Real Family Values: Planning for a Future that Ensures Dignity for an Aging Population

8202019 Real Family Values Planning for a Future that Ensures Dignity for an Aging Population

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1 Center for American Progress | Real Family Values Planning for a Future that Ensures Dignity for an Aging Population

Real Family Values

Planning for a Future that EnsuresDignity for an Aging PopulationBy Emily Baxter July 15 2015

In he coming years our naion will ace myriad challenges relaed o he care o he

growing number o aging Americans Elder care encompasses many hings rom healh

care o reiremen securiy o he menal physical and financial coss o caring or hose

who cared or us Curren policies and pracices or ending o he needs o elders are

expensive haphazard and emoionally challenging Tere is a grea need or policiesha help Americans care or heir aging loved ones and hese policies mus reflec real

amily values including ully embracing he shared responsibiliy o ensuring ha older

Americans can age wih digniy airness and respec A he same ime he decisions

ha elders and heir amilies will991252and ofen mus991252make in order o guaranee he

digniy and saey o loved ones are as much values-based and emoionally laden choices

as hey are economic or financial necessiies Local communiies and communiies o

aih hroughou he counry are meeing he challenges acing an aging populaion and

hose who care or hem in boh radiional and innovaive ways

Caring or hose who cared or us can be boh an emoionally and economicallydemanding experience ye i is one ha millions o Americans ake on wihou hesia-

ion Tere were an esimaed 462 million people in he Unied Saes over age 65 in

20141 Furhermore 397 million people99125216 percen o Americans over he age o

15991252provide daily unpaid care or a leas one elder2 Te paid elder care workorce is

growing as well In 2014 799080 people worked as home healh aides3 an occupa-

ion ha is growing much aser han oher jobs and ha is prediced o increase by 48

percen by 20224

Te Cener or American Progressrsquo Faih and Progressive Policy Iniiaive believes ha

economic policies mus address he needs o each group involved in he care o he

aging991252elders heir amilies and amily caregivers and he paid elder care workorce991252

as well as live up o he values ha srenghen amilies Recognizing and respecing he

digniy o all work embracing he responsibiliy o amily and caring or he mos vul-

nerable ciizens are values ha mus inorm he Unied Saesrsquo approach o elder care o

do his i is necessary o define rame and undersand he curren elder care landscape

as well as is inersecions wih economic policies ha reflec real amily values




Addressing the needs of Americarsquos elderly and aging population

In he coming years he elderly populaion in he Unied Saes will grow rapidly

Americarsquos elderly will ace unique economic challenges ha mus be me wih policies

ha ensure digniy and help individuals accep and shoulder responsibiliy991252in shor

honor real amily values As he Baby Boom generaion991252hose born beween 1946 and

1964991252ages he elder populaion is projeced o double o 88 million people by 20505

Looking orward policymakers will have o consider he abiliy o older Americans o

suppor hemselves and mee he financial burden o heir care needs Tose over age

65 are currenly he leas likely age cohor o be living in povery6 hanks in large par

o Social Securiy and oher programs such as Medicaid which are generally atribued

wih lifing he majoriy o elderly Americans ou o povery According o he Cener

on Budge and Policy Prioriies in 2012 only 91 percen o Americans over age 65

had incomes ha ell below he ederal povery line bu 44 percen would have been

in povery had i no been or Social Securiy benefis7 In ac one sudy ound ha

he rae o povery or hose over age 65 dropped rom 283 percen in 1967 o 116percen in 2000 and ha he change was largely even enirely atribuable o increases

in Social Securiy benefis8 Despie his he nonprofi womenrsquos advocacy group Wider

Opporuniies or Women or WOW ound ha ldquomore han hal o all ully-reired

elder-only households are economically insecurerdquo Tis assessmen defines economic

securiy as having an income ha covers necessary living expenses wihou ldquorelying on

public suppors loans or amily gifsrdquo according o WOW9

Even wih he sabilizing effec o Social Securiy Medicaid and oher programs i is

clear ha many Americans99125252 percen991252are a risk o no being able o ldquomainain heir

pre-reiremen sandard o living in reiremenrdquo afer age 6510

Tese acs give rise oquesions abou how bes o encourage Americans o save or old age and he associaed

care coss or which hey will be responsible as well as abou Social Securiyrsquos abiliy o

mainain benefis as increasing numbers o older Americans reire

Currenly 67 million Americans over age 65 require long-erm care services and sup-

pors991252assisance wih daily asks o mainain a good qualiy o lie despie cogniive or

physical disabiliies Ta number is se o double by 2050 or all Americans who need

long-erm care services11 While or some his migh no mean round-he-clock care

or assisance wih day-o-day asks he 11 percen o people over age 6599125251 million

people or one in nine older Americans991252who suffer rom Alzheimerrsquos disease12 as well

as ohers who ace cogniive and demenia-relaed disorders may require more inensive

care Te number o hose who need long-erm care is expeced o grow as more Baby

Boomers reire13




Long-erm services and suppors include paid and unpaid caregiving or a combinaion

o boh Americans pay or long-erm care suppors and services in a variey o ways

including hrough incomes asses long-erm care insurance and Medicaid Alhough

Medicaid covers wo-hirds o he cos o all paid long-erm services and suppors in

he Unied Saes hrough ederal and sae programs many Americans believe ha

Medicaid or privae healh insurance will pay or daily suppors and services auomai-

cally or exended periods o ime I does no Raher individuals wih asses musspend down heir personal savings in order o qualiy or Medicaid14

