By: Pamela Dombrowski-Wilson
recent months I have met with an increasing number of families trying
to figure out how to access long term care for their parents. The
challenge for most is that they never for a moment considered that
they would have to pay for care; they simply assumed the government
would take care of it. This illustrates very clearly the looming long
term care problem in the United States. We do not have a system that
educates or requires individuals to pay for their own long term care
so the default is to access the government Medicaid program.
More importantly, families are angry about the requirements and seek to
figure out creative ways to avoid giving up assets in order to spend down to the
financial level required to access Medicaid. After all, the children want their
inheritance and due to recent economic issues, many children see accessing the
retirement savings or home equity of their parents as way to bail themselves out
of financial difficulties. To many, this sounds cold; children seeking to use
their parent's assets for their own financial good. It happens more often than
one would think and is one of the most underreported crimes against the elderly.
In fact a summit was held in Denver on October 23rd to seek solutions against
financial abuse of the elderly, most committed by family members.
How does this financial abuse occur and why shouldn't these families be angry
about Medicaid? The government has taught us an important lesson, why pay for
care when the government gives it away? So why would families not seek ways to
keep money, investments and assets away from the government? The difficulty is
the ethical decision between retaining assets and accessing quality care for
family members. Government programs show it's nearly impossible to accomplish
one without giving up the other.
This is clearly illustrated by public perception of the quality of care in
nursing homes. How many people do you personally know who cannot wait to spend
the rest of their life in a nursing home? Yet how many people realize that
nursing home care represents the most significant portion of Medicaid spending?
By not planning to fund long term care expenses most individuals are pushed into
the nursing home system.
Sure, it's easy to complain about the poor quality of care in nursing homes.
How many people realize that Medicaid reimbursed $13.15 per bed per day below
break even costs for nursing homes in 2006? How can individuals receive quality
care in nursing facilities that lose money on large numbers of patients? It's
time for us to realize that we get what we pay for and if we want to access
quality care we, not the government, are going to have to pay for the care.
The latest financial issues occurring with the economy has shown that a lack
of education leaves consumers holding the bag in the way of foreclosures and
financial issues. It may not be the government's responsibility to educate
consumers so we have to educate ourselves.
There are many older adults and parents scarcely managing in private homes
while families are trying to hold onto assets so as not to spend them for care.
Is the thought that the parents will die more quickly if care isn't provided and
then the inheritance can be gained? Where is the logic? Where is the ethical
responsibility and balance between accepting personal responsibility for our own
care by spending our own resources for quality care versus the expectation that
our money is our own and the government should pay for care? How many care more
about retaining family money and inheritances versus providing needed care that
is in the best interests of family members?
These are tough questions to ask and even more difficult to answer especially
when the immediacy of reality and the need for care is upon us. Often I find
myself the bearer of bad news when I give families the list of requirements for
Medicaid. I become the adversary versus the advocate when families want to
retain assets and they feel I now have too much information or am in a position
to judge their decisions. It's difficult enough to find oneself in a position of
having to make difficult decisions about the care of a family member, let alone
to then live with the consequences and the guilt of choice made. Research shows
an abundance of cases where family caregivers experience a great deal of guilt
regardless of the outcome of their decisions. My position is not as a judge; my
position is to give families and individuals information to allow them to make
their own decisions and then look to their own future.
If we don't want to end up in the same situations we are experiencing with
family members, we must plan and pay for our own long term care. Examining and
educating ourselves about long term care insurance is one way to plan for a
future of quality care not reliant on strained government programs resulting in
financial losses for those providing care.
Even the best of us cannot continue to maintain long term when our monthly
expenses are greater than our income. How can we expect those providing services
reimbursed by government programs to do the same and then complain about their
ability to provide quality care? Many service providers reimbursed by government
Medicaid programs cannot financially afford to provide the level of care
expected by the public. It's time to wake up and make your own plans.
Author Resource: Pamela
D. Wilson helps individuals and families navigate health care and
aging issues.Contact her at
The Care Navigator
The Care Navigator Blog
for free information.
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