Despite the fact that she dedicated more than 16 years to caring for her mother, Janice Zazulak still feels a lot of guilt. Zazulak, a practice manager for a group of physicians in Metairie, began looking after her mom when her father died in 1990. At first, her mother was well enough to live in an apartment complex that had lots of senior citizens. But gradually her health slipped, and last year Zazulak moved her mother to an assisted living home on the West Bank. A few months later, her mother fell and broke her ankle. The surgery seemed to bring on more problems.
Zazulak felt like a person on a carousel, trying to visit her mother, line up sitters, field emergency phone calls – all while holding down a job and caring for her own family. “I would get very frustrated,” she says. “I would really get down. It wasn’t easy.”
Tragedy struck during Hurricane Katrina, when Zazulak’s husband had a heart attack just as the city was evacuating. She went through the hurricane at her husband’s bedside at East Jefferson General Hospital. Her mother was evacuated two days after the storm. Luckily, her mother’s caregiver stayed by her side on what turned out to be a horrendous bus ride during which several elderly people died.
Zazulak’s mother, 87, is now in an assisted living facility in Dallas, where another daughter cares for her. That’s where the guilt comes in. “She was so much a part of my life, and I always felt guilty that I didn’t do more,” Zazulak says. “We go every two months to visit, and even now, I call her every night. I do miss her, but my life is so much easier now.”
Thousands of baby boomers are walking in Zazulak’s shoes as their parents enter their final years. Even those whose elderly parents are healthy and financially independent can suddenly find themselves scrambling to line up housing, caregivers and physicians when Mom falls and breaks a hip or Dad suffers a stroke.
The situation is especially precarious for those of us in New Orleans because the community’s resources for the elderly haven’t returned to their pre-Katrina levels. Nursing homes and assisted living facilities can’t hire enough labor to open all their beds. Many senior citizen and adult daycare centers were flooded and are still closed. Hospital beds are fewer, physicians have left town and nursing homes are already worrying about how they will evacuate their residents during this year’s hurricane season.
Insurance issues
Just like buying a house or choosing a college, finding the best care plan for an aging family member can be easier if you learn about the options beforehand. One of the most complicated issues to navigate is that of insurance. Experts say that if they could tell adult children just one thing about health insurance, it would be that Medicare does not pay for nursing home care. Medicaid, the federal health insurance plan for the indigent, does pay for care at some nursing homes, but generally the more attractive, well-staffed homes are private pay, and that can run up to $3,000 or $4,000 a month. Medicare does not cover the cost of assisted or independent living facilities, either.
It’s a good idea to talk with your parents while they are still healthy to get a clear picture of their financial situation, including whether they have long-term care insurance and where their assets are. One niece learned only after she had cleaned out her elderly aunt’s refrigerator that the aunt had literally “frozen” her money inside of containers of food. Other caregivers tell stories of parents who aren’t sure which banks they have money in, or who have deeds to paid-for cemetery plots stashed away in safe deposit boxes they’ve forgotten about.
It’s also important to know whether your parent has a Medicare managed health care plan or traditional Medicare plus a supplemental insurance policy. Medicare HMOs have service areas, and if your relative moves outside of the plan, he or she might have to drop the coverage and join another plan.
Mike Putiak, a spokesman for Peoples Health, which administers Tenet Choices 65 and several other Medicare advantage plans, says that according to federal guidelines, if a Medicare HMO member is outside of the service area and needs immediate medical care, that care must be provided. During Hurricane Katrina this provision kicked in for hundreds of senior citizens. Tenet Choices 65 serves only the New Orleans metropolitan area, and during the evacuation many members found themselves in Houston, Atlanta and other cities outside the plan. Tenet, like most other managed health care plans, told its members the insurer would cover the cost wherever members obtained care, even if they had to go outside the network.
Putiak says that federal law requires members to live in a plan’s designated service area to continue to receive coverage; if they leave the service area for more than six consecutive months, they must be dropped from the plan. So far, he says, many plan members living out-of-state are still keeping their New Orleans addresses. He expects this situation to shake out as people make decisions about whether or not to return home.
Where should home be?
