Eldercare Difficult For Families As Economy Suffers An estimated 1.5 million Americans reside in nursing homes, many of whom heavily depend on the financial support of relatives. But a national increase in job losses and a struggling health care system leave some families struggling to provide quality care for loved ones.
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Eldercare Difficult For Families As Economy Suffers

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Eldercare Difficult For Families As Economy Suffers

Eldercare Difficult For Families As Economy Suffers

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And now it's time to go Behind Closed Doors. That's our weekly conversation, where we take on issues that are often kept private due to stigma or shame.

For millions of Americans, the current economic crisis has hit where it hurts the most: The family. It's had a great impact on the ability to care for elderly loved ones, especially those in nursing homes or assisted living facilities or those who need to be in those facilities.

It's estimated that about one and a half million Americans already reside in nursing homes, many of whom depend on the financial support of relatives. But with job loss and a struggling healthcare system, some are wondering how to afford quality care for the people they love most.

Joining us now to talk about this are NPR senior business editor Marilyn Geewax, Jen Frumer is an associate executive director at the Alpert Jewish Family and Children's Service in West Palm Beach, Florida, and Adolph Falcon, he's a senior vice president at the National Alliance for Hispanic Health.

Welcome to you all. Thank you for joining us. I feel I should let you know that I'm also facing this dilemma right now. So I'm eager to hear your insights, and I promise not to cry if you promise not to cry. We'll try to keep us all in place here.

Marilyn, let me start with you. Just yesterday, you placed your aunt in a nursing home.


MARTIN: How hard was that?

GEEWAX: Yesterday was her first day, and I've got to say that everything that's led up to it was really difficult. But yesterday evening, I kept trying to call her room to see how she was doing, and I got a hold of the - she wouldn't answer the phone, and I finally got a hold of someone who worked there and said oh, well she was dancing at the happy hour, and then she went to see a movie.

And I can't tell you how tears of sorrow and anger have been turned to tears of joy to know that finally after this long process, we've got her into someplace where she has some social interaction, where she can watch a movie with other people. It's been tough but I think worth it.

MARTIN: What's been the long process? Tell me about it. You said there's been a long process. As I understand it, it's been, like, three years, a three-year effort to try to get to this point.

GEEWAX: Well fortunately, my aunt now is 82 years old, but when she was in her late 70s, she started to realize she was going to be having problems, and she asked me if I would take responsibility for her. She's a widow and had no one else to take control of her situation.

And I said okay, I'll do that, but I had to fly down to South Florida and meet with an attorney - and I really recommend that to anybody who sees that they're going to have a problem in coming years to first establish that relationship while your relative is still able to sign papers and make decisions. And that way at least I had durable powers of attorney. I had a trust set up. I had some legal standing to take control of this situation.

MARTIN: But why did it take three years to get to this point?

GEEWAX: Well, after I got the control over her, she said well, but I don't want to move right now. I'm fine, and you know, this is for down the road.

Well, when do you decide along that road when is it the tipping point? When do you have to make her move? And I kept being reluctant to get her out of her house because she loved her home. That is her home.

But what I found, finally last year, I flew down and realized that she was just surrounded by what I consider Florida's vulture industry: Where cleaning ladies who focused primarily on cleaning out the bank account, a church group that wanted to have her sign her house over to them, a roommate...

MARTIN: A roommate.

GEEWAX: Yes, who had her buy a car for her. And when I sat down and went over her assets, I realized that as she was losing her memory, she didn't even remember that she was signing $2,000 checks for, you know, a little light housework.

MARTIN: And then how has the economy factored into all this?

GEEWAX: Well, what I found is that you know, as I realized we've got to move her, got to move her, and got the court - I finally got a court order to create a legal guardian over her. And then, now the question is how do you sell a house. That's really her only significant asset, to sell the house to help pay for this assisted living that she so desperately needs.

Well, I finally got everything set up. I've got the guardian. He's wonderful. I got everything done, and she's moved into the assisted living. But now a key factor here, going forward, is I have to sell that house to create enough to money to pay for it.

Well, how do you do that in an economy in South Florida where housing prices are plummeting? Houses sit on the market for months, years. What do we do if she runs out of her cash before I can sell that house?

MARTIN: Well, let me bring Jen into the conversation and, Adolph, you as well, and I need to say we're going to take a short break in a minute, but we're going to come back and spend a lot more time on this conversation.

