OPINION
LANSING, Judge.
This appeal is from an amended dissolution judgment and decree modifying a maintenance award. Lidia Eichenholz appeals the modification as insufficient because it does not allow her to meet increased rent and medical expenses, cost-of-living increases, and her individual income tax. Alfred Eichenholz, in a petition for review, challenges the amount of the award as too high and asserts that no change of circumstances occurred sufficient to trigger a modification. We reverse and remand.
FACTS
Alfred Eichenholz and Lidia Eichenholz were married June 22, 1952, and divorced by judgment and decree entered September 8, 1966.
Alfred Eichenholz is a physician and is employed by the Veterans Administration. He currently lives in Long Beach, California, with his second wife, who is also a [700]*700practicing physician. Although he has also experienced medical problems, he is fully employed. His gross income, not considering his wife’s income, was $94,954.61 in 1985-86.
Lidia Eichenholz, 62, was physically disabled by two problem pregnancies which occurred during the 14-year marriage. The first pregnancy, resulting in the birth of the couple’s son, Philip, caused severe hypertension. In an effort to control the hypertension, she underwent two exploratory surgeries and has been on an aggressive drug treatment program for a number of years. This treatment has only marginally decreased the hypertension and its attendant risk of stroke, and she continues to suffer the related medical disabilities of heart disease (angina pectoris) and loss of vision (hypertensive retinopathy). Her second pregnancy ended in the birth of a stillborn child.
Although Lidia Eichenholz attended medical school in Germany, she did not obtain a license to practice medicine in the United States. She has been unable to work since 1956. Her heart disease and vision problems have resulted in permanent disability. She was the only member of her family to survive over three years’ internment in a World War II concentration camp and has few close relatives.
The original dissolution decree provided permanent spousal maintenance of $300 per month through January 1967 and $200 per month thereafter. Lidia Eichenholz also received $175 per month child support, which was terminated when her health required the transfer of Philip’s custody to his father. From 1967 to 1982, the $200 per month Lidia received in maintenance was her sole source of income, other than public assistance. She received $58 per month supplemental security income (SSI, social security for the disabled non-wage earner) and food stamps. Medicaid paid for her medical care. As her health deteriorated and her mobility declined, her medical expenses have steadily increased.
In 1980 she petitioned for an increase in spousal maintenance. After two years of litigation, maintenance was increased from $200 per month to $550 per month. That increase disqualified Lidia Eichenholz from receiving SSI, Medicaid coverage and food stamps, which had supplemented her income. She was unable to pay her medical expenses and several procedures had to be postponed for lack of funds. As a result, she went back to court in 1986 to have her support increased to reflect her increased expenses.
The trial court, based on essentially undisputed affidavits detailing Lidia Eichen-holz’s increased medical and housing expenses, affirmed the referee’s specific findings on her necessary medical expenses:
10. That because [Lidia Eichenholz’s] medical and dental expenses were paid by medical assistance before the increase in spousal maintenance, the Court’s finding as to her minimal monthly expenses was, necessarily, an estimate.
11. That [she] incurred medical expenses averaging $99.31 per month during the period from April 1982 through July 31, 1985. Because these expenses were mainly for the treatment of chronic hypertension and not an isolated period of illness, they are expected to continue at the same level or greater.
12. That during the period [she] deferred certain other medical needs, namely: replacement of upper and lower dentures which would cost $656 or more, obtaining a new eyeglass prescription and purchasing new eyeglasses which would cost $349.95 or more, and a complete bowel examination with x-rays which would cost $183.10 [total $1,189.05].
13. That [she] is without insurance to cover medical needs and the same will cost approximately $214 per month.
These medical expenses total $412.40 per month ($99.31 for treatment for chronic [701]*701conditions, $214 per month for medical insurance, and $99.09 per month for deferred medical treatment expenses). However, when calculating Lidia Eichenholz’s total monthly expenses to arrive at a maintenance amount, the court included only $115 per month for medical expenses.
The court granted an increase in maintenance from $550 to $825 per month. Both parties appeal.
ISSUE
Did the trial court err in modifying the maintenance award?
ANALYSIS
The trial court’s findings of fact must have a reasonable and acceptable basis in fact and principle to be affirmed. Bollen-bach v. Bollenback, 285 Minn. 418, 426,175 N.W.2d 148, 154 (1970).
To support a modification of spousal maintenance, the moving party must show
(1) substantially increased or decreased earnings of a party;
(2) substantially increased or decreased needs of a party;
(3) receipt of [public] assistance * * *; or
(4) a change in the cost of living for either party as measured by the federal bureau of statistics, any of which make the terms unreasonable or unfair. * * *
Minn.Stat. § 518.64, subd. 2 (1986).
