Don hadn’t expected his wife to lose her ability to walk so quickly. The degenerative nerve condition from which she suffered came on so fast that neither were prepared for it. Don had never given much thought to the chance of his wife’s disability, although he had insured through his employment for his own disability. His wife’s disability hit Don, his wife, and their marriage like the proverbial ton of bricks. Don found that having his wife suddenly bound to a wheelchair to move around had turned their entire life upside down, from where and how they lived, how they cared for one another, and even when and whether Don worked. The change in their lives and marriage was so swift and complete that they each reeled from it. And their marriage reeled with them.
Definition
Spouses have their physical and mental ups and downs through the course of a long marriage. At any one time, one spouse or the other may be sick with a flu bug or other condition, physically ailing from a nagging condition or injury, or mentally out of it due to some physiological, hormonal, or circumstantial cause. But in the usual case, the spouse functioning at a slowed pace or barely at all soon recovers, to the relief of the healthy spouse who had been caring and concerned for the ailing spouse, while carrying the full burden of maintaining the marital household. Spouses help one another get through short-term illnesses, recover from them, and maintain the marital household in the interim. Disability, though, involves a spouse’s incapability to function in the usual marital role for a period long enough to require both spouses to adjust to the incapacity with a long-term change in circumstances and roles. A spousal illness, you soon both get through. With a spouse’s disability, you soon both take on adjusted roles.
Onset
As the above story illustrates, the onset of a spouse’s disability can have a lot to do with how well or poorly the marital couple copes with the disability. Spouses can see some disabilities coming from a long distance away. You and your spouse may have months or even years to plan for the anticipated disability from a slow-moving neurological condition, slowly progressing diabetes or heart disease, and other disabling conditions. Prayer and treatment in the meantime may extend that period of full or nearly full ability, or may even prevent it. But the long notice gives the couple time to prepare. Other disabilities come on quickly, within just weeks or even days. And some disabilities give no notice at all, such as disability from an auto accident, workplace accident, heart attack or stroke, or home fall down stairs. Generally, the quicker the onset, the greater the upset, and the harder the couple will find it to plan, prepare, adjust, and manage. Stay on the lookout for approaching disability. Don’t stick your head in the sand. If you can see disability coming, for either you or your spouse, give diligent study and preparation to ease the transition and provide for the necessary support and care.
Probability
The probability that you or your spouse will suffer disability for a period longer than three months at some point during your long marriage is surprisingly high. Workers aged thirty-five have as much as a 50/50 probability of such a work disability before retirement at age sixty-five. About a quarter of individuals suffer disability in their first ten years of retirement, rising to nearly one half beyond ten years of retirement. The odds for at least one of two spouses suffering disability are naturally much higher than the odds for just one. You and your spouse may be in great health and fitness, with full abilities, and with no apparent looming issues. You may nonetheless decide to take at least some steps, if not to prepare for disability, then at least to plan for the high probability of disability. You don’t have to wait to see disability coming. You can sneak up on it rather than have it sneak up on you.
Plans
Planning for the disability of one or both of you, even before any sign of it appears, may begin with the hardest thing to change, which tends to be housing. Transportation, home care, medical care, and medical equipment you may be able to requisition relatively quickly. Modifying your home to install handicap ramps, lifts, wider doorways, handicap-accessible toilet and shower fixtures, and master suites on the main floor, or getting to the head of the line for preferred assisted-living units, may take far longer. When selling, buying, or improving the marital home, especially later in life, consider planning for ease of use and access. Prefer a one-level ranch over a tri-level or walk-up. Maybe install wider doorways and a larger bathroom and shower in, and avoid having any steps up or down to, that small new addition you’re planning to the back of your home. You may make similar anticipatory choices regarding your transportation, proximity to medical services and hospitals, and even your residence’s proximity to desirable assisted living or nursing homes, in the event that one spouse may need residential care before the other is ready to abandon the marital home. You don’t have to plan your whole lives around the fear of future disability. But factoring in some of the above choices may cost you little or nothing and gain you much in the event of disability, providing an encouraging degree of comfort and security.
