Controversy 5

1
Controversy 5

• Should Families Provide For Their Own?

2
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

3
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

4
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

5
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 ADLs

6
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

7
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 ones own children
• Unresolved question is how government should
  interact with spousal and filial caregiving
  duties and financial responsibilities

8
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

9
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 spouses assets are
  assumed to be available to pay for the partners
  long-term care

10
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 doesnt necessarily save money
• Woodwork effect government policymakers are
  afraid of people coming out of the woodwork to
  demand services that families have been providing

11
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