Social Issues of Elder Care in the US - Essay Example

Running head: Elder Care Elder Care [The of the appears here] [The of appears here] Elder Care Among the activities labeled "caring" or "care work,” care provided to the disabled elderly population exhibits several distinctive features. Social norms as well as legal requirements dictate that parents provide care for their children, and all children require such care for at least part of their young lives. Furthermore, parents are expected to enjoy, on balance, the experience of providing that care, despite its occasional frustrating, exhausting, or otherwise unpleasant moments. In contrast, grown children may not anticipate providing personal-care services to their elderly parents, may hope not to find themselves facing such care needs, and may not face a legal requirement that they do so or face a requirement that is not enforced. The children may not, in fact, ever face such needs because some percentage of the elderly reaches the end of life without developing personal-care needs. The need to care for a child is in nearly all cases a temporary situation, followed by a transition a lengthy and gradual transition, to be sure - to the capacity for self-care associated with independent living as an adult. However, the transition into disability during old age may occur gradually or rapidly, and is likely to signal the onset of an irreversible state of dependency, one that will end only in death. Thus, for several reasons elder care merits, and receives, special attention. Yet, elder care and other major types of care work, such as caring for young children, share many common elements: much of the care is provided in private households and is done so "informally" by family members; the care entails heavy use of time inputs; care is provided more often by women than by men; the care effort imposes costs in many intangible domains upon those who do it; and, the caring produces benefits for society at large. Both the costs and the benefits are hard to quantify, in principle and in practice. (Arno, P., Levine, C., and Memmnott, M, 1999) The importance of informal elder care Although different countries exhibit considerable variation in the types and generosity of publicly funded programs with which to meet the care needs of older people, the family remains "everywhere the most important provider” of such care. There is a voluminous research literature concerned with the nature, extent, components, and consequences of informal care provided to disabled elders. Much of that work is based on small, local-area samples, but in recent years a number of national-level data sources have become available with which to study elder care. One of the most detailed sources of national-level information on elder care in the United States is the National Long-Term Care Survey (NLTCS). This panel study includes interviews with persons 65 and older, conducted in 1982, 1984, 1989, 1994, and 1999. All sample members receive a brief screening interview intended to establish the presence of disability with respect to either Activities of Daily Living (ADLs) eating, getting into and out of bed, getting around indoors, dressing, bathing, and using the toilet or Instrumental Activities of Daily Living (IADLs) doing housework or laundry, meal preparation, shopping, getting around outdoors, getting places beyond walking distance, money management, and taking medication. Those screening positively for such a disability receive a detailed follow-up interview, whether they live in a nursing home or in a community setting. One component of the follow-up interviews used with community-dwelling elders identifies all "helpers" persons providing either hands-on or standby help with one or more of the ADL or IADL tasks. NLTCSs term "helpers" and the term "caregivers" interchangeably. (Hooyman, N. and Gonyea, J, 1995) The NLTCS respondents are asked to indicate, for each helper, how many days in the past week the helper provided help, and how many hours of help were provided during the past week. One hours-of-help question pertains to all ADLs as a group and another pertain to all IADLs as a group; time spent helping with individual tasks is not ascertained. The relationship of each helper to the respondent is also obtained. The relationship codes used distinguish among family members in considerable detail, as well as among friends, employees, and people from "helping organizations." Thus, the NLTCS data permit a very detailed study of the help received by dependent elders in the United States. It is possible to determine the number and types of individuals helping with each ADL or IADL task, as well as to identify all the tasks that each helper provides help with. The total volume of care hours expended on behalf of a care recipient, the division of these hours between ADLs and IADLs, and the distribution of those components over the set of helpers, can also be analyzed. A weakness of the NLTCS data is the use of "last week" as a reference period. Other US-based studies have used a wide range of informal-care accounting periods, ranging from one day either "yesterday" or a "typical" or "average" day to two weeks , one month, or even, in the case of the Health and Retirement Survey, a full year. The longer reference periods will presumably elicit a larger volume of care hours, at a likely cost of greater measurement error. (Davis, K. L., Marin, D. B., Kane, R., Patrick, D., Peskind, E. R., Raskind, M. A., and Puder, K. L, 1997) In the 1999 NLTCS data, a surprisingly large percentage of all identified helpers - about 41 percent are reported to have spent zero hours helping during the past week. Informal helpers, particularly children and other relatives who may not live nearby, may help out only occasionally, or may regularly alternate with others in providing help with various tasks. Some tasks, such as money management, providing transportation, or even shopping, may not be performed as often as once a week. The analysis of 1982 NLTCS data by Stone et al. (1987) presented the first descriptive profile of elder-care helpers based on nationally representative US data. Stone et al. described the characteristics of caregivers in great detail, pointing out that a majority (71.5 percent) were female, and that close family members (spouses and children) constituted