In today’s episode, I sit down with Lori Sumekh of the New York Elder Law Group to discuss Medicaid home care planning, protecting senior assets, and navigating the financial realities of long-term care. Lori shares how her career evolved from mortgage banking into elder law, and how working on guardianship cases led her to specialize in Medicaid planning.

Throughout our conversation, Lori breaks down complex Medicaid income and asset rules in a way families can understand. She explains how pooled income trusts work, what expenses are allowed (and not allowed), and why planning early can make a significant difference. We also discuss the emotional side of caregiving, the cost of home health aides, inheritance misconceptions, and the importance of using a senior’s resources to enhance their quality of life.

Lori provides practical guidance for families trying to balance protecting assets with ensuring their loved ones receive proper care at home.

🕒 Timeline Summary

00:07 Introduction and Lori’s background.

00:20 – Why professional guidance matters and common mistakes families make alone.

00:35 – Preparing documentation: doctor notes, medical history, and required assessments.

00:51:54 – 24-hour care process overview: vendor coordination, assessments, six-month reviews, care hours, overnight coverage, and follow-up strategies.

00:52:03 – Explanation of Medicaid’s six-month care renewal process.

00:54:51 – Securing 24-hour care, cost comparisons, and value of expert support.

00:55:55 – Typical care setups and long-term care insurance considerations.

00:57:50 – Caregiver workload, qualifications, and professional expectations.

00:58:54 – Private vs. Medicaid-contracted agencies and coordination challenges.

01:02:34 – Step-by-step Medicaid process: eligibility, income trusts, documentation, assessments, approvals, and care initiation.

01:03:21 – Why attempting the process alone can lead to delays and errors.

01:04:54 – Introduction of A Home Guide to Medicaid as a structured resource for families.

01:06:00 Emphasis on Medicaid planning as a specialized field requiring expertise.

5 Key Takeaways

Medicaid Planning Is Strategic: Proper planning allows seniors to qualify for home care benefits while preserving assets legally.

Pooled Income Trusts Are Powerful Tools:

These trusts allow excess income to be redirected toward approved expenses without disqualifying Medicaid eligibility.

Care Costs Add Up Quickly: With home health aides often costing $30–$35+ per hour, early planning is essential.

Quality of Life Comes First: Laurie emphasizes that a senior’s money should support their care, comfort, and dignity—not just inheritance goals.

Transparency Prevents Crisis: Understanding income, assets, and potential estate recovery helps families avoid surprises later.

Links & Resources

Learn about Elder Law, Trust and Estate Attorneys in New York at:

Website:

https://www.nyelderlawgroup.com

Phone Number: 718-740-3300

Location:

Garden City Office

401 Franklin Avenue

Suite 312

Garden City, NY 11530

Learn about Leave The Key Homebuyers Senior Transition Service at:

Phone Number: (631) 837-2898

Website: leavethekey.com/seniors

Final Thoughts

If this conversation with Lori provided clarity around Medicaid and home care planning, please take a moment to subscribe, review, and share this podcast. These conversations help families make informed, proactive decisions rather than reactive ones during times of crisis. Lori’s expertise highlights how strategic planning can protect both assets and peace of mind while ensuring seniors receive the care they deserve.

In today’s episode, I sit down with Renata Landskind and Terence Ricaforte of Landskind & Ricaforte Law Group, P.C. to discuss why Medicaid planning isn't just for the impoverished, but a vital "life planning" tool for the middle class. Renata and Terence expose the common misconceptions that keep families from protecting their legacy, explaining why waiting for a medical crisis to strike is the most expensive mistake a senior can make.

Throughout our conversation, we break down the strategies of the "mass affluent"—families with assets between $1M and $5M who are often caught in the middle: too wealthy for automatic aid, yet vulnerable to being wiped out by long-term care costs. We dive deep into the mechanics of Medicaid Asset Protection Trusts, the critical nuances of the Elder Law Power of Attorney, and how to navigate the 5-year look-back period. This episode serves as a roadmap for families who want to ensure their hard-earned assets go to their children rather than being exhausted by nursing home bills.

• 00:00 Intro & Guest Background

• 05:30 Defining the "Mass Affluent"

• 10:15 Long-Term Care Insurance Trends

• 14:45 Medicaid Asset Protection Trusts (MAPT)

• 20:10 New York Medicaid Income Limits

• 26:50 The Psychology of Inheritance: The "Consolation Prize"

• 33:15 The "Broken Hip" Trigger & The Death Spiral

• 40:00 Look-Back Period & Penalty Months

• 48:20 Essential Elder Law POA vs. Standard POA

• 55:10 Coordinating the Will & POA to Avoid Litigation

• 01:03:00 How to Contact Landskind & Ricaforte

1. Planning is for the "Mass Affluent": Families with assets between $1M and $5M are the most at risk. Proper planning allows you to bridge the gap between your income and the high cost of quality care.

