You may have noticed there is a massive heroin addiction in our country today, with fatal overdoses destroying far too many families. The use of opioid painkillers, relatively easy to obtain, is often the starting point for the addiction. If the prescription is no longer available, or the insurance company will not pay for it, people often resort to heroin, which is inexpensive and easily found on the streets.
Members of our military are typically prescribed opioid painkillers when they are injured, whether in training or in combat. Wars in Iraq and Afghanistan have contributed to injuries that require soldiers to be on prescription painkillers, including oxycodone, the main ingredient in Percocet and other addictive painkillers, and hydrocodone. By the time they are discharged, some are addicted. Once out of the military, they may no longer have access to the prescriptions or coverage, and some, like civilians, turn to heroin.
In a recent article in The Wall Street Journal, the U.S. Department of Veterans Affairs acknowledges its role in creating a large population of opioid-addicted veterans by overprescribing painkillers for injuries and post-traumatic stress disorder. According to the Department of Veterans Affairs, VA patients getting opioid prescriptions increased by nearly 77% between 2004 and 2012. In 2012, one in three VA patients received opioids to manage pain.
Recognizing they had a problem, the Department of Defense and the Department of Veterans Affairs began to de-emphasize opioid painkiller use by turning to other treatment options, including chiropractors, yoga and aquatic therapy. Active-duty soldiers are closely monitored and undergo random drug testing; only about 2% test positive.
While some programs are proving effective, others have created new problems. For example, last year the Drug Enforcement Administration began requiring veterans to refill painkiller prescriptions every 30 days instead of 90 days, to help ensure that the drugs are not being abused. But backlogs at the VA prevented many patients from being able to see a doctor before their medications ran out, causing some to fear more vets will seek heroin to relieve their pain.
The VA has established several opioid-addiction treatment programs. In 2012, it started a detoxification protocol for veterans with an opioid disorder. In 2013, the Opioid Replacement Therapy Program was created and provides vets with Suboxone, a medication-assisted treatment that is FDP-approved for opioid dependence. Veterans are also taught coping skills to achieve and maintain abstinence from opioids and other drugs. In 2014, the substance abuse treatment program expanded education to teach veterans and families how to prevent an opioid overdose, providing information on Naxolone, an FDA-approved medication to treat an opioid overdose. Another program educates veterans on the dangers of combining opiates with drugs and alcohol.
As we age, it is likely that many of us will need help for at least some period of time with life’s daily activities. (These include bathing, dressing, eating and using the bathroom.) And while we may not want to think much about being in that position some day, it would be a good idea to start thinking now about who will take care of us in our old age.
According to a 2011 study by the U.S. Department of Health and Human Services, about half of all informal caregiving is provided by adult children, with spouses providing another 20%. In addition to helping with daily activities, these informal caregivers navigate health care options and insurance benefits, manage medications, provide transportation to doctor appointments, and manage finances. Even when people go into nursing homes or assisted living facilities, their children or spouse still provide a lot of hands-on care.
But what if you don’t have a spouse or child who will be able to take care of you? Your children may live too far away, have health issues of their own, or have family and/or work obligations. Maybe your child or spouse predeceases you. Maybe you didn’t have children. According to a study by Urban.org, nearly one-fifth of women born after 1970 will not have any children.
You may find you need to rely on a sibling, niece or nephew, distant relative, friends or paid helpers. Assisted living facilities are an option for many people. Nursing homes are often regarded as the place of last resort, but people without caregivers are more likely to enter them.
Most of these options can be expensive, depending on the type of care you will need and how long you will need it. For example, the national average cost for a home health aide is $45,760 per year; for assisted living, it’s $43,200 per year; and for a semi-private room in a nursing home, it’s $80,300 per year. (Genworth has researched these costs in each state.) So, in addition to determining who will provide your care, you also need to consider how you will pay for it.
Medicare does not pay for assisted living and only pays for a limited number of days in a nursing home. Aid & Attendance benefits from the Veterans Administration will help pay these costs for wartime veterans and their spouses who qualify. Medicaid will pay for nursing home care, but you have to spend down your assets in order to qualify. Long-term care insurance is an option, but if you wait too long it may not be affordable and you may not qualify. If you have substantial savings and/or have equity in your home, those resources can be used to pay for your care.
The point is this: It is never too late to start thinking about who will care for you in your old age, in what setting you want to receive that care, and how you will pay for it. Don’t assume your first choice is willing to provide hands-on care for you. Have that conversation with your candidates to make sure they are on board with your wishes. If not, you’ll need to come up with Plan B or Plan C. Without a plan, you could end up having no say in your end-of-life care.
Contact our office for consultation.
Jason A. Waddell is a Board Certified Florida Elder Law Attorney who practices on the Panhandle of Florida.