Eldercare, as defined in the book Growing Old in America, is "the process of caring for an older person in order that he or she may remain as independent as possible for as long as possible. In the United States of America in 1998, approximately 34.4 million people were over the age of 65 (12.7% of the population). By the year 2050, that number is expected to increase to 23%,according to the Census Bureau. More than 40% of hospital stays and 20% of physician expenses are incurred by the elderly. As older individuals become unable to live independently or care for themselves without assistance, eldercare often becomes a difficult emotional and financial issue for them and theirloved ones.
Aging in America
According to the U.S. Administration on Aging (AoA), since 1900, the number of people 65 years of age and older increased from 4.1% of the population (or3.1 million) to 12.7% in 1998 (34.4 million). In addition, the elderly are living longer-in 1998, the 75-84 age group was 33 times larger than in 1900. Older women (20.2 million) outnumbered older men (14.2 million), 75% of men and43% of women were still married, four times more women than men were widowed, the number of divorced men only increased three times, and three out of five women older than 85 lived alone. Also, while children born in1900had a lifeexpectancy of approximately 47 years, those born in 1997 had an average lifeexpectancy of almost 77 years-primarily due to a lower death rate among children. The 85+ population is expected to increase from 4 million in 1998 to 8.5 million in 2030, at which time minorities are expected to compose 25% of the elderly population compared to 16% in 1998.
In 1998, approximately 7.6 million elderly women and 2.3 million men lived alone. However, approximately 80% of older men and 58% of older women lived with their families. This percentage decreased with age while increasing with age was the number of elderly living in nursing homes: only 4.2% of the 65 andolder age group were in long-term care facilities compared to 19.8% of thoseover 85 (approximately 1.6 million). As the "baby boomers" (those born between 1945 and 1968) begin to age, this figure is expected to increase drastically, placing a huge demand on families, skilled nursing staff, and long-term care facilities.
Income Levels of the Elderly
The AoA reports that, in 1998, 3.4 million elderly lived below the poverty level while 2.1 million were "near poor" for a total of 16.8% of the population. The median annual income of elderly men was $18,166, and $10,054 for elderly women. The primary sources of this income were Social Security (which accounts for approximately 40% of the combined income of the elderly), investmentincome, pensions, earnings, and public assistance. Net worth for 17% of olderhouseholds was higher than $250,000 and lower than $10,000 for 16%. In 1998,8.9% of elderly whites, 26.4% of elderly African-Americans, and 21% of elderly Hispanics were poor, while elderly white women had a higher poverty rate (12.8%) than their white male counterparts (7.2%).
Physical Condition of the Aged
Many older people experience restricted physical activities due to chronic illnesses. More than 10.%% were unable to participate in a major activity compared to 3.5% of the general population and, in 1995, almost 4.5 million elderly were experiencing difficulty with ADLs. This number increases almost two-fold in people over 80 compared with the 65-80 age group, as does the number ofelderly with disabilities. Also, most elderly experience one or more chronicphysical conditions such as arthritis, high blood pressure, heart disease, hearing loss, cataracts, and diabetes. The elderly accounted for 36% of all inpatient hospital treatment in 1997, the average length of stay being 6.8 daysas compared with 5.5 for people under 65.
As the population of elderly Americans continues to increase, the number of adult children taking care of their elderly parents is also expected to increase. According to American Demographics, up to 30% of working Americansprovided care for an elderly relative in the late 1990s and, in 1999, 80% ofeldercare was provided by family or friends. Three of every four of these caregivers were women who, in many instances, held full-time jobs as well as raising their own children. Another American Demographics article entitled "The Unseen Costs of Eldercare," estimates women caregivers invest up to 14 hours a week in that role, and that the average woman will spend 17 years raising her children and 18 years helping care for elderly parents. This demanding workload often impacts not only a caregiver's personal time and time with their children and spouse, but their professional lives, as well.
The National Alliance for Caregivers estimates that employees involved in care-giving cost their employers $3,000 or more a year in lost time, absenteeism, interrupted work schedules, medical, and replacement expenses. Studies addressing these issues believe that by providing caregiver benefits packages, employers will help reduce these problems. Benefits may include the family andmedical leave act, "flex" hours, the right to refuse overtime, and adult daycare facilities. One study done by an insurance company estimates that employers could save $3 to $5 for every dollar they invest in helping their care giving employees solve eldercare issues.
Geriatric Care Management
This profession developed as recently as the mid-to-late 1990s due to the increasing portion of aging Americans and their eldercare needs. Geriatric CareManagers provide assessment of an elderly person's medical and personal careneeds, along with a wide range of services to aid families in providing the most suitable living arrangements for their aged loved ones. These services include crisis and family conflict intervention, counselling, legal and financial services, travel and housekeeping services, and evaluation for appropriatealternative housing. All Geriatric Care Managers must have a minimum of a bachelor's degree, and many have doctorate degrees in one or more fields-oftenwith backgrounds in social work, gerontology, psychology, or nursing. Their services are usually costly.