Tere are also ways o esimae he coss o unpaid long-erm suppors and services Te

Congressional Budge Office or CBO esimaed ha paid and unpaid long-erm elder

care suppors and services cos Americans roughly $426 billion in 201115 Likewise

using an opporuniy cos measuremen based on unpaid caregiversrsquo or he elderly los

wages and daa rom 2011 and 2012 economis Amalavoyal Chari and ohers ound

ha unpaid elder care cos $522 billion16

Te rising need or long-erm and oher kinds o elder care as well as concerns abouolder Americansrsquo financial abiliy o suppor hemselves and mee heir care needs

illusraes he imporance o acing hese issues wih a values-based mindse Tis means

acknowledging ha meeing he needs o an aging populaion no only involves grea

financial concerns bu i also requires people o recognize he emoional and psycho-

logical aspecs o care and aging

Lasly in addressing he challenges ahead or he growing populaion o older

Americans real amily values require he recogniion ha here are currenly 3 million

lesbian gay bisexual and ransgender or LGB people over age 5517 who ofen have

paricular legal healh and care needs Years o legal discriminaion and social sigmamean ha many LGB seniors rely on amilies o choice and are more likely o live

alone and be financially vulnerable in old age as well as more concerned abou disclos-

ing heir sexual orienaion o heir healh care providers18

Respecting the needs of unpaid elder care providers

Real amily values compel us o ully appreciae caregiving including is sruggles and

rewards Unpaid caregivers wheher riends or amily by blood or choice care ou o

love and a sense o responsibiliy and as such heir work should be recognized and

valued Unpaid care is someimes a choice bu ofen i is also an economic necessiy due

o he high cos o and he lack o inrasrucure surrounding paid care Par o valuing

unpaid elder care requires an undersanding o he economic991252as well as he physical

and menal991252sresses associaed wih i beore one can address how policy can help sup-

por hose who care Tis is he case wheher care involves organizing medicaion pay-

ing bills cooking dinner shopping dressing bahing ransporing or simply visiing an

elderly amily member or riend




Fast facts Unpaid caregivers for the elderly

bull 397 million Americans over the age of 15 reported providing unpaid elder care in 2012

and 2013 and 16 percent of those individuals were also employed19

bull 76 percent of family caregivers reported providing day-to-day care with help only from

their families In other words very few caregivers rely on significant help from paid care

workers20

bull 23 percent provided care on a daily basis21

bull An older study found that 42 percent of employed Americans had provided care for an

elder relative within the past five years22

bull From 2012 to 2013 57 percent of caregivers were women23

bull From 2012 to 2013 nearly one in five American women cared for someone over age 6524

A 2010 repor by he Families and Work Insiue ound ha many unpaid caregivers

or he elderly coninued o work and mos repored no having enough ime or oher

people in heir lives such as children and spouses or even heir own needs Nearly hal

o he caregivers in he sudy were members o he so-called sandwich generaion991252

meaning ha hey cared or boh children and elders25

Te repor based on he Naional Sudy o he Changing Workorce 2008 or NSCWdescribed how eldercare can affec amiliesrsquo and unpaid caregiversrsquo work lives 38 per-

cen o caregivers ook ime off o work in he previous year o care and o hose people

nearly hal repored losing income Mos also waned o reduce heir working hours o

provide beter care bu only 23 percen did so26 Tose who earned less income el he

economic effecs mos srongly Anoher sudy ound ha 21 percen o all caregivers991252

a number ha can include hose who care or elders as well as children and aduls

under 65 years old wih long-erm care needs991252wih annual household incomes under

$50000 ound caregiving o be a significan financial burden27

Ineresingly in he qualiaive porion o he NSCW caregivers or he elderly ended o

rank heir experiences as posiive overall hough many el guily abou he necessiy o hav-

ing o juggle caring and working and as a resul many ound i challenging o navigae heir

relaionship wih he person or whom hey cared28 Tis makes sense amily members

care or elders ou o love bu also may no have anoher choice when paid care services are

unaffordable A he same ime here can be echnical aspecs o caregiving or which amily

members are no equipped991252or example adminisering medicines giving medical care or

providing physical assisance such as helping someone ge ou o bed or use he bahroom




