Monday, November 16, 2009

Long Term Care Awareness Month

Like most elderly, I want to remain independent and in my own home until I die. My greatest fear is of having an illness so debilitating that I can no longer do that.  I am not alone in my worst nightmare because we elderly do not want to burden our families.  Therefore, unless we are wealthy we must enter a nursing home or allow a loved one to give up part of their life being our caregiver. Neither one is a palatable option.  

This is a subject that you don't hear much about in the debates on the pending health care reform legislation.  For those of us in our declining years it is a subject that is of primary concern and should be addressed.  

In my grandparent's day there was no social security or medicare.  When aging parents were no longer able to live alone a loved one would step in and move the elderly relative into their home.  Quite often this was an unhappy event for all concerned.  My grandfather died at home and my grandmother, a fiercely independent business woman, continued working and helping to support her children.  She was the provider for her son, daughter and their families during most of the Great Depression.   After the death of my grandfather she continued to provide for my mother and me although my Mom had remarried.  

Then my grandmother, in her 70's, broke her hip and she was no longer able to run her business.  She owned a Cottage Court and Trailer Park that catered to tourists.  My mom and step-father moved into my grandmother's home and took over.  My step-father was a very lazy man and he resented having to take money from my grandmother.  (The psychology of that might be a subject for a future discussion).  As a result, he was not kind to the woman who had taken on the responsibility of providing for him and his family.  After a few months of what must have been bitter unhappiness, my grandmother moved into the home of her sister. 

 I am now older than my grandmother was at that time and I can understand how miserable her last years must have been.  

I have given some thought about what will become of me should a stroke fell me.  I do not have the money for an assisted living place, nor will I burden my children with my care.  What is left?  It is too late to obtain a long term care policy so I have come to the conclusion that my only out would be suicide.  There is the possibility that I will not be  physically able to carry it out.  

Oregon had the best answer for this; the Death with Dignity law.  Doctor assisted suicide  should be the right of anyone in my position.  If you recall, John Ashcroft, Attorney General under George H. W. Bush, sued to make this illegal.  The law remains in effect after the Bush Administration sued and lost the appeal.  (As an aside I have to throw this question in.  What is it about the conservatives that make them think they have to be the guardian of the morals of those who do not believe as they do?)

It would be less expensive for Medicare to pay for in-home care instead of the costly alternative of a nursing home.  Why is this not part of the health care debate?  After all, they will be eliminating Medicare Advantage to pay for the program.

I am posting on this subject not as a 'pity party' issue, but as a wake-up call for those of you who are younger.   I don't think our legislators will help you so my advice to you is to look into Long Term Care insurance.  

 An article on the Huffington Post by Ken Dychtwald, PhD, gerontologist, had some eye opening statistics. 

  • A person who is 65 years old today has a life expectancy of 85 and it continues to rise.
  • Home care is approximately $42,000 per year and a nursing home is $74,000.
  • Nearly 70% of those over 65 will need some type of long term care
  • The children of the elderly are working and/or relocated to another state.

     Long Term Care insurance rates go up as you get older.  I do not believe that politicians will do the sensible thing and include home care in the legislation. If you are younger and can afford it, it would be prudent to check out Long Term Care policies.  We are not all going to "go gentle into that good night". 

    Helpful resources:
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    kenju said...

    Darlene, it might be argued that there is a great possibility of fraud, if the gov. paid for in-home care - but I cannot see how it would be any worse that the fraud perpetrated every day by sleazy nursing homes and docs.

    Stella is about 2 1/2 " from toes to toes (so to speak)....LOL

    Leslie Parsley said...

    I used to know Dereck Humphries who was head of the Hemlock Society which was behind a lot of that legislation. Actually, his 2nd wife and I went to HS together.
    Ann assisted her mother and father and a couple of years later rode her horse through the woods and then ended her life. Derrick was not been very sympathetic to her cancer diagnoses - another interesting study.

    I have no problems with suicide. I've always said that if I was diagnosed with something terminal and the odds were not that great, I would at least opt for no treatment.

    I read an article a couple of years ago that senior North Americans were going to Mexico to get a drug from vets there. Can't remember the name and don't know if it's still allowed.

    Anyway, we are NOT going there, ok?

    Your step-dad sounds as if he was narcissistic and had a great sense of entitlement. This from a non-psychologist.

    Darlene said...

    *Kenju - Any time money is involved there is always the possibility for fraud. The home care givers would have to be licensed and monitored.

    If family members would be paid it would allow them to be able to quit their jobs and care for their loved ones.

