Medicare is health insurance for individuals
age 65 and over who are entitled to Social Security retirement benefits (or
have received Social Security disability benefits for two years.) When Medicare
was enacted in 1965, the thinking was that working people would “pay in” during
their earning years, so that illness in their later years wouldn’t eat up their
life savings.
And yet now, almost 50
years after its enactment, Medicare is not the panacea many had hoped. Why not?
Because Medicare
doesn’t cover long term care which is what you need with Alzheimer's or Dementia. Medicare only provides coverage for acute care and skilled
care. According to “America’s Long Term Care Crisis,”
in July’s Trusts & Estates Magazine,
13% of the population is now over age 65, and 1.8% of these folks (5.7 million) are over 85. More than
half of those over 85 need assistance with daily living and assistance is
expensive
With home care cost now running $55,000-$75,000/year,
and care in a nursing home costing up to $180,000/year, how does the
unaffordability of long term care play out in human terms?
My Dad: A Case Study
My Dad worked for one company for
45 years. Between his pension, social security and lifetime medical coverage
(lucky guy!) he could afford a simple life on about $40,000/year. But by his 85
th
birthday, after a series of fender benders and stairway falls, Parkinson’s and Dementia got the better of him. My siblings and I forced him to surrender his
car and figured we’d move him to an
apartment with an aide in his neighborhood.
But my Dad vetoed the new ground floor
apartments, mostly because he couldn’t handle the change and new floor
plans. This is a very big deal with Dementia. Without a car, and with
increasing phone calls to bring him food, we took him to my home until we could
formulate Plan B.
For two weeks, as I explored renting a house with him,
getting an aide and senior living, my 20 year old daughter babysat him. He had difficulty navigating our home and at
night he plopped into whatever bed he happened upon. The full reality of his
illness hit us and we now knew first hand how tough basic living had become for
him.
Within a few weeks, we felt “lucky” to have
him safely ensconced in a senior living facility, for about $6,000/month. Since
the layout was the same as his former apartment, he got the hang of it quickly. In his lucid
moments, he was enraged that his new digs were about a third the size and 4x the cost. He cursed me and thought me a lunatic to have agreed to such a thing. Mercifully,
logical discussions about these subjects became less frequent as his disease progressed.
But even at this juncture, the economic reality of my Dad’s situation
proved quite sobering for his children. None of the four of us had had one employer for more than 10 years, let alone 40. Already in our 50s, our lives reflected the times we live in: several jobs, job losses,
periods of unemployment; retirement benefits and IRAs cobbled together between
mortgages and kids’ college education.
What would await us when we need long term care?
After about a year in “senior
living,” my Dad took a fall and was given the “do not return” card from the
facility. Fortunately, because he was in
the hospital for at least three days, and admitted to a rehab-nursing home with
skilled care within 30 days after that, he was covered by Medicare in full, for
the first 20 days, and then was required to pay a daily co-pay of $148/day for
days 21 through 100. After Day 100, there is no coverage unless another illness
crops up. After 100 days in skilled
care, then what?
Long Term Care Isn’t
Covered by Medicare
Folks like my Dad who lived long
enough to be debilitated by Dementia and Parkinson’s require care, but not the
“skilled” care needed to secure Medicare coverage. The rules regarding how much is covered for
home care benefits etc., is limited, because the definition of medical
necessity is limited. So what happens
next?
In my Dad’s case, he couldn’t tend to his daily needs because he couldn’t walk, bathe himself or go to the bathroom on his own. He didn’t so much require “medical” or “skilled” care, but rather “custodial” care. And that’s not covered by Medicare.
Out of options, we felt fortunate to have found a clean safe nursing home where the monthly bill climbed to $12,000/month instead of the $6,000/month in senior living.
By that point we had begun the 18 month process of securing Veterans’ Benefits for him (he was a WWII veteran), which were later paid retroactively from the date of application. With these new funds, we managed to negotiate a more affordable rate with the nursing home. His monthly income was too low to afford the place, but rendered him ineligible for Medicaid. A real tough "Catch 22."
It really made us wonder who has $12,000/month to pay for care! And we’re not
talking about Ritz-Carlton care here. We’re talking about a nursing home where residents
are in various states of dementia, disability and ability to care for
themselves. In this difficult environment, the care, health and well-being of
the residents essentially depends on the caring kindness of very low paid workers.
Neither Medicare nor
the new Patient Protection and Affordable Care Act of 2010 covers care for long
term chronic care. With Alzheimer’s, dementia and similar ailments on the rise
for seniors, the promise of Medicare is a false one. When a person runs out of money and needs
care, not covered by Medicare, your next “failsafe” is Medicaid. Medicaid is
another federal system, run at the state level, with rules, regulations, and
hurdles. It is another subject for another day.
My Personal Long Term
Care Plan
After
experiencing the process of watching my father move out of his home and move
into the “system,” it became quite clear that unless I had a big lottery
winning, there’s likely no way I’ll be able to afford long term care.
An apt analogy is college costs: When I
was younger, college cost $5000 a year at a top school. Forty years later it
costs $60,000/year. If nursing homes
cost $180,000/year now – there is no hope for me – even if I don’t need that
“greener pasture” for another 20 years.
 |
| My Long Term Care Plan |
Instead
I came up with my own plan.
I'm holding onto a small ranch house in Florida with
three bedrooms and two baths, all on one level, close to the beach and where
handicapped accessibility is commonplace.
There will be enough room for me, an aide and a visiting child. And the
sunshine will feel good, no matter my mental capacity.
And with a little luck, my mortgage will be paid off and it will cost far less than $180,000/year.