Options for Eldercare
Eldercare involves a wide range of responsibilities and options-from checkingon one's parent on a daily basis at their own home, to providing 24-hour-a-day care in the caregiver's home, to admitting the elderly person into a full-time care facility. Usually, the desire of both the elderly person and his orher children is to remain at home, living as independently as possible for as long as possible. When this is no longer feasible, alternative living arrangements must be made, depending upon the level of medical care, physical assistance, or emotional and social requirements of the individual or couple. Animportant issue when placing and elderly person into an institutionalized setting is to assure the facility is licensed or accredited; holds activities orentertainment suitable for the resident's level of participation; provides physical,occupational, and other types of therapy as required; and has a caring, supportive staff. Choices in eldercare include:
- Adult Daycare: Thisservice is provided in a facility which includes qualified nursing staff, meals, organized and supervised activities/exercise programs, and assistance with activities of daily living (ADL). This can be an excellent option for caregivers who also work outside the home, or for those who need or want respitecare-a break from the demanding day-to-day responsibilities of care giving.
- Retirement Centers/Communities: Primarily "independent living" communities, these are usually private, gated neighborhoods where residents live insmall, single-family homes, townhouses, or condominiums designed and equipped to facilitate the physical needs of aging individuals. Most have homeownersassociations that provide grounds maintenance, many have a clubhouse and exercise facilities such as swimming pool and gym, a communal dining center where healthful meals are provided, and a management team that organizes activities within and outside the community such as social evenings, shopping trips,or travel packages. Many communities provide medical staff and emergency services, as well.
- Assisted Living Centers/Personal Care Homes: These centers provide assistance for those requiring help with ADL but do not yet needskilled nursing care. They can range in size from small, private homes withonly a few residents, to large facilities. The range of services provided mayvary widely, and it is important to find a place that meets the requirementsof the individual. Most centers now also provide special facilities to meetboth the demanding physical and emotional needs of patients suffering from Alzheimer's disease and other forms of senile dementia.
- Skilled NursingFacilities: Often called nursing homes, these facilities provide complete care for the individual who needs medical monitoring and assistance with most aspects of daily living, administration of medications, or even life-support measures such as feeding tubes and oxygen. Services provided include 24-hour nursing staff; visiting doctors; rehabilitation services such as occupational,speech, and physical therapy; and provision of all meals. Many also providea range of activities and entertainment to help the resident feel as much a part of normal society as possible.
- Hospice/Palliative Care Facilities: Here, care is provided for persons with terminal illnesses. Hospice care can include personal care, skilled nursing and medical care, and counseling forboth patients and their families. Hospices may be located in or near a hospital, skilled nursing facility, or assisted living center. Home hospice care is also available for those who wish to die at home.
Costs Associated with Eldercare
Long-term eldercare can be expensive, particularly when the caregiver is nota family member or friend. The average cost of skilled care nursing facility,for example, is $100 a day, with the average stay being two years. Several options, ranging from private insurance to Medicare and Medicaid, are available to help defray some of the costs associated with medical expenses and long-term care for the elderly:
- Long-Term Care Insurance: This is a privateinsurance plan purchased by the individual anticipating the need for long-term care. It covers costs associated with nursing homes, assisted living facilities, and home care by nurses and certified nurses aids. Because this is animportant as well as major financial decision, experts advise that people considering purchasing long-term care insurance seek the advice of professionalsin the field, such as insurance brokers and financial planners.
- Medicare: Available to all U.S. citizens and permanent residents aged 65 and older, this national health insurance plan helps cover both hospital and medicalexpenses such as home health, skilled nursing facilities, hospice services, and outpatient visits. It covers very little nursing home and other long-termcare living arrangements, however, because it does not help pay for "custodial services," which comprise approximately 95% of nursing home fees.
- MediGap/Supplemental Insurance: While this helps pay for deductibles and co-payments, it does not help with expenses that are not covered by Medicare.
- Medicare HMO: These are relatively inexpensive managed care insurance plans available for purchase by the consumer that provide-at the minimum-the same benefits as Medicare but often also help with the cost of prescription drugs; dental, vision, and hearing services; as well as some other types of medical expenses. One such plan even helps cover long-term care costs.
- Medicaid: Medicaid is a program designed to assist severely financially handicapped individuals and families with their medical needs. Although this is a federal program, each state determines eligibility status, as well as what typeof long-term care assistance will be covered.
Other Services Available to Help with Eldercare
The emotional decisions involved in determining living arrangements for the older individual no longer capable of living independently can be difficult for everyone concerned. Also, complicated financial and legal issues surrounding the lifestyle changes may add to the trauma. All this can be challenging atthe least for both the person in need of care and their families:
- Mental Health Services: Mental Health Services can be extremely valuable in improving the quality of life for the elderly. Qualified professionals experienced in geriatric issues can positively impact emotional issues involved with the life-style change, behavioral issues such as alcohol and drug dependency, and depression. Depression in the elderly is a common and often overlooked andunder-treated condition that can be effectively controlled in many instanceswith drugs, counseling, or a combination of the two. Mental health servicesare available through private practitioners, on an inpatient or outpatient hospital basis, in the patient's home, and sometimes even in personal care andskilled nursing facilities.
- Legal Services: Qualified attorneys can handle complicated and difficult legal issues such as preferences for health care, estate planning, probate, Power of Attorney documentation, wishes aboutlife support (a living will), and other issues. Selecting a trustworthy attorney who specializes in the particular issue at hand is important. However, legal advice can also be expensive. Legal insurance plans are available to helpdefray legal costs in much the same way as a medical HMO defrays medical expenses. Prepaid legal plans or legal insurance companies are state regulated,highly reputable, and economical. Agencies such as Legal Aid, Legal ServicesCorporation, and Legal hotlines, and on-line information, are available to help individuals find the appropriate legal services.