By JUDD MATSUNAGA, ESQ.
For those of you who wondered what happened to my annual Nisei Week Seminar, I’ll tell you what happened — I’m getting old and close to retirement. But if I did have the energy to host a Nisei Week Seminar in 2026, this Rafu Shimpo article is to tell you what I would have shared with the Japanese American community.
According to a 2024 report in Consumer Affairs, “Over half (56%) of Americans turning 65 today will develop a disability serious enough to require long-term services and support.” The U.S. Department of Health and Human Services (HHS) estimates that from 2020 to 2065, the number of individuals with significant disabilities is expected to grow from 7.6 million to 14.7 million, given the aging population.
That means if you’re a younger Nisei or older Sansei, you need to understand that Medicare and your private health insurance will NOT cover nursing home care. I’ll repeat — there’s over a 50% chance that you might need long-term care.
You might say, “Medi-Cal paid for Grandma’s nursing home care at Keiro, and also for my uncle’s nursing home care at Keiro. So, if I need it, I’ll get Medi-Cal to pay for my nursing home care at Kei-Ai.”
Not so fast!!! With the leading edge of the Baby Boomers turning 80 this year, all the long-term care experts and senior care advocates are warning that the government cannot pay for nursing home care for the next 19 years of the Baby Boom generation. In a nutshell, Medi-Cal (Medicaid in other states) is gradually being phased out by our lawmakers.
“Say what?” you might ask. According to California’s Legislative Analyst’s Office (LAO), Medi-Cal spending continues to grow under the governor’s budget, with estimated Medi-Cal spending reaching an all-time high of $49 billion. Since the 2026–27 General Fund is $222 billion, that’s over 20% of the budget — and rising every year.
The government knows it can’t pay for long-term care for the Baby Boom generation. So, the government is making it harder and harder to qualify for Medi-Cal. One day soon, the government is going to shift the financial burden of LTC off the public sector and onto the private sector.
“How?” you might ask. By forcing workers to buy long-term care insurance, i.e., privatizing long-term care.
In other words, workers will get their paycheck and look at the deductions. They’ll see the standard deductions, e.g., federal and state taxes, Social Security, Medicare. But soon, they’ll see another deduction for long-term care insurance. It’s already happening in Washington State. California and several other states are already writing laws to do the same.
But the problem is that the state-sponsored long-term care insurance isn’t any good.
So, if there’s no more Medi-Cal (Medicaid in other states), and you don’t want to end up in a state-run facility, what should you do? I asked the very same question to Tony Chicotel, senior staff attorney for California Advocates for Nursing Home Reform (CANHR). Tony is at the top of the long-term care community, often asked by legislators for his comments and recommendations on the law.
Here’s what he said: “HAVE A BUNCH OF DAUGHTERS.”
Why daughters? Parents are better off having daughters if they want to be cared for in their old age, suggests a new study by the American Sociological Association (www.asanet.org). “Daughters provide as much elderly parent care as they can. Sons do as little as possible,” says study author Angelina Grigoryeva, Ph.D. “This suggests that sons pass on caregiving responsibilities to their sisters.” Sons tend to reduce theirs when sisters are present.
Historically, caregiving has been socially expected of women. In the U.S., a 2020 report presented by the National Alliance for Caregiving (NAC) and the AARP Public Policy Institute shows that the majority of caregivers (61%) are still female. Daughters tend to provide more hours of care per week and are more likely to be the sole caregiver or the main provider in a caregiving team.
According to AgingCare, daughters provide more care for aging parents than sons.
According to Psychology Today (March 18, 2025), caregiving remains gendered, with women continuing to take on most unpaid caregiving. In some families, caregiving is shared among siblings, with one child taking the lead but others contributing. But research shows that daughters are more often the primary caregivers for aging parents than sons, though the picture is more complex than a simple “daughters always” rule.
Though caregiving can create stronger bonds within a family, it can also create stress and emotional fatigue. Forty-two percent of those surveyed described caregiving as stressful but manageable. Much of the stress comes from trying to balance multiple responsibilities, including work, personal needs, and the needs of each aging parent. Balancing work, family life, self-care, and caregiving is a challenge.
In addition to the time that adult daughters put into caring for their aging parents, this role has a significant impact on various aspects of everyday life, such as work. Six in 10 caregivers are employed at some point while providing care, and the majority of working caregivers report having to make workplace accommodations, such as cutting back their hours, turning down promotions, and taking time off.
