The unexpected perils of aging

My mother will be 94 years old in less that a month. She's taught me a lot in those many years, but I think what she's teaching me right now, simply because of our shared experience, is perhaps the most difficult yet the most valuable. You see, what I'm learning is that old age really isn't for sissies. But neither is it for the strong-willed, the modestly positioned (financially speaking), or righteous-thinking.

Here are some lessons I'm learning about elder-care:

1.  Doctors don't understand the difference between a true medical emergency and a situation that still requires immediate attention.  We all agree that symptoms of a heart attack or bones sticking through the skin require a call to 911 and a trip to the ER. But a very fragile old person suffering from confusion and immobility is only tortured by an ER ordeal, which inevitably mounts to 6+ hours on a stretcher, getting little attention, and being discharged in worse condition than when you arrived. Doctors want to see healthy patients (meaning ambulatory and coherent) and ER doctors want to see blood, bones, and arrests.

2. You have to be in the hospital for 3 days before Medicare will cover admission to a nursing or rehab facility (and then only for 30 days). This means if your doctor won't admit you, and the ER doctor won't admit you, then you're not going to rehab unless you go on your own hook (and dime). Even if you have a really great supplemental health insurance plan, like BC-BS for federal employees, the law mandates that Medicare will be your primary provider and thus they call the shots. The cost of rehab for "private admissions" at the place we checked was $6000 for 30 days, and this was only for room and board.  That's twice as much as my mom makes in a month (and she's one of the lucky ones).

3. Geriatricians are few and far between and many are not accepting new patients. When you do find a new doctor, you will have to wait weeks or months for a first appointment. If you need immediate attention, you need to go to the ER, where you'll lie on a stretcher for 6+ hours, get little attention, and be discharged in worse condition that when you arrived.

4. If you have a regular income from retirement or an annuity and this income total exceeds a very low limit, you cannot qualify for Medicaid. My mom makes about twice as much as the Medicaid threshold, but falls short of being able to pay privately for rehab or nursing care by about $3000 per month.

5. In-home care is a very desirable alternative but costs approximately $18/hr. This will cover basic assistance for an ambulatory patient who otherwise can dress, bathe, and feed herself.  At my mom's income level, after paying her room and board at an independent living facility, this buys about 55 hours of care monthly. Right now, she's getting about 180 hours of care monthly or 3 times what she can afford.

6. If you've been fed the "use it or loose it" philosophy all your life, you'll have a hard time accepting that you have, at long last, lost it. Old age is not something you recover from. At some point, you are not going to get better and you will have to accept unpleasant changes.

7. Unless you have a large and well-positioned family, your loved-ones cannot possibly support your needs financially, and they will struggle with the physical and emotional toll your advanced age exacts.