Learning too late elderly health-care changes

The last day of my grandfather’s life was supposed to be the first day of his new job delivering newspapers for the Ottumwa Courier. He died of a heart attack in the middle of the night Nov. 3 – right around the time – 1 a.m. – he had set his alarm to go off so he could get up and go to work. Unfortunately, his new job was not the inspired effort of a senior citizen trying to stay active in his twilight years. Delivering newspapers was how he intended to pay Medicare premiums no longer covered by Iowa for my grandmother and him – a recent and, supposedly, temporary development in their medical benefits package.

My grandfather worked all his life, including a good many years after his “retirement” in 1992. Typically, these jobs – working in a meatpacking plant and driving semis back and forth across the country – had no formal retirement or pension plans. So, for most of the last decade, my grandparents’ income consisted of about $1,200 per month in Social Security benefits and whatever my grandfather could earn in various jobs around Ottumwa, Iowa.

For the most part, they managed to make ends meet, though with little room to spare. My grandfather bore the burden of managing their limited finances, not fully cluing anyone in to their difficulties and never asking for help in managing paperwork

associated with the miasma of their social services benefits. What he dealt with concerning health-care costs and available benefits did not fully come to light until my dad began going through his father’s papers and checkbook, pursuing information concerning my grandma’s future entitlements.

What he found is a potentially wide array of services and assistance, but with few answers or accommodations from the agencies dispensing them. For the better part of two days, he drove from office to office in Ottumwa, being referred and re-referred to other agencies, given interminable forms and asked to make appointments for future dates to receive answers to basic questions. He will return to Iowa in December to meet with various agency representatives – who will likely provide five-minute answers to simple yet necessary queries. In the meantime, my grandmother’s available benefits are languishing in a bureaucratic limbo with no clear answers as to what exactly will be covered and what will be out-of-pocket.

This is not intended to be an account of personal hardship and frustrations concerning the death of my grandfather. Rather, it is an attempt to illustrate some street-level issues facing seniors in the latter years of their lives. My dad is 53 years old, has a master’s of business administration, a reliable car and personal resources to take the necessary time and expense in pursuing the status of my grandmother’s situation. What happens when he is 30 years older, has difficulty traveling all over a city with no public transit, cannot wait weeks for answers to medical benefit questions and is treated as a confused, elderly annoyance rather than a concerned, middle-aged son? In short, what happens when he enters the same situation as my grandfather?

Add to these logistical concerns a small fixed income and the desire to preserve a sense of personal dignity and competence at the end of a life spent working hard, raising a family and trying to do the right thing. That is the state of affairs faced by many of this nation’s senior citizenry: seniors who don’t have a lot to begin with and are only asking for the assistance they think is available, but are unsure or uninformed when it comes to accessing that assistance.

While prescription drug benefits, universal health care and the repercussions of welfare reform are bandied about in the public eye, we might be turning a blind one to the real gains possible in simplifying existing processes for seniors. I’m all in favor of better benefits and assistance to the superannuated citizens who did the lion’s share of work in making this the wealthiest country in the history of the world. More than that, though, current and future benefits must be made accessible to seniors in an environment in which they are not exposed to the fog machine of unnecessary, bureaucratic paperwork, taxing travel and the propensity for interacting with a teeth-gritting desk zombie who is concerned more about how fast the clock on the wall is ticking than how well his or her client’s heart is.

Sure, stellar customer service has never been a hallmark of local, state and federal agencies dispensing aid to U.S. citizens – just spend some time in line at the Department of Motor Vehicles or sit in the waiting room of a public health clinic if you doubt that – but we are smart enough to rectify that situation. Training, employee screening and assigning individual case workers to seniors rather than asking them to spend a good deal of their remaining time standing in lines to nowhere are good places to start.

The realms of Medicare, Medicaid, Social Security and other programs for seniors are vast and complex. I am not suggesting any kind of complicated re-budgeting or shift in national scope. My concerns are simple – if we’re going to give something to people who need it, let’s make sure they get it and that the process of receiving it is not the most painful ailment they face as they grow older.

Aaron North, a columnist, wrote this with his father Jim. Aaron welcomes comments at [email protected]