How Can We Treat People This Way?

In fact, you may spend a lot of time in those days gone by. You might be taken from your room in the morning and brought down to the community room, where a television is playing, and be left there to amuse yourself till it’s time to go back to bed at night.

Ah, you say, she’s crazy. She’s describing the worst of the worst, and I have insurance. This can’t happen to me. Guess again. I’m actually describing a pretty good nursing home, one I know of personally, and it’s not a bad place as such places go. I know there are better ones, but I also know there are far worse places. A July 2001 government study titled Abuse of Residents Is a Major Problem in U.S. Nursing Homes, conducted for the House Committee on Government Reform, investigated the problem. The study (at www.house.gov/reform/min/nursinghomes.html) detailed the widespread abuse of nursing home residents, from beatings and theft to murder. Over 30% of the nursing homes in the country were cited for various abuse violations over a two-year period.

I’m not crazy, and here’s the point.

In a country that prides itself on its standard of living, that rewards hard work and intelligence, why are those of us who are less than perfect (in age, physique, or mind) shunted off to live away from the rest of us, often for the rest of their lives? Grandparents can’t grow old among grandchildren. Elder wisdom is lost. No one cares about these people (or the visiting rates wouldn’t be so low). Picture yourself for a moment without long-term care insurance to ensure your placement in a pleasant facility with top care and enjoyable surroundings, and envision what life would be like if you were never able again to hear the sounds of your favorite music without having to weed it out from among the sounds of televisions, canned music, and the conversations of hundreds of other people. How would you like it if you could no longer indulge your passion for good books, or good food, or whatever it is that makes you happy?

The system we have created to take care of our elderly and infirm is not working, not by a long shot. Those fortunate enough to afford insurance, pay for residence in an assisted living facility, or surround themselves with caring family are fortunate indeed. But the rest are not. Families struggle to keep loved ones at home rather than let them go into substandard facilities where abuse and neglect are the order of the day. Caregivers burn out and families are bankrupted by the cost of care for the patient and respite care for the caregiver. Yet those in even respectable nursing homes live a far from ideal life.

Some Solutions

Many people, dreading this fate, have begun to think of ways to avoid it – both for themselves and for others. An experimental system in Japan that is also being tried out here involves something called an “hours” bank. People contribute hours of their time caring for those who need it. When the donors themselves or a close relative needs care, they can draw on their deposited hours and another donor will provide the kind of help they need. It is forming a community of sorts, one that can partially replace the communities of generations ago, when the elderly and infirm lived among family, friends, and neighbors, and everyone pitched in to help so that no one bore the entire load alone.

Yes, that system wasn’t perfect by any means. People became outcasts; plenty of people did bear the burden alone, and there were those who were consigned to institutions that were far worse than the nursing homes of today. But there was a sense of community, and a respect for the elderly and others who needed help, that’s missing today. Everything has been reduced to an equation of some sort, and those who fail to provide some return are cast aside, banished to institutions staffed by the underpaid, undertrained, and sometimes cruel. Those with some sort of return to offer – a LTC policy, perhaps, or enough money to pay for alternative care, at least for a while – find a place a bit higher in the hierarchy. But this is not a system that works. This is a dehumanizing way of forgetting about those who are an inconvenience, or worse, who by outward appearances have nothing more to offer to society.

There has to be a way that decent care with dignity can be provided to those who have worked hard all their lives and to those who couldn’t work hard due to illness or accident. There has to be a way that enough of us can contribute to the care needed that none of us need to feel overwhelmed, exhausted, and burned out the way so many caregivers do.

There have been instances of people in the workplace contributing some of their sick or vacation time to a colleague whose family circumstances include something dire, such as a spouse or child with cancer. This is a wonderful option that some companies have the flexibility and foresight to allow, but it too does not cover all the options. If it were more widely available, though, it could help in more cases.

And what about neighborhoods with healthy retirees who perhaps could do with a bit more company and maybe a bit more money, who could be prevailed upon to help care for family members unable to fend for themselves? If there were some sort of centralized place where such opportunities could be posted and such people found to help, whether through town databases or church or civic groups like veterans’ organizations, much of the burden could be lifted from many shoulders. Many of these groups already offer some such services to their members, but there are a lot of people who need such assistance. These people could help educate the rest of us.

What You Can Do

Those with the imagination and the means – influence, money, or determination – can help solve this problem. Many advisors argue today that they are interested in all their clients’ needs: financial, emotional, even spiritual. If that’s true, don’t advisors have an obligation to point out the shortcomings of our current system, where even the prudent use of long-term care insurance is only part of the solution? Lobbying the insurance industry or the government might be one way of alleviating the situation. (Of course, involving the government may not be the right way to go on this. Sweden has a national long-term care benefit, and its tax rate is 58%, according to Phyllis Shelton in Long-Term Care: Your Financial Planning Guide.) Convincing more employers to offer a long-term care policy as an employee benefit could be help, too, even though it’s liable to be a hard sell in the current economic atmosphere. On the flip side, employers will find their employees losing less work time or even staying on the job longer if they have some solution to home care needs for their family. Perhaps the FPA might even decide to involve itself in this issue that will touch so many people in the coming years.

But there’s another way to look at it. Advisors are in something of a unique position, particularly the ones who seek to plan for their clients’ quality of life as well as the well-being of their finances. Advisors understand the workings of the financial end of care, or can draw upon the expertise of those who do. They also have clients who might want to involve themselves in a philanthropic project that could do so much good for so many. Using the entrepreneurial skills and creative strategies that both advisors and clients possess, surely some solutions could be found that would at the very least be a start.

While no solution works for every case, and LTC insurance is a given, there are bound to be more solutions out there. Maybe you, or your clients, can help find one. Send an e-mail to me at [email protected] and I’ll share your thoughts and concerns.