Saturday, October 17, 2009

The high cost of a long life

Wise people save for old age. But who can put aside enough money to save for a time when one's infirmity requires 24/7 caregiving?

My mother has lived a frugal life. She's now 94 and seldom gets out of a chair. When she does, it is with assistance and requires great effort on her part. She cannot safely walk without a walker. She needs someone to cook meals for her and help her to the bathroom. Others shop for her and clean the house.

She has had a physically active life, but she didn't jog or play tennis or do exercises, which she considers "for the birds." Mostly she spent her time doing housework and some occasional dancing. As she aged arthritis set in and it became painful to move. She suffered a possible stroke recently and spent three weeks in a rehab facility undergoing physical therapy, which she found very difficult. Though staffed by friendly people, the rehab facility itself was a depressing sight, at least it was on the floor where she lived. When I would pay her a visit I unfailingly saw old and shriveled people sitting idly in wheelchairs, scarcely giving evidence of life.

She's home now and feels better about that, but there is the matter of paying her caregivers. Nurses visits are covered by insurance, but not caregiving services. The agencies that provide around-the-clock caregiving usually charge $20 - $25 an hour. At $20/hour, that works out to $14,400 for a 30-day month (30 days x 24 hours x $20). Add to that the usual monthly bills, and you could find everything you've saved evaporating quickly.

My mom had a roommate while she was in the rehab facility. Let's call her Karen. Karen was about 10 years younger than my mom, I would guess, and far stronger. She had no trouble handling a knife and fork and could move with a walker at amazing speed. Her mind was fully intact. I wondered at times what she was doing there, given her level of health.

One day Karen's granddaughter paid her a visit. I was in the room visiting my mom at the time and overheard parts of the conversation. The granddaughter was despairing over how she could afford to keep Karen in the rehab facility. Karen had just lost her second appeal to Medicare for more money. Karen's other insurance was gone, and no family member could afford to keep her. In short, Karen had no other place to go, and she could no longer afford to stay at the nursing home.

I then went away for two weeks, and during that time I called my mom several times and Karen would usually answer the phone first. Somehow, I thought, the money had been found to keep her there.

When I returned and paid a visit to my mom, I noticed Karen's bed was stripped to the mattress. Had she finally been released? No, my mom said, she contracted pneumonia, and they took her to the hospital.

The next day I learned Karen had died.

I was stunned. At no time did Karen exhibit symptoms of illness, particularly a respiratory infection. She didn't cough, sneeze, wheeze, or sound congested. With her walker she could and did move about with ease. Can pneumonia set in quickly and kill a person virtually overnight? Apparently, it did. From Wikipedia:
Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. Hospitalized patients may have many risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances. Additionally, the microorganisms a person is exposed to in a hospital are often different from those at home . Hospital-acquired microorganisms may include resistant bacteria such as MRSA, Pseudomonas, Enterobacter, and Serratia. Because individuals with hospital-acquired pneumonia usually have underlying illnesses and are exposed to more dangerous bacteria, it tends to be more deadly than community-acquired pneumonia.
Curiously, the pneumonia also ended Karen's financial problems.

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