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Health care

Return of the Creature!

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SDXB escapes from the hospital today! They’re tossing him out sometime during the day. Sister-in-Sin is headed back to her normal life—BiS has already slipped out of town. And thank goodness, New Girlfriend has agreed to stay with him for the next month or so.

Yesterday he sounded pretty chipper over the phone. They’d let him walk around outside, which much revived his spirits.

He’s not supposed to be left alone at all for several days. But there’s some hope he’ll recover fairly quickly, all things considered. The Mayo Clinic website says many bypass survivors are driving after about three weeks and frolicking in the sack three to four weeks after the surgery. Apparently it takes about 12 weeks for the bones in your chest to reknit, about three months (uhm…four times three: isn’t that the same as 12 weeks?) for the person to start to regain normal energy levels.

The scary thing about this is that SDXB already does all the things the Mayo describes as “cardiac rehabilitation” strategies. It would be impossible for him to make the lifestyle changes this site recommends, simply because he already lives like that. He cooks all his own food, and it’s very good food—by and large low in fat, high in vegetables and fruits. He rarely puts any salt in the food. He doesn’t drink much any more—certainly not the way he used to—and he quit smoking twenty or thirty years ago. He exercises enthusiastically and with pleasure, every day. And he has few sources of emotional stress.

BiS remarked that an element of genetics comes into play with cardiac disease. His mother did die of cardiac problems, but not until she was in her 80s. You’ve gotta die of something, eh? The aunts and uncles are similarly long-lived. His dad died young of Parkinson’s disease brought on by exposure to chemicals in the cleaning plant where he worked, so we don’t know if he might have developed heart disease later in life—but at least one of the aged uncles is on the father’s side. Consider: this guy is 70 years old and he has relatives in his parents’ generation who are still living.

What will be will be, I guess. Meanwhile, just in case…this old bat is off for a vigorous walk, before the sun comes up.

Update:

So here he is, climbing into his car under the doting care of a pretty young  nurse. He must be lapping it up. SiL sent this picture… This afternoon he sounded almost like his old self and was looking forward to a fifteen-minute walk (at least) around the neighborhood in the cool of the evening.

It LIVES!

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So SDXB came through the gerzillion-bypass surgery with flying colors. They dissected him yesterday; today he he’s been up walking around twice, and he socialized so exuberantly with all his relatives that his sister (who runs the tribe) had to send them all out of the place so he would settle down and sleep. New Girlfriend went off to transport a recliner from her palace to his—oddly for such an Archie Bunker sorta guy, he’s never had a classic Naugahyde recliner (or any other kind of recliner).

SiS (Sister-in-Sin) sent a photo, saying he looks “cute”…

Except for all the gear attached to him, the old buzzard looks almost normal. It’s amazing, isn’t it, what medical science can do? Now if we can just manage to get access to it…

SDXB has a combination of military retiree coverage and Medicare, which should pretty well cover what probably is something over a hundred grand worth of surgery and treatment.

BiS, the eminent cardiac anaesthesiologist, says the reason SDXB was navigating pretty normally despite a chestful of clogged arteries is most likely is steady, vigorous exercise. He climbs the hills in the local mountain parks, hikes, walks, bicycles, and swims—a day never goes by when he doesn’t get some kind of exercise. As it develops, exercise causes your body to develop new blood vessels around the heart, and that probably is how blood was getting to his heart. BiS also learned that apparently SDXB’s heart itself is not damaged. So assuming he recovers from the surgery without complication, he should be OK. In fact, he should be better than OK.

I hope that New Girlfriend will stay around over the summer. She has a home in Colorado, where she usually decamps to escape the heat—he had planned to spend part of the summer there, in between junkets to Michigan, Canada, and the Pacific Southwest. In spite of SDXB’s apparent vigor, I’m afraid it will take two or three months before he’s back to normal, and somebody needs to be in the offing during that time.

The daughters discovered that both his insurance plans provide in-home care, though it remains to be seen whether he’ll be incapacitated enough to qualify (usually you must need help in several living tasks, such as dressing, bathing, feeding, toileting). If he can get someone in to help, that would be good. Otherwise…it’s 19.44 miles from my house to his. {sigh}

At any rate, the guy’s a poster boy for daily exercise. If he hadn’t kept himself in the kind of shape he’s in, he’d have croaked over long ago.

Sad news

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Yesterday SDXB went into the hospital for an angiogram. He’d been having some mild shortness of breath, which he put down to a hangover from a severe respiratory infection he’d had a couple of months ago. The doctor, however, thought otherwise: he diagnosed it as angina, but given SDXB’s vigor and overall physical condition, he thought probably treatable with an angioplasty or a stent. He even said it was possible the examination would find nothing.

