Caring for Aging Loved Ones Can Be a Catch-22

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By E.J. Mundell
HealthDay Reporter
Monday, October 27, 2008; 12:00 AM

MONDAY, Oct. 27 (HealthDay News) -- In her long struggle to care for her gravely ill husband, journalist andPassagesauthor Gail Sheehy recalls one defining moment.

More than a year ago, her husband, publisher Clay Felker, was being discharged from a New York City rehabilitation facility after spending several months there in his long battle with throat cancer. As always, Sheehy was at his side.

"So, he has to come home now, and we've run out of benefits," Sheehy recalled at a recent media briefing in New York City. "We're coming out, and there's also nobody telling me what I have to do. He has a feeding tube, he has a tracheotomy, he has medications. I don't know where to start."

Desperate, she sought out and hired a "geriatric care manager" -- at $125 an hour -- to advise them. Their insurance might still pay for an at-home nurse, she found out, but only if it's a Medicare-approved nurse -- and there aren't any available in the city.

Therearehome health-care aides, of course, "but they cannot do medical services like giving a shot, taking care of a trach, changing a feeding tube," Sheehy said.

And then there's the quandary of how to pay for a nurse, should one be available. Once private insurance benefits end, the only option for most Americans is Medicaid, which requires that recipients have less than $5,000 in assets.

Her geriatric care manager spelled it out to Sheehy: If the couple first exhaustsalltheir remaining assets, then Medicaid will cover Felker's nursing care.

And if Sheehy, in her late 60s, wasn't willing to give up all her assets and income?

"Then, you need to divorce him," the geriatric care manager told her.

In Sheehy's case, it never came to that. She and Felker scraped together enough money to hire qualified, in-home caregivers via the network of health care helpers known as the "gray market," and Felker's last months were spent at home, relatively serene. He died in July at age 82.

Sheehy called her 15-year journey with Felker through the U.S. health care system a "nightmare," and she wonders how less affluent and well-connected Americans are faring.

"I'm a journalist, I have a lot of contacts, I've worked all my life and done reasonably well. My husband was successful," she said. "But we had a hell of a time trying to maintain some quality of life."


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