COMMUNITY SENSE

A CASE FOR FAMILY CARE

Mark R. Wenger

I first heard the idea about 30 years ago. Too clever by half, it sounded like the perfect way to protect the family estate and stick it to the government at the same time. Not talked about openly, the plan is still making the rounds in quiet family discussions and private offices of financial counselors and attorneys. Here it is: Persuade aging parents to transfer their financial assets to family members so they can qualify to receive Medicaid-funded nursing home care.

What a deal! Jesus of Nazareth once told a rich man to sell his assets, give the money to the poor and become a disciple (Mark 10:21). That was the way to put money in the bank of heaven, said Jesus. The man turned away with a sad look on his face. In an ironic twist, the advice given to some seniors today turns Jesus’ words on their head: "Give what you own to your children; then let the government take care of you. That’s how to protect the family nest egg!" Except the scheme is dishonest and selfish, becoming harder to do legally, and at the bottom stinks as a disgrace to the family.

After such an opening, perhaps I ought to locate myself. I am 50 years old with children in high school and college. My parents are 88 and 84, living independently, although my brother and his wife just moved in next door. God knows what the future holds; we don’t.

I have been a pastor for 18 years and participated in the struggles of persons with the predicaments and decisions of getting old. And for the last six years I have been on the board of directors of a faith-based retirement community with a wide continuum of services and a commitment to provide care for those with limited finances. Nursing home care eats up assets like an elephant.

Here is my conviction: Families still carry the primary moral obligation for the care and cost of aging parents and close relatives. Getting old and becoming dependent is an ancient human anxiety. With rare exception, the social contract in most cultures has assumed that children take care of aged parents just as parents once took care of the helpless children. Families, as a matter of honor and respect, care for their own aged.

This kind of social bargain remains the norm in most global cultures. Many examples can still be found even in American culture that prizes individualism and independence. The Amish will commonly build a house-beside-a-house so that three generations live under one multi-angled roof. A woman I know renovated the basement of her home into an apartment so that her mother could move from out of state to live there. Another family made arrangements for someone to cook and clean for an aging parent. Churches have constructed retirement communities partly to help families with the sometimes overwhelming challenge of caring for senior relatives.

But what happens when people live longer than their money lasts? Whose responsibility is it when someone in a nursing home or assisted living residence runs out of money? This is where things really get tangled, partly because there are so many variables, partly because it’s become less clear where the moral obligation resides. There are no easy solutions.

I’m convinced that each level of community plays an important role: the individual, the family, the congregation, the retirement center, local and state social services, and national government. In a society in which traditional circles of community have weakened, government plays a more critical role as caretaker of last resort. For those without adequate personal or family resources, there is no indignity in tapping Medicaid. The isolated and vulnerable are worthy of society’s guardianship. Don’t get me started about the immoral budget priorities of the current national administration!

But shame on those who game the system merely to protect family assets! The case I’m making is for children and families not to sidestep their primary responsibility of caring for and even helping to cover end-of-life living costs. Purchasing a long-term care insurance policy is one option. Another is for immediate family members to pool financial resources. Throwing Mom and Dad onto the tender mercies of the government in an artificial move to poverty is the antithesis of basic human decency and family honor.

I am appealing as well to congregations, which typically invest heavily in the nurture of children and youth—rightfully so—but proportionately offer much less toward the well-being of seniors who have sometimes been longtime members. Many congregations grant scholarship monies for young adults to attend high school or college. This aid is integral to the identity and mission of the body. What about expanding that vision to enable support for senior saints who lack the financial means for their own care?

Families and congregations need to join other layers of society in taking on their share rather than too easily passing the buck. There will always be the need for retirement communities to offer unreimbursed compassionate care—those with means to pay offsetting the cost of those without. There will always be the need for local, state, and national social assistance for the elderly and families who can’t pay. But the first place of sharing is within smaller circles of family and faith communities.

Would I feel differently if my parents were poor and needing long-term care? How would I feel if faced with the choice of helping to pay for their care or sending my daughters to college? For me, this is currently a hypothetical question; I know it isn’t for others. It would be tough to choose. None of us wants to face such a choice or for our children to face it on our behalf.

Many of us live within a contradiction: financial independence and a sense of entitlement. We cherish privacy and self-sufficiency, but if tragedy strikes or we goof up we expect the government to bail us out. Again government assistance can be crucial. When social networks break down or needs turn catastrophic, if the government does not care for the poor, oppressed—or elderly—too often no one does. But we need more. We need to revive smaller circles of community burden-sharing, especially in the care of the elderly.

The issues are much more complex than I’ve sketched in this short column. But sometimes complexity becomes an exit for ducking the obvious: Children and immediate family members with the means to help carry primary responsibility for aging parents who become dependent and low on money. Accepting such responsibility is the honorable thing to do. Likewise congregations share in this circle of community. This is the loving thing to do.

If some financial counselor suggests that Mom and Dad transfer all their assets to the children to qualify for Medicaid, take a deep breath, go home, get a Bible and read James 1:27. "Pure and lasting religion in the sight of God our father means that we must care for orphans and widows in their troubles and refuse to let the world corrupt us."

—Mark R. Wenger, Lancaster, Pennsylvania, is Director of Pastoral Studies for Eastern Mennonite Seminary at Lancaster.