Luck Be a Lady
Last weekend we busted Grandma out of her Rest Home for a fancy dinner-outing to celebrate — scratch that — acknowledge my aging.
Even though celebrating my birthday is not that important to me, when we thought my mom’s Covid restrictions wouldn’t be lifted in time, I was feeling badly she wouldn’t get to mark the moment which, let’s face it, is more significant for the one who gives birth.
But I admit to having mixed emotions when I realized we could see Grandma again. There was something peaceful and pressure-alleviating about the five weeks since Christmas when I wasn’t allowed to visit, or have her to our home, or take her out to dinner. In an abundance of caution I had also changed her medical appointments to tele-heath, so for the first time in two years there was nothing I “had” to do for her.
The “have to” feeling carried through to the prep for going out — it had been a long time since any of us dressed up! — and negotiating her into and out of the car, to the table, to and from the bathroom, and through her lifelong laborious decision-making disorder when choosing her courses. When we brought her home two hours later we were ALL exhausted, and for the first time ever my mom asked me to help her get ready for bed before I left. I watched as her hands shook while changing, and listened to her now-audible and omnipresent wheezing from severe emphysema. Five weeks is apparently like five months in elder years.
The next day, a neighbor who immigrated to the U.S. inquired about Grandma, curious if the cost of her residence is paid through Long Term Care Insurance. He was wondering whether he and his wife should get coverage, i.e. trying to understand how the hell elder Americans cover the costs of decline in a country that doesn’t provide government-funded healthcare services. For many reasons it is not appropriate for me to give “advice” for or against LTC insurance, but I want to acknowledge the elephant in the room that it raises: money, or the lack thereof.
When I reached out to my eldercare consultant buddy to get his thoughts on the topic, Howard launched into a passionate diatribe against. His main criticism is the restrictions LTC policies place on what’s covered, namely the “social” supports like assisted living or non-medical home help most of us would prefer, versus spending our remaining days in a “certified” medical nursing home. (“No one thinks ‘I’d REALLY like to be in a nursing home!!’” Howard barked.) Like all insurance gambles, that means you’re paying into a policy — generally starting in middle age when you’re already juggling many other expenses — for a “what if” outcome. Namely, you might never end up needing or wanting the covered services.
Add to all this that premiums are rising, the industry is tanking, and the costs an LTC policy is meant to cover will continue to go up — and it makes for a worthy debate. A hilarious example of the insurer’s allegiance is when my friend’s father, who is in the pro-LTC insurance camp, received notices from his carrier saying, “you haven’t made a claim in two months so we’re going to drop you.” I.e. being healthy enough NOT to use the insurance you invested in begs the question from them whether you’re already six feet under.
The “better” alternative to LTC insurance, as eldercare and financial types argue, is working with a good investment advisor to maximize personal savings to cover future healthcare and support costs. The flaw in that argument, as I know all too well, is presupposing someone HAS money to invest for the future, as opposed to living paycheck to paycheck, or Social Security check, in my parents’ case. (Howard will recall that when I first sought his advice about a place for my mom it took a couple conversations before he realized “she doesn’t have any money” was a literal statement.)
In the end, the elders and the insurance providers have the same problem: neither predicted the policyholder would live so long. Palliative care doctor BJ Miller sums it up well in his must-watch educational Financial Care video by saying, “There is a curse to our progress in the medical front in some ways. We are able to live longer and longer with chronic and serious illness that would have taken our lives a generation ago. So you can imagine the poor actuarial tables are getting to be pretty tricky stuff.”
But the good if imperfect news, as Dr. Miller says and I can personally attest, is that our “clunky” and chaotic American system does have safety nets — like Medicaid, and spousal waivers, and hospital policies — that prevent people from being abandoned for lack of funds. If you or your elder need to explore alternatives to insurance and investments, my own experience proved the best place to start is contacting your local depart on aging.
So that brings us back to Grandma. At 87 she’s thriving — or being kept alive, depending on your point of view — because of the many medicines and interventions and the assisted living available to her, and the Medicaid funding that pays for it all. She’s got a seat at the Blackjack Table, and now we’re just waiting to see when her luck runs out!