The call came right after lunchtime. “I’ve fallen again,” my great-aunt Emma said, and her arm hurt too much to move. This was her fourth fall of the year. How bad was this injury and how would this affect her long recovery from problems she sustained during the first fall? Emma is the kind of person I want to be when I finally grow up: sharp, indomitable, open to new experiences, independent. And always bandbox neat, often in a cute hat.
As I waited for her in an emergency room, I realized I’d been in denial. It wasn’t that I hadn’t thought about losing her as she went from her 80s to her 90s, but I hadn’t thought about what she might go through before that.
Emma had a clean break in her upper arm — they put her in a sling and sent her home with ibuprofen — but what happened after showed me how difficult it is for the elderly and their families to navigate health care in this country. Once home, Emma struggled with everything from eating to dressing to washing. Four days later, she fell again. She escaped with only a scraped knee, but we realized she couldn’t be alone until her arm had healed. But because she hadn’t required surgery, insurance wouldn’t cover the astronomical costs of a rehab center.
Long-term care insurance she’d been paying steep premiums to for years wouldn’t kick in for at least three months. Moving in with me wasn’t an option, and neither was me moving in with her. It was time to look into home care. That process has given me a good idea of how frustrating our medical system can be for seniors and their families. Between a lack of information on most home care agencies (only agencies that provide skilled nursing get reviewed by the government), a rapidly worsening worker shortage and no financial relief for the services Emma needed, I now understand why one doctor told me a lot of people just wind up putting elders in nursing homes instead of having them stay home.
Not wanting to take a risk on a freelancer on Craigslist, we searched for an agency, even though we knew that was no guarantee of safety. I learned there are two tiers of services: Home health, which includes skilled nursing and physical therapy, and home care, which gives assistance with hygiene, cooking, errands or making sure a senior with a history of falling doesn’t fall again. Emma’s primary doctor gave us a referral to a home health agency. After declaring her homebound so Medicare would pay, the agency started sending physical therapists and nurses — which we didn’t necessarily need, considering I was already taking Emma to multiple doctor appointments each week. What the agency didn’t offer was night care, our most urgent need, so we had to go to a home care agency.
Medicare doesn’t pay for a penny in that case, so Emma was lucky she had funds set aside. But researching reputable home care is quite a chore. Many agencies have very little presence online: a website and maybe two or three reviews on Yelp. We wound up relying on a referral by a state social worker and that agency was neither reviewed on Yelp nor the Better Business Bureau. Luckily, that agency turned out to be a good one, but once we found Emma a night caretaker, I saw how our eldercare system treats the people who actually do the caretaking. Despite the critical need for eldercare, getting the workers needed is not easy. The night caregiver we found for Emma confided in her that her take-home pay was about $10 an hour. (We paid the agency who oversaw her $16 an hour.)
Unsurprisingly, turnover among these workers is as high as 60 percent. The shortage is only going to get worse, a phenomenon being dubbed the “caregiving cliff.” According to the Institute of Medicine, by 2030, the United States will need 3.5 million more workers in home care and geriatric medicine. None of the people I spoke to about nonmedical long term care could offer a solution that would balance workers’ rights to make a living and seniors’ rights not to go bankrupt for the care they need.
Months away from her 92nd birthday, Emma has regained the use of her arm and much of her independence. Even with all the problems that have plagued her in the last 18 months, she remains the woman I hope to be should I make it, mostly unscathed, into my 90s. I may even buy a hat or two. And I’ll definitely have a number of home care agencies on speed dial.