There was a time when Judy Emerson lived a carefree life. She went to school and worked in her church while planning a career as a Methodist minister.
Then her sister, Susan, died of pneumonia at the age of 33 in January of last year, and Judy Emerson became responsible for the welfare of her ailing parents in their Parkville home.
While Congress argues the dollars and cents of health care, Ms. Emerson contends with the real-life problems of a mother and father who can't care for themselves and might eventually need substantial government help.
The family is in a typical middle-class bind, said Camille B. Wheeler, director of the Baltimore County Department of Social Services.
"They don't have enough money to go it alone, and they have too much to attract a lot of government support," Ms. Wheeler said. "There are many, many people in the same situation."
Ms. Emerson, 31, says her parents "pretty much require constant attention," adding, "I'm trying to put Band-Aids on a hemorrhage."
Her parents have a catalog of illnesses common to the elderly.
Frances Emerson, 67, also has diabetes and is legally blind. She is in the last stages of renal failure and is on kidney dialysis three times a week. She gets around in a wheelchair.
Judy, and Susan before her, have called on the Baltimore County Department of Aging for assistance.
"The department had a wheelchair ramp built for my mother, and they arranged payment for a nursing aide 10 hours a week," Ms. Emerson said. "They've done some other things, and they've been on top of the situation from the start."
Charles L. Fisher Jr., director of the county's Department of Aging, said, "Our goal is to keep people in their homes as long as possible.
"It's more comfortable for them, and the average cost of nursing home care is $3,000 a month. Obviously, many can't afford it," he said.
Ms. Emerson, a graduate of the College of Notre Dame of Maryland, is entering her third year at Wesley Theological Seminary in Washington and works part time as a program coordinator at Linden Heights United Methodist Church on Old Harford Road, five minutes from her home.
"I skip back and forth to check on them, but they really can't be left alone for any length of time," Ms. Emerson said.
She helps her parents dress and bathe in the morning, prepares their meals, handles their finances, and supervises their medication. Mrs. Emerson takes 15 pills a day. Mr. Emerson takes eight. Mrs. Emerson's sister, Sophia Bunting, lives nearby and also helps out.
"Fortunately, they're on a state prescription plan from my father's former employment," Ms. Emerson said. "I don't know how we would cope financially otherwise."
Ms. Emerson was taking 13 to 15 credit-hours per semester at Wesley, but now can take no more than six. She groups her classes on one day to make it easier to care for her parents and to continue working. The family lives on a modest income from Social Security and two small pensions.
Mr. Emerson worked for 25 years for Davidson Transfer & Storage, and was a workmen's compensation claims examiner for the state until he retired four years ago.
"My mother began to notice changes in him about six years ago, and he's really gone downhill since," Ms. Emerson said.
Susan Emerson was a graduate of Towson State University and worked as a nurse's aide at St. Joseph Hospital until she resigned five years ago to care for her parents.
"Susan was very organized, and I could just lead my own life and help out when I could. But her health took a nose-dive after she took on the responsibility," Judy Emerson said.
"The Emerson sisters had an unheard of dedication to maintaining the family and staying together," said Margaret Davison of the Parkville Senior Center. "But care-givers do experience burnout. We want to help keep them in place. They were spinning their wheels going it alone."
Ms. Davison is part of the Department of Aging's Center Connection program, which helps senior citizens with the paperwork associated with joining a center and keeps them aware of the center's activities.
"My father enjoyed the Parkville center for three years, and the staff was very good about noting changes in his condition," Ms. Emerson said. Her father is now in the adult day-care program at the Bykota Senior Center in Towson for six hours a day, three days a week.
"The $300 a month it costs is stretching our budget, but it has saved my sanity," Ms. Emerson said.
Arnold Eppel, deputy director of the Department of Aging, hooked up the Emersons with CountyRide, a department-sponsored bus service for seniors, which takes Mr. Emerson to Bykota and Mrs. Emerson to dialysis.
"Until then, driving was wiping out my day," Ms. Emerson said. Mr. Eppel also handled Mr. Emerson's transition from Parkville to the day-care center, and negotiated a price the Emersons could meet.
Sophia Quigley of the Parkville staff initiated the in-home care for the Emersons under a state program based on income, but Mr. Eppel said there is now a long waiting list for the program. The ramp was also financed under a state program, but funding for that program has been lost.
Does Ms. Emerson feel any resentment about the sudden change in her lifestyle?
"No resentment," she said, "but you go back and forth on what you could be doing with your life. And I know there will come a point where I can't take care of them. Then what?"
The Emersons might be eligible for Medicaid funds if one or both of the parents need long-term care.
The regulations generally are based on income and assets, and apply to all levels of care, such as in-home, assisted living, a nursing home and group home. Applications for Medicaid support must be made through each jurisdiction's Department of Social Services.
More than 17,000 people in Maryland are being supported in some form of long-term care under the state/federal Medicaid program.
For information on services available to senior citizens, call the local Department of Aging office.