In the afternoon, New Girlfriend called to report the amazingly bad news: the arteries on the right side of his heart are 70 percent blocked; on the left, 100 percent. The doctors were astonished that he hadn’t already had a heart attack and immediately put him on support to stave one off. They want to do a multiple bypass—and by “multiple,” we mean “quadruple” may be an understatement—and they plan to do it today or, at latest, tomorrow.

It’s hard to believe. The man is not just active; he’s athletic. This guy hikes up and down mountains several times a week. When he’s not climbing, he’s swimming laps in an Olympic-sized pool, bicycling twenty or thirty miles from Sun City into Phoenix and then bicycling back, hunting, fishing, camping, or taking long walks around town. He hasn’t smoked in thirty or forty years, he doesn’t eat junk food, he drinks moderately (of late…most of the time), he keeps his blood pressure under control.

New Girlfriend, present when this news was delivered, was unnerved. A recent widow, she’s already seen one husband and a son into the grave, and she doesn’t relish going through that again.

Everyone else is unnerved, too. Sister-in-Sin is on her way to Phoenix at this moment, as is Sane Daughter. Both are extremely competent women; the daughter is a nurse, and the sister, the wife of the pre-eminent cardiac anaesthesiologist in the Northwest. I don’t know how long his daughter will be able to stay here, since she has a full-time job and a family. But his sister probably can hang in for the duration.

Given that he is pretty fit—except for the fact that he’s about to keel over dead—maybe he’ll recover fully, and maybe he’ll spring back in three months or so. It’s extreme surgery, and IMHO dubious in some cases. Circulatory disease is not limited to the arteries around the heart. My father told me, after his triple bypass, that if he had known how much he was going to suffer for the rest of his life, he wouldn’t have called for help when he had his heart attack. But he was 80 when he went under the knife; SDXB is only 70. And at 80, my father was no athlete.

So, we shall see. I hope SDXB’s health and active lifestyle aren’t ruined.

In an unguarded moment, NG remarked that they had discussed marriage and she had told him that after what she’d been through with her husband, she didn’t want ever to marry again, because she didn’t want to care for and watch another man die. But now, she said to me, she was pulled into it.

Exactly so. Few women will admit it publicly, but that’s a large reason many active, lively older women don’t take on new spouses late in life. It certainly is the main factor in my lackluster interest in men. I watched what happened to my stepmother after she married my father.

My mother died in April, when my father was 70 years old. By December, Helen had him at the altar. She was a very active, social woman who loved to travel, loved concerts, loved church-going. My father had seen the world, thank you, and couldn’t see any sense in leaving a perfectly good home to go gadding around expensively. A committed atheist, he wouldn’t go near a church and thought anyone who did was a superstitious fool. He called classical music “piddly-piddly music” and loathed sitting through a concert.

Helen’s first husband, a coronary invalid, had died of a massive heart attack while she was off leading a bus tour. She never got over the feeling of guilt for not having been at his side when he died. So, as my father grew weaker and sicker—he also became a coronary invalid—her life grew more and more constrained. They lived in a three-room apartment in a life care community. I can’t imagine—make that “don’t want to imagine”—being trapped with my father in three tiny rooms, month after month after month.

She spent the last few good years of her life dutifully taking care of a sick, unhappy, cranky old man. By the time he passed, there was nothing left for her. She was a mental wreck, and her physical health was pretty well wrecked, too.

They were married for about 14 years. Eight or nine of those were years in which Helen was still vigorous enough to continue her active, outgoing lifestyle. But that came to an end within two or three years after they married. Long before he was hit with a heart attack, my father was unable to do much. By marrying him, she traded her vigorous, if sometimes lonely, life for one as an unpaid nurse and maid. She sacrificed the last good years of her life to take care of a man who secretly wanted to divorce her.

I hope she never realized that last bit.

That sacrifice is necessary and maybe even fine if you’ve been married to a man for thirty, forty, fifty years and you have a lifetime commitment. But not so much when it’s someone you’ve met late in life, when really what you’re looking for is not to build a family but to have someone to go out to dinner and a movie with. There are worse things than loneliness. Way worse.

Old age is not for the faint of heart. That’s for sure.

Update: SDXB himself just called on the phone, sounding as bushy-tailed as usual. He said the docs have moved the surgery up to 9:00 this morning. He didn’t sound too depressed; thankful, maybe, that this discovery was made before he had a heart attack. It’s possible the heart itself is not damaged, which would mean he may make a good recovery. Brother-in-Sin is also headed into town, an excellent development: Arizona’s hospitals leave a lot to be desired, and this guy, an eminent member of the doctors’ club, will ride herd on what’s going on there.

Government Long-term Care Coverage: Better than nothing?

