From Home to Long-Term Care | A Wisconsin Family's Guide and Checklist Series

When my mother could no longer live safely at home, I was not a real estate broker with 23 years of experience. I was a daughter standing in a hospital hallway, holding a folder of papers I did not fully understand, being told by a discharge planner that she could not go home.

I have helped thousands of families sell homes. Many of those sales came at exactly this moment in their lives. But nothing prepared me for walking it myself, and nobody handed me a list. Every family I have talked to since says the same thing. You find out what you needed to know about six weeks after you needed to know it.

So this is the list I wish I had. It is written for Wisconsin families, because Wisconsin has its own forms, its own Medicaid rules, and its own agencies, and advice from a national website will get you only part of the way. It is organized in the order things actually happen: what to put in place before there is a crisis, what to do in the hospital, how to choose a facility, how to pay for it, what to do with the house, and what to watch out for along the way.

Print it. Put it in the binder. Share it with your siblings. And please, do the first checklist now, while your parent can still sign.

Do this before you need it. Once a doctor determines your parent can no longer make decisions, the only path left is a court guardianship, which is slow, public, and expensive. Every document below can be completed in an afternoon with an attorney while your parent still has capacity. Wisconsin has its own statutory forms, and out-of-state documents may not be honored here.

Power of Attorney for Health Care (Wis. Stat. Chapter 155)

• Signed, dated, and witnessed by two adults who are not relatives, not heirs, and not your parent's health care provider
• Names a primary agent and at least one alternate
• Specifically authorizes the agent to admit your parent to a nursing home or community-based residential facility (CBRF) for long-term care. In Wisconsin this box must be checked or the agent cannot do it
• Addresses feeding tubes and whether the agent may make that decision
• Activated. A Wisconsin health care POA only takes effect after two physicians, or one physician and one psychologist, certify in writing that your parent is incapacitated. Ask the hospital to do this and get a copy of the activation letter
• Copies on file with the primary care physician, every hospital your parent might use, and the long-term care facility
• A copy in your car and a photo on your phone

Durable Power of Attorney for Finances and Property (Wis. Stat. Chapter 244)

• Signed and notarized. Durable means it survives incapacity. Confirm the word is on the document
• Decide whether it is effective immediately or springing (only upon incapacity). Springing sounds safer but creates delays at the worst moment; many Wisconsin attorneys recommend immediate
• Explicitly grants authority over real estate, including the power to sell the home
• Explicitly grants authority over Medicaid applications, gifting, and trusts if that may be part of the plan
• Copies delivered to every bank and brokerage. Banks often push their own form or delay acceptance. Wisconsin law limits their ability to refuse a valid POA, so have your attorney ready with a letter
• Recorded with the county Register of Deeds if you expect to sell real estate under it

Living Will, POLST, and HIPAA

• Declaration to Physicians (Wis. Stat. Chapter 154) completed and witnessed. This is separate from the health care POA and speaks only to life-sustaining treatment
• If appropriate, a Wisconsin POLST form signed by the physician, and a state Do Not Resuscitate bracelet if wanted. These are medical orders, and EMS will follow them
• A standalone HIPAA authorization naming every family member who should be able to get information. The POA agent has access automatically; siblings and other helpers do not

Wills and Trusts

• Will is current, signed, and its location is known to the personal representative
• If there is a revocable living trust, confirm assets were actually retitled into it. An unfunded trust is a common and expensive mistake
• Understand this clearly: a revocable trust does not protect assets from nursing home costs or Medicaid. It avoids probate. That is a different job
• If asset protection is the goal, an irrevocable trust must be funded more than five years before a Medicaid application. This is Wisconsin's look-back period and it is strictly enforced
• Beneficiary designations on life insurance, IRAs, 401(k)s, and annuities reviewed. These pass outside the will and override it
• A Wisconsin Transfer on Death deed considered for the home. It keeps the house out of probate without a trust and without triggering a Medicaid transfer penalty during life
• Wisconsin is a marital property state. If one spouse remains at home, the rules for what that spouse keeps are specific and deserve an attorney's attention before any application

The Binder (one physical, one digital)

• All of the documents above
• Social Security card, Medicare and supplemental insurance cards, long-term care insurance policy
• Birth certificate, marriage certificate, and military discharge papers (DD-214) for possible VA Aid and Attendance benefits
• Deed to the home, current mortgage statement, and homeowners insurance policy
• Every account, every login, every recurring bill, every pension
• Physician list, medication list with dosages, allergies, and pharmacy

Most families do not choose the moment. A fall, a stroke, or an infection puts a parent in the hospital, and suddenly everything moves fast. Your job is to slow it down.