Te emoional financial and ime burden o caring or elderly loved ones can be sress-

ul bu Americans mee hese growing demands daily o ruly value he welare o

hose who have cared or us i is necessary o ensure ha caregivers have he abiliy

opporuniy assisance and guidance o care or hemselves as well as heir loved ones

Maintaining the dignity of paid elder care providers

Currenly a very small percenage o elderly people abou 35 percen in 2012 29 live in

assised living aciliies reiremen communiies or nursing aciliies Moreover in 2008

only one in our Americans repored ha paid caregivers provided a ldquosignifican amounrdquo

o daily care30 Sill he Congressional Budge Office predics ha by 2050 meeing he

needs o Americarsquos elders would require beween 7 percen and 11 percen o he adul

nonelderly populaion o paricipae in paid or unpaid caregiving 31 One o he big-

ges concerns raised by he ederal Commission on Long-erm Carersquos 2013 repor o

Congress was ha rapidly growing demand would resul in a shorall o elder care proes-

sionals I said ha atracing and reaining workers rom geronologiss o nursing homenurses o home healh aides would be a grea challenge in he coming years32

As demand or elder care proessionals991252including healh proessionals991252grows i is

imporan o make sure ha he working sandards or he men and women who make

up his workorce exempliy real amily values which means respecing he digniy

and worh o his work and hese workers oday 90 percen o home care aides are

women more han hal o hese are women o color33 And wages are low or hose who

provide care proessionally In ac he median wage or home healh aides was $1028

in 201434 Such wages ell below 200 percen o he ederal povery line or a single-per-

son household in 201435

According o analysis rom he Paraproessional HealhcareInsiue 56 percen o home care aides rely on public assisance o some kind36 Tis is

no a perec measuremen as home care aides include wo job classificaions991252home

healh aides and personal care aides according o he Bureau o Labor Saisics991252and

do no make up he enire elder care workorce Moreover home care aides may also

care or nonelders wih long-erm care needs Neverheless he numbers do provide

some needed conex

On Sepember 17 2013 he US Deparmen o Labor made a leap orward in sup-

poring hese workers For nearly 40 years under he Fair Labor Sandards Ac home

care aides were classified as ldquocompanionsrdquo and comparable o par-ime babysiters991252a

designaion ha excluded hem rom minimum wage and overime proecions In 2013

he Deparmen o Labor ended his exempion Alhough a Washingon DC disric

cour sruck down he move he Deparmen o Labor has appealed he decision and as

o his May he case is sill pending37




Te Deparmen o Laborrsquos effor o reclassiy home care aides was in line wih values

ha Americans hold dear airness jus compensaion he value o work and economic

securiy All o hese values help make American amilies sronger Home care aides

provide a vial and growing service and heir work should be compensaed accordingly

Furhermore here are oher workplace proecions and benefis beyond wages For

example he elder care workorce should have access o paid sick days and ranspora-

ion allowances o ravel beween muliple cliens Proecions such as hese could helpreduce urnover and make hese jobs more atracive and viable or workers I is pos-

sible o creae good jobs ha a he same ime provide affordable care or amilies who

ace he economic sress o hiring care services (see he sidebar on page 9) bu i will

require a commimen o ransorming he naionrsquos care culure and inrasrucure

Next steps

All o he acs noed above show ha here are many policy inervenions ha would

help Americans beter care or hemselves and heir loved ones as hey age in a way hareflecs real amily values Tere is a wide variey o economic policy inervenions wih

differen ocuses and end goals ha could improve he lives o elders as well as hose

who provide paid or unpaid care Creaing programs o rain amily caregivers could

help grow he paid elder care workorce38 Anoher inervenion a piece o legislaion

proposed in 2014 would esablish a Caregiving Corps ha could provide shor-erm

respie or caregivers39 Furhermore he ederal governmen offers long-erm care

insurance o is employees and promoing he upake o his coverage could help sar

a larger conversaion abou long-erm care planning40 CAP also has proposed urher

reorms and ax credis relaed o long-erm care insurance41

Reauhorizing he Older Americans Ac991252firs enaced in 1965991252is anoher necessary

acion and amending i o include provisions ha help LGB people gain access o

he unique suppors and services hey may need would improve he ac even more42

Likewise updaing and srenghening Supplemenal Securiy Income or SSI benefis

could improve he lives o very low-income seniors43

Te Family and Medical Insurance Leave Ac or FAMILY Ac inroduced by Sen

Kirsen Gillibrand (D-NY) and Rep Rosa DeLauro (D-C) is a clear example o a

piece o legislaion ha could provide suppor o hose caring or people across he age

specrum Te legislaion would vasly increase access o paid amily and medical leave

or working Americans While such leave is ofen associaed wih maerniy or paerniy

leave i also would provide caregivers he flexibiliy o ake ime off o care or aging

loved ones suffering rom severe illness44 Similarly he Healhy Families Ac inroduced

by Sen Paty Murray (D-WA) and Rep Rosa DeLauro (D-C) would ensure ha he

approximaely one in hree Americans45 who do no have access o paid sick leave can

earn up o seven days per year o deal wih heir own illness or ha o a amily member46