    *Leslie Parsley - That's interesting that Dereck was not sympathetic to his wife's cancer diagnosis. Sounds like his compassion was only for strangers.

    Suicide isn't easy. I have a friend who is a member of the Hemlock Society and her method of ending her life is not one I could do.

    Alan G said...

    As you pointed out early in your post, this is an extremely important issue that gets little attention, either by the government or by individuals themselves. By the time they come to realize what can befall a person in their old age, for most it is too late to take any reasonable steps to protect themselves and their finances.

    I have been single for a good long time so my well-being became of interest to me early on when I was just entering my fifties. Realizing that I was my own keeper, if something like a stroke hit me (and they run in my family) I would be in deep pooh-pooh really quick, given the costs of nursing homes, associated care and the like.

    Long term insurance was just coming into its own at the time so I got myself a policy and consider it one of the smarter things I did to help try to secure my future in some measure. It’s not a limitless policy of course. At the time I got mine you could get coverage up to five years and I opted for the three-year coverage. When I bought mine one of the stated perks was that my premium could never be raised and so far that has remained the case. I purchased my policy through State Farm and have a semi-annual premium of $264 which I consider a bargain in today’s world of health insurance.

    Supposedly from what I have read there is a piece of the health care legislation addressing long-term care, supposedly paying some $50 to $100 a day and would be opted into by an additional payroll deduction. I assume, of course, that folks who have already retired and are on Medicare would be excluded.

    I have a couple of sisters several years younger than me and have stressed often to them about getting the coverage. They continue to procrastinate and that is a big mistake in my opinion. I think married couples seem to be the most vulnerable because they assume they have a spouse who will look after them. But it is after one or the other spouses passes away that most find themselves facing serious problems when they have serious health issues. And like you said, “We are not all going gentle into the night!”

    Nursing homes and the like get a bad enough rap as it is, but when you are financially broke and your home is gone, you’ll end up in a Medicaid run home and that is even worse I would think.

    As to the Death with Dignity Law, I suppose it is right up there with abortion as a contentious issue but I would not hesitate in a moment, given dire financial and heath circumstances to sign my name on the dotted line. Unfortunately with regard to Oregon, you have to establish residency. There is no minimum residency requirement but there are other legal requirements that have to be met.

    I hope people take some note of your post and it relevance in their lives….

    Paula said...

    Thanks so much for the wake-up call, Darlene.

    On an intellectual level, I understand the rationale for suicide, but on a more practical level, I have seen the terrible fallout of suicide on younger family members. No one should assume loved ones will understand the generosity that may be at the core of an ill person's decision to commit suicide.

    Don't forget hospice. It's going to be important to keep hospice benefits covered (even increased) by Medicare as the population ages.

    Leslie Parsley said...

    Paula: I think you have a good point about the family members. While they may not understand the whys, they are left with enormous feelings of guilt. My aunt, who had had 5 back surgeries over 8 years, who was in severe pain on a daily basis, and who threatened suicide time and time again, finally did the job. She'd called me that night asking me to come over - I had a date. It still haunts me nearly 40 years later.

    Darlene: What a good topic. My friend Anne and Dereck co-authored a book called "Final Exit," which was about his first wife's strugles and eventual assisted suicide. They came to visit as in "Paradise Valley" (talk about sounding like your final resting place). Frankly I had bad vibes and didn't particularly care for him. Anne wrote a piece for the NY Times magazine and appeared on Larry King. She visited me in Denver right before she went on her final ride. By the time she headed back home I had come to the sad realization that she too had her own demons - perhaps trying to deal with the fact that she assisted both parents in their suicides? Honestly, I'm not sure she was always honest.

    Rain said...

    These are important questions and i have thought of them also. From what I have understood Medicaid will cover nursing home care after all of someone's money is gone. Some states allow a spouse to retain half of the net worth. Not all nursing homes will qualify and worse some are pretty ugly for how they treat their patients. I would suggest it's important to find someone willing to check on you once in awhile to be sure the care is good.

    Oregon's law only helps someone with a terminal illness, not standard old age. I suspect most people though can find ways to kill themselves but then it's do they do it right, take the right dosage etc. and if not, end up worse than before.

    We have thought the same thing though but in regards to a major illness that would take too much money. We have decided to not pay the monthly premium that would guarantee we would not have too much out of pocket expenses in a year because it's too high; so we will have to decide, if we end up with something very expensive, whether to do it or not. Some of them just extend dying, not living anyway; which is a whole other ball of wax

    Looking to the Stars said...