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We’re being told that one of the future benefits of the new health-care plan (assuming it survives the Republican onslaught and general hysteria) will be an opportunity to buy long-term care insurance at an affordable price.

That’s a much-needed program. But one has to wonder: apparently the average benefit will be about $50 to $75 a day. That’s as nothing: in Maricopa County, where Phoenix resides, typical cost for a nursing home is over $200 a day! And that’s just the base rate: everything, but everything costs more. If you  need a wheelchair, you have to rent it. Any therapy or special care beyond just leaving you sitting there and maybe wheeling you down to the dining room is extra. At that rate, a $50/day stipend won’t hold off bankruptcy for long.

We’re told it may be enough to cover adult day care, which apparently ranges in cost from $20 to $75 a day, depending on where you live. This arrangement, which essentially entails institutionalizing an infirm senior during the day but allowing her or him to return home at night, would require someone to schlep you to a day care center every day. You have to possess all your marbles, be continent, and be mobile, a combination that doesn’t necessarily describe most elders who need daily care.

In-home care, which might keep you out of an institution or at least stave off the evil day, costs $112 to $192 a day, only a few dollars less than the average $205 a day for a private room in a nursing home.

The Congressional Budget Office estimates that for the program to break even, premiums will have to average $1,477 a year. That’s $123 a month.

My long-term insurance with Metlife costs just under $80 a month, and it will pay up to $128 a day for nursing care for an unlimited number of years, plus caregiver training, respite care, durable medical equipment, and installation and maintenance of an emergency response system.. The cost is relatively low, compared to the CBO’s estimate for the federal program, because I bought in when I was fairly young.

So, by comparison the government plan will be expensive and its benefits skimpy. Given that nursing home care can quickly bankrupt you, even a little help would be good. But if you’re on the hook for $150 a day even after having paid $128 a month for coverage over many years, you’re looking at drawing down $4,500 worth of your assets a month for nursing care. That’s $54,000 a year.

A $50/day benefit comes under the heading of too little, too late.

Hidden costs of illness or injury

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Welp, it looks like I’m not only going to live, I’m actually on the mend. Yesterday it was off to the orthopedist. From his PA I learned that the ER staff were incorrect in their thought that the dislocated shoulder was also fractured. The orthopod searched the half-dozen(-plus) X-rays and could find no sign of a break.

Better yet, the PA estimated a 95 percent probability that no serious soft tissue damage had occurred. He said they believed the shoulder will regain 100 percent of its function within a few weeks, possibly as soon as three weeks. He got rid of the hated arm sling, described a couple of easy therapeutic exercises, and said that I should use the arm to do any  normal daily activities that don’t hurt unduly or involve lifting heavy stuff.

Hallelujah!

Having one arm out of commission for a week was an enlightening experience. It gives you a good feel for how difficult things can be for folks with even a fairly minor disability. And for how much “even a minor disability” can cost.

I’m not talking about medical bills here. It’s that being unable to perform certain daily tasks can rack up costs that you don’t think about, especially when you live alone and there’s no one to help you.

Because Easter weekend was so busy, by Sunday night (when the Great Fall happened) I hadn’t done the laundry, changed the sheets, or cleaned the house. And because Holy Week itself was very busy, the prior weekend I hadn’t found time to wash the sheets, either, so by the time I hurt myself they were already dirty.

Though I’d managed to beat back most of the rain-generated weeds, if you miss a couple they’re soon as high as your belt buckle. Within a few days, exuberant milkweeds and thistles were reaching toward the stratosphere, front yard and back.

The pool has never settled down since the water was changed. The acid level refuses to return to normal. This means that every time I think of it (which isn’t often enough), I have to add another pint or two of acid. Adding acid entails dipping up a bucket of water, carefully pouring the acid into it, then holding the heavy bucket over the pool’s surface above an active inlet port and slowly pouring in the acidulated water. Because acid is heavier than water and drops to the bottom and because Harvey the Hayward Pool Cleaner invariably zips to the spot where I’ve dumped the acid, as soon as it’s in I have to dip and forcefully dump several more bucketsful of plain water into the pool to mix the stuff as best as possible. It’s not something you can do with one hand.

Neither is cooking. If you don’t eat junk food and you don’t favor convenience foods, the larder is full of things that require great heaving of pots and pans to prepare. To slice an onion, you need two hands. To slice a piece of meat: two hands. To cut up a tomato…etc.

M’hijito came by twice a day, on his way to and from work, to get me into the damnable sling after the morning shower and the afternoon mini-exercise routine. I could not get into it by myself. And he cooked a bunch of pasta and minced a store of garlic  so that I could fix something to eat, one-handed. La Maya opened cans of beans and tomatoes for me. But there really wasn’t much anyone could do about all the rest of the survival chores, because they both had to go to work and they both have their own responsibilities.

