Quick Links OCRA OPR PSA DDPSA Website Survey Donate Top 10 Pubs

Contra Costa Times

April 3, 2010

Story reflects long-term care concerns

By Lisa Vorderbrueggen/ Contra Costa Times

With all the hoopla about health insurance reform, it's no wonder Bonnie has hope.

The knife-sharp, 82-year-old whose palsied body has inconveniently failed to keep pace may benefit from the new bans on lifetime coverage caps and prohibitions against dropping people who get sick.

But Bonnie's unabashed enthusiasm for President Barack Obama and the recently passed health care legislation is small comfort in her current circumstances. (In the interest of full disclosure, Bonnie is a lifelong friend of my mother-in-law but I have withheld her last name to protect her privacy.)

Born with cerebral palsy and a twisted body — which she says "God made from spare parts" — she nonetheless worked hard and retired from Alameda County after 35 years as an accounting clerk. She receives a monthly pension of $2,300 and decent health insurance.

That sounds pretty good, especially when a lot of folks have lost jobs, and have no pensions or health insurance.

As Bonnie has discovered, it's not enough.

In February, she fell and broke her femur, and in the course of her treatment, the doctors detected non-Hodgkins lymphoma.

She uses a wheelchair and is working with a therapist to regain some of her mobility. But her physicians say she can't leave the skilled nursing home until she has lined up 24-hour care.

Her insurance company has stopped paying the nursing home bill, saying she no longer needs skilled care. It conveniently doesn't cover what it calls custodial care but no medical insurance company does, either.

She cannot afford to stay.

She cannot afford to go.

Bonnie desperately wants to live the rest of her life in Piedmont and the rent-control apartment she has called home since 1968, where she pays just $757 a month.

Before she broke her leg, a $10,000 inheritance and help from her 78-year-old sister helped pay the monthly $3,000 it cost to hire an aide, who came twice a day and helped with meals, laundry and personal care.

The care quickly chewed up the small inheritance, although her sister is willing to stay the course.

A full-time aide would cost two or three times more, although perhaps not as much as a nursing home, which can run $7,000 or more a month.

Bonnie may have to apply for Medicaid, a state-run program that provides long-term care for people who can't afford it.

But it will mean giving up her apartment, moving into a nursing home, or an assisted living or residential care center and turning over all but $35 a month of her pension to the state.

It terrifies her.

"You cannot even imagine the horror of living in a nursing home," Bonnie says. "It's like living with the dead."
In her case, she argues, a full-time aide — which she thinks she won't need for long — would probably cost less than a nursing home, and she could remain among her stacks of beloved books and her movie and music collections.

Bonnie's story is a common one that will grow more frequent as baby boomers push toward old age, says Janet Van Deusen, program manager for the Alameda County Health Insurance Counseling and Advocacy Program.

No one wants to live in a nursing home. But it is cheaper and more efficient, in most instances, to care for the elderly in nursing homes rather than one-on-one care in private homes.

"There are a lot of people who are forced into nursing homes because they don't have the money to stay at home or lack family that can help supplement the care," Van Deusen said. "Even the private, long-term care insurance policies only provide limited home care and not the 24-hour services that many people may need. This is a serious issue that people need to think about."

Rep. George Miller, D-Martinez, one of the authors of the recently adopted health insurance reform law, agrees that long-term care is a particularly thorny public policy question.

"It's very expensive," he said. "About 10 years ago, Cynthia (his wife) and I bought private long-term insurance. We may never need it but it seemed like a smart thing to do."

Coincidentally, the state Department of Health Care Services sent out a letter last week to households — including mine — that explains the California Partnership for Long-Term Care, a public-private coalition of long-term health insurance providers.

Seven of every 10 Californians age 65 and older will need long-term care, according to the state.

Just ask Bonnie. She'll tell you.