Written by Barbara Ledig   

Eldercare: Who Pays?
I frequently hear comments from political figures about Americans being overly dependent on government programs and how that is making us “soft”. It has become fashionable in the world of some right leaning politicians to lament that Americans today “lack personal responsibility”. I find particularly jarring the comment made by then presidential candidate, Herman Cain, that people who are poor or out of job have only themselves to blame. Somehow the concept of a social structure that supports its citizens has been demonized and the individual citizen is suddenly the culprit at the root of our national problems. Programs such as Medicare, Medi-Cal (in some states called Medicaid) and Social Security are under attack. These are programs that since their inception in the 1930s as part of The New Deal have helped lift the poor and build the middle class. These are programs that help keep seniors out of poverty and keep the economically disadvantaged off of the streets.
And yet, they are programs that invoke rage and hostility on the part of politicians, who assert that dependence on such programs is a cancer eating away at the heart of our democracy. I recently read an article in a reputable magazine devoted to emotional wellness that cited lack of family involvement in the care of our elderly as contributing to “the unraveling of the family”. This comment in a non-political mainstream publication points to how far misconstrued concepts can impact our belief systems when they are stated frequently enough. It doesn't seem to matter that there is no supporting evidence to such claims. Instead, there is a plethora of information available regarding problems facing the care of our elderly today and none of them support the assertion that there is, in fact, increased dependence on government programs or that this in any way influences how elder care is manifested in our current social structure. To the contrary, more family members today are caring for their loved ones at home than ever before. This is, in part, due to the increase in numbers of people over the age of 65 and in part due to the state of our economy and to a woefully lacking health care system. As a health care professional specialized in geriatric care I work daily with the elderly and their families and see the struggles they face as they try to care for loved ones, hold down jobs and, at times, raise their children (the famous Sandwich Generation). Apart from their struggles, I see their commitment and strength as they strive to do what they feel is right, while often neglecting their own needs.
The American Society on Aging says that one out of four U.S. households, about 22 million, provide caregiver services to a relative or friend over the age of fifty while 40% of caregivers are also raising children and 64% work full or part-time. One of these 22 million is a client of mine by the name of Ruth who cares for her 60 year old husband, Ron, while working part-time running a house cleaning service. Ron suffers from Multiple Sclerosis and has recently become unable to drive. He needs someone to help him do most of the daily activities we have come to take for granted, like walking, preparing meals, and taking a shower. Apart from her husband’s small pension Ruth is the only source of income for her family which includes their fifteen year old daughter and ten year old autistic son. Ruth is also one of the informal (unpaid) caregivers who, according to the National Center on Women and Aging, lose $659,130 over their lifetimes in reduced salary and retirement benefits.
Studies by the Family Caregiver Alliance National Center on Caregiving show that most older people with long-term care needs (65%) rely solely on family and friends to provide assistance. An additional 30% pay privately for caregiving services. The value of the informal care provided by women is in the range of $180 billion a year. The same report states that 25% of the entire American workforce provided informal care during 1996. And women continued to work, often with reduced hours and employment related benefits due to caregiving responsibilities. One of these is Katherine, who provides informal care to her mother, Grace, an eighty-five year old retired schoolteacher suffering from Parkinson’s disease. Grace can no longer walk and has difficulty speaking. Over the course of her illness, she has depleted most of her savings but is not eligible for any type of government assistance. In fact, the only kind of government assistance that would help pay for her care, if her total assets were below $2000, is Medi-Cal.
According to AARP, in 1996, there were 16,706 nursing homes in the United States with approximately 1.8 million beds (the predominant recipient of government funds for long term care under Medi-Cal or Medicaid programs). If you consider that there are an estimated 43 million people providing unpaid care for parents and spouses at home (versus the 1.8 million nursing home beds), it is clear that the majority of elders are not dependent on government assistance and that dependence on government programs is not contributing to the “unraveling” of the family. I would say, rather, that an inadequate health care system and undue stress put upon families caring for aging parents and spouses is a much more likely culprit.
NOTE: This article was written in late 2011 and facts and statistics cited herein reflect information available at that time.