But Jen, let me go to you. How many stories like this are you hearing?

Ms. JEN FRUMER (Associate Executive Director, Alpert Jewish Family and Children's Service): Oh boy. Marilyn's really describing the most typical type of story. I think southeast Florida is an unusual place because we have cohorts of people who are aging together, neighbors.

The natural resources aren't really there, and the vulture industry, as you describe, is really rife. We actually run a guardianship program, and over 50 percent of our wards, is what they call them if they've gone through the court system, are actually exploited by people close to them: family, friends, neighbors.

It really is a problem. And the resistance that you describe, as well, is something that we as professionals are working with all the time, older adults who - and we'll probably all be the same - who just aren't ready to make that move that they often perceive as kind of the last leg of their lives.

MARTIN: How is the economy factoring into this? Are you seeing these predations that Marilyn told us about, do you think people are getting more aggressive about these things, or is it just such a tsunami of factors it's hard to isolate any one of them?

Ms. FRUMER: Well down here in Florida, I mean, I think we've noticed the demographic wave, and for years it's been a problem for older adults who are now really dependent only on their Social Security income or maybe a pension, which can range for the typical is $800 to $1,100 a month.

And so for years we've seen that, but family members have often pitched in, and they've often helped out by sending two or three or four - or sometimes even more - hundred dollars to really help supplement the income of that older adult who's paid off their mortgage many years ago.

And there are homeowners' assessment fees and other kinds of fees, social club fees. We're living in southeast Florida - sometimes makes it really challenging because those can average $500 or $600 depending on the development.

So family members have come to the rescue, and now family members themselves are struggling. So it factors huge in terms of the economic backlash.

MARTIN: Adolph, let me bring you in just briefly before we need to take a break. Talk about your, both your own situation, and, if you could, start by the community that you work most closely with.

Mr. ADOLPH FALCON (Senior Vice President, National Alliance for Hispanic Health): Well first of all, I have to commend Marilyn because she did the right thing.

One of the things we often put off until the last minute is look at the legal issues. And in order to help our parents, help our grandparents, help our aunts and uncles, one of the first things we need to do is really deal with the legal situation. And you know, that's a conversation that's difficult to have and, unfortunately, we put off many times - and I see it again and again in families - until it's too late.

And then you really can't provide the kind of help you need to provide. The other thing that Marilyn did was really watch out for fraud issues. It's really a horrible issue that in their golden years, so many of our families have to face fraud issues.

The good news is that the worst illness older adults face is social isolation, and Marilyn has changed that. She has brought social connection back to her loved one's life, and that really is going to change both of their lives.

MARTIN: We need to take a short break, as I mentioned, but when we come back, we're going to continue talking with our guests about how the recession makes caring for elderly relatives that much tougher, but we're also going to get some encouragement about how we can manage these very difficult issues.

So I'd ask everybody to stay with us on TELL ME MORE from NPR News. I'm Michel Martin.

(Soundbite of music)

MARTIN: I'm Michel Martin, and this is TELL ME MORE from NPR News. Coming up, I'll tell you what I think the dispute between Rush Limbaugh and Michael Steele is really all about. That's my Can I Just Tell You? Commentary, and it's in just a few minutes.

But first we're going to continue our Behind Closed Doors conversation. We're talking about how the economic downturn is affecting how we are able to care for loved ones in nursing homes or assisted living facilities or those who need to be in those facilities.

We're speaking with NPR's senior business editor, Marilyn Geewax. She just was able to place her aunt in an assisted living facility just this weekend. Adolph Falcon is senior vice president at the National Alliance for Hispanic Health, and Jen Frumer is associate executive director at the Alpert Jewish Family and Children's Service in West Palm Beach, Florida.

Adolph, before we took our break, you were talking about - we were starting to talk about how perhaps ethnic factors may influence this conversation. But I wanted to, if you don't mind, ask you about your own situation. You've been dealing with this with your mom, as I understand.

Mr. FALCON: Well, I've been dealing with - my mother passed away about a year and a half.

MARTIN: I'm sorry.

Mr. FALCON: It was the end of a long journey. I'd been dealing with it for about 10 years, and many of the same circumstances that Marilyn talked about I found were true.

