The needs of the elderly
must be carefully matched
to the facility's resources

less. Many find that what seemed to be
generous annuity or pension plans
have been reduced to bare adequacy by
inflation, making some degree of fi-
nancial dependence on their children
unavoidable.
There are various ways in which
the cost to the family can be partly
offset by tax advantages, for example,
through a dependent deduction (if cer-
tain conditions are met), through an
outright gift to the parent (up to
$10,000 per year, per parent), or
through schemes which tap home
equities, such as the "Grannie Mae," a
leaseback arrangement in which the
child buys the parents' home, giving
them the right to live there on a rental
basis, which then entitles the family to
the tax benefits of rental property
ownership. However, these can re-
quire a degree of capital or planning
not available to many families, on
whom a parent's chronic illness can
put an almost impossible financial
strain.
Nursing home care, as Ralph
Yamron discovered, can cost more
than many people earn. The average
cost of a bed in a semi-private room is
between $60 and $65 a day. In-home
services can be cheaper, especially if
skilled nursing is not required, but
costs can mount alarmingly.
Homemaker and sitter services, for
example, range from $6 to $16 an hour,
often with a three-hour minimum.
Most older people are covered by
the government-funded Medicare pro-
gram (or Medicaid, if low-income
eligibility requirements are met), but
both programs have strict limits of
coverage. A rigid and often frustrating
differential is made between skilled
and basic care. For limited time
periods, Medicare will pay all or part of
the cost of skilled care but, contrary to
popular belief, it does not pay for
chronic, long-term nursing. Nor does it

cover basic care (bathing, lifting, etc.).
Medicaid will pay for both skilled and
basic care, but its eligibility require-
ments exclude many who cannot af-
ford the necessary services.
There is very little private insur-
ance available to cover the cost of
long-term custodial care. However,
the American Association of Retired
Persons is testing a policy, developed
with Prudential, which is intended to
cover long-term costs and will not
exclude the chronically ill. Some sup-
plemental "Medigap" insurance
policies, including those recently in-
troduced by B'nai B'rith, help to fill the
gaps in Medicare coverage.
The Yamrons fell through every
gap. Ralph's mother's protracted and
terminal illness had exhausted his
father's savings and insurance cover-
age. Basically, because Jack was liv-
ing with the family and not paying
rent, he was not eligible for Medicaid.
Because he was not considered in need
of skilled care (although, ironically, he
was diagnosed thtee weeks before he
died as having cancer), he was not elig-
ible for Medicare payments.
He was not sick enough to need
nursing, but he was too sick to look
after himself. We were not poor
enough and not rich enough. Every
door was closed to us," says Marlene
Yamron.
Some safety nets do exist. The
Community Care Management pro-
gram, run by the Area Agency on Ag-
ing, is designed, says Elizabeth Sulli-
van, to serve those who, for whatever
reason, fall out of other program
guidelines."
Since it was started in May 1985,
the program has helped about 85 frail,
older people to "remain independent in
the community, in their own home or
the home of the family." Sullivan calls
it a goal not only desirable but neces-
sary as the numbers of frail elderly

increase while Medicare and Medicaid
payments are increasingly restricted.
Most clients are referred by hospital
discharge planners or home health
agencies, but some are referred by so-
cial service organizations, including
the Jewish Family Service.

Community Care Management
staff develop "personal and indi-
vidualized schemes of care" for each
client, calling on the agency's com-
prehensive range of services, which
include adv ocacy, counseling and legal
assistance as well as those which cater
to physical needs. Attention is also
given to the needs of the care-giver,
who in many cases, is also elderly.
The agency is a broker for
community-based services in six coun-
ties and most of its services are acces-
sible to anyone 60 or over, regardless
of income.
"Care of the elderly and support
for the family providing that care" is
also a major concern of the Jewish
Welfare Federation which acts, says
staffer Lawrence Ziffer, as a "central
planning resource and fundraising
agency" for a wide range of organiza-
tions and institutions within the
Jewish community. Its aim, says Zif-
fer, is to provide "a continuum of care
for the Jewish elderly, whatever their
income," in a network of services
which include the institutional care
provided by the Jewish Home for the
Aged, in its facilities at Borman Hall,
Prentis Manor and Fleischman Resi-
dence; subsidized housing in the two
Federation Apartments; and an exten-
sive range of support services, many of
them provided by the Jewish Family
Service, one-third of whose case load is
made up of the aged.
In spite of the availability of sub-
sidized agency help, many families
remain in need for several reasons.
Some are too proud to ask for aid.
Others are unaware that services exist
— a fact which has prompted the in-
stitution of the Jewish Information
Service, which, like the information

Continued on next page

Choosing A Home

What do the experts recom-
mend you look for in a nursing
home? The first thing to check is
whether it and its administrator are
licensed. Determine whether it of-
fers skilled or basic care, or both.
Some residents, who do not require
skilled care, are happier in basic
care facilities. Others prefer to be
where a sudden change in their
condition will not necessitate a
move.
Check on emergency medical
services and find out what routine,
regular physical examinations are
made. Do they include dental, hear-
ing and vision check-ups? Ask the
ratio of staff to patients and about
the qualifications of the staff. Find
out if physical, occupational and
speech therapy are available and
how the home provides for the men-
tal health needs of residents.
It is important to be clear about
the home's payment policies. Medi-
care and/or Medicaid payments will
only be made to cover expenses in-
curred in homes certified to partici-
pate in these programs. Many
homes prefer not to take Medicaid
patients, since the payments are so
low. Find out what happens to pri-
vate pay patients who later apply
for Medicaid, and to those who are

reclassified from skilled to basic, or
vice versa. Be sure exactly what is
included in the basic charge. Some
rates are comprehensive, but many
are exclusive of "extras," which can
include anything from wheelchairs
to toilet tissue.
Visit the home at least twice
and preferably at meal times. Ask
for a tour of the entire home and
check that it is warm and clean.
"Smell it," advises Renee Mahler of
the Area Agency on Aging. "And
don't be deceived by the odor of dis-
infectant," which can be used to
mask the smell of urine and dirt.
Check the fire escapes and emer-
gency exits. See if there are call but-
tons by the beds. Notice how much
privacy the rooms afford.
A lot can be learned from ob-
servation of the general atmosphere
and the interaction of the residents
and staff. Talk to both, if possible,
and find out what recreational ac-
tivities are scheduled on and off the
site.
Look for a home which
encourages visitors and which you
will feel comfortable visiting. Con-
tinued family involvement and fre-
quent visits can make a significant
difference to a resident's well-being.

47