My wife and I are in our mid-70s. We're old, but not super old. Currently we're doing just fine living at our home on ten non-easy-care acres in rural south Salem, Oregon.
Yet it's becoming increasingly obvious that with increasing age comes a diminished ability to do the things that need doing. That's why we're having more yard work done by hourly workers, use a handyman to do some routine chores we used to do ourself, and have made changes such as putting screens on our gutters and railings along our outside walkway.
Such is absolutely normal. Every old person, or senior citizen if you prefer that term, is going to need help with everyday living at some point in their life.
That's what makes our nation's crappy approach to long-term care so irritating. I used to work for the State Health Planning and Development Agency back in the 1970s-80s when health planning was a thing. (Maybe it still is, but now it isn't the same sort of thing.)
I recall a lot of talk back then, which made it into the State Health Plan that I helped write, about promoting alternatives to institutional long-term care such as nursing homes. About fifty years later, the same talk is happening, with very little action.
What spurred my recent thinking about this was getting an email from someone at Capital Manor here in Salem. We have a deposit at Capital Manor that puts us on a wait list for their Life Care Services. This is an appealing continuity of care approach where you start off with independent living, then are able to make use of Residential Care, Memory Care, and Home Care as needed.
That sounds great. But there's a catch.
As the Capital Manor staff person reminds us every time we hear from her, "The premise of our community, is much like a long term care plan. The only way to get here is to have the ability to live independently and once a resident, you will have the guarantees of assisted living, nursing and memory care. This contractual guarantee is made to our residents only and the window of opportunity to make a move here can close quickly."
So in order to receive the services of Capital Manor, you have to be able to live independently. The Capital Manor web site makes this clear, saying on the pages that I linked to above, "Capital Manor does not accept direct admissions into residential care, memory care, or home care."
This indeed is very much like a long-term care insurance plan. Or other health insurance plans before the Affordable Care Act did away with pre-existing conditions not being covered. To be approved to get long-term care through Capital Manor, you can't need long-term care at the moment.
This is exactly like the bad old days of health insurance where, if you needed insurance because you have cancer, the insurance company would exclude coverage of cancer treatment because it was a pre-existing condition.
The Affordable Care Act, also known as Obamacare, was able to eliminate this policy by expanding the insurance coverage pool markedly -- which enabled insurance companies to spread the risk of pre-existing conditions over a large base, the basic point of insurance.
Like most old people, we don't want to sell our house and move to a continuum of care community like Capital Manor. We want to keep on living where we are until circumstances demand a move. But as the email from Capital Manor said, if we wait too long and either my wife or I are no longer able to live independently, then just when we need the services of Capital Manor, we won't qualify to join Capital Manor.
So it's a tough choice: do something we don't want to do -- sell our house and move to a less desirable residence at Capital Manor while we're still able to pass the Capital Manor health assessment -- or wait and see how long we can get by with cobbling together our own ways of "assisted living."
This isn't fair to us seniors.
I'm not blaming Capital Manor for their policy regarding the ability to live independently. If Capital Manor didn't do this, then it would be similar to people not buying health insurance until they had an expensive medical problem. Insurance companies had to exclude pre-existing conditions until the Affordable Care Act required everyone to have health insurance.
I'm blaming our nation's legislators in Washington D.C. who haven't made long-term care an integral part of Medicare. Every person on Medicare should be able to get the same services offered by Capital Manor as part of their basic benefit package. This would allow old people to live in their homes for as long as possible, getting assistance as needed from caregivers just as Capital Manor offers for its residents.
Again, it's crazy that in order to qualify for what amounts to private long-term care insurance, you can't currently need the services that would be provided by that insurance. I understand that you couldn't get fire insurance for your house if it was in the process of burning down. However, health care isn't fire insurance; it is a necessity that should be guaranteed by the federal government, as it is in most wealthy countries, but not the United States.
It's clear that the next four years of the Trump administration won't bring genuine long-term care benefits to Medicare. We'll be lucky if massive cuts aren't made to Medicare and other entitlement programs. I just hope that when Democrats get back in power, they make this a priority.
Brian, retrieve your deposit! Or is Capitol Manor that "hippie retirement community" you have been looking for?
Have you watched A Man On The Inside on Netflix? It demonstrates the reason anyone would move into a Continuing Care Community: socializing with other seniors. I don't think you will be moving until you can no longer drive for your socializing. A regular retirement community would then be suitable for you. I like my rural life and still enjoy the physical work of caring for the property and infrastructure improvements. Like you, we have the resources to hire others when we can no longer do the work ourselves.
I don't believe this country will ever help seniors in the way you and I want. By the time enough voters wake up to elect the progressive government that would deliver those services, the economic resources won't be there (economic collapse). Like you, I am in my mid-70s and I don't believe we will live to see any real improvements in the well-being of the majority of our fellow citizens.
My action plan is to die "with-my-boots-on", either naturally or artificially.
Posted by: William Fouste | December 22, 2024 at 07:20 PM