23. Promises

Ken made a promise of sorts to Darlene. The two fictitious people who had reason to fear institutionalization.   Both subconsciously knew it was a contingent kind of pledge. Only a hope that Darlene would be kept at home through the caregiving years.

But the attempt to somehow control the future was important to both.

Predictably, when Alzheimer’s is involved, the promise of keeping the afflicted loved one at home is often broken. But Darlene’s plea to Ken was understandable. That she be kept at home until the end. Especially given experiences she had when growing up.

Those experiences started with losing her father in the war. And then acquiring a cruel stepfather who abandoned her mother, Betty.

The stepfather walked out the instant Betty showed signs of dementia. When that happened, Darlene’s fears were amplified by having to assume caregiving responsibilities for her mother. Then having to help her mother resort to the use of Medicaid and a substandard long-term care institution.

I wrote the fictitious story about Betty’s situation with gloomy underpinnings. They greatly impacted her daughter Darlene, as she realized a similar future could await her.

The fictional scenario might have been made much worse. Based on daily reports we hear about the deficient care of elderly people. Abuse, accidents, understaffing, incompetence, and deaths from viruses and other preventable diseases.

Darlene’s fear put an enormous amount of pressure on husband Ken. The emotional response I wrote into his story was also mine.

Panic attacks and severe feelings of claustrophobia.

For me, those reactions were in addition to bouts of depression, which are more common. Unlike many men, my reactions did not result in some form of medical emergency.


You may have noticed that at the end of the scenario I did not discuss Ken and Darlene’s finances, something I did in Betty’s case. Betty qualified for Medicaid because she was living below the federal poverty level. She may have also qualified for a myriad of other reasons, much too lengthy to recount here.

Bottom line: Betty was destitute and could prove it. And Ken and Darlene, and other members of the family, did not have the financial resources to help.

To use an archaic term, Betty essentially became a kind of “ward of the state.” That isn’t a legally correct designation any longer, but it’s kind of the same difference. Governmental funds took care of her.

I didn’t discuss how Ken and Darlene would pay for her care in a residential care facility. Early in the storyline, I noted Darlene’s concern about their limited resources. But I didn’t elaborate on that concern later in the scenario.

But financial resources are a big deal on many levels.

In fact, as painful as the subject can be, I intend to use Ken and Darlene’s story as a starting point for addressing the challenge of finances in the remainder of Alzheimer’s and the Husband.

I purposely did not give information on the kind of work Ken and Darlene did, or anything that revealed their socio-economic situation. Just that they could not afford to pay for institutional care for Betty, Darlene’s mother.

At the end of the scenario I conveyed the idea that Ken found an acceptable memory care facility to enroll Darlene as a full-time resident.

How he planned to pay for her care was not mentioned. In the story I created, I gave Darlene a sister, but she could not earlier assist with their mother’s care. Were things different now?

Possibly Ken’s parents both died and gave him a nice inheritance. Or not.

And how about their three adult children? Maybe one or two of them were prospering in a fine profession and had a bundle. Perhaps one of them married rich. And one of these prosperous adult kids was loving and generous, pledging to do anything to ensure good care for their mother, Darlene.

Maybe a fiscal fairy tale would come true. It happens all the time. If it did, Ken would still suffer from breaking promises to Darlene, and feel all the associated guilt. But at least he wouldn’t need to worry about money issues.

What would happen if, instead of a fiscal fairy tale coming true, Ken was looking at a possible financial disaster. Less than $150,000 in savings. A monthly salary of less than $5000. No long-term care insurance, A remaining house mortgage of $125,000 with a monthly outlay of over $2500. Mortgage payments, insurance, utilities, home and car maintenance, food, pharmacy, small incidentals. And even more if there is any kind of health emergency of his own.

Ken is now 67 so he can collect the second-tier amount in Social Security and qualify for Medicare. Darlene would also receive something from Social Security and be qualified for Medicare. Those things help.

But Medicare does not pay for residential or even in-home care. Except when a patient qualifies for hospice services. While helpful, hospice assists with quality of life problems in patients not expected to survive the disability. Darlene has not reached that point.

Residential care costs are not covered by Medicare, so Ken is looking at shelling out over $5800 a month for Darlene’s BASIC care.  If he continues working and stays healthy himself, and Darlene lives years more, the savings account will be quickly depleted.

And it could be worse.

If Ken loses his job for something like age discrimination, chronic illness or disability, he too will need to think about Medicaid as the only remaining option. The rules surrounding Medicaid are complex, so there are now many attorneys who specialize in both estate planning and how to qualify for Medicaid. They could help Ken through the maze of options left open to him. But they aren’t cheap, even when fees are partially covered.

So how should I have written the story line of Ken and Darlene? In some ways it does not matter. There is no happy ending in terms of how guilty Ken feels about breaking his promise to Darlene. He will likely be depressed over time. But, as with me, his emotions might become less intense. At least about Darlene.

What happens to him otherwise, in the context of his own health and management of finances, might have to be a different story.

Continue to seek ways to take care of yourself.

©2020 Stu Ervay – All Rights Reserved

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