FERTILE, Minn. – Princeton University professor Hendrik Hartog wrote a commentary in the New York Times recently about the old days when families took care of elderly people.
His conclusion: The arrangements whereby Grandma had the side room in the house were “only occasionally happy.” Elder care a hundred years ago was, according to Hartog, “a very dark world.”
My own grandmother cut short her education at St. Cloud State University in the 1920s after she got a letter from home that said she was needed to care for her aging parents.
“When I got in the front door, I slammed my suitcase down on the floor,” she told me later. “It was a bitter pill to swallow.”
Six children and two ill parents
Her career dreams over, she married my grandfather at age 30. Over the next 10 years, she bore six children and took care of her mother, who was in diapers, and her father, who was insane.
Eventually, they shipped her father off to the county poor farm. But Great Grandma remained in the third room of the three-room house, an invalid, cared for by Grandma, for over a decade.
The good old days!
And welcome to our future.
Nobody wants to talk about it, but there is no plan in place to finance care for the huge wave of older people who are coming along and coming along fast.
More indignation and despair than hope
At a conference on the topic in January at the Hubert H. Humphery School of Public Affairs at the University of Minnesota, I heard more indignation and despair than hope.
The first speaker, a reporter from the New York Times, told her grim story of managing her own mother’s care on the East Coast. In the end, to find a nursing home that wasn’t a hell hole the family forked over $14,000 per-month.
The second speaker, from California, congratulated Minnesota on being the AARP’s highest ranked state for long-term care and wondered aloud how we are going to keep it up.
The third speaker, Lucinda Jesson, Gov. Mark Dayton’s commissioner of Health and Human Services, cheerfully reported Minnesota’s plans for financing long-term care in the future.
As far as I could tell, the plan is to run a big public service announcement campaign to encourage people to buy long-term care insurance!
But first, they need to find long-term care insurance companies which 1) have an affordable product and 2) aren’t on the verge of going broke from selling plans they can’t back up!
‘Families are our hidden resource’
Oh, there are other parts to the plan.
“Families are our hidden resource,” Jesson chirped cheerfully.
“We need to encourage personal responsibility,” echoed legislators on a panel, defaulting to the political mantra of the moment.
Translation: Y’all better get ready to change Ma’s diapers.
The excellent nursing home system in Minnesota, particularly in rural Minnesota, was built for several good reasons.
First, people couldn’t adequately care for the frail elderly in their homes. Women, who did the bulk of that work, wanted and needed careers of their own.
Second, because most adult kids moved off the farm to the suburbs to work, many older people were left back home with nobody to give them care.
Finally, caring, trained professionals do a better job of changing Ma’s diaper. Although there is still potential for failures and abuse, in a professionalized, well-regulated system, those chances are fewer.
What worked is now wobbling
Our elder-care system worked. Now, thanks to the shortsighted politics of “all taxes are bad,” it is wobbling.
Today, our shortsighted, whiny and greedy generation seems to think they are going to retire, play golf for about 15 years and then ascend directly into heaven.
Even the few wise people who save for the nursing home have put away only a fraction of the funds needed.
Here’s betting that a public service campaign to get people to save for assisted living or the nursing home will utterly fail.
Nobody thinks old age will happen to them.
The solution?
We need to band together
It is time to go back to the old days. By that, I mean 40 years ago, not 80.
Just as our visionary ancestors banded together in the 1960s to build the nursing home system we benefit from today, we need to band together to build an even better system for our parents, and not so long after that, ourselves.
We need to build an elder-care system worth living in.
And we need to do what our less-prosperous but smarter ancestors did: Raise taxes on ourselves for the purpose.
If we don’t, you’d better get ready to change Ma’s diapers or wave $100 bills in the face of someone off the street who will.
Eric Bergeson, of Fertile, Minn., is studying rural long-term care under a two-year fellowship from the Bush Foundation.
Want to add your voice?
If you’re interested in joining the discussion by writing a Community Voices article, email Susan Albright at salbright@minnpost.com.
Long-term care “insurance”
I read a couple of years ago that the way some long-term care insurers stay profitable is to just delay paying benefits for care until the elder has died. Very efficient. Very Ayn Randlike.
Long-term care insurance is expensive, more than many workers can afford, especially if they are near retirement.
Assisted living retirement homes can seem somewhat affordable at, say, $2,000 – $3,000 per month, but there are add-ons for every time a person needs to see or talk with a nurse, needs help walking for exercise in the hallway, or any of many other services not covered by one’s personal monthly rent. You’d think “assisted living” meant just that, wouldn’t you?
The writer seems to be recommending public nursing homes run by counties and staffed by unionized public employees responsible to their unions, their employers, and most of all to their patients and their families, for providing professional, caring help. I would agree.
When did an inheritance become an entitlement?
One of the questions I’ve encountered many times in my legal career is whether and how one can drain assets from an estate in order to qualify a parent for state-paid nursing home care. As often as not, or possibly more often than not, the question is asked not by the parent, but the children, who fear that their potential inheritance will be consumed by the cost of long term care. Almost universally, those who inquire feel it is far better for the state to pay these costs than for the parent or the parent’s estate. If I choose to advise them, I’m obliged to tell them that yes, it can be done and how to do it. The bottom line is that a person can give every nickel away in order to bring down their assets, so long as it is done 5 years before he or she applies for Medicaid. Less than that and the state can reach back and undo the transaction.
Those who’ve sought my advice have come from all quarters: well-to-do, poor, liberal and conservative.
So, my question: when did an inheritance become an entitlement? My grandparents died with little other than their household furnishings. My parents died without requiring long term care. Had my mother required it, her assets would have been provided for perhaps one to one and one-half years of long term care. We made no effort to shelter those assets. My mother-in-law spent her last dollar on long term care, which was then paid for by Medicaid. Again, no effort was made to shelter her assets. What assets she had were liquidated over the years to pay for her care, at various levels.
Certainly, most parents want to help their children get a start in life. But those who consult me typically are those in their 40s or later, who are themselves established and in no real need. They simply want their parents’ money before it can be spent on their parents.
I don’t know how we’ll pay for long term care in the coming years, but I do know one thing that will continue to stand in the way: greed.
Long-term Care
I believe you’ve hit us right between the eyes, Mr Bergeson. How else do you explain the paucity of responses to your well-written article?
I think you are right, we are expecting to go directly to heaven without the need for long-term care. And if Ma needs her diapers changed, let somebody(anyone?) else take care of it. But not me because I need the money to send my kids to college, etc.
I just attended a supper meeting at the Lex sponsored by a law firm that went on at length to describe the so-called “spend down” solution. I didn’t stay long enough to find out exactly how they got around the 5-year rule but the law firm specialized in “trusts,” so draw your own conclusion.
And nobody is talking constructively about addressing this critical need – not even the Tea Party Republicans who gloat about personal responsiblility.