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OpinionColumnistsLane Filler

Our eldercare system is broken

Playing cribbage at a senior center in Billerica,

Playing cribbage at a senior center in Billerica, Mass. last year. Credit: Boston Globe via Getty Images

A few weeks ago, I was lounging on my mother-in-law's sun porch when talk turned to the Cherished Matriarch’s future.

She’s healthy, but turned 80 last week. She’s still buying green bananas, but not Bonsai trees.

As Cherished made sure I had enough cobbler, ice cream, coffee, cigars, fresh ashtrays and spending money, she said of her future: "I just don’t want to be a burden on you kids. Or end up in a nursing home."

"Now that’s a problem, darling," I answered through a cloud of fragrant smoke and caramelized sugar, "because I’m not allowed to shoot you. And other than putting you down when the time comes, ‘nursing home’ and ‘burden on you kids’ are about the only options left."

Elder care is not something people like to think of in such stark terms, but if we live long enough we’ll need some. We probably won’t be emotionally ready for it. We probably won’t be able to afford it. And thanks to all we’ve learned via COVID-19, we’re probably feeling worse about the prospect than ever before.

In February 2020, there were 104,110 nursing home patients in New York. One year later, fully 15% of those nursing home patients were dead of COVID. The way the disease spread and the way both patients and information were treated has made the facilities a white-hot topic now. Those 15,000 beds are still empty, with vacancies having tripled to 21%. And with COVID exposing some facilities as understaffed, lax on patient care and wholly focused on generating huge profits, many New Yorkers face newfound fears about going to the home.

Nursing homes on Long Island cost, on average, $400 a day, or $140,000 a year. The average resident has been in a home for 900 days. About 10% of those who go to nursing homes stay more than five years.

Medicare doesn’t cover nursing-home care, and because practically no one can afford or qualify for long-term care insurance, the care impoverishes most residents. That's why about 70% of all nursing-home residents are on Medicaid. And about 40% of all deaths in the United States were among nursing-home residents.

Perhaps the strangest contradiction in our society is:

  • The United States provides health care to all senior citizens, but makes no such promises to children.
  • Then the United States obsesses over the quality of the teachers who care for our children, but leaves care of our beloved elders to lightly trained workers toiling for low wages under difficult conditions.

The Cherished Matriarch will, if she lives long enough, either need help to stay at home, or need to go to the home. We’ll want her to be cared for with a skill and tenderness we can’t easily provide.

So we can’t rail against long-term care facilities proposed for our community. We can’t rail against properly funding the Medicaid system that provides long-term care for the elderly, though we can demand it root out waste and fraud. We have to create strong oversight of facilities and their owners. We have to support programs that pay to help elders who can stay home do so in comfort, and fight to see such jobs pay enough to attract trustworthy employees.

If we all want an eldercare system good enough for our own cherished matriarchs and patriarchs, and ourselves when our time comes, then we have to build one that's good for everyone.

Lane Filler is a member of Newsday's editorial board.

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