Medicare does not cover long-term care. The average nursing home costs $9,000 per month. If your parents need care, the financial planning falls to you. Here is how to build a ledger that tracks their runway.
The Coverage Gap
Most people assume Medicare covers nursing homes. It does not - only short-term rehabilitation after hospitalization. Long-term care options:
- Private pay ($9,000+/month)
- Long-term care insurance (if they have it)
- Medicaid (after spending down assets)
Setting Up a Parent Finance Ledger
; Separate file: parents-finance.beancount
2026-01-01 open Assets:Parents:Checking
2026-01-01 open Assets:Parents:Savings
2026-01-01 open Assets:Parents:Investments
2026-01-01 open Assets:Parents:Home ; May need to sell
2026-01-01 open Income:Parents:SocialSecurity
2026-01-01 open Income:Parents:Pension
2026-01-01 open Expenses:Parents:Care:AssistedLiving
2026-01-01 open Expenses:Parents:Care:HomeCare
2026-01-01 open Expenses:Parents:Medical
Runway Calculation
2026-02-01 custom "care-runway" "parents"
total-liquid-assets: "180000 USD"
home-equity: "350000 USD" ; Last resort
monthly-income: "3200 USD" ; SS + pension
assisted-living-cost: "6500 USD"
monthly-shortfall: "3300 USD"
runway-months: "54" ; Without selling home
runway-with-home: "160" ; If home sold
Medicaid Planning
Medicaid has a 5-year lookback period. Track all transfers:
2026-02-15 * "Gift to grandchild" "Birthday gift"
Expenses:Parents:Gifts 5000 USD
Assets:Parents:Checking -5000 USD
medicaid-lookback: "true"
lookback-expires: "2031-02-15"
Monthly Monitoring Query
SELECT
MONTH(date) as month,
SUM(position) FILTER(WHERE account ~ "Assets:Parents") as total_assets,
SUM(position) FILTER(WHERE account ~ "Expenses:Parents:Care") as care_costs
WHERE date >= 2026-01-01
GROUP BY month
Questions
- Have you had to manage a parent’s finances?
- How do you track the Medicaid lookback period?
- What resources helped you navigate eldercare costs?