I figured that if it took more than a couple of weeks to recover some function in the arm, I was going to have to hire a cleaning lady ($80 to $100 a day), a pool guy ($25 to $50 a hit), and Gerardo to beat back the weeds ($75). And despite having a month’s worth of food in the house and nothing left in the budget for groceries, I was going to have to go back to the store and stock up on things that could be heated in the microwave or the oven. Expensive and, to my taste, not very appetizing; but sooner or later I would have to eat something other than reheated pasta. That would probably cost another hundred bucks.

Meanwhile, it was all I could do to drag myself to class. By the time I walked out of the afternoon class, I was so exhausted I had to sleep. Grade papers…are you kidding? One of my former RAs read last week’s raft of English 102 papers, to the tune of fifty bucks.

Yesh. For a week or so of impaired function, we’re looking at costs of $330 to $375, just to stay abreast of a part-time job, keep the house running and tolerably sanitary, and put manageable food on the table. How much this would amount to if the healing process stretched over the predicted 12 to 16 weeks, I do not want to contemplate.

Just when you think it’s safe to go back in the water…

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Well, all that rhapsodizing about how much extra money resides in the checking account just turned into a dirge.

Yet another piece of paper came from the Social Security Administration, informing me that my monthly checks are about to drop to $974. That’s the net on $1,257 after the dings for taxes and Medicare: a 23 percent gouge.

Which reminded me that I still haven’t signed up for Part D, another hassle and hoop to jump through. That will have to wait until next week, since the next few days are going to be very hectic. And that I haven’t paid the Costco membership. And that I haven’t paid the COBRA bill for April.

At any rate, the cut in “pay” isn’t as drastic as it looks, because the $200 to $300 a month COBRA has been lifting out of my pocket has come from net income, and so it’s really about a wash. Medicare, Medigap, and Part D will add up to about $240 a month, about $40 more than this month’s COBRA payment that includes Delta Dental. So even though the paycheck drops precipitously, the amount I have to write checks for isn’t quite as high.

Except of course it isn’t a wash. Medicare is higher than COBRA, and it doesn’t cover dental care. Delta Dental will go away after the ARRAS discount ends, because its cost to private individuals is higher than the cost of routine care. To have enough on hand to cover the inevitable major dental work that comes with age, I’ll have to self-escrow something every  month to put into an account to pay for future dental disasters. How much, I can’t imagine. A crown costs about a thousand bucks around here, so I suppose that would be about $83 a month.

Because Medicare fails to cover dental care, I’m allowed to keep the COBRA coverage for Delta, which I will do until September, when the ARRAS discount expires. Meanwhile, in another week I’m getting a new crown on the tooth I broke when I bit down on an olive pit—it’s been patched with a large filling, since the ding didn’t hit the pulp and nerve, but the Doc agrees that it’s going to have to be fixed while I still have some coverage.

Mercifully, he says I shouldn’t need a root canal. Ugh!

Delta’s coverage is pretty piddly. I’ll still have to pay half the cost of the crown, around $400 or $500. That will have to come out of my year’s emergency savings, which I’ve kept in the bank for 2010 where it’ll be handy if I find I can’t live on my income during this especially penurious year. Thank God I have it! Otherwise I’d just have to wait until the tooth starts to rot and then have it pulled.

In the tax gouge department, I think it’s likely that I’ll get the money back next April, since I’ll earn so little this year that a) the cost of Medicare combined with the long-term care premiums, nine months of Delta Dental premiums, the crown, and God only knows whatever medical bills happen next will exceed 7.5 percent of adjusted gross income; and b) net earned income probably will be so low that I won’t owe tax on Social Security at all. But meanwhile, I have to live until next April.

Hmmmm…. Did you know contact lenses and the cost of over-the-counter contact lens solutions are considered eligible medical expenses? That’s interesting; I thought those were vanity items. They’ll also accept the cost of Lasik eye surgery and getting your teeth straightened. If you kept track of all the stuff you’re allowed to count as medical expenses and you didn’t earn much, you just might hit that 7.5 percent threshhold. On a $35,000 income, that would only be $2,625. If you’re not getting health insurance through your employer, then you can count your healthcare premiums…and in that case, $2600 isn’t very much. Even if you made something closer to a living wage, say 50 grand, health insurance premiums could easily combine with fairly routine care to push your costs up to the $3,750 that is 7.5 percent of that salary.

I wonder if health insurance premiums will still be deductible under the new regime? Since Medicare qualifies, it’s reasonable to think they’ll make the new required premiums deductible, too.

Doesn’t matter for me: Arizona intends to opt out of the federal healthcare plan, anyway. Our intrepid leaders opted out of Medicaid, so I expect they’ll get their idiotic way with this, too.