QUESTION: My husband, who has Parkinson's disease, must now move to a nursing home. He plans to apply for Medicaid, but we've heard he won't qualify until our savings are depleted. What can we do?
ANSWER: A remnant of the Medicare Catastrophic Care Act that survived repeal offers protection against impoverishment when one spouse enters a nursing home.To provide support for the spouse at home, states must add up the couple's assets (excluding the home and car), divide them equally, and allow the spouse living at home to keep half the assets, or $12,000, whichever is greater, up to a maximum of $60,000.
Suppose that you and your husband have a $50,000 certificate of deposit, stocks worth $10,000 and a checking account with a balance of $2,000. Your husband enters the nursing home. To find out how much you, the spouse at home, can keep, total the value of these assets and divide by two. The amount you can protect is $31,000. The rest (also $31,000) must be spent on nursing-home care for your husband before he qualifies for Medicaid.
In most states, if the value of the divided assets is less than $12,000, then you can keep $12,000. If it exceeds $60,000, then you can protect only $60,000.
The 1989 Medicaid changes also allow the spouse living at home to keep at least $786 a month in income up to a maximum of $1,500 a month. Under the old rules, some spouses were left with no income after everything went to the nursing home. The minimum allowance may be higher in some states, and will increase over time.
QUESTION: At age 67, I'm in good health. My problem is that Medicare doesn't cover most health-maintenance services, so I wind up paying for preventive procedures. These costs add up. Is preventive care worth the expense?
ANSWER: "Preventive care is good medicine," says Dr. David Reuben, associate director of the UCLA Multicampus Division of Geriatric Medicine and Gerontology. Noting that preventive efforts can avert serious illness, he says it's not worth skimping on preventive care to save money.
Medicare and most private insurers do not cover mammograms, flu shots, tetanus immunizations and blood-pressure measurements. Yet older adults are advised to undergo these procedures at regular intervals. (Medicare covers pneumococcal vaccinations and some pap smears. Many private insurers also cover pap smears.) To trim costs, consider these suggestions:
- Avoid unnecessary, costly tests, particularly cardiograms and stress tests. Stick to the basics: an annual flu shot, recommended for people over 65; a pneumococcal vaccination, if you've never had one; a tetanus booster every 10 years; annual blood-pressure measurements; and, for women, pap smears every three years, after two negative tests one year apart, and an annual mammogram and breast examination by a physician for those over 50. Other common preventive procedures, such as cholesterol screenings and sigmoidoscopy (used to detect colon cancer), should be discussed with your doctor.
- Find out whether preventive services are available in alternative settings. Public-health clinics and senior centers may provide low-cost flu shots, grocery stores may offer cholesterol screenings, and your pharmacy may measure blood pressure for free.
Results may be more reliable when performed by your doctor, but, says Reuben, it's better to get a recommended procedure done outside the doctor's office than to skip it.
QUESTION: I am a 57-year-old woman who has been to the emergency room twice recently because I thought I was having a heart attack. The doctor told me I did not have a heart attack, but gastroesophageal reflux, or heartburn. I was so relieved I forgot to ask about managing heartburn. What can you tell me?
ANSWER: Research indicates that 20 million Americans experience heartburn every day. Contrary to its name, heartburn or gastroesophageal reflux, has nothing to do with one's heart.
Heartburn is a burning sensation in the middle of the lower part of the chest. It is caused by regurgation of gastric juice from the stomach into the esophagus, as the "valve" in the lower esophagus relaxes. Fatty and spicy foods, smoking and drinking alcohol can cause the valve to relax, producing the burning sensation. A hiatal hernia increases the likelihood of having heartburn.
- Watch your weight. If you are overweight, reduce. The pressure of extra weight can cause heartburn.
- Avoid wearing clothing that is too tight around the stomach or waist.
- Avoid foods that give you heartburn.
- Don't eat too fast. Take small bites and chew thoroughly.
- Sleep with the head of the bed elevated about six inches (by placing wooden blocks or bricks under the legs at the head of the bed).
Over-the-counter antacids may provide relief. If the problem persists, see your physician.
Send questions about growing older to On Aging, P.O. Box 84256, Los Angeles, Calif. 90073. Questions of general interest will be answered in the column; individual answers cannot be provided.