The Universal Notebook: Old age, old Maine

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In recent months I have spent a great deal of time at Maine Medical Center and Brentwood Rehabilitation and Nursing Center, not to mention the offices of primary care physicians and various specialists, as we do our best to stay on top of my elderly parents’ various health issues.

This immersion in the local health-care system has left me with a great admiration for the people who care for our sick and the elderly.

From the EMTs who arrive at the house in response to an emergency to the critical-care doctors and nurses, the emergency-room staff, the Maine Med hospitalists, RNs, and CNAs, and the nurses, therapists and social workers at Brentwood, I get the sense of people who genuinely do care about the people they serve.

My parents’ experiences with both the health-care and elder-care systems adds personal urgency for me to the health-care debate raging in this country. If it were not for Medicare, I have no idea how they would be able to afford treatment. I’m not complaining, mind you, but when a six-mile ambulance ride costs $500 and three nights in the hospital with a bout of pneumonia costs $22,000, I can’t imagine how anyone other than those with generational wealth could ever afford to pay for health care out of pocket.

And when the governor seeks to balance the Department of Health and Human Services budget by kicking 65,000 off MaineCare (the state’s name for Medicaid), he and his kind would like you to think these are deadbeat young people scamming the system. I know they are not. They are mostly older citizens who worked hard all their lives and then got mowed down by a runaway economy.

The other lasting impression I have from trying to help my parents negotiate the elder-care system is just how confusing it is. I have made my living gathering information and trying to make sense of it, but after two years I’m still not sure how the social services system for the elderly works. I am absolutely convinced, however, that most elderly people would never be able to navigate it without help.

When my father’s stroke two years ago suddenly thrust me into the role of care coordinator, I was under the impression that there was an organization such as the Southern Maine Agency on Aging that would hold your hand and walk you through the system of rehab, long-term care, in-home care, and support services. I do remember getting a packet of information from the agency, but I haven’t heard a word from or about them since. Probably my own fault, but events just seem to have accelerated beyond the initial advice stage.

My impression of the Maine Department of Health and Human Services is of a vital state agency that is way understaffed. Maine is the oldest state in the nation. That’s one reason we have such a high demand for social services. The DHHS staff works hard to be of service, but their case loads are way to large. We don’t need a smaller DHHS budget, we need a larger one.

Once an elderly person applies for care through DHHS, a whole host of agencies swing into action. Goold Health Systems performs a needs assessment and makes a recommendation for care. Elder Independence of Maine coordinates the caregivers based on the Goold assessment. And an agency such as Gentiva Home Health dispatches the social workers, nurses, physical therapists, occupational therapists, and speech therapists who provide the transitional care when an elderly patient goes home from the hospital or rehabilitation center. Initially and naively, I assumed the DHHS performed the assessment, coordinated the care, and provided the caregivers.

After a month or two of intensive, daily in-home care, however, Medicare benefits will run out and, if MaineCare doesn’t kick in, I have no idea how people pay for long-term care which costs as much as $60,000 a year. We haven’t reached that point yet.

In the meantime, I have calculated that close to 100 individuals have provided direct health care and rehabilitation services to my parents just in the past three months. Just trying to keep them straight is a challenge, but, on behalf of my whole family, I want to say how grateful we are for their kindness and expertise, and that Maine has a safety net in place to care for those no longer able to care for themselves.

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Freelance journalist Edgar Allen Beem lives in Yarmouth. The Universal Notebook is his personal, weekly look at the world around him.

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