For Better or for Worse – Much Worse


A couple I knew were experiencing serious health issues. At one point, they were helping each other in the bathroom while both were recuperating from difficult surgeries.

The husband quipped, “When we got married and said ‘for better or for worse,’ I imagined a lot of things. Mutual incontinence was not one of them.”

While sharing a dark sense of humor, they managed to care for each other through years of heart disease and cancer. Though both have since passed away, their story is a great example of dedication and love making arduous times bearable.

Some couples fare better. While they may have to help each other through more common issues like recovering from childbirth, cataract surgery, or knee replacements, eventually the “patient” recovers. Others are left to deal with Alzheimer’s or other debilitating diseases that may last for years with no happy ending in sight.

So, what is it that makes one couple hang in until the end, while other couples split up when the going gets too difficult?
Some people believe in honoring their marriage vows and the commitment they made, no matter what happens or how they feel.  Others love their spouses or partners unconditionally, and leaving them never enters their minds.  

According to an article on Health Central, “in sickness and in health” is hypothetical. In reality, not everyone can deal with it.

Author Leslie Rott, whose relationship failed due to her chronic illness, points out that those who are abandoned due to illness tend to have poorer health outcomes. “Women are more likely to be left than men are, mainly because caregiving is still seen as a stereotypically female role,” she writes.

“Although the exact percentage is disputed, divorce rates among the chronically ill are very high. This is sad to admit, but a reality that we must face.”

A study by Fred Hutchinson Cancer Research Center, “Men Leave: Separation And Divorce Far More Common When The Wife Is The Patient,” indicates that, “A married woman diagnosed with a serious disease is six times more likely to be divorced or separated than a man with a similar diagnosis.” Also, “Among study participants, the divorce rate was 21 percent for seriously ill women and three percent for seriously ill men.”

Men tend to have a problem with emotional support. While women will turn to friends, counselors, or groups when they need help, men often don’t. Because they tend to rely on their spouse for emotional support, men can become isolated and alienated.

In some cases, men may withdraw from an ailing spouse or partner to minimize their pain in case their loved one does not survive. Caring for an ailing spouse may be more than some men can handle.  

We can’t point fingers at men, however. Some women don’t want to spend their lives caring for an ill spouse.
Women may feel that they don’t want to give up their life for their spouse’s, especially when there were problems already brewing. They may not feel obligated to assist an infirm spouse.  

Either way, both spouses may feel trapped. The caregiver becomes exhausted, and the ailing spouse may feel guilty. Depression can also affect both parties. Talking to friends, support groups, a doctor, or therapist may help the caregiver find strength to handle the days ahead.

Financial planning needs to be part of the process. In cases where one or both parties work, taking time off to care for an ailing spouse could mean financial devastation. Among older couples, divorce is on the rise because of spiraling medical and long-term care costs. While couples may not wish to divorce, the alternatives may cause more distress.

Medicare covers only the first 100 days of nursing care. If long-term care is needed, you have to pay out of pocket until your assets fall below a certain threshold, or tap into your long-term care insurance.

If Medicaid takes over, the ill spouse will have care to the end of life. However, if you’re married, all liquid assets must be tapped, no matter who’s name appears on the account, until most of your combined net worth is spent down. Only then does Medicaid step in.

Well-meaning financial advisers and attorneys may suggest divorce as a way to stave off financial ruin. To a devoted couple, this may make financial sense, but the emotional price could be unbearable.

As Baby Boomers face mounting medical and nursing care expenses, they may want to consider long-term care insurance, though the premiums can be extremely high.

The time to think about how to handle these issues is before they occur. Talk to your spouse or partner. Consult a financial adviser or elder care attorney.

Love may conquer all, but it’s still a good idea to have a plan in place.


Judith Rucki is a frequent contributor to Forever Young and Buffalo Spree.




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