Yeah, my parents set up a trust years before they needed full time care, having seen this happen to several friends and family members. I understand why it’s set up the way it is, but it sets up so much cruelty.

The cruelty is the point. That's why it's set up this way, to make the experience so miserable that people would prefer death to it. Medicare fraud if we didn't go to these extents would be a rounding error on the tax breaks we give major companies (and the GOP keeps trying to expand).