This week Bernie Sanders apparently tweeted, “Home-based Care Should be a Guaranteed Right.” I say, the right to age at home comes with responsibilities. That means taking a clear-headed look at the realities of long life right now. And using the combined influence of our generation to change the ageist, classist culture around us years before we need extra care to age at home.
The Cost and Availability of Age at Home Care is Shaped by Policy
I’m going to use my state, North Carolina, as an example of age at home expenses. You can use this form to calculate the cost of care in your area. Statewide, the hourly rate for home care in NC averages $18.50. In the Asheville Metro Area and other larger cities, the costs run $19.75 – 21.75 per hour. I did the figuring on the minimum 4 hours typically required by home health agency policies.
The Cost of Private Pay at Home
- Four hours – One day: $79
- Four hours, seven days: $553 per week
- Four weeks: $2,212 per month
- Per year: $26,544, Five years: $132,720
That’s only four hours of age at home help per day. It can’t easily be split into say two hours in the morning to help your partner rise, toilet, shower, get dressed and get fed, then two hours in the late afternoon or evening. Plus, it’s simply (personal) home care and homemaking help (light housekeeping), no home health care such as wound or blood pressure management or home dialysis, etc. That is a different level of expense. If your dependent has Alzheimer’s Disease, add another $1,101 per month. All the unpaid hours and responsibilities are up to you, the unpaid family caregiver. BTW-These costs are “cheap” compared with the average $5-7,000 a month for institutional care. Even then, the family member aging at home would still be the responsible party, just trading heavy lifting for visitations and uncertainty.
Is Medicaid the Answer?
Eligibility for NC Medicaid
Do You Meet These Qualifications?
- 65 or older,
- blind or disabled,
- 2 person household income of <$1,410 or
- 1 person household income <$1,041 per month,
- need help with activities of daily living,
- enrolled in Medicare.
- Assets (not including your home, car, furniture, clothing, or jewelry) cannot exceed $2,000 for one person $3,000 for a two person household.
The 80-20 Rule
My observation is that Medicaid focuses on providing help for the 20% most frail and impoverished citizens in our society. I consider that good judgement from both the fiscal and humanitarian perspective. This is likely the demographic that results in 80% of the healthcare spending if left unassisted – emergency room visits, re-admissions, falls, birth and early childhood complications, etc.
However it’s equally likely that 71% or more of us will need a high level of support over age 85 to age at home. And it’s projected that 33% of middle income older adults will be unable to afford the help they need. Are you comfortable with the idea of spending down your assets to become eligible for Medicaid? Or relying on support that diminishes your partner’s or children’s future well-being?
We Can Be a Burden or a Resource As We Age in Place
The middle class is defined as American households with annual income of $21 – $74,000. Quite a range. Many are people who have worked hard, done well and invested wisely within our means. As we traversed the milestones of our lives we’ve reshaped education, parenting, the workplace, the arts and the face of the military.
Working or retired, we’re currently the baby-sitters, tutors, business mentors, donors, committee chairs, volunteers and philanthropists in our communities. A resource as long as we’re able and vital.
The fact that we’re still financially solvent and have maintained our health reasonably well shouldn’t preclude our access to critical support services to age at home.
Services such as homecare and homemaking are covered by Medicaid, not by Medicare. What’s more, there are few, if any, programs at the state or local level that provide (medical) care management. If you’re middle class there is presently no “quarterback”, if you will, that can help you proactively manage multiple chronic conditions, comply with doctors’ orders, and make home adaptations that extend this active engaged period of your life as you age in place. Even private pay options are few and far between.
At this time, the policy focus of the Center for Medicare and Medicaid is to reduce the overall cost of healthcare. Can’t argue with that. Their idea is shifting the responsibility for cost management within defined caps and guidelines to insurance companies (Medicare Advantage). I prefer self-determination. I am proactively taking responsibility for my own health, God-willing will continue to do so, and am willing to private pay for hyper-local, reasonably-priced long term support services. These just aren’t available yet.
We can influence state and local policy
How? Same way we always have. By refusing to be invisible, quiet, devalued. Make accessibility to affordable, well-organized long term support services for all people aging in place a priority. Communicate regularly on this issue with your elected officials. They may not always respond, but they do tally the trends in voter concerns. The AARP is the most targeted non-partisan lobby group for older adults and an excellent source of information on this and other relevant emerging issues.
If It’s To Be, It’s Up to Me…and You
The rosy future we envision into our 80’s and 90’s is influenced by state and national policy. But it’s limited only by the level of our willingness to work locally on shaping innovative age at home models. It’s not all about money. It’s also about how we value ourselves in our later life, how we can assist one another, what we define as quality of life. Possibly you have additional criteria for a “good old age”.
My best hope for our “golden years” is a community-based approach that helps us help ourselves:
- Stay well, safe and engaged
- Manage complex chronic conditions
- Adapt to changing circumstances
- Keep costs reasonable through our own volunteer efforts and economies of scale
Are There Any Models to Follow?
In Part II of this post, I’ll highlight a variety of ways some older adults are approaching self-determination as they age in place and how savvy business people are recognizing the middle income senior as still the large and viable market we always have been.
The right to age at home comes with the responsibility to act now. Please submit a comment reflecting on this post. Your level of response will let me know if there’s sufficient interest for Part II. If it’s to be, it’s up to all of us.