Who is going to take care of our parents? For that matter, who is going to take care of us when we grow old and need assistance with such basic activities as bathing, eating or just sitting up?
And how are we going to pay for what is often staggeringly expensive care? Should the government bear most of the cost?
Those are the kinds of questions that have made long-term care for the elderly both a ”kitchen table” issue as well as a potentially significant factor in the 1988 elections.
It is a day-to-day reality for Bill and Carol Eager. They live with their 11 children and Mrs. Eager`s mother, Margaret Wallace, who suffers from Alzheimer`s disease, at their home in Reston, Va.
”I don`t want to relinquish care of my mother,” Carol Eager said. ”I don`t expect the taxpayers to pay (everything), but truthfully I think we should receive some help with the things that are necessary. . . . The bills are real, and they come monthly.”
The Eagers are finding, as have countless other families, that the policies and pensions designed to cover health care for the elderly are inadequate.
”My mother was a dues-paying member of society,” Mrs. Eager said of the 70-year-old former registered nurse. ”She was a care-giver and politically active, and when Dad died he left her a pension, and she had an extra
(insurance) policy and Medicare. So people say, `Oh, at least your mother`s taken care of.` It`s not true.”
For example, ”none of the disposable things” such as diapers are covered, nor are the special drinks prescribed by a doctor that cost $18 every second day, nor are the doctor`s home visits, Eager explained.
With an annual family income in the low $30,000s-Bill Eager is a school principal-”the financial angle is really painful,” she said.
In fact, the elderly are the most rapidly growing segment of our population. According to the Congressional Budget Office, there were 12.4 million people age 65 and older in the United States in 1950. By 1980, the number had more than doubled to 25.7 million.
Projections by the Social Security Administration suggest that America`s elderly population will increase to 64 million to 74 million by 2030, when the Baby Boomers enter their 70s and 80s.
The 85-plus population is growing especially fast. A report printed by the Department of Health and Human Services estimates that the 85-and-over group will grow from 2.2 million in 1980 to 16 million in 2050 and to more than 18 million by 2080.
But while Americans may be living longer, thanks in great part to medical advances that can keep people alive after heart attacks or strokes, they frequently need some kind of assistance in later years. The Health and Human Services Department reports that more than four out of five people 65 and older have at least one chronic medical condition, and one out of four has at least a mild degree of functional disability.
Long-term care is defined as a wide range of services, often involving such everyday activities as bathing, eating or getting dressed, provided over a long period of time to a person unable to perform such acts on his or her own. It does not generally refer to acute care-in other words, it does not directly involve doctors or hospitals-and it may be provided in the home or in an institution such as a nursing home.
Although long-term care can involve anyone from a teenager with cerebral palsy to a 40-year-old who has suffered a stroke to a worker who has been paralyzed in an accident, it most commonly is associated with the elderly.
”The important thing you have to understand,” said Arnold Bennett, spokesman for the Villers Foundation, a nonprofit organization involved in issues affecting the elderly, ”is that long-term care is not just an issue for the older person. It`s an issue that affects the entire family.”
And it affects the family on many levels. First, there are the many problems and stresses that arise when adults find themselves acting as parents to their parents at the same time their own children are young-the ”sandwich generation” phenomenon.
Another emerging problem is that, with more women in the work force, there is a potentially critical shortage of care-givers unless new services are developed to fill the gap. In the past, most of the long-term care has been given by female family members.
Added to this are the complications resulting from an increasingly mobile society. Whereas once children often stayed ”at home,” living out their adult lives near their parents, now they frequently are scattered around the country. For that matter, their parents may have retired to a different area as well.
All of this makes it more difficult for the child to arrange care for the parent, or even to visit as often as desirable.
”It`s really hard,” said Ann Breen, a Washington businesswoman who travels to Philadelphia every few weeks to arrange care for her elderly father. ”It puts a tremendous stress on you. I don`t have any network, so I`m starting from scratch.”
But equal to and perhaps overshadowing the personal and logistical demands of long-term care is the financial burden.
The expense of nursing home care is doubtless the most staggering figure confronted by many families. Right now, the commonly accepted average cost for one year`s stay in a nursing home is $22,000-although that figure can soar much higher in some metropolitan areas.
While only about 5 percent of Americans 65 and older live in nursing homes at any given time-the percentage rises dramatically as age increases-the American Association of Retired Persons and the Villers Foundation projected that one in two Americans will spend some time in a nursing home during their lives, and one in four will spend a year or more.
Consumer Reports magazine, in a cover story last month entitled ”Who Can Afford a Nursing Home?” estimated that ”2.3 million of the nation`s elderly will be living in a nursing home” this year, and ”three decades from now, that number will nearly double.”
By that time, the magazine estimated, a year in a nursing home will cost
”about $55,000 if inflation stays at recent moderate rates.”
Rep. Edward Roybal (D., Calif.), chairman of the House Select Committee on Aging, issued a committee staff analysis last fall that found that ”seven in 10 elderly living alone find their income spent down to the poverty level after only 13 weeks in a nursing home, and within one year of entering a nursing home, over 90 percent of these elderly are impoverished.”
Bennett of the Villers Foundation tells of meeting an elderly couple, both patients in a nursing home, who had started out with $300,000 in savings and gone through all of it after three or four years in the home.
Even if the long-term care is not in a nursing home, expenses can be painfully high. The congressional committee report estimated that home care easily could run $40 or more per day, or nearly $15,000 a year.
The obvious question is how anyone pays such bills. According to the Brookings Institution, a Washington think tank, individuals and families bore 51.4 percent of the cost of nursing home care in 1985.
Medicare, despite what many people might think, covered only 1.7 percent, and private insurance another 1 percent. Medicaid, a state-administered program that is subject to federal requirements and provides health insurance for low-income households, accounted for 41.8 percent.
But to qualify for Medicaid coverage in a nursing home, a person must be impoverished, having depleted virtually all income and assets. This not only can leave a spouse without economic resources, it can lead to instances in which couples married for decades are forced to divorce to protect the spouse`s income and assets.
Linda Zucker of Miami, who for seven years took care of her mother suffering from Parkinson`s disease, said: ”It was, and still is, a financial burden.” Her mother died last October but Zucker says she still is ”up to my ears” in bills related to her mother`s care.
”At points I was so filled with despair, I didn`t know who to turn to,” Zucker said.
A survey conducted last year for Villers and the American Association of Retired Persons by RL Associates of Princeton, N.J., showed that 60 percent of the 1,000 voters surveyed agreed strongly-and 27 percent more agreed somewhat- that the absence of a long-term care program was a ”national family crisis.”
Six of seven respondents believed it was time to consider some government program for long-term care, and 68 percent of those polled said they would be willing to pay more taxes to pay for such a program.
In terms of political implications, 50 percent said they would be more likely to vote for a candidate supporting long-term care. Four percent said they would be less likely, and 32 percent said it made no difference.
Not surprisingly, long-term care began leaping to the top of political agendas as candidates vied to show their support.
”I don`t know of a problem facing the future of this country that`s more important than long-term care,” said likely Democratic presidential nominee Michael Dukakis, who recently called for cuts in defense spending to pay for elderly care.
”We must develop innovative solutions to the problem of financing long-term care,” said Vice President George Bush, who will be the Republican candidate for president.