Preparation
When you or your spouse learn of an approaching disability, or suffer a sudden disability, give due attention to preparing to accommodate the disability as best you both can. If the disability is total or serious, and you’re not clear on the necessary accommodations and services, work with an occupational therapist, nurse life care planner, or similarly qualified professional to learn both the needs and available accommodations and services. A skilled nurse life care planner may introduce you to options of which you were unaware and that could both improve your lives together while saving costs. Even in the case of minor or moderate disability, a disability professional may be able to specify equipment or services that relieve much of the disability’s impact on both the disabled spouse and spouse caretaker, and on the marriage. The point is to get qualified help with preparations, and then take the actions you and your spouse best discern within your means and what’s available in your locale.
Impacts
You and your spouse should consider several different impacts that the disability of one of you can bring about. The first impact, and your primary concern, is on the disabled spouse. Give your full and primary attention to relieving your spouse’s disability as far as you are able and to comforting and accommodating your spouse. But also consider the impact on the caretaker spouse, whether you or your spouse. Don’t expect the caretaker spouse to be a hero, when heroism may come at an unreasonable and unnecessary cost to the caretaker spouse. If the disabled spouse needs and deserves more help than the caretaker spouse can provide, then try to arrange that help. A third area to consider, though, is the disability’s impact on the marital household. Both spouses tend to underestimate the value of each spouse’s household services. The disabled spouse may have been providing substantial household services that the caretaker spouse will now have to provide. Alternatively, the caretaker spouse may no longer be able to supply substantial household services because of the new care the disabled spouse requires. Evaluate the help you’ll both need with household services due to the new disability, and get the help you need if you can afford it. The final impact to which to pay attention is the impact on the marriage. Don’t overlook your need and your spouse’s need for quality marital time, even though the disability demands new care and attention. Simply caring for your spouse’s disability, or your spouse caring for your disability, is not equivalent to full and healthy marital relations. You and your spouse still need a healthy dose of marital time, respect, love, and encouragement.
Finances
The disability of either spouse can also have a significant impact on the marital household’s finances. If the spouse who suffers disability was earning an income, then the financial impact of the disability may be direct in the loss of household income. If, instead, the spouse who suffers disability was a homemaker while the other spouse earned an income, then the financial impact may come from the working spouse having to reduce work hours or stop work to care for the disabled spouse. Disability can also require a married couple to pay for all or the uninsured part of medical services, prescription drugs, medical equipment, home modification, in-home nursing or attendant services, and the like. Disability costs can add up quickly and impact the household’s current ability to pay for ordinary living expenses and affect the couple’s retirement savings and plans. Medical expenses are a big reason for marital money issues, civil court lawsuits and account garnishments by creditors, and even personal bankruptcies. Don’t underestimate the potential impact of disability on your marital finances. When one of you suffers disability or learns of a developing disability, examine your budget and investigate disability costs to develop and put in place your best financial plan.
Insurance
Insurance can be a prudent way of managing some of the risk and cost of disability. If a workplace injury caused the disability of a spouse earning an income, then worker’s compensation may pay 60% to 80% of the spouse’s wage, plus medical expenses related to the injury. Worker’s comp wage replacement may take months to begin, though, and won’t generally provide all or even most of what the injured spouse was earning. Expect to make adjustments in the interim. Likewise, if an auto accident caused the disability, motor-vehicle liability or personal-injury-protection (PIP) insurance may cover some, much, or all of the cost. Get qualified attorney representation to investigate and enforce your insurance benefits and rights. You and your spouse may also purchase private disability insurance, or your employer may offer disability insurance as an employment benefit. Disability insurance can be expensive but may be prudent if you and your spouse depend heavily on earned income, and you perceive a greater than usual risk of disability. Social Security disability can also provide a limited safety net of public benefits. Savings and investments can also effectively cover some of the disability costs that you and your spouse risk. A skilled financial advisor can help you weigh benefits and risks, if you and your spouse do not feel sufficiently informed to do so.
