True or false: Medicare, the federal health insurance program for people over 65, pays for long-term nursing home care.
Answer: false. It does not, and therein lies the source of tragedy for a number of elderly people whose spouses have to be put in nursing homes. The couple must go through a period of impoverishment and selling off of most assets before the spouse in the nursing home becomes eligible for Medicaid, the federal health program for the poor. In the process, the spouse who remains in the community loses most of the couple's life savings and, for as long as the institutionalized spouse lives, has to live on a small monthly allowance. The principal option for avoiding poverty is divorce.
Alice Quinlan, the public policy director for the Older Women's League, is lobbying on Capitol Hill for legislation that could provide a measure of protection to the spouses who remain in the community.
"When you go into the nursing home you begin by paying for it yourself," she says. "Only when you are down to $1,800 for an individual or $2,600 for a couple in assets that are left are you considered for eligibility for Medicaid. The assets do not include your house, your car and your home furnishings. It includes everything else: your Individual Retirement Accounts, stocks, bonds and any other savings.
"When you are down to that, Medicaid looks at your monthly income." If the husband is in a nursing home, Quinlan says, chances are that he has a pension and Social Security checks. If the wife is a dependent spouse, she has a Social Security benefit that is only half of her husband's. Most states provide for a spousal maintenance allowance that will continue to come out of the husband's monthly income, but that allowance, says Quinlan, is about $300 a month in most states. "Who can live on that? There's no life savings to dip into." Women, she says, are much harder hit by spousal impoverishment because they live longer and are much less likely to have money of their own that would be exempt.
"We don't have any kind of national long-term health care policy," says Quinlan. "Spousal impoverishment forces middle-class couples into poverty in order to qualify for a poverty program because there isn't anything else available.
"What people are frequently counseled to do when there is no other recourse is to divorce or sue for spousal support. You're talking about people in their late sixties, seventies, 80 years old. You're talking about people being married 45, 50, 55 years. The very thought of divorcing, even a pro forma divorce, just going through the motions, is a total trauma."
A woman in Connecticut, she says, wrote the following letter to the Older Women's League: "At the age of 70, I'm now in the position of so many other spouses, having to liquidate all of our assets to pay for his nursing home care. I postponed putting him into a home for two years, making our home a care facility, until he was released too soon from the hospital and he had to be put in a nursing home."
This woman, says Quinlan, will have to keep paying the nursing home bill out of their life savings until there is no money left. "His Social Security and pension end with his death. She's left with Social Security but probably no pension. You're talking about a 75-year-old woman who has very little opportunity to generate income or build savings back up again."
Several bills are pending in the House and Senate that would protect more of the monthly income and life savings of a couple when one spouse has to be institutionalized. Sen. Barbara A. Mikulski (D-Md.) introduced the first such bill when she was in the House and has introduced a bill in the Senate that would protect $25,000 in life savings and would allow the spouse in the community to keep $750 of the monthly income, with the remainder being used to pay nursing home expenses.
Quinlan says that between 10 and 12 percent of nursing home patients are married and have spouses in the community, which means that roughly 150,000 to 200,000 people in nursing homes are part of a couple. There is no definite figure on how many have had to divest themselves of assets to qualify for Medicaid, she says, but at least half of all nursing home patients are on Medicaid.
It is yet another count in the lengthening indictment of our health care system -- or lack thereof -- that we have created a situation in which elderly couples are forced to choose between poverty and divorce to secure nursing home care for a spouse. People who have paid a lifetime of taxes deserve infinitely better than that.