Red and I walked into the Mansion Activities Room late one afternoon a couple of days ago, and D— was sitting on the sofa by herself, watching the news on the large screen TV. Sometimes movies are shown there, at this time of day, when the night shift comes on and the Mansion quiets, the TV is tuned to the news until dinnertime, when it is turned off.
D was alone.
On this day, I set next to her, and Red puts his head on her knee.
I like visiting the Mansion at this time of day. It is quiet there, the residents are settling in.
D is transfixed to the news on the screen of the new Senate health care bill. The reporter says it could force as many as two-thirds of the people in nursing homes and Medicaid assisted care facilities – there are 1.8 million of them in America – out of their homes if Medicaid is turned completely over to the states and funded by block grants rather than actual costs, and no longer supported as fully as they are now.
I know D well, she is active physically and mentally but has crippling arthritis in her legs, diabetes, congestive heart failure, and is a cancer survivor. She was an elementary school teacher for 30 years. Her husband died of colon cancer, a long struggle that took all of their savings and all of her pension money.
Mansion staffers will tell you that the patients they get are older and sicker all the time, we are able to keep them alive but balk at paying the cost.
Almost all of the people I meet there were working people, they lost a spouse, needed more care than their families could provide and ran through the savings they had always been told were necessary to get them into a safe and secure retirement. They were lied to, it seems.
We are obsessed with stories and arguments, it is so easy, from our fixed ideological perches, to forget there are human beings attached to them. Our hearts have turned to stone.
It is one thing to read about the immigration crisis, it is quite another to know an undocumented farm worker who lives in terror, avoids the doctor and the police and shops only in remote general stores where she believes federal agents cannot be bothered to go.
The stories seems different from the one you see on cable news when they are reduced to people, something the news media no longer is able to capture since they mostly sit on panels in big cities and argue with one another and call it news. It is one thing to read about the new Senate health care bill, and another to visit the Mansion Assisted Care Facility, where the residents often watch the news late in the afternoon, when the organized activities are over.
The news has become a frightening ritual for many of them.
The Mansion is a Medicaid facility, which means that people who have already used up their savings on health care or who have none almost always have no place to go. Some have stayed with families as long as possible, until their care became so complicated and expensive they had to move. The elderly face soaring life spans and spiraling health care costs. People are kept alive so that businesses can make money off of their illnesses, but then blamed for costing so much money.
There is nothing in the new health care plan to force doctors to consider the implications of keeping people alive by any means at all costs, or to reduce the cost of pharmaceuticals or medical procedures, by far the biggest factor in rising health care costs.
The Mansion is a loving and beautifully run place, but no one should be deluded into thinking it is luxurious and has any extra resources. It does not. Patients can live there but with minimal care, and those who are no longer mobile or who need more advanced care are transferred into nursing homes, from which very few return.
In this universe, that is the end of the line. There is no where else to go. Medicaid pays for most of the 1.4 million people in nursing homes. It covers 20 per cent of all Americans and 40 per cent of poor adults.
Federal statistics show that 64 per cent of Americans in nursing homes are dependent on Medicaid. Every single independent study of elderly care reports the same thing: if this health care bill passes, many will lose their final homes, their last place. It is not possible for me to imagine what will become of them if their support is reduced, rather than expanded.
Since the new law would cut Medicaid drastically, hard pressed states could allow nursing homes to require families to pay a portion of their care, they could also limit the types of services and days of nursing home care they pay for, as Medicare already does.
The new health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. In the many states with expensive real estate markets – New York, California, Massachusetts – that would make eligibility tougher.
Anyone with an older friend or parent, including D, knows that hundreds of thousands of dollars of savings vanish in weeks or months when patients face serious or chronic diseases.
Marketers who frighten people into paying enormous amounts of money into retirement savings don't talk much about the speed with which those savings vanish as people age and live longer. There is no security for the elderly in a country where health care is a for-profit business and a political stand to be exploited by almost everyone, there is no real argument about that.
D was still staring at the screen and shaking her head when the news segment ended and a panel began screaming at one another. She asked me to turn off the TV, "it frightens me when they shout like that," and I shook my head, a former journalist hearing that the news is frightening an 81-year-old woman sitting in an assisted care facility.
D turned to me and asked, "Will we have to leave her? Where will I go? I have no one, no people and no money left. They took it when I came here. Where will I go? I'm not a freeloader."
I did not know what to say, and I understood it was not my job to answer this question for her. I said I would ask a Mansion supervisor to come and speak with her, I just did not know what to say.
I took her hand and assured her that she would have a home, but my heart sank as I realized that might be a lie, politicians can threaten that and still sleep at night.
I felt my face blush, and I realized I was embarrassed for my country, shaming and frightening this sweet and vulnerable woman, wanting only peace and safety at the edge of her life. She has earned that much and more.