2199 Unintended consequences will help fill nursing homes

The Wall Street Journal today has an article on the cost of a short or long term nursing home stay. The government is tightening the rules, and it will be harder to shift your medical costs to your neighbor by giving your assets to your children. Many people in my parents' generation were able to "impoverish" themselves to qualify for Medicaid, but now that is out of control in many states. We were very fortunate in that neither of my parents required nursing home care before they died. My in-laws both had relatively short stays, well under the average. My paternal grandparents, however, one of whom was blind and the other who had Alzheimer's, did need nursing home care. Actually, only Grandpa needed it, but my grandmother who could have lived with her children didn't want to be separated from her husband of nearly 70 years.

We've purchased long-term care insurance which costs about $3,000 a year. That's a lot of money (and the rates are rising), but think of the auto and home insurance you've paid for over the years and (hopefully) rarely had to use. Or, if you are a smoker, think of the Social Security you've paid for that you might not live long enough to ever collect! One year's premiums for two of us is the cost of half a month for one of us in a nursing home. Or a one week vacation in Florida in February.

One of the unintended consequences of better health care and miracle drugs and technology is that people are now living well into their 90s, although the actual years of frailty probably isn't that different than a century ago--we've just changed the time line. I'm arranging a retrospective quilt show at our church for a woman who died at 102, and was out walking and quilting just a few weeks before she died.

WSJ says 11% of 65 year old men and 28% of women will need 5 years of care of more. Men don't live as long as women, marry younger women the first time, and also they tend to remarry younger women when widowed or divorced who become their care givers (WSJ didn't say that, I do.) Nursing home care and costs are very much a critical women's issue. Good nursing care actually extends the life and huge amounts of money go into the final years.

What's going to be different for boomers and busters and gamers in 20, 30 or 40 years is that because of all the abortions since the 1970s and reduced family size, they'll have fewer or no off-spring to look after them so they can avoid the nursing home either by living with their children, or having a daughter look after them as they stay in their own homes. A strong family network is still the best guarantee of love, care and community in your final years. But for some, that net was cut years ago.