My mother and my father had bought our home in Corpus Christi, Texas, in south Texas, when they were a young couple. That was not a home she wanted to leave. That was the home that she raised her children in. That was - it was the symbol of their success, and it was a many-year process convincing my mom to leave that home.

And you know, we talked about raising children, and you know, it's the common phrase it takes a village. You know, with an elderly parent, it also takes a neighborhood.

Without the help of friends and with neighbors, I would've never been able to get it done. And the expectation in Hispanic families is that the family lives near each other and that they will care for each other, often in the same household.

But like the rest of America, Hispanic families are changing. Children are moving away for school, they're moving away for jobs. And particularly now in this economy, where there's a job available, you need to move.

MARTIN: Can I ask you, though, if you've ever felt criticism or judgment from either family or relatives about the fact that your mom did not live with any of her kids, even if it was her decision? Did you ever feel, like, criticized or judged because she was still in the home?

Mr. FALCON: I did. There were family that had conversations with me. There were friends in particular of my mom's that had conversations with me, as if I didn't realize what was going on - or why haven't you moved her out.

The reason - I was living in Washington, D.C., she was living in south Texas - the reason I hadn't moved her out is my mom has her own will, and she wanted to stay in that house, and I couldn't move her out. So I put together a patchwork of care, which I think is a very common experience of adult children, is they have to find a patchwork of care.

It's people that they can hire to come into the home to do certain activities, be it cleaning the house, help - assistance with certain activities of daily living, making sure medication is right, but also neighbors and friends coming and checking in. You know, one of the most important things I did was to take charge of the check book, because the same situation about fraud started to happen - was happening to my mom.

MARTIN: Well, that's another issue I wanted to point out, though, is the kind of neighborhood your parents live in is a factor in how you are able to care for them or whether you even want to keep them in place. I mean, for some of neighborhoods there's a reason why people are leaving them, right? But if the kids have left and they don't want to live nearby - and perhaps that the senior doesn't recognize that the neighborhood is not what it was when they first moved there.

And there's a bridge - there's a gap of understanding about the circumstances that they're in. And there's also, and we've reported on this, a gap sometimes in the willingness of agencies to service certain neighborhoods. Marilyn, you wanted to talk some more about how the economy is playing into what's already a difficult dynamic.

GEEWAX: Well, it's just so bad on so many levels in terms of taking care of the elderly, because, as you said, that when the economy is so poor, people don't want to take time off of your job. I mean, it was difficult to say, okay I'm going to take some time away from NPR here. This is a new job for me. I don't really have vacation time. So, it was difficult to even begin to deal with this. Well, that's true for many people. If you've lost a job, you're in a new job, how do you have time to deal with this. Do people have enough money to hire people, as you were saying you did for your mother?

Well, in these tight times, maybe you don't have money to hire reliable cleaning ladies, or whatever. State cutbacks are also a factor. We're seeing there's just not enough money in the system. People are closing community centers - places where the elderly could go for some socialization, some recreation is a problem. But probably overriding all of that is the housing crisis, because in places - Michigan, Ohio, all over the Midwest especially -there are so many houses sitting on the market that many elderly people, even if they want to move in with their children, even if they want to go to assisted living, they just can't sell that house.

MARTIN: And could you talk, if you don't mind, about your own situation: While you were trying to persuade your aunt to move, her house was declining rapidly in value. Do you mind giving us some parameters?

GEEWAX: She bought that house years ago. It was just a modest house, I think she paid $120,000 for it or something, 20 years ago. Well, three years ago, she called me and said, well a realtor just came to me and said she has somebody who wants to buy the house for $400,000. I was like, sold, yes that's it. Take it, take it. She was like, no but I love this house, I don't want to move. So now, we're looking at, you know, three years later in South Florida - maybe, if we're lucky, something like 250,000. But how do you deal with that kind of a loss of, you know, equity? At least, she owns the house outright but…

MARTIN: But you're worried that the money to support her care is going to evaporate far sooner than (unintelligible).

GEEWAX: She's in great health. She'll probably live at least another 10 years or so. I hope she has a good and long and happy life in assisted living, but to afford that, we have to be able to sell that house. And in a market where you're seeing the price drop from 400 to 250 to - where will it be six months from now. I don't know. How much money can I get for that? So everyone is dealing with this in all sorts of markets. No matter where you are in the country, you don't really know what your parents' assets are.

