September 5, 2001

How Can We Treat People This Way?

People need long-term care insurance because Ameri

How do you plan to spend your retirement? A little fishing, a little golf, some travel, maybe indulging in all those hobbies or sports you've been putting off in favor of your job for the past twenty or thirty years?

Some people achieve this idyllic state in retirement. Most don't have that luxury.

We're all getting older. But have you really considered what your aging years will be like if you can't live in that idyllic state. For some of us aging is a lot more than a bit of slowing down, a little more gray hair, a couple (all right, several) extra pounds, occasionally forgetting where we left the car keys - or the car.

Just for a minute, suppose you were in a car accident. Or had a stroke, or a heart attack, or experienced some other event that left you unable to care for yourself in the style to which you've become accustomed. Don't say, "It can't happen to me"; every day it happens to people who thought it wouldn't. Look at Christopher Reeve. Suddenly quadriplegic at the age of 43, and hoping for a miracle to make him independent again. Life can change in a heartbeat.

Suddenly you find that you can't care for yourself, whether it's cooking, cleaning, or more intimate activities. You're dependent on others to feed, clothe, and bathe you, even perhaps to turn the TV on and off or to get you the book on the nightstand. Who is it that you will depend on to do these things for you? Your wife or husband? Your children? Another relative or even a friend? Maybe. Are they there with you 24 hours a day? Can they be? Or do they work, or have families of their own, or even live on the other side of the country?

If any of those last situations exist, you're probably going to be dependent on strangers for at least part of your care, either at home or in an institutional setting.

Familiar Comforts - and the Lack Thereof

We all get comfortable. We take things for granted: the easy chair in the den, the nearness of the kitchen to that den, the dog lying at your feet. Maybe a favorite musical instrument that you enjoy playing occasionally on a deck that looks out over a peaceful stretch of green. The smell of flowers in the spring from that yard, or the scent of leaves and chrysanthemums in the fall. Holidays among your family, with your favorite food and drink.

We take them all for granted.

Let's go back to that image I asked you to imagine. You're disabled, whether by age or accident or illness. Say you're in a nursing home. You require too much care for your family to provide it; your spouse has several years left until retirement, and anyway you need round-the-clock care. Your kids live on the other side of the country, and their careers and families won't permit them to uproot themselves to care for you.

So you're in that nursing home. You're in a strange bed, in a place where you can't regulate the temperature, change the d?cor, turn off your roommate's television if it bothers you, or even shut off the canned music that's piped through the facility's halls and rooms all day. You don't happen to like the music they play, but that's too bad. You can't play your guitar or piano any more; even if you could, the guitar would probably develop legs and as for the piano - well, have you ever checked the tuning on a piano in a group facility?

You don't have your dog any more, though if you're lucky you'll be in a more enlightened facility where there's pet therapy once a week or month.

Privacy? Nonexistent. If you get visitors when your roommate is in the room and you're not ambulatory, get used to an outsider at family gatherings.

And we're not even talking about bathing, toileting, dressing, that sort of thing. It can be fine, with caring assistance, or it can be awkward as anything, if noncaring staff make you feel as if you're a nuisance and talk about you as if you're not there even as they're helping you.

Remember all those nice scents you used to enjoy outside? I hope your memory is good, because most of the time you won't get to smell those things. You may have windows in your room, but chances are they won't open. Actually, your memory will probably work well only with the more distant past.

In fact, you may spend a lot of time in those days gone by. You might be taken from your room in the morning and brought down to the community room, where a television is playing, and be left there to amuse yourself till it's time to go back to bed at night.

Ah, you say, she's crazy. She's describing the worst of the worst, and I have insurance. This can't happen to me. Guess again. I'm actually describing a pretty good nursing home, one I know of personally, and it's not a bad place as such places go. I know there are better ones, but I also know there are far worse places. A July 2001 government study titled Abuse of Residents Is a Major Problem in U.S. Nursing Homes, conducted for the House Committee on Government Reform, investigated the problem. The study (at www.house.gov/reform/min/nursinghomes.html) detailed the widespread abuse of nursing home residents, from beatings and theft to murder. Over 30% of the nursing homes in the country were cited for various abuse violations over a two-year period.

I'm not crazy, and here's the point.

In a country that prides itself on its standard of living, that rewards hard work and intelligence, why are those of us who are less than perfect (in age, physique, or mind) shunted off to live away from the rest of us, often for the rest of their lives? Grandparents can't grow old among grandchildren. Elder wisdom is lost. No one cares about these people (or the visiting rates wouldn't be so low). Picture yourself for a moment without long-term care insurance to ensure your placement in a pleasant facility with top care and enjoyable surroundings, and envision what life would be like if you were never able again to hear the sounds of your favorite music without having to weed it out from among the sounds of televisions, canned music, and the conversations of hundreds of other people. How would you like it if you could no longer indulge your passion for good books, or good food, or whatever it is that makes you happy?

