exceed $9,000 per month.

  • Quality variation. The quality of care varies from one facility to the next, making thorough research and visits essential.

  • Emotional difficulty. For seniors and families, the transition to a care facility often carries grief, guilt, and a sense of finality that deserves acknowledgment.

  • Advocacy. Family members often must serve as active advocates to ensure their loved one receives attentive, respectful care.

The Long-Term Care Ombudsman Program helps residents of care facilities resolve complaints and understand their rights. Medicare’s Nursing Home Compare tool provides inspection reports, staffing data, and quality ratings for facilities nationwide.

What Senior Spaces Brings to the Conversation

What sets Senior Spaces apart from other housing or lifestyle programming is its commitment to showing the full picture, with its uncertainty, second-guessing, and surprises. In the pilot, Rick and Mary’s story unfolds in ways that challenge assumptions about what seniors want and what ultimately feels right.

The show treats older adults as thoughtful, complex people making consequential decisions, not as a demographic to be managed or a problem to be solved — a meaningful framing in a culture that often sidelines the voices of people in later stages of life.

The show goes beyond square footage and market value. It explores the emotional landscape: the attachments people carry, the family conversations that don’t always go as planned, and the relief that often follows a decision everyone was afraid to make.

Starting the Conversation Early

One consistent insight from senior housing specialists, geriatric care managers, and social workers: families who navigate these transitions best are those who started the conversation before a crisis hit.

That means asking while everyone is still well: What matters most about where you live? What would have to change for you to consider a move? What does a good day look like at 80? These conversations aren’t always comfortable, but they’re far less painful than making the same decisions mid-crisis, without consensus and against a deadline.

Resources such as the National Institute on Aging and ElderCare Locator can help families identify local resources and care managers. Those managers, now often called Aging Life Care Professionals, specialize in comprehensive care planning and navigating complex housing decisions.

The Human Side of a Practical Decision

The question of where to live later in life is not purely logistical. For most people, a home is not just shelter — it is a repository of identity, a symbol of independence, and a place where the self feels continuous across time. Leaving it, even for something better, involves a form of grief.

This dynamic makes Senior Spaces valuable viewing not just for seniors, but for the adult children, spouses, siblings, and friends who stand alongside them during their later-life transitions. Watching someone else move through the process can make it easier to imagine walking the same path yourself.

The show also offers a quiet but important message: there is no shame in needing more support, wanting community, or choosing safety over sentiment. These are not failures of aging but acts of wisdom.

Rick and Mary’s story, like so many others, does not end with a simple answer. It ends with a decision that feels right — not because it was obvious, but because they thought it through together with honesty and care. That is the kind of conversation Senior Spaces is trying to make easier for everyone watching. And in a country where millions of families are wrestling with the same questions, that matters more than most people realize.

Long-Term Care Costs Are Hollowing Out Generational Wealth

Takeaways

  • Long-term care is common and expensive — and for many families, a few years of paid care can erase decades of savings.

  • Medicare coverage is limited, and Medicaid often requires “spending down” — leaving many middle-class households exposed until they’re near poverty-level assets.

  • Planning ahead can reduce the financial shock — by learning what programs do (and don’t) cover and exploring options like long-term care insurance and state-specific Medicaid planning.

For most Americans, the plan goes something like this: work hard, save diligently, pay off the house, and pass something on to the kids. This quiet promise at the heart of the American Dream is that a lifetime of effort can translate into security for you and the next generation.

A study published by the Roosevelt Institute in April suggests that for most Americans, that promise is being broken — not by bad luck or poor choices, but by the crushing, largely unseen cost of long-term care.

The report lays out a stark picture: The long-term care system in the United States isn’t just failing older Americans in their final years but systematically draining the wealth of middle- and lower-income families and making it nearly impossible for the next generation to get a financial foothold.

What Is Long-Term Care and Why Does It Cost So Much?

Long-term care refers to the ongoing help people need when they can no longer fully care for themselves. It can encompass home health aides, adult day care programs, assisted living facilities, and nursing homes.

Over half of Americans aged 65 will need long-term services and supports in their lifetime, and one in five of those adults will need care for more than five years. This is not a fringe issue; it is, statistically speaking, a near-universal part of aging in America — and the costs are staggering.

In 2025, the national annual median cost of in-home, long-term care was about $80,000. The annual cost of community and assisted living ranged from $25,000 to $74,000, and nursing home care was between $115,000 and $129,000 per year.

Meanwhile, the median household income for Americans aged 65 and older is approximately $57,000 — meaning a single year in a nursing home can cost more than twice what a typical senior household earns in a year.

Why are prices so high? Over the past two decades, long-term care costs have risen sharply as the over-65 population has grown rapidly.