MARTIN: Jen, are you seeing people who are - because of the factors that Marilyn just described, job loss and this contraction of housing values -unable to pay the bills at these facilities where their family members are already residing or unable to move them in? Jen, I think we're having difficulty with your line somehow, so we'll go to Adolph on this. Adolph what about you? You're advising people at all income levels, I would imagine. Are you seeing this in the communities that you serve - people because of job loss, people because of the contraction of assets unable to afford the care that their relatives need. What are people doing?

Mr. FALCON: Sure. Our options weren't great before the economic crisis and they've only gotten worse. Assisted living is expensive. I had the luxury of being able to move my mom into assisted living. And it certainly had a dramatic effect on her life because it removed her from social isolation, and those were some very good years in her life. But that's not a luxury many families have and, particularly in this economy, it's a luxury more and more families do not have.

And it's basically an issue of national policy. We've been hiding from this issue for so long. And it's really important that we start looking at issues of long-term care, that we start saving for our elder years in our working years. Social Security just simply can't do it all, so we really need to be moving forward on policy.

MARTIN: Jen, can we bring you back into the conversation. We were talking about - Marilyn was talking about - the fact that in those years that she was trying to persuade her aunt to move and to sell her house, the house has declined dramatically in value. Are you seeing this with people that you work with in Florida and how are families responding to this?

Ms. FRUMER: It's a huge problem, and unfortunately, I wish I had some of the answers. What we are finding, though, is that families, through our encouragement within our role as case managers are able to help facilitate discussion and families are talking about options. We really encourage communication. Adult children aren't - as someone said earlier, one of you guests - just aren't able to keep flying down to Florida. And so, there are services whereby the patchwork piece can actually be facilitated by a professional and within that professional role, be the eyes and the ears locally for adult children.

Life-planning is such a critical issue. I think that for many of us when we think of the end of our lives, we do wills and we do estate planning, but rarely do we realize that we are most likely going to be disabled, for whatever reason - acute or a chronic illness, or dementia - and so be able to plan for those things. And then regardless of the planning you've done, now given the economic situation, you are faced with these kinds of options and limited resources. And having lived in Florida for 23 years, I really do see the change. There's no one cookie cutter approach or one cookie cutter answer.

It's really working with the families to understand the big picture, to understand what resources can be brought to bear. And it's not often that one can sell a home or use those, you know, proceeds to help fund long-term care, so I see it becoming even more and more of a problem. We don't know what the bottom is.

MARTIN: Marilyn, we only have about a minute and a half left. So just in this journey that you've been on, do you have some advice for how people can possibly get ahead of this, even opening up these conversations?

GEEWAX: Boy, the most important thing it seems is to just at least begin that legal process while your loved one is still rational enough to be able to sign papers, to make decisions, to get that power of attorney, to create some kind of a relationship that they have a living will, that they set up a trust, that they have given you durable powers of attorney. And then at least it gives you some kind of a handle on the problem. But if I hadn't at least had an attorney to work with - gosh, I don't know, we would've been terrible shape. So fortunately for me, at least, my aunt opened that conversation while she still had, you know, her ability, her capacity to do so. But I don't know where we would be today if I hadn't had that basic conversation years ago with her.

MARTIN: Well, at least things are moving in the right direction now.

GEEWAX: Now, I just need that real estate market to turn right.

MARTIN: We'll all keep our fingers and toes crossed for that and thank you all so much for being willing to share these stories, which are not easy. It's not easy to talk about. Marilyn Geewax is NPR's senior business editor. She was here with me in our Washington D.C. studio along with Adolph Falcon of the National Alliance for Hispanic Health. And Jen Frumer joined us from Florida. She is the associate executive director at the Alpert Jewish Family and Children's Service. She was with us from West Palm Beach, Florida. I thank you all so much for speaking with us today.

GEEWAX: Thank you.

Ms. FRUMER: Thank you.

MARTIN: And now we want to hear from you. Is the recession affecting your ability to care for elderly relatives? Instead of a nursing home are you opting to care for relatives at home? Are you hopeful that healthcare reform will affect this issue, as Adolph was just describing for us? To tell us what you know and to hear what other listeners have to say please call our comment line at 202-842-3522. That number again 202-842-3522 or visit our Web site, the TELL ME MORE page at npr.org and blog it out.

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