Home Care Can Prove Financially Draining
Author Gail Sheehy recalls challenges faced in her husband's last year

(HealthDay News) -- As the U.S. population continues to age, many middle-class Americans are going to be faced with difficult choices when it comes to providing health care for aging loved ones.

Gail Sheehy, a journalist and author of Passages, was confronted with this stark reality when a geriatric care manager told her the only way to provide her dying husband with adequate care without draining the couple's assets was to divorce him.

At the time, her husband had been discharged from a New York City rehabilitation hospital after undergoing treatment for throat cancer.

"He has to come home, and we've run out of benefits," Sheehy said in recalling that time in their lives. "There's also nobody telling me what I have to do. He has a feeding tube, he has a tracheotomy, he has medications. I don't know where to start."

At the time, her insurance would cover only the cost of a Medicare-approved nurse, Sheehy said -- and there were none available in her area. Although the insurance probably would have paid for a home health aide, what her husband really needed was a nurse because home health aides "cannot do medical services like giving a shot, taking care of a trach, changing a feeding tube," she said.

Medicaid won't assist until recipients have less than $5,000 in assets, which would have left Sheehy penniless after her husband died. And that's when the care manager suggested divorce.

As it turned out, Sheehy was able to get together enough money to hire qualified, in-home caregivers until her husband died a year later.

But "nightmare" was the word she used to describe her 15-year journey through the U.S. health-care system.

"I'm a journalist, I have a lot of contacts, I've worked all my life and done reasonably well. My husband was successful. But we had a hell of a time trying to maintain some quality of life," she said.

"For people who are very wealthy, if the family cares about the loved one, they'll be able to provide this care," she said. "And the poor finally get a break because they can get on Medicaid. But it's the vast lower-middle to upper-middle class that is really getting the shaft."

Another big problem, according to Carol Raphael, president of the Visiting Nurse Service of New York, is that "there's no one accountable" in the current system. "That's why it can cost you $125 an hour [for a geriatric care manager]," she said, "because you're trying to fill that hole."

Because of reimbursement issues, much of the care that's needed ends up being given by home health aides. But the training required for these positions varies greatly from state to state. New York, for instance, requires 120 hours of training to be certified as a home health aide. Yet in California, nail technicians must have 350 hours of training before they can work in a salon.

Home health aides "are the glue that is holding the home health-care system together," Raphael said. But in many states, "we have very minimum training requirements for these para-professional workers, who are handling very complex cases."

On the Web

To learn more about hiring in-home help, visit the Family Caregiver Alliance.

SOURCES: HealthDay News ; Oct. 17, 2008, New York City news briefing with Gail Sheehy, journalist, and Carol Raphael, M.P.A., president and CEO, Visiting Nurse Service of New York
Author: Serena Gordon
Publication Date: Sept. 30, 2009
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