The First 24 Hours

• Hand the health care POA and living will to the nurse. Ask that they be scanned into the chart, and confirm on the next shift that it happened
• Ask these exact words: "Is my mother admitted as an inpatient, or is she under observation status?" Medicare only covers a skilled nursing rehab stay after three consecutive inpatient midnights. Observation days do not count. Ask every day, because status can change
• Get the name and direct number of the case manager or discharge planner
• Give the hospital one family point of contact and have it noted in the chart.
• Bring hearing aids, glasses, dentures, and a familiar object. Confusion in the hospital is often a parent who simply cannot hear or see

Watch for Hospital Delirium

• Sudden confusion, agitation, or withdrawal that was not there before is often delirium, not dementia, and it can be reversible. Ask the team whether they have ruled out infection (especially UTI), dehydration, medication interactions, and pain
• Be present in the evening if you can. Delirium is worse after dark and staffing is thinner
• Ask that sleep not be interrupted for non-essential vitals

Medications

• Get a printed medication reconciliation on admission and again at discharge. Compare them line by line to the home list
• Question every new sedative, antipsychotic, or sleep aid. These are often started in the hospital for agitation and never stopped

Before Discharge

• Do not accept a discharge you are not ready for. Medicare gives you the right to a fast appeal through Wisconsin's Quality Improvement Organization (Livanta). The hospital must give you written notice and cannot discharge while the appeal is pending
• Ask for physical and occupational therapy evaluations in writing. Their notes are what justify a rehab stay
• Ask whether skilled nursing rehab, inpatient rehab, or home health is being recommended, and why
• Get the list of facilities the case manager offers, then do your own research. Hospitals must provide choices but are not required to tell you which ones are good
• Confirm Medicare or insurance authorization is actually in place before the transfer
• Get the discharge summary and have a copy sent to the primary care physician
• Get a follow-up appointment date, not just "follow up with your doctor"

Know the levels first. In Wisconsin the main categories are independent living, assisted living (RCACs and CBRFs, which are licensed differently), memory care, skilled nursing, and continuing care retirement communities that combine several under one contract.

Research Before You Tour

• Search the Wisconsin Department of Health Services provider search and read the last two years of survey results and complaints. Every citation is public
• Check Medicare's Care Compare star ratings for any skilled nursing facility
• Ask who owns the facility and when ownership last changed. Quality can shift quickly when a nonprofit is acquired by a for-profit or private equity operator
• Ask for the staff-to-resident ratio by shift, including overnight and weekends, and the staff turnover rate. High turnover is the single most reliable warning sign
• Ask whether the facility accepts Medicaid if private funds run out. If not, you may be forced to move your parent later at the worst possible time

On the Tour

• Go unannounced at least once, ideally at 7 p.m. or on a Sunday
• Smell the hallways. Talk to residents' families in the parking lot
• Watch a mealtime. Are residents being helped to eat, or is food sitting untouched?
• Ask to see the memory care unit even if you do not need it yet. It shows you how they treat the most vulnerable
• Ask what happens when a resident's needs increase. Can they stay, and at what cost?

The Contract: Read Every Page

• Never sign as "responsible party" or "guarantor" in your own name. Federal law prohibits a nursing home from requiring a third-party guarantee of payment as a condition of admission. Sign only as "agent under POA" and write those words beside your signature
• Strike or refuse pre-dispute arbitration clauses. Admission cannot be conditioned on signing one
• Understand the entrance fee, what is refundable, and under what conditions. Some "refundable" fees are paid only when the unit is re-occupied, which can take a year or more
• Understand how rate increases work and how much notice is required
• Understand the discharge and eviction provisions. When can they ask your parent to leave?
• Take the contract home. Any facility that pressures you to sign on the spot has just told you something important
• Have a Wisconsin elder law attorney review any contract with an entrance fee

On File at the Facility

• Health care POA, activation letter, living will, POLST, and HIPAA release
• Names and phone numbers of the POA agent and alternate in the resident's chart, not just an office file
• Ask how they contact family in an emergency, and test it

