Attempts to define Marriage’s benefits and shortcomings always seem inadequate. Is it healthier to be married or live alone in a treehouse in the woods? No one knows for sure. It probably depends who you are married to and if the treehouse has Wi-Fi. When illness strikes one spouse, the married couple’s future plans and financial security will be shaken. Applying for Medicaid is a sound way to control long term health care spending when that major illness appears. For long term care Medicaid purposes, being married is a major economic benefit. For middle class couples with assets, financial transfers between spouses are exempt for Medicaid eligibility purposes. This is true for community based home care as well as for nursing home care. Spousal Refusal in New York, as a protective measure, allows a disabled spouse to become eligible even though the well spouse retains significant assets. Though Nursing Home Medicaid does impose a spousal contribution for a well spouse owning close to $120,000 in assets (not including the marital residence), the contribution can be negotiated along with a payment plan. Post-Medicaid estate planning can also help steer a family financially through the latter stages of a spouse’s illness. A family’s financial legacy should not be wiped out because of illness. New York has maintained allowances for specialized Medicaid planning to protect vulnerable individuals and especially married couples.
While the financial benefits of marriage during a long term illness can be quantified, the burdens of spousal caregiving are heavy while the benefits are not easily digestible. Spouses process the diminishment of their partner differently than a child or other caregiver. Resentment and guilt push caregiving spouses to consider escape in several forms – the most severe being marriage dissolution and separation. These are valid feelings. The fun is gone, replaced by responsibility. Watching a romantic partner decline is a soul damaging exercise. One casualty can quickly turn into two if the spousal caregiver does not have the proper support system. Utilizing paid caregiver options, whether private pay or Medicaid can sustain a spouse’s resolve in the face of a long term illness. Not everyone is blessed with a strong nuclear or extended family support system. Asking for help is usually the quickest way to get help. Pride, stubbornness, blame or the quest for perfection is the surest way to cause a long term health care crisis to become overwhelming.
One real benefit of marriage is that another person is willing (and legally bound) to keep you company on life’s trip. Illness may damage the body, but it should not define the companionship that has been tested and proven since that piece of wedding cake was first smeared in each other’s faces.