Funding: family vs. nursing home

In recent years my mother, who is almost 91, has had two nursing home stays while rehabilitating from falls. In both cases the nursing home staff was kind and efficient, but my mother did not do well.

For my mother, the best solution is the 24-hour home care she has been on for the last three years. But it is also an expensive solution, costing far in excess of an Ivy League education.

A recent study by the National Alliance for Caregivers and the National Center for Women and Aging at Brandeis University, conducted for Metropolitan Life Insurance, showed that family caregivers pay dearly for keeping a loved one at home. On average they lose a staggering $566,443 in lifetime wages, $25,494 in Social Security, and $67,202 in pension benefits as a result of passing up job-training, promotions, and education to spend their time caring for their family member.

The irony is that I or anyone else paying for home care could avoid these expenses by putting a parent in a nursing home.

I am not yet close to any of the figures in the Metropolitan Life survey, but they make sense to me.

My salary as a college professor - together with my mother's income - allows me to pay for her 24-hour home care. But I am running at a deficit when I combine my living needs and hers. Over the past two years it has been necessary for me to take money out of my savings account and cut back on my retirement plan. In addition, I have become a constant commuter between my job in New York and our family home in Cleveland.

While medicine affords no cures for my mother's condition, there are remedies for my financial situation.

If I were to put my mother into a nursing home, I would be required to sell her house, spend down all her assets, and save for a token cash reserve. But after that, Medicaid would pay all of my mother's nursing home expenses.

What is hard for me to accept is that while Medicaid will pay a nursing home more than $100 a day, it will not do the same for me, even if I pay down her accountable assets.

The best I can do is get compensation for about 20 hours a week of care through the Medicaid Passport program.

The gap between those options, as the long-term care ombudsman in Cleveland tells me, is deliberate. The Medicaid Passport plan was designed to be a "cost-effective" alternative to nursing-home care. It was intended not to be equal to what the government will pay a nursing home to care for an elderly person.

It is time to reverse this policy. The 85-and-older population, which is the fastest growing group among those over 65, nearly quadrupled between 1960 and 1994.

Nursing homes are already straining to give quality care, and the idea of making it harder for families to take care of their aging loved ones themselves makes no sense.

I am, in this regard, fortunate. Unlike so many of my friends, I do not have children in college. I can choose to cut back on the quality of my retirement years in order to help my mother now. I am the only one who pays for my decision.

But nobody should have to have a middle-class income or be free from the expense of a college education in order to keep an elderly family member at home.

Nothing is more devastating than the thought of being unable to give our parents the quality of care when they are older that they gave us when we were younger.

Even with both political parties professing their belief in family values, I'm unsure what it will take to get the government to change its policy on home care for the elderly. With the number of family caregivers expected to grow in the next decade from 11 million to 15.6 million, I am optimistic that our current practice of making it easier to put the elderly in nursing facilities, rather than keeping them at home, cannot last. Politicians will have to reckon with a lobbying group that is sure to be a match for the nursing home industry in competing for future funding.

* Nicolaus Mills is a professor of American studies at Sarah Lawrence College and author of 'The Triumph of Meanness: America's War Against Its Better Self' (Houghton Mifflin, 1997).

(c) Copyright 1999. The Christian Science Publishing Society