If We’re on Hospice, Why Bother with Long Term Care Planning?

Carla called me only after much urging from her friend.  Carla’s husband, Dennis, had lung cancer and it had spread throughout his body.  The end of his battle was nearing and he had been approved for placement on hospice, an approach to medical care where the goal is to enhance the quality of life for patients with terminal illness but who are likely to die within 6 months.  It appeared that Dennis only had weeks to live and a long term nursing home stay wasn’t a likely scenario. So, why was she calling me?  Let’s take a closer look.

 Carla told me the last several years have really taken a toll on her health.  She is 70 but starting to slow down physically.  She said she has put knee replacement surgery on hold.  It was clear that Carla’s focus was completely on Dennis but her friend recognized that she also needs to focus on “life after Dennis”.  That’s why Carla was calling, although I don’t think she realized it entirely.

 I asked her about her finances.  Dennis had a pension of $2500 and Social Security of $1500.  Carla, who didn’t work outside the home during the years she raised their 3 children, only received Social Security of $750 and no pension.  She also told me that Dennis’ pension would stop once he died.  She remembered that he took the maximum pension option when he retired a few years ago but that there would be no survivor option if she outlived him.  I told her that she would lose one Social Security check as well, keeping the larger one.

 I asked Carla about their assets.  She and Dennis owned their home which she estimated to be worth approximately $300,000 with no mortgage.  They also had savings totaling $250,000.  They had no life insurance and no long term care insurance.  I asked about their legal documents.  Carla said she and Dennis had both executed powers of attorney and health care directives several years ago.  Their wills she estimated to be about 20 years old, prepared when her children were of school age.  Their wills left everything to the surviving spouse and then alternatively to the children.

 As I mentioned, Dennis was now on hospice.  Carla had set up a hospital bed on the first floor and brought Dennis home.  At this point he was bedridden.  A hospice nurse was coming to the home several times a week.  Although very tired, Carla said that Dennis was completely lucid.  She then asked me what exactly I could do to help her.

 It was clear from her question that her focus was on Dennis.  She wasn’t thinking about her own needs but I was.  Although not easy for her to do, I asked Carla to shift her focus for a few minutes.  I asked her about her own health and long term care needs.   She again told me she would address it after Dennis’ passing.

 “Who will care for you”, I asked, “if you need long term care in the future.”  Carla told me her children don’t live nearby and she never really thought about it.  She wants to be cared for at home, just as she is doing for Dennis, but she recognized that it won’t be easy.  I then told Carla that we could help her try to accomplish that but there are steps that we need to take immediately, without delay.  Next week I’ll give you the details.