“We’re Not Poor”: Why Pride Keeps Some Seniors From Planning for Medicaid

Attorney RJ Connelly III Certified Elder Law Attorney Professional Fiduciary

Two short sentences are heard surprisingly often in elder law offices throughout the country. Here in Southern New England, they may come from a retired mill worker in Rhode Island, a former teacher in Massachusetts, a Connecticut couple who have lived in the same Cape-style house for more than fifty years, or a widow who carefully saved every extra dollar her husband brought home. The words are usually spoken with conviction and sometimes with just a hint of offense: “We’re not poor. We don’t need Medicaid.” On the surface, it sounds like a statement about money. Underneath, however, it frequently says something much deeper about pride, independence, sacrifice, dignity, and the values by which an older generation has lived its entire life.

For many seniors, especially those who grew up in hard-working Southern New England families, independence was not merely desirable. It was a measure of character. You worked for what you had. You paid your bills. You bought a home, maintained it, paid off the mortgage if you were fortunate enough to do so, put something aside for retirement, and tried not to become financially dependent upon your children. So when an adult child or professional suggests speaking with an elder law attorney about Medicaid planning for long-term care, the recommendation can strike an emotional nerve.

“People sometimes hear the word Medicaid and immediately believe someone is suggesting that they are poor or that they have somehow failed financially,” says Professional Fiduciary and Certified Elder Law Attorney RJ Connelly III. “That is not the purpose of the conversation. Many of the families we see have worked incredibly hard their entire lives. They have homes, retirement savings, and assets they accumulated over decades. Planning for Medicaid is about understanding what could happen if long-term care enters the picture and making informed decisions before a crisis takes those decisions out of your hands.”

A Lifetime Built Around Self-Reliance

A Southern New England couple we will call Carl and Marie. Carl spent most of his adult life working. Marie worked too, while also raising their children and keeping the household running. They never considered themselves wealthy, but neither did they think of themselves as struggling. They learned early that money had to be earned before it could be spent, and they lived accordingly.

Their first house was not large. Over the years, it became much more than property. It was where their children took their first steps, where Christmas mornings unfolded, where graduation photographs were taken on the front lawn and where grandchildren eventually ran through rooms once occupied by their parents. Carl repaired what broke. Marie saved receipts, paid bills on time and knew exactly what was in the household accounts. They refinanced when necessary, saved when they could, and eventually reached the milestone they had dreamed about for decades: the mortgage was paid.

By their early eighties, they thought they had done everything correctly. They had Social Security, retirement income, a healthy savings account, and the house. They had never lived extravagantly, but they felt secure. Then Carl fell. What initially looked like a relatively routine hospitalization became rehabilitation. Rehabilitation raised questions about whether returning home would be safe. Suddenly their children heard unfamiliar phrases involving skilled nursing care, long-term care, asset eligibility, spend-down planning, and Medicaid.

One of the children suggested contacting an elder law attorney to discuss crisis Medicaid planning. Carl's reaction was immediate. “Why would we do that? We're not poor.” In these words, the obstacle was clear.

When Medicaid Feels Like an Admission of Failure

For Carl, the word Medicaid did not initially describe a long-term-care financing program with complicated legal and financial rules. It represented something emotional. Asking about Medicaid felt uncomfortably close to admitting that everything he had done to remain financially independent had somehow not been enough.

"That is one of the most important psychological dimensions of Medicaid planning," said Attorney Connelly. "A family's willingness to discuss long-term care is often influenced as much by emotion as by finances."

A senior may have spent sixty years believing that responsible people take care of themselves. Consequently, the suggestion that government benefits might someday become part of a long-term-care plan can feel inconsistent with that person's identity. Pride enters the conversation, and what should be an exercise in gathering information instead becomes a defense of a lifetime of accomplishment.

The irony is that the very characteristics that make some seniors resistant to Medicaid planning, thrift, responsibility, independence and concern for family, are often the same characteristics that should encourage them to investigate their options.

“Planning is not an admission of failure,” Connelly explains. “I would argue that learning about your options before you need them is actually an extension of the same responsibility that allowed you to build those assets in the first place. The goal is not to tell every family that Medicaid is the answer. The goal is to make sure the family understands the rules and makes informed decisions based on its own circumstances.”

The House Is Never Just a House

Throughout Rhode Island, Massachusetts, and Connecticut, many older homeowners live in properties they purchased decades ago. To an outsider, the house can easily be reduced to a line on a financial statement. To the owner, it may represent an entire adult life. That difference matters.

