When Your Spouse Needs More Care Than You Can Give

What happens to the healthy spouse when one spouse enters a nursing home?

Federal spousal impoverishment rules, applied in Virginia, protect the spouse at home. The community spouse may keep a share of the couple's countable assets, called the Community Spouse Resource Allowance (CSRA), and may keep enough income to live on, called the Minimum Monthly Maintenance Needs Allowance (MMNA). They also keep the home within an equity limit.

The nursing home spouse is the one who must meet the Medicaid test: $2,000 in assets for a single applicant and an income cap of $2,982 a month in 2026. The healthy spouse is not required to spend down to that level. Confirm all figures with the local department of social services or the Virginia Department of Medical Assistance Services, because they change every January and July.

How much can the spouse at home keep in 2026?

In 2026 the CSRA ranges from $32,532 to $162,660 in countable assets, and the MMNA runs from $2,643.75 to $4,066.50 a month. Virginia applies the federal minimum home equity limit, $752,000 for 2026. The MMNA minimum shown applies through June 30, 2026 and is recalculated each July 1.

The exact CSRA depends on the couple's total countable assets on the day the nursing home stay begins. If the community spouse's own income falls below the MMNA, part of the nursing home spouse's income can be shifted to make up the difference. A Medicaid attorney can run this calculation in an afternoon. Gather statements for every account, the deed and recent tax returns before you meet.

What is the five-year look-back and why does it matter?

Medicaid reviews asset transfers made in the five years before an application. Gifts or below-market sales in that window can cause a penalty period during which Medicaid will not pay for nursing home care. Spouses may transfer assets between themselves, but gifts to children are another matter.

Families sometimes act in a panic and sign a house over to a child. Do not do that before talking to an elder law attorney. See nursing home Medicaid and spouses for how the rules fit together, and keep records of every large payment. Even ordinary gifts, such as helping a grandchild with tuition, can be questioned later if they fall inside the five years.

Can a couple live together in an assisted living facility?

Yes, many Virginia assisted living communities have apartments for couples, even when the spouses need different levels of help. One spouse may be at the residential level and the other at the assisted living level, and the license has to cover the higher need. Ask whether the community prices each spouse separately.

If one spouse needs a safe, secure unit, the couple may live apart in the same building, which keeps them close. Ask how often they can eat together and how staff handle the transition. If the Auxiliary Grant is a possibility, the countable resource limit for a couple is $3,000, and each facility must agree to accept the grant. Check the Auxiliary Grant.

Also ask what happens if one spouse dies or moves to a higher level of care. Some communities let the surviving spouse keep the apartment; others offer a smaller one. Get the answer in writing, because it affects whether the healthy spouse stays in familiar surroundings.

When should a spouse move to a nursing home instead of assisted living?

Consider a nursing home when the spouse needs continuous licensed nursing care, a ventilator, tube feeding that assisted living cannot manage, or other limits that make assisted living unsafe. Assisted living is more home-like and costs less at the Virginia medians, $6,944 against $10,250 a month for a semi-private nursing home room.

Medicaid can pay for the nursing home, while assisted living has the Auxiliary Grant. Ask the physician which setting fits the medical need before deciding based on price. A spouse who needs skilled care often cannot be kept safe in a setting chosen for cost, and a move after a failed placement is harder on both of you. See assisted living vs. nursing home.

How do you care for yourself while your spouse needs more?

The spouse who stays home often neglects their own health. Keep your own doctor visits, and let others take part. If your spouse moves into a community, plan to visit but not to live there. Many partners go daily at first, then settle into a rhythm that fits their energy.

Some Hampton Roads couples arrived for a Navy posting and stayed, with few relatives nearby. Ask the area agency on aging about caregiver support, and a pastor or a veteran's group about company. See caregiver burnout and respite. We are paid by communities when a referred family moves in.