    Good post, as always :)

    My husband's grandmother lived in assisted care. It was provided long ago by her deceased husband, he was a presybertain minister (sorry about the spelling) and that was one of the perks. They took good care of her to the very end.

    Going to a nursing home is giving up your very last freedom. It is the breaking of a heart. But it has its postive points also.

    Suicide is a subject that needs to be out in the open and talked about. How many of us, when we have gone thru hard times, hasn't said that we should end it all. That is normal and what you have thought is normal.

    No one wants to be a burden and I don't believe you ever will be. You are a sunshine flower and wherever you go and whoever you talk to, you spread sunshine. That is your destiny.

    Love you, kiddo :)

    trillium said...

    I used to run a CBRF (A Community Based Residential Facility) and I never encountered a long term care insurance policy that would pay me, despite being licensed. My clients who had ltc policies, had policies that would cover only skilled nursing home care, or only care in their home—a drafty old farmhouse with an upstairs bathroom—but not in mine. Their policies would not pay family members to care for them, even if the grandaughter or daughter in law would get the credentials necessary. There was always some loop hole that prohibited my ladies from collecting from these shysters. Most of my ladies were poor, even those who had policies were not wealthy enough to have assets that needed protection. I believe that most of the salesman are knowingly selling a worthless product, and laughing all the way to the bank. Save your money, remodel your house instead, and you can age in situ longer than otherwise.

    Darlene said...

    *Alan - Thank you for your thoughtful comment. Yes, in Oregon you do have to establish residency, find a doctor who will accept your wishes, and be terminal. Every state should have this option.

    *Paula - You are right. Suicide is a touchy subject. Just as in the case of a living will, you should discuss this with your closest relatives before it becomes necessary and assure them that they should feel no guilt.

    *Leslie Parsley - Please try to stop being haunted by your aunt's suicide. If your aunt was in extreme pain there was no longer any quality to her life. She alone made the decision and if you did not go when she asked you to she could have waited. You have no blame in her death.

    *Rain - Scroll down and read trillium's comment on LTC policies. It contains a warning that I should have put in my post.

    You are lucky that you live in an enlightened state and have the option open to you if you want to use it.

    *Looking to the Stars - You are so kind in your comments. Thank you. I believe that the kind of care your husband's grandmother got is rare now. There are good assisted living places, but they are horribly expensive. I could stay two months by depleting my assets and then what would I do?

    *trillium - Thank you for your visit. I do hope you will return.

    Thank you for the information on Long Term Care policies. This is just another reason that the insurance industry has no place in health care. Your information is important and I thank you for adding it.

    One Woman's Journey said...

    Darlene, you discussed all that I keep in the back of my mind. My circumstances are similar to yours
    My grandmother's were at home and my mother in hospital just 10 days.
    Hopefully, I go quick when the time comes.

    Anonymous said...

    My sister-in-law's parents, each, several years apart, escaped their miseries by refusing food. Each had health problems that took them rather quickly once they determined not to eat.

    I would add to Darlene's suggestion that we talk to our nearest relatives about our wishes, that we also talk (and leave it in writing, of course) to our primary health care professionals. I would almost be in favor of taking out a front-page ad in the newspaper so that no one has a chance to say that they didn't know what I wanted. Fortunately, I trust my daughters, husband, and internist to know and follow my wishes.
    Cop Car

    Darlene said...

    *One Woman's Journey - To go quickly is the wish of everyone, Ernestine. If we could all die quietly in our sleep there would be no problem.

    *Cop Car - We are both fortunate in having understanding relatives. I have told everyone my wishes and they have all agreed to abide by them.

    I think it might take me too long to starve myself since I am about 20 pounds overweight, but it's certainly a way to go if you can prevent the doctor from having you force fed.

    joared said...

    "It would be less expensive for Medicare to pay for in-home care instead of the costly alternative of a nursing home. Why is this not part of the health care debate?"

    I have long been a proponent of this approach to health care and would love to see a groundswell of support across this nation to bring this about.

    Nursing home care is more expensive than the figures quoted -- don't know what year's figures they citing, but the cost is not going to decline.

    Long term care policies may or may not be the best investments to accumulate monies for old age living arrangements young people should purchase. They need to thoroughly check into a variety of other options as well, I think, and be very careful about any company from whom they purchase a long term care policy -- plus the wording of said policy.

    Kay Dennison said...

    The Ohio Dept. of Aging has an 'aging in place' program and for elders. I intend to use it if at all possible.

    Happy Thanksgiving!!!!