• Get honest about cost. Private-pay skilled nursing in southeastern Wisconsin commonly runs well into five figures per month. Assisted living and memory care are less, but climb quickly with care level
• Contact your county Aging and Disability Resource Center (ADRC). It is free, it is the front door to Wisconsin's public long-term care programs, and the options counseling is genuinely good
• Learn Wisconsin's programs: Family Care, IRIS (self-directed), and Medicaid nursing home coverage. Eligibility is both financial and functional, and the ADRC performs the functional screen
• Know the five-year look-back. Any gift or transfer for less than fair value in the 60 months before applying can create a penalty period. That includes helping a grandchild with tuition or adding a child to a deed
• The home is generally exempt while your parent is alive and intends to return, or while a spouse or dependent lives there. But Wisconsin's Estate Recovery Program can claim against the home after death for Medicaid benefits paid. Plan for this before, not after
• If there is a long-term care insurance policy, file the claim early. Most have a 90-day elimination period that starts only once care begins
• Veterans and surviving spouses: ask the County Veterans Service Officer about Aid and Attendance
• Do not spend down or gift anything on your own advice or a facility's advice. Legitimate planning can often preserve far more than families expect, but only if it is done correctly and early, with an elder law attorney

This is where I live professionally, and where families make some of their most emotional and most expensive mistakes.

• Do not rush to sell. Selling too early can eliminate the Medicaid home exemption and turn an exempt asset into countable cash. Selling too late can mean a vacant, uninsured house deteriorating through a Wisconsin winter. Timing is a legal and financial decision first
• Notify the homeowners insurance carrier the moment the house is vacant. Most policies restrict or void coverage after 30 to 60 days. Ask for a vacancy endorsement
• Winterize: heat stays on, water shut off if unoccupied, someone checks weekly
• Confirm who has legal authority to sign a listing contract and a deed. If it is you under a financial POA, the title company will want the original recorded POA and will scrutinize it. Get it reviewed before you list, not at closing
• If the home is in a trust, the trustee signs. Confirm the trust actually holds title
• Understand the capital gains exclusion. Up to $250,000 of gain ($500,000 for a married couple) is excluded if the home was the primary residence for two of the last five years. Time in a care facility can count in some circumstances. Ask a CPA
• Get a valuation as of the date of any transfer, and again at death. The step-up in basis at death can eliminate capital gains for heirs entirely, which is one more reason not to gift the house during life
• Do not let siblings take furniture and belongings before there is an inventory. This is where families fracture
• Plan the clear-out with an estate sale company or senior move manager, and give your parent a say in what goes with them
• Work with a broker who has done this before. A vacant estate home, a POA signer, an out-of-state family, and a Medicaid timeline together are not a normal transaction

Some of this I learned the hard way.

Financial Exploitation

• New friends, new caregivers, or new romantic interests who appear around the time of decline
• Unexplained withdrawals, new credit cards, changed beneficiaries, or a sudden new POA. Review statements monthly
• Caregivers who isolate your parent from family or discourage visits
• Report suspected abuse or exploitation to county Adult Protective Services and, if a facility is involved, the Wisconsin Board on Aging and Long Term Care Ombudsman at 1-800-815-0015. The ombudsman is free, independent, and on your parent's side

Care Quality

• Unexplained weight loss, dehydration, bedsores, bruising, or a parent who is always "sleeping" when you visit
• Call lights that go unanswered while you are standing there
• Staff who cannot tell you your parent's name without looking
• A parent who becomes fearful or withdrawn when a particular staff member enters
• Antipsychotic medications started without a clear diagnosis and your consent

Contracts and Business Practices

• Any admission agreement asking for your personal guarantee
• Pressure to sign quickly, or before you have seen the full fee schedule
• Facilities that discourage you from involving an attorney
• Vague answers about ownership or recent management changes
• Facilities that will not put their Medicaid policy in writing
• Decide early who is the point person, and have it in writing (the POA). Communicate with siblings more than feels necessary
• Keep a simple log of every conversation with every provider: date, name, what was said
• Caregiver burnout is real and it ends badly. Accept help. Use the ADRC's respite programs. You cannot advocate for your parent if you go down first

Family and Yourself

• Decide early who is the point person, and have it in writing (the POA). Communicate with siblings more than feels necessary
• Keep a simple log of every conversation with every provider: date, name, what was said
• Caregiver burnout is real and it ends badly. Accept help. Use the ADRC's respite programs. You cannot advocate for your parent if you go down first

Wisconsin Resources

Aging and Disability Resource Centers (ADRC): dhs.wisconsin.gov/adrc

Board on Aging and Long Term Care Ombudsman: 1-800-815-0015

DHS Provider Search (survey results and complaints): dhs.wisconsin.gov

Medicare Care Compare: medicare.gov/care-compare

Wisconsin Medicaid and Family Care: dhs.wisconsin.gov/medicaid

State Bar of Wisconsin Lawyer Referral (ask for elder law): 800-362-9082

Medicare discharge appeals in Wisconsin (Livanta): 1-888-524-9900