DESK JOCKEY - The Sandwich Generation:
Eldercare and Me
August Cosentino and his Dad, August Cosentino, Senior
“Funny,” sang Hermie to his girlfriend Rose, the star of “Gypsy,” the musical.
Funny, indeed. Me, self-styled Prince of the City, circa 2011. Mister First Nighter. Bicycle vacations by the tireful, 33-inch waist, $150 jeans. Few cares in the world except whether or not I would make a conference call on time.
Then, last September, everything crashed. How come?
Two words: Elderly parents.
GOT AGING PARENTS WITH ISSUES? YOU’RE NOT ALONE.
Last September, I discovered what millions of other members of the “sandwich generation” already knew firsthand. Not only are middle-aged Americans zapped by the cost of raising children, we are simultaneously-zapped by the prohibitive cost of eldercare. Hence, “sandwiched” in between generations.
Note: While I have never had children (but I do like other people’s children, mind you!) I qualify as a member of the “sandwich generation”, anyway. Because now my 87-year-old parents have started to behave exactly like children. Willful. Needy.
LET US RETURN TO THOSE EARLY DAYS OF YESTERYEAR, 2011.
At the end of last summer, my elderly father in New Jersey suddenly lost his appetite and began sleeping all day and about four hours a night. Whenever he awoke, he felt an urge to go to the bathroom. When he tried to get up and go (which was every five minutes), he would fall down on the way to the bathroom.
Soon, despite the urges and the frequent trips to the bathroom, he wasn’t able to “go” at all.
My mother, who is panicky on a good day (and whom you therefore wouldn’t want in the lifeboat) quickly called the local rescue squad and had my father rushed to the hospital, where he remained in the critical care unit.
At that point, it was determined that he was in such a state of decline (can you say senility, anemia, low blood pressure, swollen prostate blocking his bladder?) my mother and I were advised to place Dad in a nursing home.
A nursing home, I soon discovered, is like a Roach Motel for the elderly. Once you check in, you rarely check out.
ONLY THING WORSE THAN A NURSING HOME: A TERRIBLE NURSING HOME - STRIKE ONE.
Most nursing homes, I have subsequently discovered from personal experience, are awful. They are understaffed, the staff is underpaid and overworked, and the atmosphere is about as lively as a mummy convention.
But when the staff of a nursing home is indifferent to its residents, and careless in the execution of its daily duties, you know you have chosen a really awful nursing home.
My father, for example, had COPD (Chronic Obstructive Pulminary Disease)—a lung condition that required him to lay in a hospital bed at an incline so that he wouldn’t choke on his phlegm. So what did the awful nursing home attendants do? They put him in bed and laid him perfectly flat.
THE FEEDING TUBE SYNDROME - STRIKE TWO.
I was then advised that my father needed a feeding tube because he could no longer swallow solids or liquids. By way of background, most immediate families of patients like this are given the option of not inserting this tube, or anything artificial into the body, to keep the patient functioning. My mother and I chose the feeding tube option—wrong curtain. It’s a choice we are living with to this day.
That’s because patients on a feeding tube are only allowed 100 days of Medicare-paid nursing-home care. After that, they are on their own when it comes to paying the bill.
The bill for the awful nursing home was equally awful: close to $300 a day.
THE FALLACY OF HOME CARE - STRIKE THREE.
As the winter progressed and the 100-day period was dwindling down, my father continued to deteriorate (in-between several trips back and forth to the emergency room.) My mother and I began to think about other options such as home health care.
I began poring through catalogues for home healthcare agencies throughout the state of New Jersey, in order to find one that a) was not as incompetently managed as the nursing home and b) that was covered by his father’s insurance plan.
When I arrived at the terribly finite universe of agencies that satisfied both these conditions, I was dismayed to learn that these home health care attendants were as stingy with their time as a New York City pigeon is with a breadcrumb.
For one thing, you had to basically give the attendants the right to enter and remain in your home for several hours a day—a schedule of their choosing–then spend a minimum of 15 hours a week with the patient, even though you may not have had the room, or need, for so much time.
For another thing, you soon became acquainted with a long list of duties the attendants would not do, including administer medication of any kind, at least in the state of New Jersey. Thus, if we wanted to “feed” my father through his feeding tube, we would have to do it ourselves. A course of action that not only stupefied my manually un-dexterous family, but drove one family member to a nervous breakdown.
Home health care wasn’t going to work, obviously.
MEDICAID HELP AGENCY - BASE HIT.
It was at this point that I heard about an agency that intermediated between patients and Medicaid, a government healthcare assistance program for people without funds. The conditions for getting on Medicaid are strict: There must be a living spouse in the community who is allowed to keep a house—and up to a certain amount of assets. The patient him/herself must have no more than a few thousand dollars in assets. And there must not be any fund transfer between the spouse and any other family member for five years before the process begins.
The bad news: Navigating the bowels of an agency like Medicaid is beyond Kafka-esque. The good news: There are agencies that can navigate for you. In early 2012, my mother and I engaged such an agency that is as of this writing, helping us spend down the already meager sums of our family, in order to qualify for Medicaid.
As of autumn 2012, we have spent approximately $100,000 to keep my father alive in the nursing home. A man who is basically senile, does not know why he is in a nursing home, has the memory of an infant, and needs 24/7 care. Living large, huh?
A BETTER NURSING HOME - A DOUBLE.
Since we began private-paying for my father, I decided that we also had the option of upgrading to a better nursing home. Through a family connection, we were able to find, and transfer him to one. This was more expensive, but at least the home is one where the nursing staff is professional. The premises are clean. There are pets to engage the patients. And the doctors are not animals themselves.
Unfortunately, we are paying down my father‘s (and my mother’s) estate to afford such “quality” care which will eventually get my father on Medicaid, at which point the government will foot the bill (but only a portion). This dissolution of funds also means no inheritance for me or my siblings. And quite possibly, inadequate funds to take care of my mother, once my father dies.
Cheery, isn’t it?
WHAT TO DO? JUST WHAT I’VE BEEN DOING.
I realize there are no easy answers to the question of what to do with ailing, elderly parents. Except that I would advise those who are facing such situations to consider the following:
Above all, take it slowwwwly. Caring for elderly parents is like playing Russian roulette, or betting the weather in Vermont. The odds change by the day. Often by the minute.
"Funny, isn’t it?" as they sang in “Gypsy.”
So why aren’t I laughing?