Here There and Everywhere

Expat wanderer

Long Term Care for The Aged: Hidden In Plain Sight

One of the most amazing things that happened to me while I was living in Doha was a conversation I had with a group of Qatteri and Palestinian women. We were talking about our summer plans, and when it was my turn, I told them I was going back to the US to take care of my Dad while my Mom had a knee replacement. They all looked at me in stunned silence, and I wondered what I had said wrong.

“You do this?” one of them finally asked me, “You take care of your parents?”

“Yes, of course,” I replied, not understanding her puzzlement.

There was a burst of excited chatter I couldn’t follow, and then one of the younger women said to me “but we NEVER see this on TV.”

Things have probably changed by now, with all the cable stations available, with Lifetime and a broader spectrum, but what they think of as America is Dynasty and – well, think of what your favorite programs are, and then imagine an alien culture watching and trying to figure out your culture from what you watch. If you are living with the aliens, they way we portray our own culture on television and in movies is appalling!

Long story short, most adults want to stay independent as long as possible. They never want to be a burden on their sons and daughters and grandchildren. I am willing to bet that this is almost universal. For one thing, from the point of view of the aging, if you live with someone else, you know you will increase their work load, and if you go to a facility, you lose a lot of options to choose. Being able to have someone to come into your own house allows you to remain independent as long as possible. If you live with one of your children, you still get to have home-care, which relieves a lot of the burden on those with whom you are living.

Here is an AOL Health News article on a ‘hidden’ provision of the new health care act which will make it possible to keep our elders at home longer. Believe me, this is a very good thing, if you have ever dealt with a rehab facility, or a residence for the aged.

Health Care Reform Will Impact Long-Term Care
From AOL News: HealthCare
Robert W. Stock
(March 26) — As health care reform became the law of the land this week, a huge bloc of Americans with a unique interest in the outcome sat watching on the sidelines.

The 49 million people who care for older family members were hidden in plain sight, as usual, quietly shouldering a burden that so often takes a heavy toll on their finances and their physical and emotional well-being. Many of them — I know a few — are opposed to the new health care law, even though it includes one of the most important steps ever taken to improve caregivers’ lot, especially those of the middle-class persuasion. Of course, hardly any of them are aware of that.

The Community Living Assistance Services and Supports Act, otherwise known as CLASS, provides for a national insurance program to help cover the cost of long-term care — something 70 percent of people over 65 will need at some point along the way. The premiums will be much lower than those for private plans, and you won’t get screened out because you’ve already had some health problems. Once vested after five years, enrollees unable to care for themselves will be able to claim cash benefits for as long as needed.

Joe Raedle, Getty Images
A health aide helps a patient at his home in Miami. The new health care reform law could “transform long-term care” and make it possible for more patients to stay at home, said the chief of the National Council on Aging.
If you’re rich, you don’t require much financial help with long-term care. If you’re poor and can no longer fend for yourself, Medicaid pays the bills, often at a nursing home. For the rest of us, long-term care — at home or in an institution — now requires that we, or our caregivers, choose from among some unpleasant options.

We can spend down our retirement savings until we’re eligible for Medicaid funds. We can protect our savings by taking out expensive long-term care insurance — it costs my wife and me more than $5,000 a year. Or, depending on how dependent we are, we can throw ourselves, or be thrown, on the mercy of our families.

My friend — I’ll call him Frank — was a retired lawyer and in great shape until four years ago. He had just turned 90 when emergency surgery laid him low for months on end. Then his sight and hearing began to go. “I’m one of the lucky ones,” his wife, Helen, told me. “His mind is fine. But he can’t get around on his own — he falls, even with a walker. He can’t make a cup of tea or shower by himself.”

For now, Helen can afford to hire an aide for a few hours a day to help with Frank and allow her to get out of the apartment. “James gives me a life,” she said. The future looks darker.

Surveys show that 90 percent of Americans want to age at home. Frank is no exception, but he never signed up for long-term care insurance. “If I couldn’t keep taking care of him, I don’t what I’d do,” Helen said. “If he went into assisted living, it would use up all our money. It’s very scary.”

CLASS, one of the legacies of the late Ted Kennedy, offers caregivers and care recipients another option. “If it’s successful, if a large enough number of people sign up, it will transform long-term care,” says James Firman, president and CEO of the National Council on Aging. “It will create a market-based economy for keeping aging people at home.”

That’s an important “if,” since the program, by law, must be self-sustaining. Premiums will generally be collected as part of workers’ payroll deductions unless they opt out. The younger the worker, the smaller the premium.

There is a vicious circle built into the current arrangements. Many caregivers must hold down a job and maintain their own separate family household while also watching over an aging parent. That kind of pressure can have consequences.

In recent studies, workers 18 to 39 years of age who were caring for an older relative had significantly higher rates of hypertension, depression and heart disease than non-caregivers of the same age. Overall, caregivers cost their companies an extra 8 percent a year in health care charges and many more unplanned days off.

In other words, the strains of family caregiving can hasten the caregiver’s need to be the recipient of care.

CLASS bids to crack if not break that vicious circle. Its benefits would make it much simpler and less expensive for families to make sure Mom gets the support she needs to be able to spend life’s endgame where she wants — in her own home. Good news for Mom, and good news for the future health of her caregivers.

In the last few days, I’ve conducted a poll of a dozen friends who have been closely following the health care reform debate. I wanted to find out how much they knew about CLASS.

Not one among them had even heard of it. It somehow seemed fitting that this major program, just like the caregivers themselves, was hidden in plain sight.

March 27, 2010 Posted by | Aging, Bureaucracy, Community, Cross Cultural, Doha, ExPat Life, Family Issues, Financial Issues, Generational, Interconnected, Living Conditions, Relationships, Seattle, Social Issues | 6 Comments