Long Term Care

Back when I was a respectable white collar gentleman, earning my living with no dirt under my fingernails, one of my job titles still was adequate to draw a condescending view from a portion of the public.  One of the services that I offered as part of my financial practice was insurance.  So part of the time, in a manner of speaking, I was an insurance salesman.

I spent a good deal of my time, vis a vis insurance, debunking the asinine rhetoric from the likes of Dave Ramsey and Suze Orman.  I know plenty of you folks love your helpful talking heads on TV or radio, but they have their own set of biases just like the rest of us.  Educating people about the realities of permanent life insurance, the various options and cost structures involved, was important work as far as I'm concerned.  People still had an inclination to choose term insurance for various reasons, mainly the low price, but at least I made sure that they understood their options.

Another topic about which I regularly had to educate people was long term care.  Among the many clients that I acquired at American Express and then later at MetLife, very few chose to purchase LTC policies from me.  As was the case with the life insurance though, every one of my clients understood the topic very thoroughly.  (I never claimed to make anybody rich, but I sure as hell tried to make them smarter.)  This is a part of the medical care/insurance market that is poorly understood and people are, as a result, poorly prepared.

My buddy Mr. Pedro is still staying at the rehab facility at Wyandotte Hospital.  It has been determined that he suffered a minor stroke roughly a month ago.  This was what led to his fall at home, his trip to the hospital, and his subsequent difficulties.  After the hospital had him stabilized and safe, he was transferred to the rehab unit to begin working on his strength and coordination.  The goal is to get him back home, with the ability to use a toilet and feed himself and so forth.  He's making noticeable progress toward this end.

Mr. Pedro has a top-notch supplemental insurance package to go along with his Medicare, so the costs of his hospital stay have been well covered.  In related news, the hospital wants him out.  Funny little thing about Medicare - it sucks for the taxpayer, it sucks for the doctor, and it sucks for the hospital.  No wonder the old folks seem to love it so much.  Since the money coming in tends to be less than the market would dictate, hospitals don't want people lingering any longer than necessary.

So where do you go when you're 97 years old, you can't fully care for yourself, and your son just had his hip replaced, rendering him incapable of fully caring for himself at the moment?  You go to a nursing home for skilled rehabilitation services, of course.  And how do you pay for it?  Medicare, obviously.  (Unless you're one of the few who has LTC coverage, but we'll get back to that soon enough.)  The Medicare coverage will carry you through for twenty days.  Then, assuming that you can get your doctor's approval and afford the ~$130 daily copayment, it'll go for up to 80 more days.  Those Medicare supplemental policies sure do come in handy for filling that 21-100 day gap, even if our president likes to bitch incessantly about the companies that provide them.  Since Mr. Pedro has such a policy, he doesn't need to worry about the copayment.  So he's covered on the insurance end, at least for now.

Now then, what about the nursing homes?  The social worker at the hospital, as far as I can tell, has one job.  Her job is to get the guy out of the hospital.  ♫You don't have to go home but you can't stay here...♫  She called my buddy the reverand this morning and told him that she had everything lined up for his father to go to a local nursing home.  The reverand, dealing with his own recovery from hip surgery and the stress of his father's predicament, was relieved to hear the news.  Relieved until I got to his house this morning, that is.

I've spent some time as a pizza delivery man in this area.  I started at Pizza Hut in Taylor while I was in college.  Then I became the boss at Pizza Hut in Livonia, so I didn't deliver anymore.  Then I left Pizza Hut for a while and worked with a buddy at Papa Romano's in Southgate.  Then, for a brief time, I was delivering pizzas for another buddy's place in Wyandotte.  I ultimately wound up managing the place in Wyandotte, then moving on into the corporate world and such, but there was a period of time during which I delivered virtually everywhere in Southgate, Wyandotte, and the surrounding communities.  You know who orders a lot of pizza?  Nursing home workers.  I've seen 'em all, man.  Of particular note - I've seen the nursing home where the social worker wanted to send Mr. Pedro.  I've seen the workers there and the way that they interact with the patients.  Oh hell no.

I had spent a lot of time last night, during which I should have been sleeping, compiling a list of places that I thought might be worth the Pedro boys' consideration.  My intent was to learn whatever I could about the various options available and then do a little leg work today to get a feel for what's out there.  I didn't have to work today and my unfortunate lodger has been serving as a de facto aid worker for the two old guys, so the two of us headed over to the reverand's house this morning.  We had a pretty good idea regarding how we would approach our fact-finding mission, but we're not part of the Pedro family so we didn't want to do anything that would appear as overstepping our bounds.

This is when the reverand shared his "wonderful" news from the social worker.  I found myself in a bit of a pickle.  By nature, I'm not one to tell other people how to conduct their personal affairs.  If this was the place where Mr. Pedro would be going and it made his son happy, then so be it.  On the other hand though... fuck that.