Years ago, there was never any question about where Grandma and Grandpa would live when they became infirm. People lived with their families, and it fell to daughters or daughters-in-law to care for them. Today, choices abound – independent living, assisted living, nursing homes and everything in between.
But thanks to Katrina, finding housing in the New Orleans area has become more difficult than ever. Before the hurricane, about 40 percent of the licensed assisted living space in Louisiana was in greater New Orleans, says Lisa Comeaux, president of the Louisiana Assisted Living Association. Today, some of those facilities are permanently closed, and others are only partially open because they can’t hire enough caregivers. Waiting lists are especially long in areas such as Baton Rouge, Comeaux says, where many former New Orleanians are living.
Nursing home space is also scarce, says Joseph Donchess, executive director of the Louisiana Nursing Home Association. Sixteen nursing homes in the New Orleans area are closed. Several should reopen this summer, but even with plenty of beds, availability is down. “Manpower is the problem,” Donchess says. “We can’t fully staff the beds we have.”
Lack of workers also makes it difficult to keep elderly people at home with sitter/companions, says Dianne Boazman, cofounder with Betty Landreaux of Care Management Solutions, a Metairie company that helps people find care for their elderly relatives. Boazman and Landreaux added a home health agency several years ago but since Katrina, they have lost many of their employees.
The issue of home care versus an institution is complicated, Boazman says. She had a client who lived at home with a caregiver until she was 98. Finally, her relatives put her in an assisted living facility. “I was afraid she would decline from the shock,’ Boazman says. “She had Alzheimer’s, but she ate breakfast, socialized … she came out in an amazing way,” Boazman says. “She looked much better than she had been at home.”
But other elders do better in their own house, even if they have to get a reverse mortgage to afford to it. Laneaux had a client who at 91, with major dementia, got lots of pleasure from living in her Uptown home, getting dressed up and going out with a caregiver to eat in a restaurant or get her hair done.
Help for aging minds
Often the symptom that prompts adult children to seek help for their parents is a failing memory. Dr. Ted Bloch, III is medical director of the Geriatric Assessment Program at Touro Infirmary. He points out that not all memory-related problems are caused by dementia. Depression, anxiety, or untreated and undiagnosed adult deficit hyperactivity disorder can all cause memory problems, Bloch says.
Bloch is a board certified geriatric psychiatrist – one of only several left in the city since Katrina – and his geriatric assessments include an interview with him, testing by a neuropsychologist, an evaluation by an occupational therapist and a review of the patient’s medical records and medications by a registered nurse. Lab tests, including imaging studies of the brain, are done to rule out other medical causes of cognitive problems, such as a subdural hematoma. Patients are screened for strokes and tumors as well.
Not every older adult needs this kind of examination, Bloch says, but for those with cognitive disorders it can be the only way to get a clear picture of what is causing the problems. “There is a bias of in our society that older people are supposed to be impaired cognitively,” he says. “That simply is not true. A lot of times, these things are treatable.”
Keeping an elderly person in his own home is preferable if the resources are there to hire sitters, and if wandering, urinary incontinence or severe agitation don’t become too big of a problem, Bloch says. On the other hand, if the money isn’t there for sitters and the senior would be alone most of the day, adult daycare might be a better choice, he says.
Post-Katrina, the picture for elderly people with cognitive impairment is grim, Bloch says. There are very few inpatient psychiatric beds, and the hospitals who do have them are bursting at the seams. “DePaul’s is gone, Charity is gone, places you might have been able to hospitalize any kind of geriatric patient aren’t there,” he says. He estimates that before the storm there were about 189 psychiatrists in the greater metropolitan area; about 22 remain.
Adult daycare programs are also scarce, as are therapeutic programs for patient’s with Alzheimer’s. The Orleans Parish Council on Aging, for example, had 17 senior citizen centers before the hurricane. Today only five are open.
People who are on the fence about whether to bring their elderly parents back to New Orleans need to weigh carefully whether the type of support they need will be available, says Zazulak, whose mother will remain in Texas. Caring for aging family is difficult under the best of circumstances, she says. In a city still recovering from its own trauma, some people may decide it’s impossible. “It’s hard for all of us now,” she says. “Life is not easy. I know my mother is better off.”
