By the time lung cancer and back problems forced Geraldine Woelke into a nursing home, they had consumed her savings and left her only one option: Get on Medicaid to help pay the $5,000-a-month bill.
"I never, ever thought that I'd be on Medicaid," said Woelke, 75, who had been living with her daughter in Villa Rica.
As the baby boomers age, paying for long-term care is confounding families and policy makers alike. Recently, the Obama administration jettisoned its effort to make private long-term care insurance available to more people, primarily through plans administered by employers. The stumbling block: making the program financially sustainable.
That means that Medicaid -- the program created to provide basic medical services for the poor -- will continue to be the solution of last resort for people who require nursing home care. And that's a headache for Georgia officials, who are already at wit's end over the billions of taxpayer dollars that Medicaid sucks out of the state budget.
Medicaid pays for almost 28,000 Georgians to live in nursing homes, according to the state Department of Human Resources. The state receives about 2,200 Medicaid applications a month for nursing home care, although more than 40 percent are denied.
The numbers are sure to grow: The state's senior population is rising rapidly, with metro Atlanta seeing a 44 percent increase in the past decade, according to the 2010 Census.
"Obviously it can become a tremendous burden," said state Sen. Buddy Carter, R-Pooler, a pharmacist and vice chairman of the Senate's health and human services committee. "The baby boomers that are getting older need to be more self-sufficient, as opposed to people in their golden years depending on the government."
However, the costs can quickly equal or exceed many people's retirement savings. About one-fourth of Americans turning 65 this year will need at one year of nursing home care during their remaining years, according to the Center for Retirement Research at Boston College. On average, couples of that age will need $260,000 to cover all their medical needs.
Medicare, which pays for medical services for people over 65, does not cover nursing home care. Most private long-term care policies do, but only about 3 percent of adults carry such coverage. Thus, Medicaid remains the nation's number one funding source for long-term care, paying for more than 40 percent of nursing home services, according to Boston College researchers.
In theory, a person must be poor to qualify for Medicaid. An individual's monthly income cannot exceed about $2,000, and assets generally cannot exceed $2,000, although a home is excluded from that figure.
With nursing home costs running as much as $80,000 a year, many middle-class people apply for Medicaid after they essentially bankrupt themselves paying for care. Others use provisions in the law that allow them to place assets in a trust so they can qualify for Medicaid.
Woelke didn't initially qualify. The retired Defense Department worker was receiving a pension of $3,000 a month, which exceeded the income limit. But she was able to shift half the pension check into a qualified income trust, which brought her into line. She was approved for Medicaid three weeks ago. Nearly her entire pension check goes to the nursing home, and Medicaid covers the rest of the cost.
"I never thought it would come down to this," said her daughter, Sandi Acker of Villa Rica. She knows some people would call that gaming the system, but, faced with quitting her job in order to care for the mother, she felt they had no other choice. "You stoop as low as you have to stoop."
Conversations about how to care for the elderly without overburdening taxpayers can quickly turn political.
Sen. Nan Orrock, D-Atlanta, said Medicaid should be expanded to pay for more community-based and at-home services, as well as stays in assisted living facilities, which offer less intensive services than nursing homes.
Georgia already channels some Medicaid dollars to community services through its Community Care Services Program, which serves about 12,000 people. But the program has a waiting list of 1,707 people.
"Are we going to have a tax structure that addresses the needs of our population, or continues to turn a blind eye?" Orrock said.
But the notion of expanding an entitlement program such as Medicaid draws howls of protest from some state officials, especially considering the already tight state budget.
"I don't know how we can expand it. It's about to break us now," said Rep. Mickey Channell, R-Greensboro, a member of the House health and human services committee.
Some conservatives want to fight any growth in spending but allow greater flexibility in how Medicaid dollars are used -- for instance, on community and at-home services. Others emphasize tightening eligibility criteria to exclude people who find ways to qualify even though they have other income or assets.
Looking to the future, some analysts are placing faith in the advances of technology to improve people's care at home. They point to monitoring devices that can check vital signs and prompt people to take their pills.
But new innovations raise new questions, including the age-old conundrum: Who's going to pay the bill?