Paying for a parent's care: the first-30-days checklist
When a parent suddenly needs help, the money questions arrive before the answers do. Here is what to do in the first month, week by week, before anyone signs a contract.
Margaret "Peg" Ellison · filed August 17, 2026
It often starts with a fall, a hospital stay, or a phone call from a neighbor. Suddenly your parent cannot manage alone, and you are making decisions about money you have never seen. Take a breath. The first month is mostly about gathering information, and almost nothing has to be signed on the first day.
Here is the order I would work in.
Week one: understand what kind of care is needed
The single most important question for the money is this: is the care skilled or custodial?
- Skilled care is care that needs a nurse or therapist: wound care, injections, physical therapy after surgery.
- Custodial care is help with daily living: bathing, dressing, eating, getting to the toilet, taking medicine on time.
Why it matters: Medicare generally does not pay for long-term custodial care. It can cover skilled nursing facility care for a limited time, up to 100 days in a benefit period, after a qualifying inpatient hospital stay of at least three days, with a daily coinsurance after day 20. It can also cover part-time skilled home health care for people who are homebound. The details are in the official Medicare & You handbook and on Medicare.gov.
Ask the hospital discharge planner or social worker, in writing if possible:
- What care does the doctor say my parent needs?
- Is any of it skilled care that Medicare is expected to cover, and for how long?
- Was my parent formally admitted as an inpatient, or held under observation status? (It affects the three-day rule.)
Week two: find out what your parent has
Gather, in one folder:
- Medicare card and any Medicare Advantage, supplement or Part D cards.
- Medicaid card, if your parent has one.
- Income: Social Security, pensions, annuities, retirement account withdrawals.
- Bank and investment statements for the last few months.
- Insurance policies: long-term care, life insurance, any hospital indemnity coverage.
- Legal papers: power of attorney for finances, health care proxy, and any will or trust.
If there is no financial power of attorney and your parent can still sign one, make that the priority this week. Without it, paying bills on their behalf can become a court matter.
Week three: check every source before paying privately
Work down this list before you sign a private-pay contract.
| Source | What to ask |
|---|---|
| Long-term care insurance | What is the elimination (waiting) period? What daily or monthly amount does it pay? Does it cover home care? |
| Medicare | Is any of the current care skilled and covered? When does coverage end? |
| Medicaid | Does your parent qualify, now or after spending down? Does the state have a home and community-based services program? |
| VA benefits | If your parent or their late spouse was a veteran, do they qualify for a pension with Aid and Attendance? |
| Area Agency on Aging | What local programs exist: meals, respite, adult day, caregiver support? |
To reach your local Area Agency on Aging, call the Eldercare Locator run by the U.S. Administration for Community Living at 1-800-677-1116, or search at eldercare.acl.gov.
A note on Medicaid: if your parent may need Medicaid for long-term care, do not move money around to make them qualify without professional help. Medicaid reviews transfers made in the 60 months before an application, and gifts in that window can delay eligibility. An elder law attorney in your state can explain the rules.
Week four: write the monthly budget
Now put it on one page. Three columns are enough.
| Monthly | Amount | Paid by |
|---|---|---|
| Parent's income (all sources) | ||
| Care costs (aides, adult day, facility) | ||
| Housing, food, utilities | ||
| Insurance premiums and medicine | ||
| Gap (income minus costs) |
If there is a gap, write down who is covering it and for how long. If brothers and sisters are sharing costs, agree on it in writing now, while everyone is still on good terms. If you pay for care yourself, keep receipts; some of it may count toward medical expense or dependent care tax rules, which IRS Publication 502 and Publication 503 explain.
Two things not to do in the first month
- Don't sign an open-ended contract with an agency or facility without reading the cancellation terms.
- Don't assume the hospital's suggestion is the only option. Ask for a list of agencies or facilities, and ask how each is paid.
Comparing hourly options is the next step. I worked the arithmetic in Adult day programs vs in-home aides: the hourly math.
Before you close this file
Due: Age 85- Get written discharge instructions and a list of what care the doctor says is needed.
- Find out whether the care is skilled care Medicare may cover, or custodial help it generally does not.
- Collect your parent's insurance cards, income statements and bank statements in one folder.
- Call the Eldercare Locator at 1-800-677-1116 to reach the local Area Agency on Aging.
- Check for long-term care insurance, VA benefits and Medicaid eligibility before paying privately.
- Write a one-page monthly budget showing income, care costs and who is paying what.
Print this page and tick the boxes in pen. It is meant to be used, not just read.
A note from the desk: this file explains how things generally work so you can ask better questions. It is not advice for your situation. Rules, prices and policy terms differ by state, by company and by year, so confirm the details with the agency, insurer or provider before you sign or pay anything.