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‘Bittersweet Season’ puts debate into perspective

By Matt Pommer

Before you rush to join the growing political debate over Medicaid and Medicare, you ought to read A Bittersweet Season,” a new book out this week.

In the book, New York Times journalist Jane Gross describes the nine-year struggles her upper-middle-class family had as her mother’s health declined until her death at 88. The family was lucky; mother did not have dementia.

The story includes her mother’s return north from senior-citizen housing in Florida and takes readers through the anguish of moves to assisted care and then to the final stop — a nursing home.

First, here’s a short explanation about Medicare and Medicaid. Medicare is the federal program of care for the elderly. Medicaid is the state-federal program to pay for the poor. Purists will say Medicaid is welfare, and they are right. The combination of the two is a Rubik’s Cube, writes Gross who explains Medicaid and Medicare details.

The nine-year cost of care was $609,123, including $470,818 of her mother’s own money. Finally she was “spent down” to Medicaid status. “My mother, in her own eyes, officially became a welfare queen,” Gross wrote.

An estimated two-thirds of Medicaid is spent on those older than 65. Eighty percent of those in nursing homes are on Medicaid. The other 20 percent are private-pay patients, charged rates that help subsidize those on Medicaid. The government payments for Medicaid fail to cover the costs or all of what might be needed.

Much of elder care is accomplished outside of assisted care, nursing homes, and institutionalized settings. Experts say 43.5 million Americans are care-givers for the elderly. The average care giver is a 50-year-old daughter or daughter-in-law who spends 19 hours of care a week, Gross said.

“She probably has a full-time job, a husband with his own needs, and maybe children still at home,” Gross wrote. Much of the care goes to older women. Females live longer and often have outlived their spouses. The caregiver “job” lasts an average of four years, she wrote. It might be buying and changing the diapers of an elderly relative. Or buying foods and providing transportation. Or answering calls for help.

Statistics are a small part of the book. It follows the twists and turns that Gross and her brother experienced in those nine years. She admits mistakes were made and offers some tips that would make the process easier. For example, have one person making the medical decisions. Or perhaps judge a nursing home on how it handles dentures for its patients.

Other ideas include selecting a physician, opting for “slow medicine” rather than a long list of tests for the elderly, taking away a driver’s license and car, and struggling with a job and the caregiver’s role.

Talking about the potentials in the declining years is not easy. It’s as uncomfortable as talking about sex with your first teenager. We’d rather think our parents will be active and vigorous into their 80s and then have quick exits. That’s unrealistic, Gross wrote.

We’d rather not talk about death. She relates how one expert startled an audience by asking how many expected to die. The audience raised its hands — slowly.

Matt Pommer worked as a reporter in Madison for 35 years. He comments on state political and policy issues.

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