GROWING OLD IS NOT FOR SISSIES, Part 3:
The Moment of Truth
"The human mind thinks best in the presence of a question."
Nancy
Kline
My unannounced arrival in
Mississippi alerted my mother-in-law that something serious was afoot. I told
her I am here to talk about money, and the numbers don't look good. Between the
cost of around-the-clock sitters and the repair and maintenance of her huge old
house and property, we could be flat broke in four years. Staying here much
longer is NOT an option, I said.
We've found a private room
in a U.S. News & World
Report "Five Star" facility, the nicest around. It costs
40% of what we're paying now and it's $25,000 less than other nursing
homes in the area. It's an amazing opportunity. Then I posed a question I knew
would draw her in, because at 90 she still loves mental puzzles:
"How can the
highest-rated nursing home charge $25,000 less for a private room than all the
others charge for a non-private room? How is that possible? Can you make sense
of that?"
There was a method to my
madness, which had come to me on the airplane. I asked a question that invited
her to try to solve the riddle rather than become confrontational. I phrased
the question so as to focus on two things she values deeply: making smart
financial moves and staying in a private room. And I knew the answer to the
question would be compelling for her because she treasures self-reliance
and abhors the bone-headed outcomes (in her view) produced by
"big-government meddling."
The answer, I said, is Medicaid. I explained
that Medicaid covers 50% of nursing home patients in this country but only pays
40% of the total cost of nursing home care. In other words, private-pay
patients pay more, based on an artificially high "rack rate," and
thus in effect subsidize Medicaid patients, who pay far less. "Our"
nursing home doesn't accept Medicaid so it doesn't have to play the "rack
rate game." As a result, it offers superior rooms and great service at a
$25,000 savings.
As intended, my
explanation struck a nerve with her. She has always prided herself on her
independence and not having to rely on government assistance. She sees Medicaid
as welfare and cannot imagine herself being any part of it. The wheels inside
her head were spinning.
As things stand, I said,
we now have two options. If we act quickly, we have a rare, miraculous chance
to snag a private room in a first-class Five-Star non-Medicaid facility. If we
do that, we'll have enough money to care for you comfortably for 10 or 12
years.
Or, we can keep doing what
we're doing and in about four years, we'll run out of money. We won't have any
options then. You will become a Medicaid patient. You'll live in a semi-private
room in a facility with a lot of other Medicaid patients. That's not what we
want for you. We want you to be happy the last years of your life, with the
best care possible.
If we go with the first
option, you will have several important decisions to think about. You can
decide which day next week we make the move. You can choose the furnishings and
artwork and decorations you want to take with you. You can pick which sitter
you want to accompany you for the next few weeks while you settle in at your
new place. You can choose to be smart or short-sighted, happy or surly. Those
choices are yours to make.
I realize this is hard
news to hear. You've always assumed you'd pass away peacefully here in your own
home. We've done our very best to make that happen, but unfortunately we don't
have the resources any more.
I'll stay with you for the next several days as you come to terms
with this transition. It will be tough. It will be like the death of a long
phase of your life and you will go through a grieving process. You'll feel
anger, frustration, pain, denial, loneliness, guilt, and a dozen other
emotions. We'll both cry a lot, but you will get through it, I promise. You're
a strong woman and you can do hard things. I'll be here to help. We can do this
together.
To be continued.
No comments:
Post a Comment