Higher-hour caregivers (who are predominantly female) are most likely to report these kinds of negative impacts on their careers.
In many cases, something must give, and family caregivers often choose to put their professional aspirations on hold by quitting or retiring early. This decision can financially hamstring the entire family. In addition to the immediate reduction in household income, caregivers who stop working lose out on months or even years of earnings, benefits, and work credits for retirement programs like Social Security and Medicare.
Giving up a job has a lasting impact on one’s current financial situation and plans for one’s own retirement and care.
When all siblings in any given family cannot contribute an equal amount of time to caregiving, some seek financial support to equalize contributions, i.e., money instead of time.
An article in ElderLawAnswers says that “32% of respondents earning $150,000 or more think that a sibling should contribute money if they can’t contribute time.” This may indicate a growing awareness that time, labor, and emotional energy have value.
Now, if you are the primary caregiving child (son or daughter), here’s my Nisei Week advice:
First, make sure your parent updates their powers of attorney, both for assets and for health care. Even if you got them from an attorney, banks are taking the position that the Patriot Act (federal law passed after 9/11) gives banks the discretion to not honor a state legal POA. Some banks won’t honor POAs that are more than 3 to 5 years old. If you’re not sure if the bank will honor them, take them to the bank and ask.
Also, did Mom and/or Dad give you an “immediate” or “springing” power? Springing means that you have the power to act ONLY IF a doctor signs a letter stating that Mom/Dad lacks capacity, i.e., then it springs into effect. An immediate power gives you the right to act immediately upon execution, i.e., you don’t need a letter of incapacity from a doctor. If Mom or Dad is “slowing down,” you want an immediate power.
Second, since Mom and Dad probably want to stay at home and “age in place,” see if you can get any kind of financial assistance from In-Home Supportive Services. IHSS is the only public program that will pay for “at-home” care. If the government can keep seniors at home, it saves money by not paying for their care at a 24/7 nursing home. IHSS is run by the county and is available for low-income people only.
The maximum monthly IHSS hours an individual can receive in California is 283 hours per month, i.e., roughly 9.5 hours per day. If you get maximum hours, you can get close to $4,000 to $5,000 per month (possibly doubling your income). Best of all, Mom or Dad gets to pick their own care provider, e.g., an adult child already helping UNPAID.
Third, in order to qualify for IHSS, you first have to get Medi-Cal. Now, Medi-Cal is a “needs-based” program, i.e., you have to qualify, as opposed to Medicare, which is called an entitlement. As a U.S. citizen, you are entitled to get Medicare at age 65, even if you’re a multimillionaire. Not so with Medi-Cal, i.e., there’s an “Asset Test.”
Here’s what you need to know about qualifying for Medi-Cal. Even if you were told you don’t qualify because you have too much money, there are ways to “spend down” to qualify without triggering a penalty period of ineligibility, e.g., a three-year waiting period for making a gift. See your friendly neighborhood Medi-Cal planning attorney for more information.
Fourth, make sure your parent’s Living Trust is up-to-date. Many trusts that were created 20 years ago have handwritten cross-outs and changes that are not legally enforceable. Also, if your parents own a home, make sure the home is still in the name of the trust. Occasionally, a homeowner will refinance and the lender will take the home out of the trust but never put it back in.
This is important for two reasons. One, to avoid the court process called probate, a legal nightmare. Second, to avoid a state recovery claim in the event Mom and/or Dad needs long-term care paid for by Medi-Cal. The current law on Medi-Cal recovery is that the state can only recover what’s in the probate estate. Thus, if the home avoids probate with a trust, it avoids recovery.
In conclusion, some of you parents don’t have any daughters, but you have daughters-in-law. In my experience (I’ve met with thousands of mothers-in-law), 1 in 5 of you mothers-in-law don’t get along with your daughters-in-law. If you hope to be well cared for when you get old and feeble, I suggest you start being nice to your daughters-in-law.
To help, here are some suggestions I found online:
Tell your daughter-in-law that she brings immense joy to your family and that you love her like a true daughter.
“Now that you’ve come along, our family is complete.”
“My daughter-in-law is the woman my son picked to be my best friend.”
Judd Matsunaga, Esq., is the founding partner of the Elder Law Services of California, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Encino, Pasadena and Fountain Valley, he can be reached at (310) 318-2995. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.