Sunday, April 21, 2013

Caregiving's Costly Burden

Hey - If I had known that official government policy toward caring for elderly parents was that their children would have to do it all, well I would have had 10 kids.

While it's said that those in the developing world have numerous children with the hope that some will survive to care for them when they're old, those in developed counties have about two children.

Somehow I guess I thought our so-called developed world had some type of policies for elderly caregiving, but the United States simply doesn't. While Medicare will take care of hospitalization for a heart attack, those who need chronic care for Parkinson's disease, diabetes, Alzheimer's disease or heart failure just have to depend on family, pure and simple. After that, long term care insurance coverage is the only answer.

Boomers can purchase long term care insurance for their own future care, but this doesn't help the greatest generation that needs care now. With no program to address chronic care, Medicaid, a welfare program for the proven poor, has become the default option for much long term care - nursing homes. So if a person has the $90,000 needed in New York state, he or she can enter a nursing home. But that money will be gone within two years, and Medicaid will then pick up the nursing home expenses. About 2/3 of Medicaid goes to pay nursing home care for those who have outlasted their money. But remember, over 40% of nursing home residents are under age 65.

"Nursing homes are the last resort - where a disabled person will go when a family caregiver can no longer care for the relative at home," said a doctor.

Studies show that a decision to place somebody in a nursing home comes not when the person reaches some type of medical criteria; it's when a caregiver can no longer give the care because of health or financial reasons.

And while most don't have the money to place a relative in a nursing home, many of the 80 percent of U.S. caregivers don't even want to go the nursing home route. Despite being regulated by government, nursing homes, with a very few exceptions, aren't places most people want to go.

Family caregivers adding home care for the disabled to their many other responsibilities, suffer physically and mentally. A nes report, "Study of Caregivers in Decline: A Close-up Look at the Health Risks of Caring for a Loved One", details how the stress and worry about caregiving results in millions of caregivers neglecting their own physical and mental health, resulting in depression, fatigue, poor eating and exercise habits and greater use of alcohol, drugs and medications.

When these caregivers' responsibilities and concerns are taken in the context of the responsibilities they also have for their own lives - including work and family - many caregivers are overwhelmed, and the stress can take the physical form of heart-attack scares, high blood pressure, acid reflux, headaches, arthritis flare-ups and other conditions, the report said.

I've articulated the caregivers' predicament to 100s of policymakers and lawmakers, and for the most part, this problem is just not on their radar screen. There are a few expeditions, and ther are a few programs such as the National Family Caregiver Support Program, but an overall strategy of supporting caregivers, who supply more than $257 billion in care each year, simply does not exist. The answer that I keep getting is this: "it's a societal problem."

Meanwhile, where does a caregiver turn? Some of the forty six percent of caregivers who are now employed can turn to professional caregiving assistance via his or her employer, and some employers provide free, but limited, geriatric case managers to assist employees in negotiating thi path of family caregiving, but it can be costly.

For example, the home assessment costs $580, and a case manager earns an hourly rate of $125/hour.

In California, Caregiver Resource Centers provide some services free or at low cost, including social workers to assess the caregiving situation for current and future needs.

Those with access to a free home assessment should take advantage of it, especially before a health crisis occurs, and folks without long term care insurance coverage can get personal advice and free comparative rate quotes online.

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