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Column: A hard, personal look at the twilight we’re all headed for, but often unprepared to handle

Tony and Grace Lopez
Tony and Grace Lopez in 1973.
(Debra Lopez)

On a walk in the park, she fell face first and broke her nose.

In the middle of the night, she tried to get to the bathroom but fell and crashed through closet doors.

Multiple infections, along with heart and kidney disease, landed her in the hospital, where her dementia raged and she didn’t always recognize loved ones.

She got better and they sent her home, but in her mind, something is wrong.

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“It doesn’t look like my home,” she told me, sitting in the living room of the Contra Costa County house she has lived in for 55 years.

My mother is in the waiting room now, the one we’re all headed to, millions and millions of boomers on the march. My father walked this way, too, before his death almost five years ago.

Now, like then, it’s hard to know what’s best or how to decide.

I find myself wondering if I’d still want to live if I didn’t recognize my own family.

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I’m thinking again about medical advances blurring the lines, sometimes, between extending life and prolonging death.

When you go into the hospital for a few days, you come out at a lower functional level.
Dr. Bruce Chernof, Senior Care Action Network Foundation

Would my mother be better off in a nursing home, with round-the-clock professional help? Or would she do better staying in her own house, even if she doesn’t always recognize it, with hired help looking after her?

Which would be more expensive?

Why don’t Medicare and her supplemental insurance cover more than they do?

At a cost of several thousand dollars a month, how long will it take before she burns through her savings?

Grace Virginia Lopez is 87 and lucky in a way, despite the length of her medical chart. My sister lives with her and looks after her, and they’re like best friends. But my sister has her own health issues. Ten years ago, she got ovarian cancer. Eight years ago, it spread to her brain.

My sister keeps fighting, same as my mother. It isn’t fair that the older you get, the tougher you have to be.

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When my mother was ready to leave the hospital, we were told that if she were deemed eligible, Medicare would cover a week of assisted living. If not, she would go home, and Medicare would cover a month of twice-weekly visits by a nurse and physical therapist.

We hoped she’d qualify for a week of assisted living to help get her stabilized before she went home.

Without explanation, she was denied.

Then we were told that despite her falls, and difficulty walking, Medicare would not cover a ride home from the hospital.

This came as no surprise to Susan Geffen, a gerontologist and elder care attorney. She hosts informational symposiums around town and said that at one of them, an elderly man said he fell and injured himself but didn’t use an emergency buzzer to call for help because he knew an ambulance ride would not be covered.

Geffen said families are routinely being thrown into “a massive state of financial and psychological disarray” because of the cost of healthcare and the arcane regulations that can be so difficult to navigate.

If you can afford it, Geffen recommends buying a long-term healthcare policy when you’re my age (63), or preferably much younger, to help defray healthcare costs later on.

If you own a house, another option to pay for healthcare costs is a reverse mortgage. And she said you can now turn a portion of your IRA into a healthcare annuity.

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Dr. Bruce Chernof of the nonprofit Senior Care Action Network Foundation (SCAN) said the country needs to urgently reconsider the state of elder care.

“Our healthcare system was purposely built for a different time and place,” Chernof said.

Average life expectancy was 69 in 1955, “so people expected to live four years beyond Medicare.” As for Medicaid, he said, “nobody expected it to be the primary payer for long-term care as it now is.”

My mother, at 87, is now the norm, having lived for years with chronic medical problems. Her recent hospital visit may have saved her life, but she became far more disoriented after batteries of probes, tests and doctor visits, and tried to flee.

“Hospitals are dangerous places for older people,” said Chernof. “They’re fine if you have to be there, but … very good evidence shows that when you go into the hospital for a few days, you come out at a lower functional level.”

Chernof recommends a transformation of care, and a more cost-effective redistribution of public funds.

“When you look at us compared to every other industrialized country in the world, we’ve spent far more on acute medical services and far less on community-based and home support services,” said Chernof.

On its website, SCAN has published an open letter to President-elect Donald Trump, warning that “older Americans and their families have no financial protection against the high cost of disability when it strikes,” and without a new plan, families and Medicaid budgets will be crushed.

SCAN recommends the appointment of a White House-level leader on elder care, integration of Medicare and Medicaid to simplify regulations and lower costs, an insurance program for catastrophic long-term care needs, and focusing more “on what is most important to the person actually getting the care.”

If you have questions about how to help a parent get the best care or plan ahead for your own care, go to thescanfoundation.org and click on Aging Well. Scroll through “10 Things Every Family Should Know,” “10 Things to Discuss with Your Doctor” and other helpful lists.

For information on Susan Geffen’s upcoming elder care symposiums, go to www.susanbgeffen.com.

For all she’s been through, my mother’s spirits are pretty good. She loves hearing and telling family stories and sometimes recalls small details from 50 years ago, even though she can’t remember what day today is.

At breakfast Friday morning, she looked up from her toast and eggs, and apropos of nothing, she said:

“Dear Lord, I’m not afraid to die, but I don’t want to suffer.”

 

Get more of Steve Lopez’s work and follow him on Twitter @LATstevelopez

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