Monday, June 01, 2015

Money




"Money, get away/get a good job with good pay and you're okay"

– Pink Floyd, Money

I had a good job with good pay but I don't know that I qualify as "okay". If someone had asked me in college if I would be "okay" without a shred of independence by the age of 35, I am certain the answer would have been, no.

Recently a good friend sent me pictures of his new house. It is gorgeous. Breathtaking. And I am 100% happy for him. I swear. I am not at all jealous of his beautiful house or his in–ground pool in the back yard or even of his beautiful family. I am however just a smidgen resentful that as a result of this disease all of my hard earned savings will inevitably be used for caregiving costs. I am scared that after 12 years of teaching in Baltimore city public schools all I will have to show for it is a remarkably uncomfortable $33,000 power wheelchair, a $10,000 standing frame, a $14,000 RT bike and a car payment for an ungodly expensive accessible (and shockingly unreliable) Dodge minivan.

I suppose I am a tad bitter that rather than spend my money on things I want (a vacation to Australia, a house on the lake, an accessible bathroom for Kelly's house so we may one day live together), I'm worried about saving my money for things I will likely need (caregiving). I currently live rent-free with my parents in a beautiful accessible house, and I pay for a private caregiver who works between 9 AM and 3 PM Monday through Friday. Thanks to the physical therapy and occupational therapy programs at Ithaca College, I have a number of responsible and highly entertaining college girls who work with me every evening and over the weekends. All told my caregiving costs range from $550-$650 a week  (which is actually a steal considering how much it could be without my mom's help every afternoon and Kelly's help whenever she isn't working). In addition I pay hundreds of dollars out of pocket for supplements and biweekly acupuncture appointments. Add to that my copayments for prescription drugs/doctors appointments/durable medical equipment and I am lucky if any of my monthly pension check remains to pay my credit card bill.

When I think about the facts of my situation it results in a distressing combination of emotions that range from rage to misery. On good days I ignore the facts and temporarily convince myself that everything will be fine. I am, after all, one of the lucky ones. It's true: although I cannot voluntarily move three and a half of my four limbs, I am probably the luckiest immobile person you'll ever meet. As a teacher in Baltimore city I had great benefits, I qualified for a pension, I have both Medicare and a supplementary health insurance plan, a prescription drug plan, all of the physical therapy and mobility equipment I need, a family I love and a girlfriend whose support I can hardly fathom. What I do not have, however, is peace of mind.

So I made some phone calls regarding my aforementioned facts. I called the Department of Social Services concerning long-term care programs. I explained my situation and, after giving all of the background, asked: "Is there any financial assistance available for caregiving costs?"

"Do you qualify for Medicaid?"

"No I do not."

"Well I am sorry, there is nothing we can offer you at this time."

Not altogether surprised by that conversation, I called Medicare and my supplementary health insurance:  neither one provides any financial reimbursement for home care services or home health aides. Both conversations ended with similar sentiments: "I am sorry, there is nothing we can do for you."

The conclusion I am left with is this: there are no services available for people with disabilities who live above the poverty line. So what do I do? Continue spending the majority of my pension check on caregiving and healthcare and keep my meager savings intact until a rainy day? And the reality is, I don't necessarily want to live with my parents forever, my goal is to one day live with Kelly; a goal I can only reach if we can both come up with money to redo her bathroom, and add a small addition to her basement. Do I dare spend my savings on something so luxurious when, at the same time, I will need to pay additional caregivers on the days that she works?

I suppose I am just confused. 7.8 % of the adult population in the United States qualifies as severely functionally disabled (click here), but it seems that without Medicaid eligibility no support is available to these millions of people.  Further, if someone is Medicaid eligible, circumstances are still far from ideal – many private homecare agencies do not accept Medicaid eligible clients, which leaves a person with decidedly little control/choice over his own home care. So what do these millions of people do? How do they afford care? How do they live comfortable and productive lives in accessible environments with compassionate caregivers? Do not even get me started on a potential expense of full-time in-home caregiving services; one local agency here in Ithaca, New York charges $15,000 per month for 24–hour care, $180,000 a year.

