Sometimes I Feel Like a Piece of Bologna

Thursday, July 23, 2009

Caring for Our Parents: Inspiring Stories of Families Seeking new Solutions to America’s Most Urgent Health Crisis – Part 1

Howard Gleckman has written a captivating book that will challenge, inspire, and disappoint those of us caring for our aging parents, especially those of us who are Boomers. The book is readable and enjoyable, while at the same time providing lots of statistics and data in a very readable form.

The first half of the book tells compelling stories of how a variety of families are coping with eldercare needs using nursing homes, home care, family care, hospice, adult day care, and other solutions. He discusses the financial and practical challenges they face, including compromises that are forced by government rules and reimbursement. The thing that struck me the most in these chapters is the incredible lack of creativity and flexibility in all government reimbursement systems. Despite personal preference or financial common sense, the government has rules and people without personal resources are stuck. It’s a perfect reminder of what we’ll face if the government takes over even more of our care. The stories also point out what most of us doing eldercare already know: the ideas of the Boomers are not necessarily the ideas or preferences of the elder generation. What makes sense to me isn’t how my mom wants to live out her life. It’s not just me….

The second half of the book is chock full of statistics. Gleckman’s data is well documented in endnotes, but his style is conversational, even when discussing complex information, so even if you don’t like numbers, you’ll appreciate his interpretations. The net effect of these data was to make me realize how very serious our eldercare problems are and are becoming. And there really isn’t an answer. As an example, he notes:

“In 2005, America spent more than $200 billion for nursing home care, and other long term-care services. About half of that, or more than $100 billion was paid by the government, through our tax dollars. Most of the rest was financed by individual families, out of their own pockets. A small amount – less than ten cents out of every dollar – was covered by private insurance…. How much is $200 billion? Nearly $2,000 for every household in the nation.”

But the needs aren’t evenly distributed. “Three out of ten seniors will never require [eldercare]… “…two out of every three will need some period of personal assistance in their old age. About 17 percent will require help for a year or less, and many of them will get by with relatively little aid from family members or friends. However, more than half will need care for at least a year, and one our of every five will need help for five years or longer. Women are far more likely to need long-term care than men and the odds are nearly twice as high that they’ll need it for five years or more.”

Researchers estimated that 42 percent of sixty-five-year-olds will have no long-term care costs before they die and about 20 percent will have less than $10,000. However, about one out of every six will generate costs in excess of $100,000 and about one in twenty will incur expenses of more than $250,000.”

The cost of a nursing homes averages “$78,000 a year and home health agencies charge close to $20 an hour for aides.”

“Fewer than 7 million people have private long-term-care insurance…. Americans seem unable—or unwilling—to build up a financial reserve for their old age… Before the real estate and stock market collapses of 2008, the median net worth of all those over sixty-five, including their home, was somewhere between $110,000 and $150,000.”

He evaluates Medicare, Medicaid, pensions, retirement, long term care insurance, reverse mortgages and concludes – sadly – that there really are few good answers for today’s elderly. And the challenges are even worse for Boomers, whose future will be defined by three factors:
1) the vast number of those born between 1946 and 1964,
2) their rapidly increasingly life expectancy, and
3) profound changes in the nature of families.

Tomorrow we’ll look at his assessment of the Baby Boomer generation.

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