The Geriatric Nightmare

There is an elder care nightmare in this country, one that has only recently been addressed with any sense of urgency.  And only when one has lived through the nightmare, as I am doing now, can it be appreciated to its full extent.  There are no shortage of articles about shoddy elder care in nursing homes, and signs of potential elder abuse.  Adding insult to injury, the cost of paying for half-fast care has become astronomical.  A recent front-page article in the Star-Ledger reports that a year of nursing home care is approaching $100,000.


Yes families are finding themselves tapped out, but it’s not just those who have loved ones in nursing homes.  Although aging in place in one’s apartment sounds like a lovely idea, it has its own set of challenges – and tapping out family finances is near the top of the list.  Allow me to explain experiences with my 95 year-old father in the hope that others will benefit from the information.

Trying to keep this relatively brief, let’s go back about five years ago when my father had reasonable mobility.  He was going to set up a trust fund but didn’t, because in his mind he didn’t have enough $ in his retirement account to be worried about preserving.  He was in a rent-controlled apartment and getting by on social security payments and what he had saved.  His wife, my stepmother, not nearly in the throes of dementia that grips her now, had already set up a trust account for her family and was moved over to Medicaid.  My father continued to pay for his medical care through Medicare services.  Last December is when the trouble began.


Dad had a defibrillator implanted in the hospital and was too weak to go home upon discharge, so he went to a local rehab center.  That was its own disaster, but suffice it to say that’s when we started with a private health agency supplying an aide to act as his advocate.  Two 12 hour shifts per day.  Different people on various days.  Some competent and others of questionable competence.  What does this privilege cost?  $3192 per week.  You read that right.  Three-thousand, one-hundred and ninety-two dollars per week, based on $19 per hour, 168 hours in the week, and $28 per hour on holidays (which extends for 36 hours, not 24).  These private home health agencies have built a burgeoning business that verges on a license to print money, and the printing machine is your credit card.

Credit Card

You see, care won’t be initiated until you leave a credit card on file, and the meter begins running the moment the aide sets foot in the door.  It then becomes a bottomless pit until the money runs out.  Think you or your loved one will recoup any meaningful reimbursement through Medicare?  Guess again.  Turns out, if you have worked all of your life to pay into the Medicare benefits system, you’ll get far less coverage than if you have Medicaid.  Each of these home health services essentially works under a parent billing company, and the industry standard is that of the 168 hours per week, the most you can expect is 15 – 20 hours per week.  Even if the Medicare provider, in my father’s case United Health Care, tells you that he’s eligible for 35 hours per week, the agency will tell you they’re unable to “justify” more than 20 hours per week.  This is even when your loved one deteriorates to the point where he has no independent bodily functions left, and has to be cared for 24/7.

To be continued, perhaps …

About Leonard J. Press, O.D., FAAO, FCOVD

Developmental Optometry is my passion as well as occupation. Blogging allows me to share thoughts in a unique visual style.
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One Response to The Geriatric Nightmare

  1. doctuhdon says:

    A very moving and most important post, Len. Glenn D. Braunstein, M.D. has an excellent medical blog on the Huffington Post and provided details in one of his posts about the staggering financial, emotional and physical costs of taking care of elderly, infirm parents.

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