11 11 2006

This next bit is a little complicated to explain, but bear with me.

If you own your own home, but don’t have much income or other assets, and quote/unquote “need” nursing home care at the end of your life, Tenncare will pay for it, but then they are entitled to sell your home to recover their expenses. In a way, it sounds reasonable, but it seems less reasonable when we examine its actual effects and its impact on Tenncare’s overall nursing home expenditures. When we start to look at the “need” for nursing home care and consider what this says about our society, this provision starts to look like another case of the rich getting richer while the poor get poorer.

First, the numbers. Tennessee, in combination with the federal government, spent 994 million dollars on nursing home care last year. This covered about 24,000 people out of the approximately 33,000 in nursing homes in the state last year. Nursing home care costs an average of about $46,000 a year per person in Tennessee.

How much was recovered by sale of the assets of deceased nursing home patients?

Fourteen million dollars. About one and one-half percent of the total. If you figure that each home was worth about $140,000, that’s a hundred homes. A hundred lower-class family homes. A hundred families in which the older generation passed away, leaving nothing much but memories, ’cause the government took the old homestead. What a trade—a family’s center knocked out to cover point zero-one-four percent of a government bureaucracy’s bloated budget—and that budget is funded in part by the taxes that family paid. Shouldn’t they be getting something for their money? This is a prime example of government policies contributing to the erosion of the middle class in America—but it’s not just a government policy.

More math: thirty-three thousand people at forty-six thousand dollars a year each comes to about a billion and a half dollars. That’s the budget of the nursing-home industry in this state, and as long as lobbying is legal they will be working to keep that money going into their pockets, even though home care has consistently been shown to be better for most older peoples’ health, happiness, and longevity—not to mention their pocketbooks. Home care costs about half of what nursing home care costs.

I know about this from personal experience. My mother used to live far away from me, and, as she grew older and her health and ability to care for herself deteriorated, she needed to stay in nursing homes occasionally. She was fortunate enough to be able to afford an upper-level nursing home, but when I and my family visited her there, we found it impersonal, shabby, and depressing—and it was one of the “nice” ones.

When her condition deteriorated to the point that she needed constant care, we figured out how to build a place for her adjacent to my son’s home, and arranged for her care among family members and close friends. She is taken care of by people she knows, loves, and trusts—for a fraction of what it would cost us to hire strangers in an institution.

But we are among the lucky few in this country– because my mother has a pension that’s actually sufficient to cover her care at our informal, not-coverable-by-insurance level, because I and my friends have the kind of flexibility in our lives that allows us to work with her, and because we get along well enough as a family to figure these things out. I am painfully aware of my rare good fortune, but I think it shouldn’t be so rare.

The focus of government policy on elder care should be on keeping people with their families and in their homes to the greatest extent possible. This should focus on psychological and emotional issues as well as economics, and should be coupled with a deeper change of attitude: we need to abandon the materialistic view that everyone must be kept alive as long as possible regardless of the cost and quality of life that result. It is OK to die when you’re old. The bulk of medical expenses and interventions in a person’s life come when they are dying; it would be easier on them, us, and the economy to shift the paradigm into recognition that death is a graceful part of life, not a desperate battle to the finish. I’m not specifically talking about assisted suicide or euthanasia here, just putting natural death on the same footing as natural birth. If we can get millions of people to crave artificially sweetened, carbonated, caffeinated liquids that don’t quench their thirst, we ought to be able to put an idea like “easy death” across.

This is pretty radical. It’s a long way from the economics of elder care, in a way, but then again, when I say it’s radical, I mean it’s a view that encompasses the root of the situation. That’s what we Greens are about—rethinking the fundamental assumptions of our dysfunctional society. Old age, sickness, and death are inevitable—so what’s the intelligent way to treat them?

music:  James McMurtry, “Hands Like Rain




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