2. The "Elder Law" POA is Critical: A standard Power of Attorney is often a liability in a crisis. You need a document that specifically allows for unlimited gift-giving and trust creation to protect assets at the eleventh hour.

3. Trusts Are More Flexible Than You Think: "Irrevocable" doesn't mean "unchangeable." Under New York law, these trusts can be revoked with beneficiary consent, and you retain the power to change your trustees at any time.

4. The 5-Year Clock is Your Friend: The best time to protect your home and savings is while you are healthy. Starting the 5-year look-back clock early ensures that your assets are "invisible" to Medicaid when you eventually need care.

5. Inheritance Has a Quality of Life Value: Giving to your children earlier in life often provides more utility than a larger inheritance when they are already in their 70s. Proper planning facilitates this "living legacy."

Landskind & Ricaforte Law Group, P.C.:

• Website: ricafortelaw.com

• Phone: 718-333-5007

• Resources: Free Elder Law e-books and educational videos available on their site.

Learn about Leave The Key Homebuyers Senior Transition Service:

• Website: leavethekey.com/seniors

• Phone: (631) 388-7771

Medicaid planning is ultimately about maintaining dignity and choice in your final years. If this episode helped you understand how to protect your home or clarified the "look-back" confusion, please subscribe, leave a review, and share it with someone planning for the future. Don't wait for the fall to start the plan.

Timeline Summary5 Key TakeawaysLinks & ResourcesFinal Thoughts

In this episode of Unlocking Senior Resources, Larry Wagner is joined by Deanna M. Eble, a Partner at Russo Law Group, P.C. With over 17 years of experience at one of Long Island’s most respected elder law firms, Deanna tackles the number one fear among seniors: losing the family home to a nursing home.

This conversation is a must-watch because it peels back the curtain on the "human side" of elder law. Larry and Deanna break down complex Medicaid rules into actionable advice, covering everything from why your current Power of Attorney might be a "ticking time bomb" to how a specific trust can protect your house while keeping your tax exemptions. If you are a senior or an adult child concerned about the rising costs of long-term care, this roadmap is for you.

IN THIS EPISODE, WE DISCUSS:• The 5-Year Look-Back Audit: What Medicaid looks for in your bank statements.• MAPT vs. Life Estates: Why the "cheaper" legal option can lead to massive tax bills.• New York Asset Limits: Navigating the 2026 thresholds ($32,000+ in assets).• Pooled Income Trusts: How to stay in your home if your income is over the limit.

TIMELINE SUMMARY:00:00 Introduction to Deanna M. Eble and the human side of elder law.04:30 The Best Nursing Home: Why proximity to family beats a fancy lobby.09:15 Medicaid Asset Protection Trusts (MAPT) vs. Life Estate Deeds.14:00 The cautionary tale of the ex-daughter-in-law and the deed lawsuit.21:10 Understanding Capital Gains and the "Step-Up in Basis" benefit.28:45 The 60-Month Audit: How dividends and hidden stocks can disqualify you.35:20 Protecting Retirement Accounts: Why you don't have to spend down your IRA.42:50 Power of Attorney Red Flags: The importance of "Unlimited Gifting" clauses.51:10 Spousal Refusal: New York’s unique protection for married couples.58:00 Closing thoughts: Why "Something is always better than nothing."

5 KEY TAKEAWAYS:

1. TRUSTS BEAT LIFE ESTATES FOR PROTECTION: A Medicaid Asset Protection Trust protects your home from a child’s creditors or divorce and preserves your $250,000 capital gains exclusion.

2. IRAS ARE OFTEN EXEMPT ASSETS: You do not necessarily have to liquidate your retirement accounts. In New York, these can stay in your name as long as they are in payout status.

3. THE POWER OF ATTORNEY CRISIS: An outdated Power of Attorney can prevent your lawyer from saving your assets in a crisis. Ensure yours is updated to the June 2021 NY standards.

4. THE HUMAN METRIC FOR CARE: Choose a facility based on where you can visit most often. Family interaction is the greatest factor in ensuring quality care.

5. POOLED INCOME TRUSTS FOR INDEPENDENCE: If your income is too high for Medicaid, you can use a Pooled Income Trust to pay for your own utilities and taxes while receiving care.

CONNECT WITH DEANNA M. EBLE & RUSSO LAW GROUP, P.C.:• Website: vjrussolaw.com• Phone: 516-683-1717• Office: 100 Quentin Roosevelt Blvd, Garden City, NY 11530

CONNECT WITH LARRY WAGNER & LEAVE THE KEY:• Website: leavethekey.com• Phone: 631-388-7771• Senior Transition Service: leavethekey.com/senior-transition-services-long-island/• Facebook: facebook.com/leavethekey

FINAL THOUGHTS:At Leave The Key, we view our work with the senior community as a vital service to the families of Long Island. Transitioning from a family home is a major life event, and our goal is to ensure you have the resources and legal knowledge to do so with confidence. If this episode helped clarify your future planning, please subscribe and share it with someone who needs to hear this message.