The court is also required, in a motion for modification, to apply the factors in Minn.Stat. § 518.552. These factors include the financial resources of the parties; the time and training necessary to return the party seeking maintenance to the work force; and the probability, given the party’s age, physical and emotional condition and skills, of becoming fully or partially self-supporting; the standard of living established during the marriage; duration of the marriage; and the length of absence from employment. Minn.Stat. § 518.552, subd. 2 (1986).
Lidia Eichenholz presented the court with affidavits about her health, the increasing expense of her health care, her lack of medical insurance, and announced increases in her rent. Although she reported that she had a checking and savings balance of $4,349.45 as of February 11, 1985, she also reported $3,103.86 in medical and $800 in personal debts. In addition, she has expenses for ongoing health problems. She has deferred needed medical procedures because of her inability to pay for them. She does not have access to necessary hospital procedures because she has no insurance.
Her rent has changed since the 1982 support increase. The letter from her landlord stated that by July 1,1986, the rent on her efficiency apartment would be $350 per month. The increase went into effect, and the trial court was notified before it approved the referee’s findings.
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OPINION
LANSING, Judge.
This appeal is from an amended dissolution judgment and decree modifying a maintenance award. Lidia Eichenholz appeals the modification as insufficient because it does not allow her to meet increased rent and medical expenses, cost-of-living increases, and her individual income tax. Alfred Eichenholz, in a petition for review, challenges the amount of the award as too high and asserts that no change of circumstances occurred sufficient to trigger a modification. We reverse and remand.
FACTS
Alfred Eichenholz and Lidia Eichenholz were married June 22, 1952, and divorced by judgment and decree entered September 8, 1966.
Alfred Eichenholz is a physician and is employed by the Veterans Administration. He currently lives in Long Beach, California, with his second wife, who is also a [700]*700practicing physician. Although he has also experienced medical problems, he is fully employed. His gross income, not considering his wife’s income, was $94,954.61 in 1985-86.
Lidia Eichenholz, 62, was physically disabled by two problem pregnancies which occurred during the 14-year marriage. The first pregnancy, resulting in the birth of the couple’s son, Philip, caused severe hypertension. In an effort to control the hypertension, she underwent two exploratory surgeries and has been on an aggressive drug treatment program for a number of years. This treatment has only marginally decreased the hypertension and its attendant risk of stroke, and she continues to suffer the related medical disabilities of heart disease (angina pectoris) and loss of vision (hypertensive retinopathy). Her second pregnancy ended in the birth of a stillborn child.
Although Lidia Eichenholz attended medical school in Germany, she did not obtain a license to practice medicine in the United States. She has been unable to work since 1956. Her heart disease and vision problems have resulted in permanent disability. She was the only member of her family to survive over three years’ internment in a World War II concentration camp and has few close relatives.
The original dissolution decree provided permanent spousal maintenance of $300 per month through January 1967 and $200 per month thereafter. Lidia Eichenholz also received $175 per month child support, which was terminated when her health required the transfer of Philip’s custody to his father. From 1967 to 1982, the $200 per month Lidia received in maintenance was her sole source of income, other than public assistance. She received $58 per month supplemental security income (SSI, social security for the disabled non-wage earner) and food stamps. Medicaid paid for her medical care. As her health deteriorated and her mobility declined, her medical expenses have steadily increased.
In 1980 she petitioned for an increase in spousal maintenance. After two years of litigation, maintenance was increased from $200 per month to $550 per month. That increase disqualified Lidia Eichenholz from receiving SSI, Medicaid coverage and food stamps, which had supplemented her income. She was unable to pay her medical expenses and several procedures had to be postponed for lack of funds. As a result, she went back to court in 1986 to have her support increased to reflect her increased expenses.
The trial court, based on essentially undisputed affidavits detailing Lidia Eichen-holz’s increased medical and housing expenses, affirmed the referee’s specific findings on her necessary medical expenses:
10. That because [Lidia Eichenholz’s] medical and dental expenses were paid by medical assistance before the increase in spousal maintenance, the Court’s finding as to her minimal monthly expenses was, necessarily, an estimate.
11. That [she] incurred medical expenses averaging $99.31 per month during the period from April 1982 through July 31, 1985. Because these expenses were mainly for the treatment of chronic hypertension and not an isolated period of illness, they are expected to continue at the same level or greater.
12. That during the period [she] deferred certain other medical needs, namely: replacement of upper and lower dentures which would cost $656 or more, obtaining a new eyeglass prescription and purchasing new eyeglasses which would cost $349.95 or more, and a complete bowel examination with x-rays which would cost $183.10 [total $1,189.05].
13. That [she] is without insurance to cover medical needs and the same will cost approximately $214 per month.
These medical expenses total $412.40 per month ($99.31 for treatment for chronic [701]*701conditions, $214 per month for medical insurance, and $99.09 per month for deferred medical treatment expenses). However, when calculating Lidia Eichenholz’s total monthly expenses to arrive at a maintenance amount, the court included only $115 per month for medical expenses.
