FOR AGED, BIG COSTS CAN MEAN LITTLE CARE LONG-TERM AID OFTEN IMPOSSIBLE

THE BALTIMORE SUN

He looks like somebody waiting for a date, sitting in the lobby on the vinyl-covered couch that matches the flowered wallpaper. On this Saturday afternoon, the balding man wears pressed gray wool pants, a stylish cotton shirt striped in red, white and blue and a navy blue cardigan.

He straightens the cusp of white hair that has receded to the middle of his head, taps his foot gently and looks at his watch. In his hands, he holds a little plastic container fastened with a rubber band.

The 72-year-old gets up and heads for her second-floor room. He feels the bottom of the plastic container.

"Good, it's still cold, you know I don't want it to melt before I get there. She loves it, you know, Haagen-Dazs coffee flavor. Boy, that's her real love."

When he sees her, his eyes light up, and a smile spreads across his ruddy face.

He kisses her and touches her face ever so gently, and his words, full of excitement and nervous anticipation, run together in the thick accent of his native Boston.

"You know what I have in here, Lillian, don't you? I brought you some of your favorite ice cream. I got you some Haagen-Dazs coffee ice cream."

He pulls the little yellow cup from the plastic container of ice that keeps her favorite treat cold on the way from Annapolis. Then, staring into her eyes, he feeds her little spoonfuls of the ice cream.

"There, there, how does that taste? Kinda mushy today. It's warmer than it was yesterday. Does it taste good?"

William MacDermott's wife of 45 years, Lillian, slurps the ice cream, spoon by spoon. Some spills onto the white sweat shirt marked "Lillian MacDermott" in the black letters of a felt-tip marker. She says nothing and shows not the slightest hint of emotion.

His smile fades, and he swallows hard.

She sits in a big tan chair with wheels on it, and rests her hands on a tray connected to the chair. He grasps her right hand, massaging her palm and stubby fingers between his hands, and stares hard into her eyes.

"Do you know who I am? Who am I? You tell me."

Her blue eyes focus on him for just a moment.

"I don't remember," she grumbles, her voice sounding at once hoarse and out of practice.

He turns away from her and sighs. Then, as if fearing she'll see his pain, the smile returns, and he fixes his gaze on her once more.

But her vacant eyes shift from him to the hallway outside the door of her room at the Glen Burnie nursing home, Arundel Geriatric and Nursing Center.

Just like that, she is asleep.

Still, he clings to her hand and watches her intently.

"My greatest pleasure is to be with her," he says. "Just to sit here and hold her hand. Sometimes, we don't even talk, or it's a pretty one-sided conversation."

Every day for the past six weeks, the retired federal mediator has followed the same routine. He packs her Haagen-Dazs coffee ice cream and drives from his Annapolis town house and holds her hand and combs her hair and talks to his 70-year-old wife who no longer recognizes him.

And every day when he walks out, William MacDermott wishes, more than anything, that she could come back home with him.

For almost two years, he managed to keep her there with him, even though Alzheimer's disease had devoured her mind. He paid private nurses to work eight-hour shifts seven days a week, cleaning her, dressing her, helping her to the bathroom, fixing her meals. The cost: about $40,000, the couple's life's savings.

Then a blood clot in her leg left her unable to walk. At once, the cost of keeping her home would have tripled because she needed round-the-clock supervision.

Medicaid, which now pays the bulk of her nursing home costs, wouldn't help with the tab for in-home care, and the couple's pension and retirement income couldn't come close to paying for round-the-clock care in the home.

"Nothing in this life," MacDermott says now, "nothing could have prepared me for her leaving home. You look and you see this 70-year-old woman. But that's not what I see. I see the woman I knew from 45 years of marriage.

"The good Lord provided that. She never ages in my eyes. Every day, I wish she could be at home with me."

*

William MacDermott, like countless others, quickly became an expert on "long-term care," out of necessity.

In Anne Arundel County, where the elderly population is growing faster than anywhere else in Maryland, you'll hear the term more and more in the coming years.

It encompasses a bewildering array of services: "home health aides" who help with daily tasks; round-the-clock nursing care at home; respite care; case managers who help find services and a way to pay for them; adult day care for seniors; nursing homes.

And in this county, it's getting harder and harder -- often impossible -- to find care for frail seniors and to pay the hefty tab. Already, experts say, shortfalls plague practically every facet of long-term care in Arundel and will likely worsen considerably in the next few decades.

For as the population grays, the fastest growth will occur in the "old-old," those 85 and over and most likely to suffer the debilitating effects of chronic illness and thus further strain an already overwhelmed care system.

