Connie and Nancy, my best friends since the seventh grade, and I were chatting on a kind of cross-country speakerphone conference call — catching up on jobs, husbands, kids and, sadly, mothers in nursing homes.
Connie's mother is in terrific physical health — for 92 — but her mind has left the building. Nancy's mother's mind is still sharp, but her body has quit on her. Connie's mother doesn't know her. Nancy's mother knows very well where she is, and how unhappy she is.
We changed the subject to talk about our next girlfriend getaway, but I dragged the conversation back to the tough topic of aging.
"We shouldn't be planning vacations," I said. "We should be working on exit strategies. The one of us who still has it together needs to promise to mix the pills in the applesauce for the ones who don't."
This wasn't an isolated conversation. It seems as if everyone is talking about the end of life, and how to pay for it.
Another friend returned from traveling on the West Coast and declared she wanted to move to Oregon — not only for its natural beauty but also for its laws allowing assisted suicide.
During a recent meeting with our financial counselor, he mentioned that we needed to consider purchasing long-term care insurance, and my husband repeated his intention to swim into shark-infested waters wearing a steak necklace as soon as the nursing home talk started.
And during a meeting with a lawyer to update our wills, we concluded that one of us had better agree to die in a timely fashion so there is money to pay for the long-term care of the other.
More of us are living longer and dying slower. Estimates are that 70 percent of us will need some kind of residential care in the final years of life, and few of us have the savings or the insurance to pay for it — about $75,000 a year in a nursing home and about $20,000 a year for home care. (It is not either/or. And almost all of us who have home care will eventually need nursing home care.)
The CLASS Act, part of the health care reform legislation of 2010, would have provided long-term care insurance for anyone who wanted to buy it, regardless of age or health. But it was withdrawn last month when the Obama administration realized that it was wildly unaffordable.
Private insurers appear to have made the same actuarial mistakes and are asking for permission to increase premiums on policies they have already sold by 40 percent. And some companies are getting out of the long-term care insurance business altogether.
The assumption that many of us have — that Medicare will pay for our care when we are both old and sick — is wrong. Medicare only pays for short nursing home stays or short-term at-home care, and only under certain medical conditions.
It is Medicaid that is bankrupting itself to pay these costs — and most of us are only eligible after we have drained our savings. (Maryland will allow you to keep some of your wealth and still qualify for Medicaid, but you must buy long-term care insurance.)
None of us wants to face up to end-of-life issues, let alone pony up thousands of dollars a year in premiums for long-term care insurance. It feels like betting that we won't die easily, and who wants to put their money on that number?
And we can't seem to talk about any alternatives to prolonging even the most painful or undignified life.
A proposal that Medicare reimburse physicians for having these kinds of conversations with their patients — about using only palliative care or about withholding extraordinary care — was buried by Sarah Palin and her "death panel" terror tactics. Without the candid counsel of a trusted physician, we are on our own to figure this out.
I had a friend who suffered so with colon cancer that he swore, if it ever returned, he would simply hop in a little sailboat and drift out to sea. When it did, he did not. He fought it tooth-and-nail, including traveling to Germany at enormous expense for alternative care.
Who's to say how we will feel when the choice is the nursing home or the funeral home? Or what pleasure we might still find in a life limited by a failing body?
But from this side of the bedrails, my friends (very dutiful daughters) and I agree that the end of life can be sad and grim.
I am not sure I want anybody — my family, an insurance company or the federal government — to pay a lot of money to make a suffering person suffer a little longer.
Susan Reimer's column runs Mondays. Her email is email@example.com.