March 7, 2012

USA: Care is expensive - Planning for old age at a premium

SEATTLE, Washington / The Seattle Times / Columnists /March 7, 2012

Preparing for longterm care is difficult — even for those who can afford insurance plans.
Seattle Times staff colum


Monday, I suggested exploring long-term health insurance as a way to deal with the cost of assisted living.
Like almost everything about managing when you can no longer live on your own, insurance can be complicated, frustrating and inadequate. Lots of readers shared stories about their experiences.
It was an email from a reader that led to the column. Roslyn Duffy wrote about her mother, who ran out of money and had to turn to Medicaid. She was told she'll have to move because the assisted-living facility where she lives no longer accepts Medicaid.
Care is expensive. I had no idea how costly until my wife and I began to deal with parents who needed it.
We didn't know about the paperwork and bureaucracy, or the difficult hunt for quality care that was accessible to people who hadn't managed to get rich. It's like college hunting — but with no joy attached to it.
There are good places out there, but they're harder to get into and usually cost more. Some of the most desirable places take Medicaid clients, but placements are limited.
The only certainty is that nothing is universally true.
The problem of what to do with old people who need help is a creation of modern society that we haven't committed ourselves to solving. It's almost like a monster that you don't believe exists until you answer its knock at your door.
After Monday's column, some readers were unsympathetic, a few suggested that if you couldn't save enough money to see you through your old age, you shouldn't expect society to bail you out.
At least a couple mentioned euthanasia as a solution.
But most readers were glad the topic was raised. Out of sight, out of mind is no way to deal with something so important.
So here's the deal. If you are rich, it's not a problem. If you are poor, Medicaid will pick up the tab for a nursing home.
If you are somewhere in the middle, you may want what the rich have, but be able to afford only what the poor get — and only until your money runs out, and then Medicaid will step in.
Insurance for long-term care is supposed to provide some security for people who are not quite rich, but who do have enough money to pay its premiums.
Dick Ferguson, of Burien, has long-term care insurance.
Ferguson, wrote in an email that when he retired, more than 20 years ago, "I took out a Long Term Care policy on my wife and myself, feeling that it was imperative that we be prepared for what might come. I believe that we paid about $1,600 per year in premiums."
In 1999, his wife, who had Alzheimer's, died. His premiums went up from $800, as part of a couple, to $1,200 a year.
"I have just received notice from the insurance company, which still carries my portion of the LTC policy, that my premium will go up to $1,700 per year," he said.
The older you are, the higher your premiums will be, and the less likely you will be accepted for coverage at all.
Ferguson had urged his children to get coverage. When his daughter applied, he said, the insurance company found out she'd consulted her doctor about her mother's Alzheimer's. The company declined to cover her.
Ferguson is keeping his policy because he doesn't see a workable alternative. While his wife was in a nursing home, the insurance paid only part of the cost, but it was enough to close the gap between the full amount and the payments they could make.
My father-in-law lives in a wonderful assisted-living building. My mother, who was in a nursing home for a time, has home care now and can tend her yard and play with her dog.
Good outcomes are possible, but we are on our own to get there. What we lack is a system that works smoothly and well for most people most of the time.
Some countries have found ways to get there (universal programs funded by taxes), but I don't see us joining them anytime soon. We Americans are ruggedly independent, right up to the point where it's our turn to need help.
Jerry Large 
E-Mail: jlarge@seattletimes.com. Twitter @jerrylarge
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