How To Get Ready For An Aging Family Member’s Housing Needs

For older Americans with specialized housing needs, Medicare provides next to nothing. In my case, Medicare was at best a speed bump on the way to bankruptcy and at worst a bureaucratic churn of paperwork.

What are the features your family should look out for as your family ages and what should you do to avoid disaster and bankruptcy when a parent needs help and housing? Here’s my advice based on my experience.

I only was slightly joking recently when, in comment thread on Facebook, told a friend that people on the left have one solution to every single problem: more money! And what makes that solution even sweeter? When the money is squeezed from “the rich” it is music to their ears. I know that my experience will be met in some minds with, “Well if Medicare only had more money….” But here’s why that isn’t true.

Apart from my suddenly becoming ridiculously wealthy, more money applied in our family’s experience would have done little to solve these problems.

Misalignment of incentives

The current system rewards narrow outcomes not complete ones. If I am given the task of “stabilizing a patient,” that’s what I’ll do. If that patient dies a week later, “Not my problem!” If they can’t pay, “Talk to the business office!” If everyone in the health care and housing system were compensated by patient outcome we would have radically different and better health outcomes.

Poor integration

It’s hard to believe, but one of my mom’s regular providers had no idea she was even in the hospital. When she finally did visit with her, she recommended changes in medication that were only made when I, over the phone and through staff, chased down the physician at the nursing home. The illusion that Electronic Medical Records (EMR) are zooming through internets from provider to caregiver to patient and back is possible, but an illusion.

Rationing

In any economy – from a desert island to the United States – if something is in scarce supply, it will get rationed. Price is an impersonal rationing system; when something is scarce its price goes up forcing innovation or substitution. In our health system, especially when it comes to housing for older people with specialized health related needs there are few alternatives that means very high prices.

So if you have an older family member who is perhaps doing ok now but who may live long enough to need supportive housing, here’s some things to do today:

Get prepared – Read your family members health coverage policies and get permission to speak about those policies with the providers. Find out what is covered, when, for how long, and at what rate. Ask your family member about their finances. How much money do they earn per month, where does it come from, and what sorts of assets do they have? Introduce yourself to your family member’s health providers if they have one. They will not call you or seek you out when something happens if they have no clue about who you are, and will be more responsive if they do.

Talk about it – Based on what you find out, have the tough and uncomfortable conversations now. While the notion of three prepared meals a day and planned recreation might sound nice, an older person sees that as a slow slide into death. Talking about their housing future and planning as much of it as possible ahead of time helps make the notion of moving – eventually and maybe – much easier than a decision made from a hospital or nursing home bed.

Advocate – Sometimes conversations with pieces of the system will be adversarial and about money and payment. Ask questions, demand answers, and when needed, drill into that person on the phone and let them know you’re not going away. Understand who’s in charge and deal with them like a professional, the same way you would with closing a financial transaction. If you can’t handle the emotional stuff, task one family member to be the “tough guy” and another to be the health expert. If you can, divide up tasks based on people’s strengths. Don’t dump everything on one person if you can avoid it.

Balance emotion, finances, and health – Keep goals in mind and organize around them. When I realized nobody was in charge with my mom’s situation, I took over. I set goals for discharge, for specific outcomes, and worked with family all with the aim of getting what was best for my mom and protecting her finances as best as I could. One of the biggest problems and challenges with moving a loved one to a nursing facility or assisted living can be the emotional aspects of it. And it isn’t just about money. But each of these, your emotions, your family members finances, and trying to figure out what they need to get as well as they can need to be balanced. It is work.

Until some bigger solution can be worked out through economic policy, we’re all on our own here. That’s frustrating. But as family members age, you can make things better if you jump in and hold the various systems – and yourself – accountable. Being focused and efficient might seem a bit heartless, in the end, rational self-interest and efficiency is compassionate, not a vice.

As Bernard Mandeville wrote in his Fable of the Bees:

Thus vice nursed ingenuity,

which joined with time and industry,

had carried life’s conveniencies,

its real pleasures, comforts, ease,

to such a height, the very poor

lived better than the rich before,

and nothing could be added more.

By Roger Valdez, Contributor