When families begin discussing long-term care, questions about the home can provoke some of the strongest emotions. An older person may hear a discussion about the house and immediately fear losing it. Adult children may worry about whether a healthy spouse can continue living there. Others may wonder whether the property can eventually pass to the next generation.

Yet the emotional history residing inside that home rarely appears on a Medicaid application. The kitchen table may be where homework was completed and family problems were solved. The backyard may still contain a tree planted when the first child was born. A bedroom may look remarkably similar to the way it did before an adult son or daughter left for college decades earlier. To tell a senior simply to think of that property as an “asset” misses much of what makes long-term-care planning so emotionally difficult. This is one reason thoughtful Medicaid planning should start with a conversation about people and objectives rather than immediately focusing on forms.

"Every family brings a different set of circumstances, including health concerns, financial resources, caregiving needs, family relationships, and long-term goals," said Attorney Connelly. "Understanding those realities first allows the planning process to focus not simply on qualifying for benefits, but on protecting the individual’s well-being, preserving appropriate resources, and creating a plan that reflects what the family is actually trying to accomplish. Only after those priorities are understood should the discussion turn to the documents, strategies, and applications that may be needed."

“We Saved for Our Old Age”

Another common response is equally understandable: “We saved for our old age. We'll pay for whatever we need.” There is dignity in that attitude, but it should not end the discussion. It should begin one.

If a couple intends to privately fund long-term care, they should understand what that decision could mean under different circumstances. What if one spouse requires extensive care while the other remains at home? What other household expenses must continue? What if the person's care needs last significantly longer than the family imagined? What happens to the financial security of the spouse who remains in the community?

These are not questions about whether someone is rich or poor. They are questions about planning for risk. A family may ultimately decide to use substantial personal resources for care. But there is a fundamental difference between doing so as part of an informed plan and simply spending money because everyone assumes there are no alternatives.

“When families come to us, I want to know what they are trying to accomplish,” says Attorney Connelly. “Are we trying to protect a spouse who remains at home? Is there a nursing home crisis happening right now? Is the family planning years in advance? What assets exist? What planning has already been done? Those facts matter because Medicaid planning is not one strategy that gets handed to every client who walks through the door.”

The Danger of Waiting Until Friday Afternoon

Perhaps the most costly misconception is the belief that a family does not need to think about Medicaid until a nursing home actually becomes necessary. Long-term-care crises have an unfortunate habit of ignoring convenient schedules. An elderly parent falls. A spouse suffers a stroke. Dementia progresses beyond what a caregiver can safely manage at home. A hospital begins discussing discharge, rehabilitation or another level of care, and suddenly the family needs to make decisions it assumed were years away.

The son who lives nearby starts searching through filing cabinets. A daughter in another state is trying to participate by telephone. Someone is attempting to locate a power of attorney. Another family member is gathering bank records. Nobody is certain how an old account is titled. Everyone remembers something vaguely different about what Mom and Dad wanted. Now add fear, guilt and exhaustion. This is precisely the point when rushed financial decisions can occur. A family that had years to discuss long-term-care planning suddenly feels as if it has days.

Attorney Connelly describes this distinction as the difference between planning with time and reacting under pressure. “When a family talks to us before the crisis, there is an opportunity to slow things down, identify the issues and discuss objectives. In a crisis, we still look for available options, but the circumstances are driving the timetable. I would much rather see a family before the emergency telephone call.”

Three States, Different Rules, One Common Problem

For families in Southern New England, another complication must be understood: Medicaid is not a single, identical long-term-care planning system from state to state. Medicaid is a federal-state partnership, and Rhode Island, Massachusetts and Connecticut each administer their programs under their respective state systems.

That distinction is particularly important here because Southern New England families frequently cross state boundaries. Parents may live in Rhode Island while their children live in Massachusetts. A couple may have spent most of its life in Connecticut but now be considering moving closer to a daughter elsewhere in New England. A family may own property in one state while exploring long-term-care options in another.

This is why advice from a friend whose mother went through the Medicaid process in another state should not automatically be treated as a roadmap for your own family. The details matter. And the family matters.

“My Neighbor Said We Should Put the House in the Kids' Names”

Few phrases should cause a family to slow down more quickly than “Someone told me...” Someone at the coffee shop heard you should transfer the house. A neighbor says she knows how Medicaid works because her mother went into a nursing home several years ago. A relative remembers what happened with an uncle in another state. The Internet produces an endless supply of articles, videos, social-media posts and discussion forums offering solutions that sound remarkably simple. Unfortunately, simplicity can be deceptive.

Asset transfers and significant changes in property ownership can potentially affect much more than one objective. Medicaid eligibility considerations can intersect with estate planning, tax issues, creditor concerns, family relationships and control over property. A strategy appropriate for one household may make little sense for another.

