A sign on the wall of Rene Stincer's handsome wood-frame home on Eaton Street declares it to be "Villa de Olga." However, the pronouncement is a bit out of date: Olga, Stincer's wife for many decades, died five years ago, leaving her husband, now 91, all alone.
As the city of Key West continues to debate the assisted living center issue, it's residents such as Stincer who are the human faces behind the headlines.
"It's better for me to stay in this house," Stincer said Friday during a brief visit from U.S. Rep. Joe Garcia, D-South Florida, Island Home Care owner/operator Kim Wilkerson, clinical director and registered nurse Heather Hunt and Stincer family friend Theresa Menendez.
"It's better than going to the hospital, anyway," he said. "There's nothing wrong with the hospital, but I'm more free here. If I need something I can call a friend. If I want to go to the movies, it's just down the street."
Stincer knows more than most about home care, and the medical profession in general. Though not trained as a medical doctor, the soft-spoken native of Cuba who immigrated to the U.S. in 1953 helped start dePoo Hospital with Dr. Julio dePoo back in the 1960s.
Now that he's arrived at the winter of his own life, Stincer -- who recently suffered from an intestinal abscess -- just wants to live out his days in the comfort of the home he and Olga bought back in '56. (Aside from his recent malady, Stincer is actually in pretty good shape, with no chronic cancer, heart or diabetes.)
Thanks to his home care employees, Stincer is enjoying living at home, although clouds are forming on the horizon -- and they spell "Obamacare."
"Right now, Medicare pays 100 percent of each home visit," said Wilkerson, whose company employs 26 people to care for the infirm at home. "The problem is that Obamacare [the Patient Protection and Affordable Care Act] proposes a $100 co-pay for this service. When you're that age, and living on a fixed income or limited resources of any sort, that kind of an increase can lead to hard choices such as cutting back on food or medicine, and it's got us worried.
"Right now, there's a shortage of home care providers, and no real assisted living facilities here to speak of. We visit Mr. Stincer about three times per week," Wilkerson added. "And if it weren't for services like ours, he wouldn't be able to stay in his own home."
It's not like Stincer spends his time thinking of ways to shift his costs onto society at large. He worked and paid taxes well into his 70s. His son, Rene Jr., who lives in Pembroke Pines, can visit to help out only about once a month.
Stincer's other son died.
Due to his deteriorating vision, Stincer no longer drives. He relies on other aging friends to take him grocery shopping, or, more often than not, to 5 Brothers Grocery for a café con leche and some cheese toast.
Though his bedroom is on the second floor, Stincer has been sleeping in the living room for some time now to avoid the havoc stair-climbing wreaks on his knees.
Stincer's grandson, Robert, also visits as often as possible, but he, too, lives on the mainland, and has a family of his own. The relatives' help is no substitute for the kind of home care Wilkerson's employees provide, with therapy, assistance with eating, taking medicine and so on.
"I want to do everything for myself, and I want to be independent," Stincer said. "But there's only so much I can do. I'll make coffee and breakfast sometimes, but I don't really like to cook. And for me, walking is the biggest challenge at this point."
Not only has the affable Stincer been benefiting from home health care, it's also a much better deal for society as a whole. At the moment, the average home care visit costs Medicare about $150, according to Wilkerson. The average hospital visit costs the federal health care program for the elderly 10 times that amount.
About two months ago, Stincer fell and hurt his colon, which eventually led to the abscess. The injury landed him in the hospital, then in the Stock Island convalescent home for three weeks. While he appreciated the treatment afforded him, he worried that the longer he stayed, the less likely it was that he'd be able to return to his living room. Thankfully, lifelong family friend Theresa Menendez came and brought him home.
"It was like the rainbow at the end of the tunnel for him," Menendez said. "When I was younger, whole families used to come see him, and if you were from a lower-income family, he treated you just the same. He was also like a second dad to me, so I've tried to help him now."
Wilkerson said the Key West Health and Rehabilitation Center often calls her suggesting a prospective client, someone who would be better off with home care.
Stincer was one such patient.
"It's a complex issue," congressman Garcia said Friday after meeting with Stincer, Menendez and Wilkerson. "Right now we spend more money on health care than any other industrialized county -- about 18 percent of our GDP (gross domestic product). That's about twice what other rich countries spend. It's crazy."
Garcia, who supports Obamacare, told Wilkerson he's hoping the health law, when fully implemented, will be a help rather than a hindrance to businesses like hers, and provide the care people like Stincer so desperately need.
"It's going to take a while," Garcia cautioned. "What we do know is that home health care services are cheaper and better than the alternatives. We've got to push best practices, and spread the risk across the system so that it costs less for everyone. The money is there."
Garcia pointed out that the U.S. health care system, as constituted before the Patient Protection and Affordable Care Act was passed, was unsustainable in terms of the rising costs and declining outcomes.
"Of course, Florida is a special case, for demographic reasons," Garcia said. "And the Keys also present some unique geographical concerns. But oftentimes people who go to convalescent centers don't come back home, which is what many of them want.
"Now that the entire system is about to be rejigged, services like yours will be getting a lot more attention," he said. "A lot more services will be made available."