Currenly only 13 percen o Americans have access o paid amily leave47 while jus

less han hal o ull-ime workers repor ha hey have he abiliy o change heir hours

only 22 percen repor he abiliy o change where hey work48 Te lack o hese basic

flexibiliy arrangemens pus an ever-growing srain on he abiliy o American workers

o care or hemselves and heir amilies

Privae businesses also can be par o he effors o help employees ha are caregivers by offering991252as some employers already do991252flexible work arrangemens reerrals o

services suppors and care managemen consulaions and even adul daycare pro-

grams and oher services As o 2012 or example media gian he CBS Corporaion

provides is employees wih emergency in-home care or elder amily members or $4

per hour Likewise Duke Universiy and Johns Hopkins Universiy provide educaional

workshops consulaions and suppor groups or employees who need care services or

amily members49

Wihin communiies grassroos soluions in he orm o so-called villages991252where

largely communiy voluneers and village members provide services ha help seniorssay in heir own homes991252have gained populariy Te Village o Village Nework has

repored ha he number o senior villages has more han doubled rom 50 in 201050 o

145 a he end o 201451 Tese grassroos membership organizaions aciliae members

caring or each oher991252wheher i is changing ligh bulbs or arranging ransporaion991252

and in some insances have grown o include larger culural programs and communiy

evens While villages are no he soluion o long-erm care needs hey can be effecive

communiy ools or aciliaing digniy in aging

In addiion o all o hese governmen business and grassroos ideas communiies

o aih are in a unique posiion o help address curren and uure elder and eldercare issues because hey already ofen fill he spaces beween financial and care needs

by helping elders say conneced o communiy and providing suppor or hem and

heir caregivers Older people atend religious services a much higher raes han

younger Americans and are more likely o say ha religion plays a significan role in

heir lives52 Tis is rue or a diverse specrum o older Americans Sudies hrough-

ou he pas wo decades have shown ha elders who are par o aih communiies

repor higher levels o psychological well-being53 One survey ound ha 38 percen o

LGB people over age 50 atend a religious or spiriual service or aciviy a leas once

a monh54 while anoher ound ha jus ewer han one in our ransgender older

people repored ha people rom heir churches or aih groups were par o heir sup-

por neworks55

Many people are amiliar wih religiously affiliaed healh care insiuions and care acil-

iies bu religious groups provide communiy services and suppors in oher ways oo

Muliservice aih-based chariable organizaions ha work on a range o povery issues




ofen find an elemen o elder care ha can be unexpeced Caholic Chariies USA or

example is made up o independen communiy agencies hroughou he counry Some

o hese agencies have senior day ceners offer care coordinaing services or simply

provide chariable unds in he orm o ren or ood assisance Seniors made up 16

percen o he people served by Caholic Chariies in 2013 and in many communiies

nonelder-specific services such as immigraion suppor ood banks menal healh or

subsance abuse services can provide a lieline or older Americans991252boh physicallyand psychologically56 One ineresing example o his cross-programmaic elder care

can be seen in Boson Massachusets and Nashville ennesseersquos Caholic Chariies

affiliaes which regularly hos special programs or Haiian and Bhuanese immigran

elders respecively57

Oher religious communiies are working o unie older Americans and he elder care

workorce Caring Across Generaions is a nonreligious campaign ha ofen works wih

communiies o aih o improve boh he qualiy and affordabiliy o care while making

sure ha paid caregiving jobs are good-qualiy careers In is view elder care challenges

are growing bu a collecive way o discussing and addressing hese issues or eldersheir amilies and paid caregivers is missing

As such Caring Across Generaions is educaing and engaging aih communiies a

he grassroos level and has aciliaed some remarkable examples o acivism In New

York Ciy or insance Te Eldercare Dialogues was a pilo program convened by he

Naional Domesic Workers Alliance and Jews or Racial amp Economic Jusice Tree

domesic worker organizaions ha represen diverse racial and ehnic groups991252

Adhikaar Damayan Migran Workers Associaion and Domesic Workers Unied991252and

he congregans o Brsquonai Jeshurun represening elders and heir amilies came ogeher

o discuss difficul siuaions and challenges relaing o elder care Te dialogues engagedalmos 700 elders amily members and care workers beween December 2012 and

