Caregiving is no joke. Kudos to you for the years of hard work you’ve put in. I haven’t done it personally but have encountered many caregivers in my line of work. It’s understandable to doubt that estate recovery happens in PA. The state only looks at transfers of assets (like houses) for a period of 5 years prior to applying to Medicaid, so many people avoid the problem entirely by transferring property early. And the enforcement of estate recovery varies. I noticed the state being more aggressive with estate recovery in the past few years though, so I personally wouldn’t take the chance. Another side note - it is way easier for a living person to transfer a house than it is to go through probate after the person passes away to gain ownership. That is why I would work on this ASAP.