Controversy 5

Should Families Provide For Their Own?

Aging and the American Family

More than half of all Americans over age 65 are married But advanced age frequently brings a need for

caregiving And older spouses are likely to be impaired

Exchange theory of aging – the idea that interaction in social groups is based on reciprocal balance

Aging and the American Family (cont.)

The overwhelming majority of care for aged relative is still provided by women Sandwich generation – describes the impact of

such caregiving responsibilities on middle-aged women (i.e., taking care of older parents and taking care of young children)

In cases of extreme frailty or dependence, family members may become so burdened that they “burn-out” This can sometimes lead to elder abuse and

neglect

Abandonment or Independence?

The common stereotype that older people are abandoned by their children is largely inaccurate Three-fourths of older adults talk on the phone at least

weekly with their children, and more than 40% talk to them daily

But patterns have changed over the past 50 years Ex., sharing a household in an extended family is

dropped off significantly “World-we-have-lost” myth – idealized image of the

“golden age” of preindustrial society Nuclear family – only parents and children in the

household; Western societies have trended toward this

Abandonment or Independence? (cont.)

Families today typically remain in close and frequent contact “Intimacy at a distance” – reflects a common

desire by older people to live independently and yet still remain close enough to have regular contact with grown children

One reason for the change in living arrangements today over last century is that more people are living into advanced age, and thus require help with ADL’s

Family Responsibility

Long-term care has remained largely a family responsibility in the U.S. Spousal responsibility is deeply embedded in our

culture as a matter of both ethics and law Many states have laws on the books which could

require adult children to support their aging parents – but these are rarely enforced

If a spouse is unable to provide care, then other family members such as children or siblings take responsibility

Family Responsibility (cont.)

Filial responsibility – responsibility for care of the aged by adult children Treated ambiguously as a matter of law, custom,

and ethics Commonly taught in some cultures, sometimes to

the extent of being expected to provide care for aging parents over one’s own children

Unresolved question is how government should interact with spousal and filial caregiving duties and financial responsibilities

Medicaid and Long-Term Care

Medicare – a U.S. health care system that provides near-universal coverage for acute diseases among the old; rarely covers long-term care Pays only 2% of nursing home costs

Medicaid – a joint government program supported by federal and state funds; created in 1965 to provide health care for the poor Pays for 36% of nursing home costs Started to give health care to the poor, but has become a

key factor in nursing home coverage for middle-class elderly Two-thirds of all the Medicaid spends goes to institutional care for the

elderly, disabled, and mentally retarded

Financing Long-Term Care

Today, one year in a nursing home can cost up to $75,000 or more Of people who enter nursing homes as “private

payers,” 70% have reached the poverty level after only 3 months, and within a year, 90% are impoverished

Medicaid determines eligibility based on income and assets All but a small portion of a spouse’s assets are

assumed to be available to pay for the partner’s long-term care

Financing Long-Term Care (cont.)

Medicaid is the fastest-growing component of state budgets, and has become the public program of last resort to pay for nursing homes

However, studies have shown that while government-funded home care may be more desirable, it doesn’t necessarily save money Woodwork effect – government policymakers are afraid of

people “coming out of the woodwork” to demand services that families have been providing

Medicaid Planning

As individuals and families have become more aware of the cost of long-term care, some middle-class families have found ways of qualifying for Medicaid Medicaid spenddown – impoverishing themselves by

spending all income and assets to qualify for Medicaid coverage

Divestment planning – appearing to be poor by taking advantage of legal loopholes to “avoid the Medicaid trap”

Unknown how many families do this, but there are enough people to sustain a rapidly growing body of “elderlaw” attorneys