The court granted an increase in maintenance from $550 to $825 per month. Both parties appeal.
ISSUE
Did the trial court err in modifying the maintenance award?
ANALYSIS
The trial court’s findings of fact must have a reasonable and acceptable basis in fact and principle to be affirmed. Bollen-bach v. Bollenback, 285 Minn. 418, 426,175 N.W.2d 148, 154 (1970).
To support a modification of spousal maintenance, the moving party must show
(1) substantially increased or decreased earnings of a party;
(2) substantially increased or decreased needs of a party;
(3) receipt of [public] assistance * * *; or
(4) a change in the cost of living for either party as measured by the federal bureau of statistics, any of which make the terms unreasonable or unfair. * * *
Minn.Stat. § 518.64, subd. 2 (1986).
The court is also required, in a motion for modification, to apply the factors in Minn.Stat. § 518.552. These factors include the financial resources of the parties; the time and training necessary to return the party seeking maintenance to the work force; and the probability, given the party’s age, physical and emotional condition and skills, of becoming fully or partially self-supporting; the standard of living established during the marriage; duration of the marriage; and the length of absence from employment. Minn.Stat. § 518.552, subd. 2 (1986).
Lidia Eichenholz presented the court with affidavits about her health, the increasing expense of her health care, her lack of medical insurance, and announced increases in her rent. Although she reported that she had a checking and savings balance of $4,349.45 as of February 11, 1985, she also reported $3,103.86 in medical and $800 in personal debts. In addition, she has expenses for ongoing health problems. She has deferred needed medical procedures because of her inability to pay for them. She does not have access to necessary hospital procedures because she has no insurance.
Her rent has changed since the 1982 support increase. The letter from her landlord stated that by July 1,1986, the rent on her efficiency apartment would be $350 per month. The increase went into effect, and the trial court was notified before it approved the referee’s findings.
These increased expenses and the termination of public assistance are a sufficient change of circumstances to justify an increase in maintenance. However, the trial court’s findings of fact do not support the conclusion of law that Lidia Eichenholz should receive only $825 per month maintenance. Balancing Alfred Eichenholz’s income ($94,954.61) against Lidia Eichen-holz’s need, it was error to disregard the clearly established medical and housing needs of Lidia Eichenholz. Despite a finding that Lidia Eichenholz was without insurance to cover her medical needs, the trial court ignored, without explanation, these insurance costs in its estimate of her current needs. The needs which are enumerated in the findings of fact are entitled to full consideration. The award is inadequate to meet the minimum and necessary needs established by Lidia Eichenholz.
The dissent raises the issue of deference to the trial court’s discretion in matters of maintenance, noting that the orginal award of maintenance and support in this case was set by stipulation of the parties. The [702]*702original stipulation contemplated that Lidia Eichenholz would be capable of regaining employment following the divorce. Because her disability continued and worsened, employment is not possible. Following the divorce, Alfred Eichenholz enjoyed a rising income in a favored profession; Lidia Eichenholz, because of her disability, has been forced into a subsistence lifestyle. The trial court recognized this change of circumstance when it increased maintenance in 1982. Unfortunately, the increase also destroyed eligibility for public assistance, food stamps and medicare. Alfred Eichenholz points out that she lost more in public assistance than she gained in increased maintenance. He argues that Lidia Eichenholz’s maintenance should be decreased rather than increased, making her once more eligible for public assistance. The fact that an obligee spouse might receive more money from general assistance medical care under welfare rules if spousal maintenance were decreased would not justify a decrease in spousal maintenance and would seemingly violate public policy. Safford v. Safford, 391 N.W.2d 548, 550 (Minn.Ct.App.1986).
Alfred Eichenholz also requests de novo review, claiming the trial court abused its discretion in ordering the increase in maintenance.
[T]he family court judge has * * * full authority to adopt the referee’s recommended findings and order, modify them, reject them in whole or in part, recommit to the referee with instructions, or receive further evidence.
Gustafson v. Gustafson, 396 N.W.2d 911, 914 (Minn.Ct.App.1986) (quoting Peterson v. Peterson, 308 Minn. 297, 304, 242 N.W.2d 88, 93 (1976)). The request for de novo review is denied.
DECISION
The trial court’s decision is reversed and remanded with instructions that the trial court fully consider appellant’s increased rent cost and the costs of obtaining necessary medical treatment and insurance.
Reversed and remanded.
PARKER, WOZNIAK and CRIPPEN, JJ., concur specially.
POPOVICH, C.J., and NIERENGARTEN, RANDALL, STONE and MULALLY, JJ., dissent.