That is why seeking advice before transferring property or rearranging finances can be so important.

“Some of my most important conversations with families involve telling them not to rush into something,” Attorney Connelly says. “Before changing ownership of a home, making gifts, moving significant amounts of money or relying on something found online, understand the consequences. Once something has been done, repairing it may be much more difficult than planning it correctly in the first place.”

Pride Can Belong to the Children, Too

Adult children can also have their own version of the “we're not poor” reaction.

Sometimes it sounds like this: “Mom will never go to a nursing home. We'll take care of her ourselves.”

The statement is usually made with love and sincerity. Yet caregiving realities can change. Dementia can progress. Mobility can decline. Medical needs can become increasingly complicated. A spouse or adult child who confidently promised years earlier that a parent would always remain at home may eventually confront physical and emotional demands that no family could reasonably have anticipated. Planning for that possibility is not abandoning the promise to care for someone. It is strengthening it.

A good long-term-care plan allows a family to explore what Mom or Dad would want under different circumstances while the family still has the luxury of conversation. It allows everyone to distinguish between a preference and an absolute promise that circumstances may later make impossible to fulfill.

Medicaid Planning Is Really About Maintaining Choices

Once families move past the stigma surrounding the word Medicaid, the conversation begins to look very different. Instead of asking, “Are we poor enough for Medicaid?” they can start asking more useful questions.

What would happen financially if one of us needed long-term care? How would the other spouse continue living? Are our estate-planning documents consistent with our long-term-care goals? Do the people we selected to make decisions for us have appropriate legal authority? Does our family know where the important financial information is located? Have we made previous gifts or transfers that should be discussed with an elder law attorney? Are there steps we should consider now rather than waiting until an emergency? Those questions are not about poverty. They are about preserving choices.

“The greatest misconception may be that Medicaid planning is simply about qualifying for a government program,” Attorney Connelly says. “For me, the larger conversation is about helping someone understand the legal and financial landscape surrounding long-term care. Sometimes we are planning well in advance. Sometimes a family has already reached a crisis. Either way, we begin with the person's circumstances and goals.”

The Connelly Law Approach to Medicaid Planning

For families throughout Southern New England, Connelly Law's Medicaid planning team focuses on the human circumstances behind the financial numbers. A Rhode Island family facing an immediate nursing-home issue may require a very different discussion from a Massachusetts couple planning ahead or a Connecticut family trying to prepare for a parent's progressing health condition. There is no meaningful one-size-fits-all Medicaid plan.

That is precisely why sitting down with experienced elder law counsel can be valuable. A professional review can bring the legal documents, finances, family circumstances and long-term-care goals together in one conversation, rather than treating each as an unrelated issue.

Just as importantly, the process can replace rumors and fear with information. The objective should never be to frighten seniors into planning. Nor should Medicaid be presented as the answer for everyone. The better approach is to give families an opportunity to understand their situation, identify potential issues and consider lawful planning options before making major decisions.

A Final Word

Perhaps we should listen differently when an older person says, “We're not poor.” What he may actually be saying is that he worked hard for what he has and wants that work respected. What she may be saying is that every dollar in that savings account represents a sacrifice someone made. They may be saying that they never wanted to depend upon their children, that the house means more to them than its market value, that they want their spouse to remain secure, or that they hoped to leave something behind for the next generation. Those feelings are not obstacles to be dismissed. They are the reason planning matters.

“People should absolutely be proud of what they built,” Attorney Connelly says. “We respect that. Medicaid planning should never make someone feel ashamed of needing care or of asking what options may be available. Our role at Connelly Law is to help families understand the issues, explain the choices that may apply to their circumstances and help them plan for the future with as much dignity and control as possible.”

The materials and information presented in this blog are intended solely for general informational purposes and should not be interpreted as legal, financial, or healthcare advice. Because laws, regulations, and best practices evolve over time, the content may not always reflect the most current developments and should not be relied upon when making personal or professional decisions. This blog may include links to third‑party websites for our readers' convenience. Connelly Law does not endorse, guarantee, or assume responsibility for the accuracy or reliability of external content. Some photographs or images appearing in this blog may be AI‑generated or stock imagery used for illustrative purposes only. Case studies shared herein are anonymized, contain no identifying information, and may be blended from multiple experiences to demonstrate common issues encountered in practice. Given the complexities of legal, financial, and healthcare matters, we strongly encourage readers to consult a qualified attorney, professional fiduciary advisor, or healthcare provider for guidance tailored to their specific circumstances. Your well‑being and ability to make informed decisions remain our highest priority.