The puzzle of paying for eldercare

MARY REICHARD, HOST: Coming up next on The World and Everything in It: caring for aging relatives.

Alongside death and taxes, long-term care is a near certainty for many older Americans. The Department of Health and Human Services estimates that 70 percent of people who make it to 65 will need some kind of long-term care as they age, costs not typically covered by insurance. So, many people are managing to age at home with help from family, friends…and consultants.

MYRNA BROWN, HOST: WORLD Radio Reporting Producer Mary Muncy has the story.

ANN EDWARDS: So we'll see if there's another dot in our folder.

MARY MUNCY: Ann Edwards pulls out a big yellow folder in Ginny and Ted Hartshorn’s room. She’s a care consultant visiting her clients in an assisted living facility. She’s looking for a rubber dot to fix Ted’s bingo card.

EDWARDS: There are dots, we’ll get a new dot on his thing.

Ted is mostly blind, but he still wants to participate in all of the social activities.

TED HARTSHORN: I memorized the card and use the same card over and over again. And so you know, I really can't cheat [laughter]

Bingo is serious business in the facility.

EDWARDS: We use these little rubber dots, these markers, so that based on where we have them located, he knows what column he's in, so that he knows you know, how to find B, and, and all that kind of stuff.

All of Edwards’ clients have yellow binders. The binders have everything she needs to know about them along with some extra supplies.

EDWARDS: I think to do my job, you have to love puzzles. Because it is it's all about figuring out how can you make this work? What can we do?

Edwards helps clients and their families with everything from labeling the pills in dad’s tackle box, to watching parents deal with dementia, to navigating Medicare and Medicaid.

Most of her clients start by needing help with personal care, and that gets expensive.

A lot of Americans are asking, how does one get quality care without breaking the bank?

Michael Guerrero is a certified Medicaid planner and runs a business called Eldercare Resource Planning. He says the not-breaking-the-bank part is only getting harder.

MICHAEL GUERRERO: We're looking at an extended expansion in need, because of kind of three different things kind of all happening at once: one, we're living longer. Two, the baby boom generation is reaching that age where they're needing more care. And number three, we tend to need more long term care in our later years than we have before.

That long-term care is often not covered by insurance. It’s the kind of care where someone doesn’t really need a nurse or a doctor, but they still have trouble performing some basic tasks on their own. If someone’s insurance doesn’t cover it, they generally have to almost deplete their savings before they qualify for Medicaid.

GUERRERO: Few people are lucky enough to be able to save for a real true Long Term Care event, two or three years. And then even fewer are lucky enough to save for both spouses.

Guerrero says long-term care prices are rising faster than inflation rates… not only because more people need care, but there’s also been a chronic staffing shortage in long-term care facilities.

Nursing homes rely on a fixed government budget, and many residents rely on Medicaid. But Medicaid typically doesn’t cover the actual cost of providing care.

So as prices rise, more people are trying to stay in their homes for as long as possible.

Last year, the Bureau of Labor Statistics estimated that employment of home health and personal care aides will grow by 22 percent over the next nine years, faster than any other industry in the same period.

In other words, people like Edwards are in high demand.

EDWARDS: There is no orientation manual. There's nobody there to guide and direct you through this. So you feel like you keep running in different directions, trying to get information and pull things together. And it's just very overwhelming.

Edwards used to work as an agent for larger companies, but then her parents began to need care. Edwards walked with them through dementia and falls and eventually a nursing home.

She says it was overwhelming for her, even though she’d been doing it for 25 years. It made her wonder, what happens to people who have never navigated the healthcare system before?

She eventually quit her job to care for her parents, and after they died, she became a private care consultant.

The puzzle of trying to get cost-effective, quality care can be difficult—but Edwards says it’s worth it, even if you have to make sacrifices.

EDWARDS: I always comment to families, you need to do what you need to do so that when you get to the end of this journey with your parents, you can feel good about the journey that you were on, and you know that you did the best that you can.

Reporting for WORLD, I’m Mary Muncy in Batesville, Indiana.

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