In the next two decades, county planners predict, the number of Arundel residents ages 60 and over will rise about 62 percent, five times the rate of the county's overall population, to 90,951. At the same time, the 85-and-over population will mushroom from about 3,000 today to almost 8,000.

Coping with such rapid growth in the frail elderly will pose a daunting challenge to a long-term care system that officials readily acknowledge is fragmented, inflexible, uncoordinated and limited by a lack of money and perennial staff shortages.

At the county's Department of Aging, Addie J. Sims, the assistant director who oversees long-term care programs, throws up her hands, exasperated.

So many elderly people, she says, plead for someone to come in and give them a hand with the most basic of tasks most take for granted -- bathing, dressing, moving about, cleaning and using the bathroom. So many elderly people must be told nobody can help.

Using mainly state funds, the county manages to provide in-home care of some sort to about 500 people, a small fraction of the 3,000 elderly people who, officials estimate, need such help but can't afford it.

The Aging Department has stopped adding names to a waiting list of more than 125 people for publicly assisted in-home care, including help with daily tasks and visits from nurses and outreach workers. The waiting list hasn't shrunk since March.

"That's as far as the money goes and we try our best to stretch the heck out of it," Sims says.

"Now -- and this is a crime -- we have to ask people if they could survive without it. Could they be cut from the rolls? It really is a sad quandary."

For some, it means simply doing without the basics.

Like the 78-year-old retired physician sitting in a sparsely furnished Arnold garden apartment where the smell of rotten milk hangs in the air, and clumps of accumulated dust cover the bare wooden floors.

He sits on the edge of a couch, and the sunshine beats down through the sliding glass doors on the patio. His gaunt face is a contour map of wrinkles framed by scraggly gray hair flecked with black.

He suffers a terminal blood cancer, and can see only blurred outlines now because of cataracts. He can no longer walk to the grocery store a few blocks away, clean his apartment, read the mail that piles up on the coffee table or prepare meals.

His savings depleted by medical bills, he says he couldn't afford the minimum $8 an hour to pay someone else to help him. Weekdays, he gets meals delivered by Meals On Wheels. Sometimes, on weekends, he subsists on water.

"This is not the way to treat a completely incapacitated old citizen, not to deprive him of every kind of help," says the retired doctor, who asked not to be identified. "This isolation makes you feel like an abandoned dog. In this world of ours, if you are old and alone, you are a beaten dog."

Maryellen Brady, director of the Owensville Medical Clinic, sees the price of neglect pretty regularly. Seniors living in rural South County, often isolated, arrive at the clinic malnourished, suffering serious illness and depression.

The myth that the elderly normally get the care they need persists.

The reality is that many do not.

"If you can't pay, you just don't get care," says Brady. "They just get sicker, return to the hospital or die.

"That's what happens in our county, and that's rampant. It's an issue that needs desperately to be addressed in this county, and we don't address it in this county."

Brady recalls a 78-year-old woman who arrived at the clinic swollen and malnourished. Her 76-year-old brother had been caring for her, when she started wandering off and got lost a few times. Before the elderly woman arrived at the clinic, her brother, frantic and unable to find care for her, had locked her away in a shed.

He simply didn't know where to turn, didn't want to put her in a nursing home and feared her walking out of the house and never coming back.

*

Even for those who've managed to stash away a healthy nest egg for retirement, good private care in the home is hard to find; few choose such hard, dirty work when they could make as much as a convenience store clerk.

Nor does care come cheap.

The expense can -- and often does -- wipe out a life's savings in a year or two. Consider that in-home help with even the basics -- like dressing, preparing meals and bathing -- averages about $10 an hour.

With eight to 24 hours of care often necessary daily, the in-home tab typically soars to tens of thousands of dollars in just a year.

That's for unskilled help. Add full nursing care and the price rises considerably.

Thus, as demand for publicly assisted care constantly expands and the costs of in-home help put it beyond the reach of most, the graying of the population leads inevitably to a sad and increasingly common paradox: Though most public health officials, elderly people and their loved ones overwhelmingly favor keeping seniors in the home, many end up in nursing homes by default.

Perhaps hundreds of seniors in Anne Arundel County nursing homes today don't need the constant medical supervision available in the institutions and could get along fine at home with assistance with daily tasks or limited nursing care, Aging Department officials say. But these seniors simply can't afford it or find public help.

Other care options, like adult day care, have begun emerging, giving children of the elderly or other "care-givers" a respite and allowing them to continue working.

But the centers are in short supply, too far away for many to get to and too costly for many others who have too much income to qualify for public assistance but not enough to shell out about $50 a day.

While senior advocates have lobbied for more public help to cover care outside of nursing homes, that appears unlikely.

