Age-wise: Heartbreak stories: The middle income elder crisis

“Provide preventive advice on issues of long term care, and assist families in finding resources to help cope with the unique circumstances they find themselves facing.”

— Age-Wise Mission

Since I retired from a consulting practice of geriatric care management, my primary “professional” activity is as a “Dear Abby.” Whether by email, text or on the street, the questions are frequently the same — “what can I do about ... mother/spouse/neighbor?”

When called on for advice, it is often under pressure with vulnerable elders who identify as middle income age 75 or older. Information and referral is easy, but quickly finding funds and facilities if needed is increasingly difficult, and a cause for state-wide alarm.

Too often the heart-breaking stories involve lack of answers from health care providers (or failure to comprehend the complexities of jargon and bureaucracy). And the most difficult situations seem to come from those who have avoided my “harp” of the past 25 years.

Many families do not anticipate tragic circumstances or are in denial of potential health issues. My wife was diagnosed with Alzheimer’s disease 20 years after I became a geriatric educator, a career decision for which I am grateful in preparation for my own role as a caregiver. The experience forced long-term care planning.

Folks may be confused about all the options and resources, which leads to avoidance of sound planning. Because Medicare does not cover long term care, waiting for the crisis is the very worst preparation for the inevitable need to have things in order.

A common question is “what do I do for my long term care in later years, or after a debilitating disease like stroke or dementia, if I do not have long term care insurance?”

The cost of insurance at a late stage, or institutional fees per month seem out of the question.

Some inquiries to “Age-Wise” come from readers with questions such as “I am looking for some advice on where to get help with my mother along with other seniors.” Many stories are “horror tales” of confusion, misinformation, and/or questionable health care practices.

Anecdotal evidence suggests that older people’s dignity and autonomy is being undermined in the health care setting ( I hear stories such as “He sat for hours in excruciating pain with health care workers and was sent home after they pumped him full of drugs to ease the pain; he then drove himself to a hospital and they admitted him — this has got to stop!”

Cited by a study recently in Health Affairs, many of these middle income seniors (currently identified as $25,000 to $75,000 per year) will not be able to afford assisted living or medical care. The difficulty of placement of a neighbor’s loved one with dementia prompted me to address the issue with New Hampshire State Plan on Aging officials.

In a nutshell, these concerns were:

Inadequate number of placement facilities (assisted living, nursing and memory units)

Cost of rental and care (dementia units range from $6500 to $10,000-plus

per month)

Waiting list issues (often the sale of a home necessary for admission)

New rules and protocols (especially when new ownership/profit — non-profit)

No admission or transfer if Medicaid eligibility is looming

So what can be done? Experts are working on it and the short answer is to contact Monadnock Service Link, an aging and disability resource center (state-wide but in Keene on Castle Street, 357-1922). Counselors there can help, but down the road?

Clearly “Age-Wise” is committed to helping seniors find dignity as they face the unknowns of later years. “Abby” and I encourage your inquiries which help identify current unmet needs. We hope New Hampshire lives up to its desire to be the best possible age-friendly state, and give more attention to our middle income folks!

Owen R. Houghton, EdD, lives in Jaffrey and is a retired aging wellness educator, comforted by Summerhill Assisted Living care of his spouse with Alzheimer’s. As a member of Monadnock at Home, he is an advocate for aging well. Readers may contact him at

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