a large majority (72.9 percent) of all helpers. Liu et al. (2000) discussed the mix of caregiver types found in the more recent 1989 and 1994 waves of NLTCS data. New findings from the most recent round of NLTCS data collection, carried out in 1999. The findings are based on data provided by 2,947 community-dwelling respondents, who listed a total of 5,105 helpers. Adjusted for differential sampling probabilities, this represents an average of 1.68 helpers per recipient of help. Helpers are classified by type (spouse, child, other informal, and formal) and coresidence status. The other informal category is mostly relatives (such as siblings and in-laws), but also includes nonrelatives ("friends") and a relationship category called "someone else". The formal category includes employees as well as anyone from a "helping organization." Coresidence status is noted only for children and other informal helpers, since nearly every spouse lives with the respondent, and nearly every formal helper does not reported in Stone et al. (1987). Over half of the other informal helpers are also family members, however, and inasmuch as this type comprises another 21.4 percent of all helpers, it is evident that the family remains the principal source of help to dependent elders. (Demeny, P, 1987) Because family members provide, without compensation, a majority of the help with tasks of everyday life that is received by disabled older people, it is natural to consider the problem of attaching an economic value to that help. Much of the large literature on the gendered nature of informal care argues that its social value should be explicitly recognized. A related literature argues for including unpaid work in national income accounts. There are several reasons to develop estimates of the implicit monetary value of informal care. Such estimates call attention to the full set of resources devoted to long-term care needs. They are especially important to the extent that public policy recognizes or interacts with informal care. Estimates of the economic value of informal care are also useful insofar as they illuminate the distribution within the population of this type of value-producing activity, particularly with respect to gender and race. (Boardman, A. E., Greenberg, D. H., Vining, A. R., and Weimer, D. L, 1996) Having an estimate of the value of informal care also provides a yardstick against which to assess the coverage or "penetration" of existing policies that expend resources on elder care, or policy proposals that would extend the collective provision of care services. For example, in the United States, direct cash payments to those providing informal care to family members are permitted in a majority of states, generally through waivers to Medicaid home health program regulations. Estimates of the social value of informal care are crucial to any distributional analysis of direct or indirect caregiver-payment schemes such as these. Another US policy indirectly related to the valuation of informal care is the Family and Medical Leave Act of 1993, which permits eligible employees to take up to 12 weeks of unpaid leave per year for purposes of caring for relatives with serious medical conditions. Theoretically, this imposes costs on employers and employees. Any such social costs, however, must be weighed against the social value of the care facilitated. More recently, the National Family Caregiver Support Program, begun in 2001, aims to "help family members provide care for the elderly at home,” explicitly underwriting social values with social costs. Proposals to expand compensation for informal care giving through tax credits or direct payments implicitly recognize that such care is valuable to society. Such proposals are well within the scope of policy discussion in recent years. For example, in 1999 President Clinton proposed legislation that included income-tax credits of up to $1000 for caregivers of dependents with personal-care needs. In the following year the proposal was reintroduced with a higher tax-credit cap of $3000. In 2000, presidential candidate Gore incorporated such a credit into his long-term care proposals, while candidate Bush proposed adding a new income tax exemption for in-home caregivers. Legislation introduced in the 107th Congress also included tax credits for taxpayers who care for spouses or other dependents. Less direct policy interventions have also been proposed: for example, one bill introduced in the House of Representatives in 2002 would give informal caregivers credits towards the determination of Social Security eligibility and benefits. (Bootsma-van der Weil, A., Gussekloo, J., and de Creen, A. J. M, 2001) Although estimates of the social value of informal care are, therefore, important for several reasons, excessively high estimates of the social value of informal care are likely to distort the policy debate with respect to public provision of long-term care, and might hinder the efforts of those who would advocate for improved societal coverage of long-term care benefits. An estimate that overstates the value of informally provided care will wrongly suggest that existing publicly funded efforts are doing a worse job than they really are, while inflating the estimated cost of achieving a more complete coverage of the target population. Thus, a critical examination of existing estimates is warranted. Reference: Arno, P., Levine, C., and Memmnott, M. (1999) "The Economic Value of Informal Caregiving,” Health Affairs, 18 Boardman, A. E., Greenberg, D. H., Vining, A. R., and Weimer, D. L. (1996) Cost-Benefit Analysis: Concepts and Practice. Englewood-Cliffs, NJ: Prentice-Hall. Bootsma-van der Weil, A., Gussekloo, J., and de Creen, A. J. M. (2001) "Disability in the Oldest-old: Can Do or Do Do’? " Journal of the American Geriatrics Society, 49 Davis, K. L., Marin, D. B., Kane, R., Patrick, D., Peskind, E. R., Raskind, M. A., and Puder, K. L. (1997) "The Caregiver Activity Survey (CAS): Development and Validation of a New Measure for Caregivers of Persons with Alzheimers Disease, " International Journal of Geriatric Psychiatry, 12 Demeny, P. (1987) "Re-Linking Fertility Behavior and Economic Security in Old Age: A Pronatalist Reform, " Population and Development Review, 13 Hooyman, N. and Gonyea, J. (1995) Feminist Perspectives on Family Care. Sage. Read More