December 2014 and showed he inerconneced naure o elder care issues across a

broad range immigraion and gendered aspecs o he elder care workorce end-o-lie

needs air employmen pracices and caregiver agencies and working wih elders wih

cogniive disabiliies Te dialoguesrsquo paricipans also ook par in acivism and rainings

or boh poenial care employers and caregivers While he program was no explicily

religious he values ou o which he program grew aligned wih he needs and values o

many religious communiies including he congregaion ha housed he dialogues and

i is a model or oher communiies and congregaions58




In addiion heologians and religious proessionals coninue o expand rameworks

or hinking abou how Americans can ace aging and caring or aging loved ones Te Journal of Religion Spirituality amp Aging ofen includes ldquopracical innovaion and schol-

arly insighrdquo on he inersecion o religion and aging62 Furhermore he Yale Diviniy

Schoolrsquos special aging issue o is magazine Reflections ocused on elder care in all 2013

and included aricles on reiremen policy heological discussions o deah and aging

and firs-person experiences wih aging and caregiving63

On a slighly more prosaic level communiies o aging ordained clergy991252paricularly

Caholic nuns and priess991252have been par o research on Alzheimerrsquos disease and

oher age-relaed cogniive diseases Because members o hese communiies live

ogeher and have had similar lie experiences hey are ideal candidaes or such longi-udinal research Over he pas nearly 30 years hese sudies have helped researchers

undersand he progression o age-relaed cogniive diseases as well as he risk acors

pahology and biological processes involved64

aken ogeher all o he aoremenioned policy grassroos research and heological

soluions highligh he many ways in which economic securiy is a undamenal expres-

sion o real amily values Communiies o aih are uniquely posiioned o incorporae

hese economic concerns ino belies and values surrounding aging he end o lie

and caregiving Moreover here is grea opporuniy or policymakers as well as paid

and unpaid caregivers and elders hemselves o parner wih religious communiies o

address elder care challenges effecively

Responsible employers committed employees

Jim Kaufman rabbi emeritus of Temple Beth Hillel in Los Angeles

California has worked with national organizations local advocates

and his congregation to educate and build a community committed

to ethical and responsive caregiving Partnering with the Pilipino

Workers Centermdasha cooperative organization of largely immigrant

paid caregivers in the Los Angeles area59mdashhe formed a committee

at his temple to work with the congregationrsquos elderly members and

to inform them about how they could be responsible employers

Likewise the committee members have partnered with local care

workers to assist them in their fight for increased workplace protec-

tions and rights on state legislative action days and at rallies60

Rabbi Kaufman who has led Temple Beth Hillel for 40 years and

watched many of his congregants reach advanced age sees his

work on elder care issues as both personal and universal He says

that as a clergyman he wants to meet people where they are and

sees both caregiving and care purchasing as huge issues in his

community In fact Rabbi Kaufman has even called upon Jewish

theology and scripture to highlight a religious basis for many as-

pects of paid caregiving issues from job quality to support for care

consumers and their families61




Conclusion

Real amily values are key o creaing jus policies and social srucures surrounding

elder care Te percenage o he American populaion over age 65 will increase dramai-

cally in he coming years and as such i is urgen and necessary ha Americarsquos eco-

nomic policies are air and able o adequaely prepare us or he road ha lies jus ahead

Caring or elderly amily members991252as well as ensuring he emoional financial and workplace sabiliy o he amily members and paid proessionals who care or hem991252

requires ha digniy is paramoun a any age and ha doing jus work proecing he

vulnerable and embracing responsibiliy are valued

Emily Baxter is a Research Associate for the Economic Policy team at the Center for

American Progress




Endnotes

1 Bureau of the Census Annual Estimates of the ResidentPopulation for Selected Age Groups by Sex April 1 2010 to July1 2014 (US Department of Commerce 2014) available athttpwwwcensusgovpopestdatanationalasrh2014indexhtml

2 Bureau of Labor Statistics ldquoAmerican Time Use SurveyCharts by Topic Eldercarerdquo available at httpwwwblsgov

TUSCHARTSeldercarehtm (last accessed May 2015)

3 Bureau of Labor Statistics ldquoOccupational Employment andWages May 2014 31-1011 Home Health Aidesrdquo availableat httpwwwblsgovoescurrentoes311011htm (lastaccessed May 2015)

4 Bureau of Labor Statistics ldquoHome Health Aidesrdquo availableat httpwwwblsgovoohhealthcarehome-health-aideshtmtab-1 (last accessed May 2015)

5 Sandra L Colby and Jennifer M Ortman ldquoProjections ofthe Size and Composition of the US Population 2014 to2060rdquo (Washington Bureau of the Census 2015) availableat httpswwwcensusgovcontentdamCensuslibrarypublications2015demop25-1143pdf

6 Kaiser Family Foundation ldquoPoverty Rate by Agerdquo available athttpkfforgotherstate-indicatorpoverty-rate-by-age (last accessed January 2015)