This guy survived a flu epidemic that killed three members of his immediate family.  He worked in a coal mine when he was eight years old.  He boxed against coal miners as a teenager, in order to earn a few bucks to help feed his family.  He was married faithfully to his wife for more than seventy years until her passing earlier this year.  With a wife and two kids at home, he packed up and joined the army after Pearl Harbor.  He jumped out of airplanes into shark-infested waters off the Phillipines.  He charged into a cave and killed a band of Japanese soldiers who had ambushed his buddies.  He was a high-ranking official in the labor movement during the post-WWII era (and perhaps knew a thing or two about the movement's seedy underside as well).  He sparred in the ring against Jake LaMotta.  He was on a first name basis with Jimmy Hoffa.  He became a friend of mine many years ago and oftentimes, without me having any idea how he knew what he knew, he was there to lend a hand before I even thought to ask.  This guy is one of the most incredible people that I've ever met.  Fuck that.  I wasn't going to keep my mouth shut this time around.

I made it clear that these aren't my decisions to make, but my roommate and I asked the reverand not to act too quickly with respect to the nursing home situation.  We offered to spend the day visiting the places on my list and then report back with whatever we found.  Much to my pleasant surprise, the reverand didn't hesitate to call the social worker at the hospital and put the brakes on everything.  So that's how I spent my day off today - driving around to various locations and touring facilities, talking with their admissions staffs, and so on.  It was a pretty productive day once all was said and done.

When it was time for my roommate to call the hospital and order Mr. Pedro's dinner (one of his de facto duties these days), we decided instead to pick up some mostaccioli from Roma Pizzeria and deliver it ourselves.  Whether his rehab caused him to work up a bigger appetite or whether he was just glad to see that we brought him some good food, the old man ate more than he has in recent memory.  The whole order of pasta was gone.  His fruit plate from the hospital was gone.  A big bowl of fresh berries that we brought from Kroger was gone.  His bowl of Jell-o for dessert was gone.  It may seem like a minor detail, but we were pleasantly surprised to see our old buddy chowing like he did.  Perhaps it's a sign that he's getting back to being himself again.

After hanging out and sharing stories for a while, we headed back to Lincoln Park to check on the other patient.  The reverand's post-op hip pain seems to be getting better, so that's good.  And he was exceedingly grateful for the research that we had done throughout the course of the day.  Given his own medical condition, the stress of having his father hanging in limbo has certainly been wearing on him.  Some of the best facilities are essentially full at the moment, but he's going to review our findings and present his own list of three choices to the social worker tomorrow morning.  As nearly as I can understand, the hospital may be inclined to let his father hang around for an extra few days if a preferred facility expects to have a bed opening up at some point in the next week.  We'll see how it all turns out from here, but things are looking up for now.  That's a start.

I told you that story so I could tell you this story.  Mr. Pedro should be able to get back to a somewhat normal state within a month or two.  Then he'll come back home, Lord willing, and resume his life of watching the news, helping his friends, and telling people stories about the old days.  He's fortunate enough to have a son living at home who can help him with the tasks that he can't do alone.  It looks like things will be okay for a while.

What happens though if he falls into a state where he will no longer be able to care for himself with his son's help?  As much as nobody wants to entertain the thought, what if he has to go somewhere for long term care on a permanent basis?  Here's what happens, generally.  Unless he can afford the ~$70,000 a year for a decent nursing home, his only option will be Medicaid.  His home, one car, personal belongings, and $2,000 will be off-limits.  Aside from that, his assets will have to be used to pay for the nursing home.  His pension payments and Social Security payments will have to be used to pay for the nursing home.  He'll have to accept whatever facility in the local area has an open bed for Medicaid patients.  To whatever extent Medicare underpays providers, Medicaid is even worse, so most of the better facilities have few or no beds available for Medicaid patients.  He'll live out his years in whatever conditions 'the system' is able to provide, maybe good, maybe bad.  His children and grandchildren won't inherit nearly as much as they should from such an impressive lifetime of work.

This won't necessarily be the way things go.  Maybe the old man will live happily for several more years and then check out one night in his sleep.  There's no way to know, but for too many families the story ends on a more sour note.  We have a population that sees fewer children being born and more people living longer.  We have a political system designed to destroy any hope of a sensible role for immigration (one side saying anything goes and the other saying shut it down), meaning that we'll continue to grow older as a society.  Nevermind whatever you've already heard about health care and baby boomers, the pressures on the long term care industry are going to be immense.  Quality is likely to decrease.  Demand and competition for placement in the best facilities is likely to cause prices to skyrocket.  Most of us are going to be caught with our pants down.

It's terribly expensive if you're already over 50 and it's still awfully expensive if you're under 50, but long term care insurance is something that each of you really should make sure you understand.  Maybe you can afford it or maybe you can't.  Maybe you'll be cool with the CLASS Act's (fairly small, for such high premiums) daily stipend for in-home care or maybe you'll want something better.  Maybe you want to roll the dice and let the chips fall where they may.  Maybe you'll get a hotshot attorney that can shield your assets from Medicaid and you'll still manage to land in a decent home.  I don't know any of you as well as I know Mr. Pedro, so I'll revert now to my general tendency not to tell people how to live their lives.  Do whatever makes you happy, but in my opinion you should at least have some idea of what that "whatever" will be.