When Your Spouse Needs Care: Legal and Financial Steps

Caring for a spouse raises practical questions about authority, work, and money. This article gives the basics. State rules vary and the figures change every year, so use it as a map, not as legal advice.

What legal documents help?

Two matter most: a health care proxy and a financial power of attorney. The National Institute on Aging says the usual way to name a health care proxy is a durable power of attorney for health care, and that a durable power of attorney for finances stays in place if a person can no longer make decisions. The Consumer Financial Protection Bureau notes that the health care document is different from the financial one. The Institute suggests talking with a lawyer about powers of attorney, an advance directive, a joint account, or a trust.

Do this while your spouse can still decide. If that time has passed, see Can Someone With Dementia Still Sign a Will or Power of Attorney? and Guardianship and Conservatorship for Adults. Also put your own documents in place, and ask the attorney about naming a backup if the first person cannot serve.

What duties come with acting for your spouse?

A person acting under a power of attorney is a fiduciary. The Consumer Financial Protection Bureau lists four duties: act in the person’s best interest, manage their money and property carefully, keep it separate from your own, and keep good records. Its guides are written for agents in general and advise against joint accounts. Married couples often already share accounts, so ask your attorney how that fits.

Can I take time off work?

Possibly. The federal Family and Medical Leave Act gives eligible employees up to 12 workweeks of unpaid, job-protected leave in a year to care for a spouse with a serious health condition, according to the Department of Labor. You must have worked for the employer at least 12 months and 1,250 hours, at a location with at least 50 employees. You may use paid leave you have earned at the same time. Some states have their own laws.

What will care cost, and who pays?

Medicare does not cover custodial care when it is the only care needed, according to Medicare.gov. The Administration for Community Living adds that Medicare does not pay for skilled nursing facility days after day 100, and that hospice covers limited respite care and grief counseling. Medicaid does cover long-term care, but it is means-tested. See Medicaid Considerations for Long-Term Care.

What protects the spouse who stays home?

Medicaid’s spousal impoverishment rules. Medicaid.gov says a certain amount of the couple’s combined resources is protected for the spouse living in the community. A federal explainer says the protections apply when the nursing home stay has lasted or is expected to last at least 30 consecutive days, that some states extend them to home and community-based waiver services, and that they do not apply when both spouses receive Medicaid long-term care. The National Council on Aging says the idea is that you will not have to sell your home to pay for care, but limits apply.

Here are the federal standards for 2026, from the Centers for Medicare & Medicaid Services:

• Resources the at-home spouse may keep: at least $32,532 and at most $162,660. In general the spouse may keep about half of the couple’s countable resources within that range, according to a New York directive. A fair hearing or court order can allow more, according to a Mississippi law school brochure.
• Monthly income allowance for the at-home spouse: a minimum of $2,705.00 in most states from July 1, 2026 ($3,381.25 in Alaska and $3,111.25 in Hawaii), and a maximum of $4,066.50.
• Home equity limit: between $752,000 and $1,130,000. States choose within that range, and Rhode Island, for example, uses the minimum.

The resource and maximum figures change each January, and the minimum income allowance changes each July. States differ: Illinois, for example, set its resource standard at $143,172 as of January 1, 2026. Some summaries still show the earlier minimum income allowance of $2,643.75, which applied until July 1, 2026.

Should I move or give away assets?

Not before getting advice. The rules for counting and moving assets are complex and state-specific. An elder-law attorney or your state’s Medicaid office can explain them before you transfer anything.

What help is there for veterans?

The VA Caregiver Support Line, 1-855-260-3274, provides information and referrals to local caregiver support teams.

What should I do next?

Put the legal documents in place, talk to an elder-law attorney about Medicaid, and call your local Area Agency on Aging through the Eldercare Locator at 1-800-677-1116. Check your leave rights with your employer. See Caring for a Spouse or Partner: What Changes and What Helps and Getting Your Affairs in Order.

This is general educational information, not legal advice. Medicaid, Medicare, and leave rules change and vary by state, so an elder-law attorney licensed in your state can confirm what applies to you.