7 Paul N Van de Water Arloc Sherman and Kathy RuffingldquoSocial Security Keeps 22 Million Americans Out Of PovertyA State-By-State Analysisrdquo (Washington Center on Budgetand Policy Priorities 2013) available at httpwwwcbpporgcmsfa=viewampid=4037

8 Gary V Engelhardt and Jonathan Gruber ldquoSocial Securityand the Evolution o f Elderly Povertyrdquo In Alan Auerbach andDavid Card eds Public Policy and the Income Distribution (New York Russell Sage Foundation 2006)

9 Wider Opportunities for Women ldquoLiving Below theLine Economic Insecurity and Older Americansrdquo (2013)available at httpwwwwowonlineorgwp-contentup-loads201309Living-Below-the-Line-Economic-Insecurity-and-Older-Americans-State-Rankings-Sept-2013pdf

10 Alicia H Munnell Wenliang Hou and Anthony Webb ldquoNRRIUpdate Shows Half Still Falling Shortrdquo (Boston Center for

Retirement Research at Boston College 2014) available athttpcrrbceduwp-contentuploads201412IB_14-20-508pdf

11 Commission on Long-Term Care ldquoReport to Congressrdquo(2013) available at httpltccommissionlmp01lucidusnetwp-contentuploads201312Commission-on-Long-Term-Care-Final-Report-9-26-13pdf

12 Alzheimerrsquos Association ldquo2015 Alzheimerrsquos Disease Factsand Figuresrdquo (2015) available at httpwwwalzorgfactsdownloadsfacts_figures_2015pdf

13 It is important to note that this projection is based on thosewho turned age 65 in 2005 See Peter Kemper Harriet LKomisar and Lisa Alecxih ldquoLong-Term Care Over an Un-certain Future What Can Current Retirees Expectrdquo Inquiry

Journal 42 (4) (2005) 335ndash350 available at httpwwwallhealthorgbriefingmaterialsLong-TermCareOveranUn-certainFuture-WhatCanCurrentRetireesExpect-461pdf

14 Sarah Jane Glynn and Jane Farrell ldquoFamily Matters Caregiv-ing in Americardquo (Washington Center for American Progress2014) available at httpswwwamericanprogressorgissueslaborreport2014020583427family-matters

15 Congressional Budget Office ldquoRising Demand for Long-TermServices and Supports for Elderly Peoplerdquo (2013) availableat httpwwwcbogovpublication44363 Note This reportarrives at the cost of informalmdashunpaidmdashelder care byutilizing the average wage of a home health aide and theself-reported donated hours of caregivers for the elderly Bycontrast the Chari studymdashcited belowmdashlooks at the oppor-tunity cost of lost wages given hours spent providing eldercare Neither is a perfect measure but both are instructive

16 Amalavoyal V Chari and others ldquoThe Opportunity Costs ofInformal Elder-Care in the United StatesrdquoHealth Services Re-search Journal 50 (3) (2015) 871ndash882 Grace Whiting phoneinterview with author November 20 2014 Joshua Phoebusphone interview with author November 20 2014

17 Services amp Advocacy for Gay Lesbian Bisexual amp Transgen-der Elders ldquoOut amp Visible the Experiences and Attitudes ofLesbian Gay Bisexual and Transgender Older Adults Ages45-75rdquo (2014) available at httpwwwlgbtagingcenterorgresourcespdfsLGBT_OAMarketResearch_Rptpdf

18 Karen I Fredriksen-Goldsen and others ldquoThe Aging andHealth Report Disparities and Resilience among LesbianGay Bisexual and Transgender Older Adultsrdquo (SeattleInstitute for Multigenerational Health 2011) available athttpcaringandagingorgwordpresswp-contentup-loads201105Full-Report-FINAL-11-16-11pdf SAGE andMovement Advancement Project ldquoImproving the Lives ofLGBT Older Adultsrdquo (2010) available at httpwwwlgbtmaporgfileimproving-the-lives-of-lgbt-older-adultspdf Ser-vices amp Advocacy for Gay Lesbian Bisexual amp TransgenderElders ldquoOut amp Visiblerdquo

19 Bureau of Labor Statistics ldquoAmerican Time Use SurveyCharts by Topic Eldercarerdquo

20 Kerstin Aumann and others ldquoThe Elder Care Study Everyday

Realities and Wishes for Changerdquo (New York Families andWork Institute 2010) available at httpfamiliesandworkorgsiteresearchreportselder_carepdf

21 Ibid

22 Ibid


24 Ibid

25 Aumann and others ldquoThe Elder Care Studyrdquo

26 Ibid

27 National Alliance for Caregiving and AARP ldquoCaregiving inthe USrdquo (2009) available at httpwwwcaregivingorgpdfresearchCaregivingUSAllAgesExecSumpdf


29 Administration on Aging and Administration for CommunityLiving A Profile of Older Americans 2013 (US Department ofHealth and Human Services 2013) available at httpwwwaoaaclgovAging_StatisticsProfile2013docs2013_Pro-filepdf


