A few years ago my 85-year-old mother looked at the column of numbers the housing manager of her new assisted-living home showed her and burst into tears. The manager had just figured out that a studio apartment, 14 by 14 feet, would cost her $2,300 a month. He handed my mother a tissue and turned to me. “So many of our elders react this way,” he said. “They’ve saved all their life for a rainy day, but when I tell them that rainy day has arrived, they can’t bear to part with their money.”
Today’s old folks are survivors of the Great Depression. My mother always delighted in finding a penny on the street. If someone handed her a business card, she’d draw a flower on the reverse side and turn it into a holiday gift tag. Supermarket produce bags, used wrapping paper and plastic cutlery from fast-food restaurants filled one whole closet of her house. When I explained that her bank account would almost certainly take her to the end of her days, she ran her fingers through her silvery spider-web hair and protested, “But I worked so hard to leave something for my grandchildren!”
Nobody wants to hoard savings only to see them hemorrhage away at the rate of thousands of dollars a month. My friends, who were once ’60s radicals, are now sixtysomething opportunists in search of legal loopholes. They discuss putting family money in trusts or tax-exempt annuities that could leave the government subsidizing their parents’ or their own end-of-life care. Ethics never enters the equation.
My mother was lucky. She died quickly enough to leave her grandchildren some college money, scraped together from her pitiful salary as a secretary and her minuscule Social Security pension.
As a child of divorce, I have another mother, too–my father’s second wife, who lives in California and suffers from dementia. When she was hospitalized and it became clear that she would need the kind of round-the-clock care a nursing home could provide, the first question the hospital and HMO social workers asked my father was “Is your wife Medi-Cal eligible?”
Medi-Cal is California’s Medicaid program. It picks up the long-term-care expenses of people who can’t pay for themselves. When I called a Medi-Cal office on my father’s behalf, I found out that to qualify he had to have $89,280 or less in assets and a monthly income of no more than $2,232. “If he has more,” said the helpful lady on the other end of the line, “he’ll need to spend down to that amount and then wait three years before he applies for aid. He might want to see a lawyer.”
“You mean about how to hide his assets?” I asked.
She laughed nervously and said that although she couldn’t advise me to do such a thing, lots of people give money to their children or otherwise arrange their finances to avoid spending all their savings for long-term care. She told me that my father could even go to court and make a case for a bigger monthly allowance.
Medicaid is designed to help the truly indigent. If we steal from the federal government, or the state of California, we steal from our fellow citizens, whose taxes go up to pay for our care. Medi-Cal currently pays about $1,000 less a month than the average private patient. That means nursing homes must raise the rates for private patients to compensate.
“When ethics and self-interest seem to be in conflict, we face an ultimate choice,” writes ethics professor Peter Singer in “How Are We to Live?” My father expressed his choice this way: “I’ve never cheated one penny on my taxes, and I’m not going to start hiding money now. If we outlive our savings, I won’t feel a bit guilty about accepting Medicaid. But I sure as heck am not going to pretend to be eligible before then.”
Every well-to-do senior who hides savings for the gain of his own family and seeks benefits meant for the needy weakens communal bonds. Have we become a nation of Scrooges, counting our own coins with little concern for others?
I’m proud of my father. If my stepmother lives several years in her nursing home, or if he also needs long-term care, their life savings will run out. But he will leave me one thing of great value: an example of ethical behavior in an era when most people are out to grab everything they can for themselves.
