When you begin researching care options for yourself or a loved one in Ohio, the initial numbers can be paralyzing. It is one thing to know that care is expensive, it is another entirely to see a monthly figure that exceeds the average mortgage by three or four times.
Most families we meet at Brumbaugh Law Firm start their journey by asking, “How much does it cost?” But as you move deeper into your evaluation, you likely realize the more critical question is, “How do we manage these costs without depleting everything we’ve worked a lifetime to build?”
Effective financial planning for long-term care is about rigorous cost management, uncovering hidden fees, and structuring your assets to last. At Brumbaugh Law Firm, we move beyond the basics to provide you with the insider information necessary to make confident, sustainable financial decisions.
Key Takeaways
- The posted monthly rate is only the starting point. Budgets need to account for annual increases and care-level upgrades that can raise costs 20–40%.
- Hidden fees are the most common budget breakers. Make sure to get them clarified in writing before signing.
- A sustainable plan combines cost buffers with legal and funding strategy (asset protection, benefits optimization, and stress-testing for a move to higher care).
Understanding the 2026 Market Reality
Care costs have shifted significantly. According to the Genworth Cost of Care Survey, we are seeing substantial year-over-year increases that outpace standard inflation.
If you are evaluating options between Assisted Living and Nursing Home care, the price gap is the first variable in your equation:
- Assisted Living: The estimated national median is about $6,129 per month (as of December 2025).
- Nursing Homes (Semi-Private Room): Median cost is roughly $9,555 per month (as of December 2025).
- Nursing Homes (Private Room): Expect around $10,965 per month (as of December 2025).
However, these numbers are just the “sticker price.” The difference between a sustainable plan and a financial crisis often lies in understanding what isn’t listed on the glossy brochure.
The 3 Hidden Costs That Break Budgets
The most common mistake families make is budgeting strictly for the “base rate.” The senior care industry often utilizes pricing models that can inflate your monthly bill by 20% to 40% if you aren’t vigilant. To create a realistic budget, you must account for these three “silent” budget-killers.
1. The Reality of Tiered Pricing
Facilities rarely charge a flat rate for everyone. They operate on “Levels of Care.” A resident assessed at Level 1 pays the base rate. However, if your loved one needs assistance with bathing, dressing, or transfers, they may be bumped to Level 2 or 3. Each jump can add hundreds or even thousands of dollars to the monthly invoice.
2. The “Pill Tax”
One of the most frustrating hidden costs is medication management. According to AARP, many facilities charge fees based on the medication regimen or even the number of pills dispensed.
We have seen instances where the addition of a simple daily vitamin triggered a tier increase in medication management fees. This “Pill Tax” is a revenue generator that you must clarify in writing before signing a contract.
3. “Related-Party” Transactions
This is a sophisticated nuance often overlooked. Many for-profit facilities pay significant portions of their revenue, sometimes up to 40%, according to the Center for Medicare Advocacy, to “related parties.” These are companies owned by the same parent corporation that handle real estate, management, or therapy services.
Why does this matter to you? Because it inflates the cost of care without necessarily increasing the quality of care. Understanding this structure helps you ask tougher questions about where your money is actually going.
5 Steps to Building a Sustainable Financial Plan
Here are 5 steps to building a financial plan:
Step 1: Realistic Estimation
Take the base rate of the facility you are considering and immediately add 20%. This buffer accounts for the inevitable annual rate hikes (typically 3-5%) and the tiered service creeps mentioned above. If your budget breaks at the base rate, the facility is not financially sustainable for the long term.
Step 2: Strategic Asset Protection
Many families believe they must “spend down” everything before receiving help. This is a myth that often leaves a healthy spouse impoverished. By working with a trust lawyer, you can utilize irrevocable trusts or other legal instruments to protect specific assets from being counted against you for Medicaid eligibility, legally and ethically.
Step 3: Modern Funding Instruments
We are seeing a shift away from traditional Long-Term Care Insurance (which can be prohibitively expensive) toward hybrid solutions.
- Hybrid Life/Annuity Policies: These offer a death benefit if you don’t need care, but allow you to access the funds tax-free if you do.
- Health Savings Accounts (HSAs): Strategic use of HSAs can provide a tax-advantaged bucket specifically for these future costs.
Step 4: Maximizing Government Entitlements
Never assume you don’t qualify. Whether it is Veterans’ Aid and Attendance benefits or Medicaid, the rules are complex. A skilled estate planning attorney knows how to structure your estate to maximize these benefits without violating “look-back” periods.
Step 5: The Stress Test
Before committing, run your plan through a “crisis scenario.” If the primary earner passes away, or if care needs escalate from assisted living to skilled nursing within 12 months, does the plan hold? If the answer is no, we need to adjust the strategy immediately.
Negotiating with Care Providers
While nursing homes have fixed costs, assisted living communities often have flexibility, especially if they have vacancies.
- The Entrance Fee: This is often a large, one-time lump sum (sometimes called a “community fee”). Ask if this can be waived or amortized over the first year.
- The Look-Back on Levels: Request a clause that requires a re-evaluation of “care levels” every 90 days. If your loved one improves (recovers from a fall, for example), their care costs should go down, not just up.
- A La Carte Caps: Negotiate a cap on annual price increases for a la carte services to prevent runaway inflation on your bill.
Empowering Your Decision
The transition to long-term care is one of the most significant financial transitions a family will undergo. It requires a legal and financial shield.
At Brumbaugh Law Firm, we help you handle the entire ecosystem of elder care. From our free educational seminars to our holistic team that includes social workers and attorneys, we are dedicated to making sure you don’t just pay for care, you manage it.
Contact us today to begin your planning journey.