31 Congressional Budget Office ldquoRising Demand for Long-TermServices and Supports for Elderly Peoplerdquo

32 Commission on Long-Term Care ldquoReport to Congressrdquo

33 Paraprofessional Healthcare Institute ldquoFacts 5 HomecareAides at a Glancerdquo (2014) available at httpphinationalorgsitesphinationalorgfilesphi-facts-5pdf

34 Bureau of Labor Statistics ldquoOccupational Employment and

Wages May 2014 31-1011 Home Health Ai desrdquo

35 Families USA ldquoFederal Poverty Guidelinesrdquo February 2015available at httpfamiliesusaorgproductfederal-poverty-guidelines

36 Paraprofessional Healthcare Institute ldquoFacts 5 HomecareAides at a Glancerdquo

37 US Department of Labor ldquoDOL Appeals Decision in LawsuitBrought by Associations of Home Care Companiesrdquo avail-able at httpwwwdolgovwhdhomecarelitigationhtm (last accessed May 2015)



12 C t f A i P | R l F il V l Pl i f F t th t E Di it f A i P l ti


39 Caregiver Corps Act of 2014 S 2842 113 Cong 2 sess (Sep-tember 17 2014) available at httpswwwcongressgovbill113th-congresssenate-bill2842

40 The Federal Long Term Care Insurance Program available athttpwwwltcfedscom (last accessed May 2015)

41 Daniel Bahr Topher Spiro and Maura Calsyn ldquoReformsto Help Meet the Growing Demand for Long-Term CareServicesrdquo (Washington Center for American Progress 2014)available at httpswwwamericanprogressorgissues

healthcarereport20141031100040reforms-to-help-meet-the-growing-demand-for-long-term-care-services

42 Older Americans Act Reauthorization Act of 2015 S 192 114Cong 1 sess (February 3 2015) available at httpswwwcongressgovbill114th-congresssenate-bill192actions

43 Rebecca Vallas and Joe Valenti ldquoAsset Limits Are a Barrier toEconomic Security and Mobilityrdquo (Washington Center forAmerican Progress 2014) available at httpswwwameri-canprogressorgissuespovertyreport2014091096754asset-limits-are-a-barrier-to-economic-security-and-mobility Shawn Fremstad and Rebec ca Vallas ldquoThe Factson Social Security Disability Insurance and SupplementalSecurity Income for Workers with Disabilitiesrdquo (Wash-ington Center for American Progress 2013) availableat httpswwwamericanprogressorgissuespovertyreport2013053064681the-facts-on-social-security-disability-insurance-and-supplemental-security-income-for-workers-with-disabilities

44 Family and Medical Insurance Leave Act S 786 114 Cong 1sess (March 18 2015) available at httpswwwcongressgovbill114th-congresssenate-bill786

45 Bureau of Labor Statistics ldquoEmployee Benefits in the UnitedStates ndash March 2014rdquo Press release July 25 2014 availableat httpwwwblsgovnewsreleasepdfebs2pdf

46 Healthy Families Act H Rept 932 114 Cong 1 sess (Febru-ary 12 2015) available at httpswwwcongressgovbill114th-congresshouse-bill932related-bills

47 Bureau of Labor Statistics ldquoLeave benefits Accessrdquo availableat httpwwwblsgovncsebsbenefits2014ownershipciviliantable32ahtm (last accessed June 2015)

48 Council of Economic Advisers Work-Life Balance and theEconomics of Workplace Flexibility (Executive Office of thePresident 2014) available at httpswwwwhitehousegovsitesdefaultfilesdocsupdated_workplace_flex_report_fi-

nal_0pdf

49 National Alliance for Caregiving ldquoBest Practices in Work-place Eldercarerdquo (2012) available at httpwwwcaregivingorgwp-contentuploads201001BestPracticesEldercareFi-nal1pdf

50 Tara Bahrampour ldquoThrough a growing number of seniorvillages in the DC area aging in pl ace becomes easierrdquoTheWashington Post February 6 2014 available at httpwwwwashingtonpostcomlocalthrough-a-growing-number-of-senior-villages-in-the-dc-area-aging-in-place-becomes-eas-ier20140206e51fc660-7fbf-11e3-9556-4a4bf7bcbd84_storyhtml

51 Personal communication from Natalie Galucia director ofVillage to Village Network December 1 2014

52 Pew Research Center ldquoReligion Among the Millennialsrdquo(2010) available at httpwwwpewforumorg20100217

religion-among-the-millennials

53 Joe Wilmoth and others ldquoExamining Social Connections as aLink Between Religious Participation and Well-being AmongOlder Adultsrdquo Journal of Religion Spirituality amp Aging 26 (2-3)(2014) 259ndash278 available at httpwwwresearchgatenetprofileJoe_Wilmothpublication271756228_Examin-ing_Social_Connections_as_a_Link_Between_Religious_Participation_and_Well-being_Among_Older_Adultslinks5535622c0cf268fd0015d9d2pdf

