Op-Ed by Travis Boldt – Democratic Candidate for Texas House District 29
For the past 8 years, I have operated a Senior Care agency that helps provide in-home support for aging elders. This has given me a unique perspective in understanding the real-world implications involved in the failure of our healthcare system. Over the years, I have helped thousands of families to navigate this system. Those with resources will find a booming industry, ready to cater to their every need. Those without will find broken and underfunded institutions and be sent down an endless rabbit-hole hoping that the next phone call might lead to some previously undiscovered resource. In Texas, we do a worse job of caring for our elders than any other state in the nation.
American’s final years.
If we ask Americans how they would like to spend their final years, almost everyone will paint you a similar picture; In our own home, surrounded by loved ones who gather near to spend their last precious moments with us, perhaps passing some final key bit of wisdom down to our progeny. It almost never happens this way. 80% of Americans die in an institutional setting like a Hospital or Nursing Home.
Other cultures deal with the biological decline of aging in the home, surrounded by loved ones who are relied upon for the most intimate levels of care.
In Asia, Africa, or South America, businesses like mine are almost unheard of. Elders are venerated, and the expectation is set throughout society that the role of the family is to support the infirm. Frequently 4-5 generations can be found under the same roof sharing the burden of caring for Children and Elderly alike. In America, we are raised to value individualism. As we age, we battle the loss of this independence with the same fervor that our teenage selves sought to gain it in the first place. However, 68% of aging people 65+ will require personal assistance in order to support themselves through their daily routine before they die.
The 800 Lb. Gorilla in the Room.
To complicate things further, the specter of Alzheimer’s Disease looms large over the prospects of families planning for late-in-life care of a loved one. We see diagnosis rates for Dementia exceeding 10% of everyone over the age of 65 and 30%+ of everyone over the age of 85. As treatments for other diseases improve, life-expectancies increase and patients with Dementia face a longer future with diminished control over their circumstances. Currently, there are nearly 6 Million Americans experiencing some degree of Dementia. This number is expected to balloon to over 14 Million by the year 2050. As of today, there are no medications or therapies which can prevent, slow the progression of or cure Alzheimer’s Disease.
Care for a patient with Dementia is fundamentally different than care for someone with their cognitive faculties in place. A well-minded patient frequently can get by on a handful of hours of support per week, normally focused on house-keeping tasks, transportation to vital appointments or basic hygiene needs, even as overall health declines. Indeed, most people would only require true around-the-clock support towards the very end of life.
In contrast, an aging person with Dementia will normally require extensive supervision and support for years (or decades). Care cannot be planned or scheduled, and the patient is frequently either uncooperative or unable to assist with their own care. Frequently patients lose the ability to take their own medications or remain on bed rest after surgery. As the disease progresses, patients may become combative with caregivers, or seek escape from their homes or care facilities.
Dementia support is the #1 reason why families find themselves incapable of providing the support their loved ones need.
Caring for a family with Dementia is one of the more trying tasks a person can engage in. The needs are constant, and to make matters worse, the patients very rarely understand their circumstances or can show appreciation or gratitude towards their caregivers. Over 16 Million Americans are engaged in full-time care for a loved one with Dementia. The Alzheimer’s Association estimates this care represents $244 Billion in labor being sapped from our economy. As the disease expands, so will these costs.
Dollars and Sense
In my role of helping families cobble together care for their loved ones, the most common question that I find myself answering is “So, my insurance will cover this, right?”. Sadly, the answer is almost uniformly “No”. Medicare and Private Insurances serve to support medical needs in a short-term crisis. It is designed to mend the break, or treat the infection, and rehab the patient back up to a level where they can support themselves. It falls woefully short when the patient has lost independence all-together. And it does not pay for residential housing, and it will not provide diaper changes or meal preparation.
Most of the time this burden falls onto a family member. In America, unpaid family-caregivers for aging adults 50+ represent a nearly $500 Billion industry roughly 5x larger than the black-market drug trade or about the size of Walmart’s annual revenue. Roughly half of that cost is associated with caring for individuals with Alzheimer’s disease. By 2050, it is estimated that the cost of providing support for patients with Dementia will exceed $1.1 Trillion.
For many seniors, family care is not an option.
Either they never had children, or the kids they did have live too far away to be supportive. These aging people, who are frequently living on Social Security incomes of ~$1,400/Month, find themselves in a place where their cost of living is inflating rapidly. A decent mid-ranged care facility will cost at least several thousands of dollars per month. Around-the-clock-care or a Memory Care Facility can frequently exceed $10k/month.
These are people who are beyond their working years and have no other way of earning an income. There is no further bootstrap by which they can raise themselves out of this situation. They are left with the unenviable position of resorting to some of the more squalid circumstances that a human being can live in (unfed, unwashed, and unsupported). Like so much of our Healthcare System, Senior Care is designed to support the wealthy, and to hell with the rest.
It didn’t have to be this way
It has long been known that this is a problem creeping over the horizon. As Baby-Boomers prepared to retire, we knew there would be a shortage of care-workers and that our healthcare institutions were woefully underfunded. When the Affordable Care Act passed in 2010, it included over $6 Billion per-year earmarked for Texans to shore up its faltering public healthcare system. This money was supposed to be used to improve state-funded facilities, used by the poorest and sickest among us, to help offer basic health insurance to the 5 Million Texans (including 900,000 children) who currently do not have the means to fund their healthcare, and to provide limited in-home support for seniors with Dementia.
In their wisdom, the Texas Legislature refused to expand Medicaid; Refused to take the $60 billion over the past decade and instead force these people to do without. This decision was not only cruel and shortsighted, it was entirely politically motivated. You see; Republicans could not be seen voting for a program that was funded through Obamacare. Their politics dictated that we must ship that $60 Billion to other states and leave millions of Texans without access to basic healthcare. Not a penny was saved, we were taxed just the same as if we had expanded the programs.
This issue is at the core of my candidacy. I could not longer sit back and resign myself supporting only those who could afford private care. Our system was rotting from the core and my experience provided the knowledge and drive necessary to solve the problem at hand and bring affordable healthcare to every Texan.
“I am a lifelong Texan and grew up in Clear Lake. I moved to Pearland just after marrying my wife, Christine. We were looking for a place to set down roots and raise our family. In Pearland, we found a vibrant and diverse community full of passionate and engaged people facing new challenges and opportunities. We now have a 1-year-old son, Jude, and I couldn’t be happier to be raising him here, where he will have friends from every possible background and a school system preparing him for the world.”
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