The system we have created to take care of our elderly and infirm is not working, not by a long shot. Those fortunate enough to afford insurance, pay for residence in an assisted living facility, or surround themselves with caring family are fortunate indeed. But the rest are not. Families struggle to keep loved ones at home rather than let them go into substandard facilities where abuse and neglect are the order of the day. Caregivers burn out and families are bankrupted by the cost of care for the patient and respite care for the caregiver. Yet those in even respectable nursing homes live a far from ideal life.

Some Solutions

Many people, dreading this fate, have begun to think of ways to avoid it - both for themselves and for others. An experimental system in Japan that is also being tried out here involves something called an "hours" bank. People contribute hours of their time caring for those who need it. When the donors themselves or a close relative needs care, they can draw on their deposited hours and another donor will provide the kind of help they need. It is forming a community of sorts, one that can partially replace the communities of generations ago, when the elderly and infirm lived among family, friends, and neighbors, and everyone pitched in to help so that no one bore the entire load alone.

Yes, that system wasn't perfect by any means. People became outcasts; plenty of people did bear the burden alone, and there were those who were consigned to institutions that were far worse than the nursing homes of today. But there was a sense of community, and a respect for the elderly and others who needed help, that's missing today. Everything has been reduced to an equation of some sort, and those who fail to provide some return are cast aside, banished to institutions staffed by the underpaid, undertrained, and sometimes cruel. Those with some sort of return to offer - a LTC policy, perhaps, or enough money to pay for alternative care, at least for a while - find a place a bit higher in the hierarchy. But this is not a system that works. This is a dehumanizing way of forgetting about those who are an inconvenience, or worse, who by outward appearances have nothing more to offer to society.

There has to be a way that decent care with dignity can be provided to those who have worked hard all their lives and to those who couldn't work hard due to illness or accident. There has to be a way that enough of us can contribute to the care needed that none of us need to feel overwhelmed, exhausted, and burned out the way so many caregivers do.

There have been instances of people in the workplace contributing some of their sick or vacation time to a colleague whose family circumstances include something dire, such as a spouse or child with cancer. This is a wonderful option that some companies have the flexibility and foresight to allow, but it too does not cover all the options. If it were more widely available, though, it could help in more cases.

And what about neighborhoods with healthy retirees who perhaps could do with a bit more company and maybe a bit more money, who could be prevailed upon to help care for family members unable to fend for themselves? If there were some sort of centralized place where such opportunities could be posted and such people found to help, whether through town databases or church or civic groups like veterans' organizations, much of the burden could be lifted from many shoulders. Many of these groups already offer some such services to their members, but there are a lot of people who need such assistance. These people could help educate the rest of us.

What You Can Do

Those with the imagination and the means - influence, money, or determination - can help solve this problem. Many advisors argue today that they are interested in all their clients' needs: financial, emotional, even spiritual. If that's true, don't advisors have an obligation to point out the shortcomings of our current system, where even the prudent use of long-term care insurance is only part of the solution? Lobbying the insurance industry or the government might be one way of alleviating the situation. (Of course, involving the government may not be the right way to go on this. Sweden has a national long-term care benefit, and its tax rate is 58%, according to Phyllis Shelton in Long-Term Care: Your Financial Planning Guide.) Convincing more employers to offer a long-term care policy as an employee benefit could be help, too, even though it's liable to be a hard sell in the current economic atmosphere. On the flip side, employers will find their employees losing less work time or even staying on the job longer if they have some solution to home care needs for their family. Perhaps the FPA might even decide to involve itself in this issue that will touch so many people in the coming years.

But there's another way to look at it. Advisors are in something of a unique position, particularly the ones who seek to plan for their clients' quality of life as well as the well-being of their finances. Advisors understand the workings of the financial end of care, or can draw upon the expertise of those who do. They also have clients who might want to involve themselves in a philanthropic project that could do so much good for so many. Using the entrepreneurial skills and creative strategies that both advisors and clients possess, surely some solutions could be found that would at the very least be a start.

While no solution works for every case, and LTC insurance is a given, there are bound to be more solutions out there. Maybe you, or your clients, can help find one. Send an e-mail to me at msatter@ia-mag.com and I'll share your thoughts and concerns.

Reprints Discuss this story
This is where the comments go.