Long-term care planning for an older person or couple raises a tangle of legal and emotional issues. When adult children or other younger family members are also involved, conflicts of interest between the generations may also arise.

Over and above intra-family concerns, there is also the growing conflict between the family's planning goals and emerging public policy on allocating primary responsibility for the costs of long-term care. The family's goal usually is to have long-term care paid for by public funds to the maximum extent allowable. Government policy, on the other hand, is to increasingly restrict access to the publicly funded program -- Medicaid -- that pays for such care but which is consuming a larger and larger portion of federal and state budgets.

Ongoing amendments to federal and state Medicaid laws make clear that the government's policy is to have public funds be used as the last resort in paying for long-term care, only after the individual's own assets have been exhausted, and only to the extent that his or her monthly income cannot fully pay for such care.

Long-term care planning thus involves trying to achieve the older person’s goals within an arena of ever-changing rules. Medicaid statutes and regulations tend to be extremely complex, prone to inconsistent interpretations between the federal and state systems, and subject to continuous change. Many Pennsylvania rules are published only for the internal use of government caseworkers, and not available to the general public.