Academic journal article Generations

Emerging Issues for Older Couples: Protecting Income and Assets, Right to Intimacy, and End-of-Life Decisions

Academic journal article Generations

Emerging Issues for Older Couples: Protecting Income and Assets, Right to Intimacy, and End-of-Life Decisions

Article excerpt

Effects of long-term-care policies and practices.

Many policies and practices in the long-term-care and end-of-life arenas present challenges to older couples-particularly if they are not married. When applying for long-term care, married couples are offered some income and asset protections under Medicaid while unmarried couples find that their income and assets are at greater risk. When living in various long-term-care facilities, many couples find that their rights to privacy and intimacy have been compromised. Restrictions on expressions of intimacy and sexuality, however, are tightest for couples who are not married. Finally, when approaching death, many older couples find that they have less power over critical end-of-life decisions, especially if not married.

Because their unions are not recognized by most long-term-care policies or programs, unmarried couples may have the greatest incentive to obtain long-term-care insurance, to avoid long-term-care facilities, and to legally bind themselves with durable powers of attorney if they wish to represent one another in end-of-life decisions. But their rights and protections would be more comprehensive if the U.S. would recognize their unions. The U.S. has been slow in following the lead of many European nations where rights to independence and autonomy are maximized and nontraditional couples are recognized.

As couples age, they often find that rights they took for granted as adults become somewhat limited. After a lifetime of being able to have sex when, and where, they like-and making their own decisions about income and healthcare-many find that they have to struggle to exercise control over key decisions in their lives. This struggle is particulariy difficult for couples who are not married. As they enter the arenas of long-term care and end of life, many older couples face difficulties in maintaining control over their income and assets, their right to privacy and intimacy, and their ability to affect the dedsions that shape their own deaths. Here we explore how various long-term-care policies and practices have a direct impact on couples' rights. We find that while most couples struggle to exercise their rights in these arenas, unmarried couples face challenges that are particulariy difficult to overcome.


Older couples may be hard hit economically when one partner, but not the other, needs to go to a nursing home. This is particularly true if the nursing home resident attempts to qualify for Medicaid. Historically, thousands of older couples became impoverished when one spouse entered a nursing home on Medicaid and the other continued to live in the community (Harrington Meyer and Quadagno, 1990). In the past, states counted all of the income and assets of both spouses when determining eligibility for Medicaid. Thus, gaining Medicaid eligibility for one spouse generally required "spending down" most of the couple's assets to qualify-in many cases divesting themselves of virtually everything they owned (Harrington Meyer, 1994). As Newton Gann (House Select Committee on Aging, 1985), a retiree, explained to a congressional committee, no amount of financial planning proved to be sufficient once his wife was diagnosed as having Alzheimer's disease:

After raising and educating our three boys, Betty and I directed our efforts toward preparing for retirement . . . unfortunately, our little retirement nest egg would be wiped out in no time ... nursing home care for ailments like Alzheimer's costs over $2,000 a month . . . that is just about the total amount of monthly income we planned for retirement, pp. 15-16

Partly in response to stories such as this, special provisions in the 1988 Medicare Catastrophic Coverage Act introduced spousal-impoverishment provisions that protect the community-dwelling spouse's income and assets (Stone, 2002). With respect to income, the new provisions do not permit the income of the community spouse to be counted when determining whether the nursing home resident is eligible for Medicaid. …

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