Old and In The Way

How slow turnings of tiny bureaucratic gears grind up real Texans

1. The Ballad of Neva and Cole
Neva Casey looks anything but destitute when she answers the door of her brick ranch-style house on a hardscrapple road near Crosby.

Trim, neatly dressed and alert, 72-year-old Casey is babysitting one of her granddaughters, who is in the other room watching television. Casey is not destitute, but she's on a financial slippery slope, having spent close to $33,000 in the previous 23 months on nursing home care for her 80-year-old husband, Cole Casey.

When she talks about what has happened to her husband and to her during that time, she doesn't sound bitter or depressed, just at a bit of a loss as to what to do next.

Neva and Cole Casey retired with a good income, lived a comfortable life, had their home and car paid for, and didn't really owe anybody anything. "We went six years thataway," Neva said.

He had his garden, his tractor. Whatever he grew in the garden, I'd put up. We had a good life for six years."

Then Cole started becoming forgetful and developed a lot of peculiar habits. One day he came home from the barber shop two hours late. "He sat down and said, "I forgot how to get home.'"

It went from bad to worse. He didn't want to go anywhere, and she couldn't go anywhere. He slept a lot during the day and would wander at night. Sitters were hard to find and expensive.

One night Neva woke up and smelled something cooking. She went to the kitchen and found Cole standing at the stove frying dry cat food in a skillet. "I tried to be kind to him as long as I could, but I'd get so vexed with him sometimes," says Neva.

Cole was in and out of hospitals and was variously diagnosed as having Alzheimer's Disease or a related dementia. Either way, there was no apparent cure, and no need for long hospital stays.

Finally, Neva realized he needed to be in a nursing home.
"I just hit a brick wall. I couldn't go forwards or backwards. I called my sons in Trinity [Texas]. I had heard that nursing homes cost so much it was almost impossible, but we did it."

Eventually they sold 18 acres in Trinity and some other lots they owned. Now she's down to what's in her checkbook, her home in Crosby, and a small house in Trinity appraised at $14,000.

"When I saw that my checking account kept going down, down, down.... I just wasn't going to make it if he lived much longer."

The two receive monthly Social Security payments of $646 and $1,350, and he has a pension from Brown & Root for $491 a month. That's a total of $2,400 for the couple. Nursing homes -- and he's been in several -- cost about $2,000 a month.

Since the government goes by the "name-on-the-check" rule, $1,841 is counted toward Cole and $646 is considered Neva's.

That is too much income to qualify Cole for Medicaid assistance for nursing-home care, but Neva will try to qualify if the proposed exempt trust option is approved by federal officials. If trusts are accepted, she could funnel a portion of Cole's income into the trust, lowering his income to below $1,302 to qualify. Upon the death of the covered party, funds in the trust go to the state.

"If we continue this way and can't get on Medicaid or some kind of assistance, which I know he and I both hated, to depend on anybody else or any other source of income, I'd have to sell the house. When that's gone, that's it."

She has toyed with the idea of putting up a tall fence around the back yard and bringing Cole back home if she runs out of money. That way if he wanders, he can't leave the yard. Whatever happens, Neva is accustomed to making adjustments.

"I certainly wasn't prepared. I never thought this is how we'd end up. He worked constantly. There wasn't a lazy bone in his body. And it takes two to run a house, and I was behind him all the way. I put the money where it would do the most good. We didn't have a great deal, but we had a house, and land, a lot here and there.

"Rather than spending money as fast as you get it, we were trying to save it for our old age and not have to worry about anything. Then he starts getting sick."

Her voice trails off. She isn't looking for sympathy, she's just describing what happened. For now, she's unsure that the trust fund will enable her husband to stay in the nursing home where he receives the attention he needs. The trust fund for Medicaid confuses her, even after her lawyer explained it.

"He told me the steps I had to go through. I don't understand any of it," Neva says. "We turned in the income [figures] and are waiting for the approval.

"Again, I'm scared. I don't know if it's going to work or not. But it's our only hope."

2. Catch $31.88
Dorothy Pate, a 71-year-old widow with Parkinson's disease, makes too much money to qualify for Medicaid assistance in Texas. Exactly $31.88 a month too much.

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