An aging relative is spending her nest egg on round-the-clock care. What happens when the money runs out?

Dear Liz: A family member is 90 and lives by herself at home. She has around-the-clock caregivers paid for by her investment accounts. Her teacher pension pays for all everyday expenses. She is high maintenance and unwilling to accept she will one day run out of money for caregivers. What would you suggest?

Answer: That depends on how much money she has, and why you’re asking.

In-home, round-the-clock care can be mind-bogglingly expensive. The median cost nationally for 24/7 at-home caretaking was about $24,000 a month in 2023, according to Genworth’s latest “Cost of Care” survey. By contrast, the median cost for a private room in a nursing home was closer to $10,000 a month.

Not many people could pay for around-the-clock care for long, but your relative may be one of the exceptions. If she has enough savings to pay for care for a few years, then perhaps she’s making the calculated gamble that she’ll run out of breath before she runs out of cash. (And if she’s the suspicious type, she may be convinced your concern is more for your potential inheritance than her well-being.)

Once her resources are depleted, though, her situation could become pretty bleak. Her income may be too high to qualify for Medicaid, the government program that otherwise might pay for nursing home care. (In California, the program is known as Medi-Cal.) Perhaps her home could be sold to pay her care. If not, she might have to turn to relatives for financial help.

If you’re one of the relatives she would turn to, then you can certainly let her know how much help you could afford to give her, if any. But first, suggest a session with an elder law attorney who can review her situation, calculate how long her resources might last and offer suggestions for managing her care bills. She may be more willing to listen to a professional third party than to her family. You can get referrals from the National Academy of Elder Law Attorneys at www.naela.org.

Changing jobs? Think about transferring your retirement fund

Dear Liz: I’m a government employee with a 403(b) supplemental retirement plan. I’m taking a new job out of state and wonder what to do with the money in this account. Should I leave it in the plan, which has been doing great, or transfer it to my new employer’s plan? Also, I have a little money, about $8,000, in a 457(b) deferred compensation plan that I would like to remove for simplicity. Can I transfer this into a brokerage IRA without any tax hit?

Answer: You mention that your current plan has been “doing great,” but it would be surprising if that weren’t the case. As of mid-October, the one-year return for the Standard & Poor’s 500 market benchmark was about 34%.

If your new employer’s plan is a good one, then transferring your money there could be a great option since you’d have fewer accounts to manage and monitor. How can you tell if a plan is good? You’ll see a number of low-cost investment options with expense ratios well under 1%. If you’re a teacher, you can find ratings of school district 403(b) plans at the nonprofit 403bwise (https://403bwise.org/).

You’re allowed to roll your deferred compensation plan into an IRA or your new employer’s retirement plan. You may want to keep the money where it is, however. Once you leave an employer, you’re allowed to access a 457(b) plan at any age without paying a 10% early withdrawal penalty. That could be a perk worth keeping.

Big banks can cause big headaches when it comes to retitling accounts

Dear Liz: Someone recently asked whether to make a bank account “payable on death” or put it in their living trust. Our bank has refused to allow us to retitle our accounts so we can have them in our trust. Is “payable on death” our only option?

Answer: No, but you may need to move your accounts to another firm.

Some large national banks do balk at retitling bank accounts, notes Jennifer Sawday, an estate planning attorney in Long Beach. By contrast, many smaller banks, credit unions and big brokerage firms have no problem retitling accounts to living trusts.

If your bank isn’t willing to help you now, just imagine how difficult it will make matters for your loved ones after you die and they need to access your accounts, Sawday says.

If you’re reluctant to leave your big bank entirely, consider keeping a small amount of money in a day-to-day checking account while putting the bulk of your cash in a more trust-friendly bank.

Liz Weston, Certified Financial Planner®, is a personal finance columnist. Questions may be sent to her at 3940 Laurel Canyon, No. 238, Studio City, CA 91604, or by using the “Contact” form at asklizweston.com.