Demand for long-term care services is increasing as American adults age, but the industry has long had problems attracting and retaining workers. Long-term care workers often face low pay and poor working conditions, with 36 percent living at or near the poverty line, which makes recruiting and retaining staff difficult. When demand outpaces supply, prices rise — and have been rising for years.

Why the System Leaves the American Middle Class Exposed

You might assume that government programs like Medicare and Medicaid would provide a safety net. However, the reality is far more complicated and far less generous than most people realize.

Medicare, the federal health insurance program for adults 65 and older, provides only short-term skilled nursing or rehabilitation care after a qualifying hospital stay. It does not cover ongoing assistance with daily activities like using the bathroom, eating, or getting in and out of bed. For the millions of Americans who need help with these basic tasks for months or years, Medicare offers essentially nothing.

Medicaid does cover long-term care but only after a family has nearly run out of money. To access Medicaid long-term care, adults must fall below income and asset thresholds that vary by state. As of mid-2025, monthly income limits range between $967 and $2,901 for a single individual and asset ceilings are generally around $2,000 in most states. In other words, a person must spend down their savings to near-poverty levels before the government steps in to help.

This leaves many middle-class Americans in a difficult position. They have too much money to qualify for Medicaid, but nowhere near enough to comfortably afford years of private care. After the onset of care needs, middle-class individuals face permanent wealth reductions to just 42 percent of their original levels and lower-income individuals realize reductions to just 11 percent of their original levels. However, the top quartile of earners eventually recover 94 percent of their assets.

Even families who consider themselves financially comfortable are not immune. Among upper-middle-class couples with lifetime earnings over $4.75 million, nearly half will spend down their assets paying for long-term care and eventually enroll in Medicaid if they require long-term care for five years or more.

The Ripple Effect on the Next Generation

Much has been made in recent years about the so-called “Great Wealth Transfer,” the enormous sum of money that Baby Boomers are expected to pass down to their children and grandchildren. The Roosevelt Institute’s findings puncture that narrative for most families.

The spend-down process required to qualify for Medicaid leaves little to be passed on to younger generations. This interrupts the potential for building generational wealth after what is often a lifetime of work and saving, perpetuating cycles of wealth inequality.

The consequences ripple outward in another way, too: through the unpaid labor of family caregivers, who are overwhelmingly women. In 2021 alone, unpaid caregivers provided an estimated $600 billion in economic value, often at the expense of their own career growth and retirement savings.

When someone steps back from their career to care for an aging parent, sacrificing promotions, raises, and retirement contributions, the long-term financial cost to them and their family can be enormous. So, the care crisis doesn’t just affect the person receiving care — it spreads.

Long-term care is not just an individual health issue; it is also a structural driver of wealth inequality. By maintaining a system that depends on unpaid family caregiving, provides public support only after families have nearly exhausted their savings, and allows private, profit-driven companies to capture rising care costs, the U.S. effectively penalizes aging.

What Families Can Do

While systemic change is needed, there are practical steps that families can take to reduce their exposure:

  • Plan early, before a crisis hits. Long-term care insurance exists specifically to cover these costs and is most affordable when purchased in your 50s, before health conditions make premiums prohibitive or coverage unavailable. Hybrid life insurance policies that include long-term care riders are another option worth exploring with a financial advisor.

  • Have the hard family conversation. Discussing aging, care preferences, and finances before a health crisis is uncomfortable but is far less painful than making those decisions under pressure. Who will provide care? Where will funding come from?

  • Understand what Medicare actually covers. Many families are blindsided when they discover how little Medicare pays for custodial care. Knowing the limits in advance allows you to plan accordingly rather than scramble when a crisis arrives.

  • Learn the Medicaid rules in your state. Medicaid planning rules vary by state. An elder law attorney can help family members understand what assets are protected (a primary home, for instance, often is) and how to plan ahead within legal boundaries.

  • Don’t assume the “Great Wealth Transfer” will apply to you. If your parents haven’t accounted for long-term care in their financial planning, a significant portion, or all, of what you expected to inherit may go toward care costs. Adjusting your own savings strategy accordingly is prudent.

A System That Needs Reform

Individual planning can only go so far. The Roosevelt Institute’s report is ultimately a call to recognize long-term care as a systemic policy failure, not a series of individual misfortunes.

The result of the current system is a force shaping who gets to grow old with security and who bears the financial cost of care. Wealthier Americans can absorb the costs and recover; most others cannot.

Other wealthy nations have approached this problem differently, such as through public long-term care insurance programs, stronger workforce investment, and universal coverage models. The U.S. has long treated elder care as a private responsibility. The Roosevelt Institute’s data show the price that ordinary Americans pay for that choice: a lifetime of savings wiped out, and a next generation left with less of a foundation than it might otherwise have had.

Additional Reading