Care
To get right down to it, nursing care for the disabled spouse, and the caretaker spouse’s physical limited ability and skill to provide it, can be a married couple’s greatest challenge when facing disability within a marriage. It’s one thing if you can care for your disabled spouse or your spouse can care for you, enough to keep the marriage healthy and marital household going. It’s quite another thing if the two you cannot provide one another with necessary care or maintain the marital household while doing so. At that point of inability, you and your spouse must get the necessary and appropriate accommodations and services. Your strong preferences will likely be to have that occur in the marital home. Often, the initial care must be in a hospital or recovery center. That institutional care may enable a sufficient recovery or stabilization for the care to move to the home, with appropriate in-home services. Anticipate these stages, and support them. If you and your spouse cannot effectively navigate the public and private programs for in-home care, enlist the help of a qualified social worker or other professional.
Institutional
You and your spouse may face significantly greater issues if the disabled one of you must have nursing home or other institutional care. Hospital, medical, and facility managers typically provide substantial guidance and support on how to qualify and pay for required institutional care. Those administrative issues, and the choices they may require you and your spouse to make, can be complex and daunting, while coming at a time when you are both stressed and emotional over the disability and the changes it is wreaking on your marriage. Get the help of a trusted adult child, other relative, or friend for support and counsel. Get the help of an attorney qualified in Medicaid planning when the question comes to paying for nursing home care, while preserving at least some marital assets for the non-disabled spouse. Public programs paying for nursing home care can require a married couple to spend down assets before qualifying for public payments but may not require exhaustion of all assets. Skilled professional advice can help you and your spouse find a lawful and most-beneficial plan. If your locale has more than one nursing facility appropriate for the needed care, investigate the options to make the best choice. Nursing home years can, with the right planning and implementation of plans, be precious marital years.
Perseverance
Perseverance is key to the success of you, your spouse, and your marriage in handling disability. Typically, the question has nothing to do with your desire and commitment to provide one another with disability care. Instead, the challenges tend to have to do with your capability or incapability of providing one another with necessary care, and the changes in your marital household and marital relationship that disability care demands. Few events and conditions will tax your marriage as much as the substantial disability of you or your spouse. Don’t underestimate or overly grieve those challenges. Instead, rise to the occasion and help your spouse do so. In the big picture, which is always good to keep in mind when considering your marital circumstances, disability simply brings to the fore, into full flower and plain expression, the love that you have for each other. Disability is not the same as grieving the loss of a spouse. Disability instead reveals your mutual and profound marital union.
Prevention
A good final thing to consider about disability is the opportunity you and your spouse may have to prevent it. Avoiding disabilities may relate in some degree to the good health practices and physical and mental fitness to which you and your spouse commit, and in which you support one another, throughout your marriage. Being reasonably cautious, prudent, and safe in your driving, recreation, work, and other activities may spare you from disabling serious injury. Being attentive to your medical and dental condition, including having regular checkups and following beneficial recommendations as to diet, health, and exercise, may delay or forestall disability relative to chronic disease. Being attentive to your physical fitness may keep you strong enough to avoid falls and minimize injuries and wear on your joints that might physically disable you. Good mental health practices, including rest, relaxation, social engagement, and religious participation, can give you the outlook to sustain your other healthy patterns. Help your spouse practice good habits, too, that may delay or prevent disability.
Reflection
Do you and your spouse currently anticipate the disability of either one or both of you, from early signs or symptoms that you see? How would things change if one of you suffered long-term disability? Answer that question as to a disability of each of you. What steps have you taken or can you take in your housing, transportation, location, or finances to plan for disability? Do you have disability insurance covering either of you? If not, should you? Consider investigating the cost and benefits. Are either of you engaging in practices or habits that you should change to reduce your probability of suffering disability? Which of you is better able to care for the other in the event of disability? What would make both of you better able to care for the other in the event of disability?
Key Points
Disability reduces capacity enough to change marital roles.
You and your spouse face a substantial probability of disability.
Notice of impending disability can help you and your spouse plan.
Disability preparation requires changes to home, work, and other areas.
Disability can seriously affect marital finances, requiring planning.
Insurance may soften the financial impact of disability.
Spouses’ ability to care for one another’s disability is the largest factor.
Institutional care for disability requires financial planning.
Expect disability to reveal the strong character of your marriage.
Adopt good habits and disciplines to reduce disability probability.