I suppose for some people it is possible to rely on family members, but that is neither ideal nor an option for me. My father also uses a motorized wheelchair thanks to this disease and my mom is too small and too fragile to care for either one of us without ending up in a wheelchair herself. Further, my suspicion is that were my mother physically able to care for me it would destroy our relationship. As it is she runs this household while dodging the near constant requests from both her daughter and her husband (thankfully he, at least, still spends a good amount of time at the office). Despite the fact that I pay caregivers for between 30 and 40 hours a week, the number of things I cannot do on my own persist during the other 520 hours a week: mom, can I please have a sip of water? Mom, can you please scratch my nose? Mom, can you fix my phone please? Mom, can you straighten my arm? Mom, I'm sorry to wake you up but my legs have spasmed into a pretzel. Mom, I know you're about to burn something on the oven but I really need to pee when you get a second please.

You get the point. The list of things that I need help with is exhaustive and could likely try the patience of Job. There are times (more often than not in fact) when I can hardly understand why any able-bodied person would choose to spend time with me without getting paid, it's a thought that does wonders for my self-esteem. It's a thought that makes me realize how dehumanizing it can be to have a disability. Because no matter how many times I remind myself that, as my mom says, I am not this disease, sometimes I feel as though my needs are suffocating everyone around me and all I am left with is a sense of guilt and shame that threatens to strangle any sense of who I am.

And it breaks my heart to realize that I am not alone. It breaks my heart to think of millions of other people struggling to figure out how to afford caregiving services. It saddens me to think of how many family relationships have suffered as a result of family members transitioning into primary care providers. Above all I feel an overwhelming, almost smothering sense of empathy for anyone whose peace of mind has been replaced by near constant logistical and financial stresses that seem to go hand in hand with any type of chronic illness or disability in this country. Although it is convenient to ignore, financial and logistical concerns – though as real and constant as the illness itself – are nothing compared to the stress of living inside a body that has forsaken you. For me that is what stings the most, that while I spend so much time stressing about caregiving and fearing that I am a burden, at the end of the day the fact remains: I hate this disease. I hate what it has done to my body. I hate what it has done to my family. I hate what it has done to the career that I loved and to my professional goals. I hate what it has done to my friendships. I hate what it has done to my bank account. Most of all, however, I hate what it has done to who I am. It replaced my confidence with insecurity, my optimism with fear, and my goals with concerns about my long-term financial obligations.

I do not want to be a victim of my disease. Most days I do not think that I am. The reality is, however, that the catalog of my physical needs necessitates full-time care. And quality care is not cheap. I try to keep my head up and follow the alcoholic's Creed: one day at a time, but when I see beautiful pictures of newly purchased houses, it still makes me just a little bit sad.


3 comments:

Anonymous said...

"It replaced my confidence with insecurity, my optimism with fear, and my goals with concerns about my long-term financial obligations.:....but when I see beautiful pictures of newly purchased houses, it still makes me just a little bit sad. "

Kate - once again, thank you for your voice.

I would like to add that there is a lot of talk about keeping people in their homes, for there they are happier, live longer and healthier, AND it is less expensive. but the reality is that the Nursing Home Industry must have great lobbyists... they get everyones last nickel. UNLESS the person was savvy.

Several years ago there was a legal article ( I think in some law journal) , called "Throw Mama Off the Train" regarding this for those fortunate enough to have some money and legal counsel. So to qualify for medicaid, seniors must plan, and legally give their children ( if they are fortunate to have them) up to $13k each/year with the goal of "die broke". There is a 5 year look-back, so you have to get rid of your money 5 years before you need it. And hopefully the people you give it to can be trusted and will hold it for your needs.

I am appalled by the way our disabled population is treated, I am appalled at the way our elders are treated, I am sick to death of Health Insurance and Disability Insurance Companies. Health Care should NOT be for profit. Evil ERISA laws should be struck down.

My unsolicited advice. Spend your money on what makes you happy today. Fuck it. xoxo -kim

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Steven Keltsch said...

Hi, Kate! I guess no one wants to be a victim of their disease, or have their disease become their identity. You are lucky despite your condition, as you have your family and girlfriend. I just hope that in no time you will get the Medicaid eligibility sorted out. Stay strong!

Steven Keltsch @ Allied Insurance Managers