At the state level, the budget ax will fall soon on some in-home care, and federal funds pay for little except acute illness or nursing homes.

Medicare, the federal medical and hospital insurance system for those over 65, pays nothing for long-term nursing care. And Medicaid, the federally mandated program for the poor, pays for nursing home care but not in-home services.

Dorothy Drummond, the long-term care ombudsman at the county's Aging Department, says she routinely hears from elderly people forced to go to nursing homes because they can't find or afford in-home help.

In Anne Arundel County, the nursing homes struggle to keep pace with demand. Seniors, families and placement specialists at the county's two hospitals say it's often difficult even to find a bed for those who need one.

Compounding the crunch, vacancies often are determined by the level of care needed.

And as is the case for all care for the elderly, the nursing home option boils down to some hard economics. Costs run around $100 a day and up, so even those who enter as middle-class patients soon are reduced to poverty and must rely on Medicaid.

Traditionally, of course, family members have staved off the move to the nursing home as long as possible, taking on the responsibility for the care and feeding of their loved ones.

But with more and more women working and children of aged parents often scattered, many seniors must fend for themselves, doing without care or rely on elderly spouses, friends or neighbors to help them through the day.

Indeed, it's common even to find seniors in their 60s taking care of parents in their 80s and 90s.

"My son -- he's such a good boy -- he takes care of all my needs," says Lillian Mae Crist, a 91-year-old resident of the Pinewood public housing complex.

"He gets my groceries and my medicine and helps me around the house and helps me with the bills. I just thank the Lord that I can get out of bed every day, and that he cares for me. I don't know where I'd be without him."

He is 65.

Other younger "care-givers" juggle work and family and do their best to reciprocate for years of love and devotion.

No easy task.

Donna Boyko, a 38-year-old receptionist at St. John's Evangelical Roman Catholic Church in Severna Park, can't remember the last time she got a full night's sleep. It was at least seven years ago.

That's when her mom got lost at Severna Park Mall, a place she knew as well as her neighborhood. Since then, Boyko has watched Alzheimer's decimate her mother's mind. Today, Helen Boyko, 78, can't prepare meals, dress herself, brush her teeth, bathe or use the bathroom without help.

Her daughter does her best. She works 30 hours a week, wakes at 3 a.m.

daily to help her mom to the bathroom, then tries to sleep until 6:30, when she wakes to help her mom get dressed and fix her breakfast.

Donna Boyko considers herself among the lucky ones; she got some help -- after six months on a waiting list. The Department of Social Services pays for a private home health aide to come in six hours a week to bathe her mom and help her with daily tasks.

But it costs almost $600 a month for another home health aide to help her mom 20 hours each week so Boyko can keep working.

Except for work, she rarely leaves for more than a few hours. When she does, she must call in a relative or a sitter or rely on her dad, who is 98, to keep an eye on her mom.

"If somebody told me seven or eight years ago that I had to do all this," Donna Boyko says, "I'd have said, 'No way, I just never could handle it. It would be too much burden to be totally responsible for another human being.' " Without her father's pension, Boyko says, she would be forced to put her mom into a nursing home because she couldn't afford the in-home help or adult day care.

She hopes that never happens.

"People said, 'you're young, why are you throwing your life away? Why don't you just put her in a nursing home?' " she says. "But this is what I chose to do, and I have no regrets. Just taking her to lunch or to get her hair fixed or for a walk in the park, all this is so important to the human spirit.

"I realize the mother who took care of me is no longer there in that respect. But I know that person is still there, though changed. The love is still there, no one can take that away. It all relates to loving and caring. No matter how sick, how ill, you just can't take that away. That's part of your essence."

*

In a sunny second-floor lounge at Arundel Geriatric and Nursing Center, William MacDermott seems to move in slow motion.

His two-hour daily visit ending, he reluctantly lets go of his wife's hand.

Startled, she looks up suddenly and says, "Where you going?"

He winces, then forces himself to smile again.

"Don't worry, Lillian, I'll be back tomorrow. I'll bring your favorite -- Haagen-Dazs coffee flavor."

He kisses her and walks off.

Before turning the corner for the elevator, he pauses to take one last glimpse of her, until tomorrow.

About this report

Here's a glimpse of what you'll find each day in this four-part series about aging in Anne Arundel County, "Golden Years, tarnished promise."

*Yesterday: The explosive growth in the number of Arundel seniors is over whelming limited resources, and the gaps will likely widen this decade.

*Today: Care for the elderly is hard to find and much too expensive for many county residents.

*Tuesday: Faced with long waiting lists for public housing and high rents, county seniors are forced to look elsewhere.

*Wednesday: The elderly, their children and health-care providers speak of frustration, fear, anger and hope.

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