54 Fredriksen-Goldsen and others ldquoThe Aging and HealthReportrdquo

55 Services amp Advocacy for Gay Lesbian Bisexual amp Transgen-der Elders ldquoOut amp Visiblerdquo

56 Jane Stenson phone interview with author February 42015

57 Ibid

58 Adhikaar and others ldquoThe Eldercare Dialogues A GrassrootsStrategy to Transform Long-Term Carerdquo (2014) available athttpscdpurbanjusticeorgsitesdefaultfilesCDPWEBdoc_Report_Eldercare-Dialogues_20141211pdf

59 Pilipino Workers Center ldquoAbout Usrdquo available at httppw-cscorgabout-us (last accessed May 2015)

60 Jim Kaufman phone interview with author February 272015

61 Ibid

62 See Journal of Religion Spirituality amp Aging available athttpwwwtandfonlinecomactionjournalInformationshow=aimsScopeampjournalCode=wrsa20VXdeXUbzN1E (lastaccessed July 2015)

63 ldquoTest of Time The Art of Agingrdquo Reflections 100 (2) 2013

available at httpreflectionsyaleeduarchives-list2013

64 David A Bennett and others ldquoOverview and Findings fromthe Religious Orders Studyrdquo Current Alzheimerrsquos Research 9(6) (2012) 628ndash645 available at httpwwwncbinlmnihgovpmcarticlesPMC3409291




Addressing the needs of Americarsquos elderly and aging population

In he coming years he elderly populaion in he Unied Saes will grow rapidly

Americarsquos elderly will ace unique economic challenges ha mus be me wih policies

ha ensure digniy and help individuals accep and shoulder responsibiliy991252in shor

honor real amily values As he Baby Boom generaion991252hose born beween 1946 and

1964991252ages he elder populaion is projeced o double o 88 million people by 20505

Looking orward policymakers will have o consider he abiliy o older Americans o

suppor hemselves and mee he financial burden o heir care needs Tose over age

65 are currenly he leas likely age cohor o be living in povery6 hanks in large par

o Social Securiy and oher programs such as Medicaid which are generally atribued

wih lifing he majoriy o elderly Americans ou o povery According o he Cener

on Budge and Policy Prioriies in 2012 only 91 percen o Americans over age 65

had incomes ha ell below he ederal povery line bu 44 percen would have been

in povery had i no been or Social Securiy benefis7 In ac one sudy ound ha

he rae o povery or hose over age 65 dropped rom 283 percen in 1967 o 116percen in 2000 and ha he change was largely even enirely atribuable o increases

in Social Securiy benefis8 Despie his he nonprofi womenrsquos advocacy group Wider

Opporuniies or Women or WOW ound ha ldquomore han hal o all ully-reired

elder-only households are economically insecurerdquo Tis assessmen defines economic

securiy as having an income ha covers necessary living expenses wihou ldquorelying on

public suppors loans or amily gifsrdquo according o WOW9

Even wih he sabilizing effec o Social Securiy Medicaid and oher programs i is

clear ha many Americans99125252 percen991252are a risk o no being able o ldquomainain heir

pre-reiremen sandard o living in reiremenrdquo afer age 6510

Tese acs give rise oquesions abou how bes o encourage Americans o save or old age and he associaed

care coss or which hey will be responsible as well as abou Social Securiyrsquos abiliy o

mainain benefis as increasing numbers o older Americans reire

Currenly 67 million Americans over age 65 require long-erm care services and sup-

pors991252assisance wih daily asks o mainain a good qualiy o lie despie cogniive or

physical disabiliies Ta number is se o double by 2050 or all Americans who need

long-erm care services11 While or some his migh no mean round-he-clock care

or assisance wih day-o-day asks he 11 percen o people over age 6599125251 million

people or one in nine older Americans991252who suffer rom Alzheimerrsquos disease12 as well

as ohers who ace cogniive and demenia-relaed disorders may require more inensive

care Te number o hose who need long-erm care is expeced o grow as more Baby

Boomers reire13















































workers20

























































some needed conex





















Next steps








































amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid



















































workers20

























































some needed conex





















Next steps








































amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid













workers20

























































some needed conex





















Next steps








































amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid



































some needed conex





















Next steps








































amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid


















Next steps








































amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid



















amily members49




















por neworks55




















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid





















































































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid



















































Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid








Conclusion









American Progress




Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid








Endnotes

























21 Ibid

22 Ibid


24 Ibid


26 Ibid




























nal_0pdf










57 Ibid




61 Ibid




















nal_0pdf










57 Ibid




61 Ibid





Documents

Real Family Values: Planning for a Future that Ensures Dignity for an Aging Population