Working with Seniors: Health, Financial, and Social Issues
Chapter 17: Long-Term Care Coverage
Jean and Octavio lived on the East Coast. Jean was 86 and Octavio was 93 years old. Jean had Alzheimer’s disease, and even though Octavio required regular kidney dialysis he was Jean’s full-time caregiver. Octavio promised Jean years before he would never put her in a nursing home. So Octavio, with the help of several local women, provided the supervision and care Jean needed around the clock in her home. The cost for the professional caregivers was $91,000 each year. As long as Octavio was still able to coordinate Jean’s care, the system would work as it had for 2 years.
Jean’s only son, Stan, age 61, lived in the Midwest. Stan made frequent visits to the East Coast and was in constant contact by phone with Octavio and the shifts of caregivers overseeing Jean’s care. Stan’s work sometimes required him to travel. On more than one occasion, a business trip of his was called to a sudden halt following yet another crisis with his mother’s health.
Jean was at home when the news arrived. Octavio had a heart attack during dialysis and died. Now it was just Jean and the team of caregivers. Jean didn’t quite understand about Octavio’s death. She became depressed, would call out his name at night, and would cry often. Stan sold his home in the Midwest, put his business on hold, and moved in with his mother, taking over Octavio’s primary caregiving role. It wasn’t many more months before Jean died, still at home and still being cared for 24 hours a day, 7 days a week, by her son and three shifts of caregivers.
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Therese and Hubert were married for more than 60 years and raised seven children. All but one of their kids lived more than three hours away from the family home. When Hubert became terminally ill, their daughter Mary—a licensed practical nurse—left her home six hours away and moved in with her parents to help care for her father, allowing him to remain at home until his death.
Four years later at age 84, Therese suffered from bowel control issues from earlier colon cancer, and she began experiencing a series of falls, culminating in a broken wrist. Her son Mike, the only child in the same town, was able to get her to the hospital. But with four children of his own as well as full-time and part-time jobs to make ends meet, Mike was not able to provide the help Therese now needed with her daily physical needs, like bathing, dressing, toileting, and eating.
Again, Mary stepped in for a week. Another daughter then came to town for a week allowing, Mary to return home to her job, and another son came to town for a third week. Even though Therese’s wrist healed quickly and the immediate crisis had passed, the family realized she could no longer live alone.
Introduction
In both of these true-life situations, long-term care (LTC) services were needed to help the individual in their day-to-day functioning. What is LTC? According to LTC experts Rosalie and Robert Kane, long-term care is assistance given over a sustained period of time to people who are experiencing long-term difficulties in functioning because of a disability (Kane, Kane, & Ladd, 1998). LTC is not an extension of acute care—it is distinctive in its very nature. Because LTC continues for prolonged periods, it becomes enmeshed in the very fabric of people’s lives.
As we live longer with chronic health conditions, the chance that we will need long-term care insurance increases. Few people have saved adequately for the possibility of long-term care, and many people continue to believe the myth that Medicare will pay for their long-term care needs.
LTC can encompass a wide range of services—from skilled nursing care to unskilled assistance or supervision. Most LTC is unskilled, helping care, also known as custodial care. Custodial care means physical assistance with activities of daily living (ADLs), which include bathing, dressing, eating, transferring, toileting, and continence. Custodial care can also refer to supervision for people with a cognitive impairment such as Alzheimer’s disease or dementia. LTC is intended to maintain and support an individual’s existing level of health, to preserve his or her health from further decline, or to manage a deteriorating condition as safely as possible. It is not primarily for the convenience of the insured or the insured’s family.