Monday, December 22, 2014

Care-Givers at Home

I daresay most of us have been to nursing homes, generally to visit someone who is living or staying there.  I do not have to tell you they are not pleasant places.  Very old people sit in the halls doing nothing until they die.  The caregivers, dedicated as most are, have no real capacity to brighten up the lives of the residents.  I don't know how they do it, and I don't know how the residents manage.

There is also a financial component, of course.  Medicare, the Federal insurance, does not cover nursing homes, which cost the residents thousands of dollars per month each.  Medicaid, the Federally-funded but state-run program for the poor, does cover nursing-home care in certified facilities.  So if you're poor, you can afford it, but if you're not poor, you probably can't, although presumably you can sign over everything you have to the facility and they'll take you in some way.

So here's the thing.  My wife and I are 63 (she looks great).  Her mother, who lives with us, is 88 and unable to live on her own.  She has a walker that allows her to move from her bedroom to her bathroom to the adjacent family room, as far as she can manage.  She takes 15 different medications over the course of the day, over 20 pills total.  She is incapable of managing her prescriptions on her own, as she cannot see close-up well enough to read labels, but can dress herself, although just able to do so.

She does, however, have a much better quality of life than most all of the other 88-year-olds similarly incapacitated.  Although she cannot leave the house save for doctor visits, she watches a large-screen TV, reads books on a Kindle-type device that enlarges the print, has three good meals a day, talks on the phone.  She never misses a pill or gets the wrong one.

That, friends, is because her daughter, who is an expert in government contracting and a recent business owner, is confined to the house to take care of her 24/7.  She does that because she is committed to her mother's care; she does it 24x7 because her mother doesn't qualify for Medicaid; cannot on her own afford a nursing home, and home nursing care is not covered by Medicare.

As a result, from the perspective of the Government, a person who is quite capable of contributing to the economy, with skills in demand in her profession, does not work and thus is not paying income tax; no, instead she is an unpaid home care nurse.  Early this year, her mother was in the hospital for five weeks, and my wife was there 14 hours a day, overseeing prescription balancing (which she understood better than the staff relative to her mother's care).  Even worse, now she is confined to the house lest her mother fall, or have a health emergency, or some personal accident only her daughter could attend to.  "Confined" means she can only leave the house for an hour at most, and that perhaps once every week or two.

What's wrong with this picture?

There's a lot wrong.  There absolutely needs to be a significant reevaluation of the Medicare coverage of intermittent home-care nursing for the elderly.  Is it beneficial to the Government to take working-age people out of the workforce and cease receiving income tax from them, rather than providing some level of home visitation care to alleviate the caregiver's confinement, perhaps to allow them to work?

May we at least run the numbers?  I know that based on her previous professional income and tax rate, my wife would be paying the US Treasury about $25,000 per year in taxes.  She now pays nothing, since she cannot leave the house to work.  We have a tax-preference category for child care to allow (primarily) mothers to work.  Has Congress even looked at the upside-down economics of home care for the elderly, and the possibility that it could be revenue-positive, if not at least revenue-neutral, to legislate around such situations?

I don't know the answer.  What I do know is that a very intelligent and immensely capable woman is completely out of the work force and, worse, completely confined to her home, with no compensation, for providing care that in a different situation, would be paid for by her mother's Medicaid if she received a little less in Social Security.

She is a claimed dependent on our taxes, of course.  She would be a claimed dependent if she were in perfect health, too, it should be noted.  So the net tax effect of the exemption, given our rate, is about $80 per month.  I guarantee you my wife would gladly pay $80 per month if she could perhaps go out to dinner once in a while.

This is just all wrong.  My congressional district has a new representative, Barbara Comstock, who takes office on New Year's Day.  I'm going to forward this to her in the hope that we might be able to testify to the absurdity of the situation.  Of  course, it will have to be I speaking, since my wife can't leave the house long enough to go to DC and testify.

We're not looking for money here, guys.  We're looking for attention to the proper solution for the caring for the very elderly in their homes.  It's a great alternative to the Government subsidizing nursing homes, if only someone will take up the cause.

I'm sure you didn't hear it here first.

Copyright 2014 by Robert Sutton

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