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Controversy 5

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

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Controversy 5

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  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 ADL’s

  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 one’s 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 spouse’s assets are assumed to be available to pay for the partner’s 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 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

  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

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