Preparing for a Better End by Dan Morhaim

Author:Dan Morhaim
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2020-11-14T16:00:00+00:00

THE COSTS OF DEMENTIA

Some people plan ahead by purchasing long-term care insurance. This insurance can cover part of the cost of nursing home care, as well as home care. Premiums for such policies can run high, and their benefits vary, depending on the level of coverage purchased. As with other insurance, such as for your car or your home, it is impossible to predict if the coverage will ever be needed.

For people with substantial financial resources, a continuing care retirement community (CCRC) is another way to plan ahead. Such facilities attract seniors who enjoy both mental and physical health. Should the person later need extra care, they can move into the CCRC’s assisted living facility or nursing care facility. Buying into a CCRC can cost anywhere from $60,000 to over $400,000, plus monthly fees that range from $1,000 to $6,000.

People without insurance or sizeable savings who have a catastrophic or long-term illness such as dementia are often forced to “spend down” virtually all their assets. For these people, a lifetime of accumulated funds is exhausted on health care. This system-imposed poverty eventually makes the person eligible for Medicaid, at which point health care costs will be paid for by the government. However, any provision for a spouse or any inheritance for children is gone. Some couples have been advised to file for divorce as soon as they learn one of them has Alzheimer’s, in order to protect the healthy spouse’s assets. You wouldn’t think a situation could be made more heartbreaking than receiving a diagnosis of Alzheimer’s disease, but under our current health care regime, it is entirely possible.

Beyond the financial expenditures, the human costs are immeasurable. At first, most Alzheimer’s patients can be taken care of at home. But as the disease takes its toll, symptoms often become worse. Stresses on caretakers mount. A person who has Alzheimer’s disease requires constant supervision, as well as help with the basics of daily living: feeding, getting dressed, bathing, and going to the bathroom. And as time goes by, that person’s demands for attention grow. The patient may become incontinent and unable to climb stairs or swallow solid food. Care for the caretakers becomes more important, but respite from these demanding chores is often hard to arrange.

Eventually medical issues arise. These sometimes are related to the dementia (such as developing an infection because of poor hygiene), but more often they are caused by the many diseases that afflict elderly people. In those situations, caretakers have to make medical decisions for their loved one. These are often challenging. How can they tell what the patient is thinking and feeling? What is a person’s inner life like when they can no longer speak? Are they happy or miserable? Do they have any awareness of what’s going on? Is it time to make a move to a nursing home? When does “care” create more suffering than healing? More pain than comfort? For a loving spouse or adult child who has been designated the health care agent for a patient with Alzheimer’s disease, these are difficult questions.

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