Declaration of Dependence

This month's topic for my retired women's discussion group was "giving and receiving." We all admitted to being typical women — comfortable at giving but lousy at receiving.

One woman who was dealing with metastatic cancer inspired us by relating her story of asking her family for help when her landlord doubled her rent. Her sons got together and paid the extra rent for a year. She admitted it was very hard to ask but gratifying to receive their generosity.

The rest of the group, mostly single women, said they were "fiercely independent" and didn't want to rely on anyone.

As someone who used to be fiercely independent, but now uses a walker and supplementary oxygen, I asked the group, "What about when you can't be independent anymore? After all, most of us are in our seventies and early eighties — and almost no one can remain fiercely independent forever."

No one had plans for this eventuality.

"You are all one fall, or one severe illness, away from not being independent," I reminded them.

The group all nodded in agreement but had no solution or plan for this eventuality. A few conceded it was something they needed to think more about.

This is not our fault. We assumed Medicare would take care of us. It does not! Not as fully as many people think, anyway. Those who think Medicare covers home health care are in for a rude awakening.

The "med" in Medicare describes all that it covers — medical care, including hospitalization and a few weeks of rehabilitation if you need it. You may be eligible for skilled nursing care at home for a few weeks if you need wound care or something only a nurse can do, but unskilled care is not included, except for help with bathing for some reason. No cleaning, cooking, shopping, transportation or any other of life's necessities.

Some of us are lucky enough to have a child or spouse to take care of us. Or the money to hire a home health aide full time. Or both.

For example, a member of my group with a severe disability due to cancer has a husband and a healthy bank account. I was envious when she mentioned that her husband made sure he took her out every day for a ride or a visit somewhere. And of course she had a home health aide.

I'm on my own. I don't have a live-in caregiver or family living nearby. Fierce independence isn't a workable life plan for me anymore. I have an aide a few hours a week and just want to stay out of a nursing home.

Luckily I can still walk, which is a big deal. You don't realize how monumental perambulating on your own two legs is until you can't do it. Once you can't get to the bathroom by yourself, you're in big trouble.

Nonetheless, mobility is now a huge issue for me. I like to go places, like to book club and out to dinner with friends. I have a car and can drive, but getting from the parking lot to where I'm going is often a logistical nightmare — even with a walker — especially in the summer heat.

Going to events that involve walking is a nonstarter. People send invitations, but without help it's hard to accept them. Being stuck home alone most of the time is not the way I wanted to spend my senior years.

We live in a society that pays little attention to disability or mobility issues. Thank God for the Americans with Disability Act but it doesn't go anywhere near far enough. Neither does Medicare.

Those of us who were financially savvy bought long-term care insurance when we were young. But the older you get, the more it costs. I'd have to turn back time to sign up.

The lesson is here is: don't follow my example. I was a hippie who thought I didn't have to plan for the future. If you haven't considered your need for help eventually, start putting plans in place before an emergency arrives and you are totally unprepared.

• Acknowledge your mortality. None of us want to deal with issues around death and dying, but denial is a trap. The more you actually think and plan about what you will do if and when you can't be independent anymore, the more options you will have when you need them.

• Assess your caregiver situation. I have a number of friends who left sunny Florida and all their friends to move back North to be near their kids. One friend moved to Israel where her daughter and grandkids live. It's unrealistic to rely on friends. Most of us have friends our own age, but they have their own limitations. Unless you're in a position to hire full time caregivers it might make sense to be near family.

• Evaluate your financial situation realistically. You might want to start a savings or investment account earmarked for emergencies only. A visit to an estate lawyer and a financial planner can help you figure out the best way to go.

• Review your bucket list. Maybe you can substitute something more modest for one of those super expensive trips and put the difference into your emergency savings. I have single friends who complain about their finances and the next thing I know they're on their way to a safari in Africa. Our American attitude of "you only live once" is not helpful when it comes to long-term planning.

• Consider assisted living. Even though I'm temperamentally in the fierce-independence camp, I often wish I could afford to live in a place where I could get three meals a day, housecleaning and other services. There are a lot of misconceptions about assisted living. It is not a nursing home — you live in your own apartment and your privacy and freedom is not impeded.
  
  Assisted living can be expensive, but if you have a house to sell you can buy into a luxurious assisted living or continuing-care retirement community which will provide care as you age.

Whatever road you decide to take start planning now. After you break a hip or get a disabling disease, it might be too late.