A study in the Journal of Clinical Psychiatry.
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Making aging and caregiving kitchen-table issues
Sharpening the end of life discussion. Jane Gross published a New Old Age blog this week in the NY Times called Mad as Hell. The gist of it was about how retired Boston Globe columnist Ellen Goodman is starting up the "Conversation Project, one of many nascent efforts to make the rigors of caregiving and advanced old age into a kitchen-table issue — not just a topic for policy wonks and health care professionals." Ellen and Jane are talking about 'family caregiving'. Something is not quite right, though, about this article and other 'conversations' that depend on first stating the facts about seniors and where they live, what they live on, and who takes care of them.
Sixty is the new 40, don't you know? Aren't you just a bit tired of the 65+ bucket? I use it, so does the Wall Street Journal and the New York Times. But that doesn't make it right. The 65+ age 'bucket' for the non-poor is likely to span at least 2 and for some, 3 more decades at varying stages of infirmity and dependency. We are consistently misled and misleading in the US about percentages of the 65+ that do this, live here, work there, retire when and so blah, blah, blah, prior to engaging us in a topic or a thought. Let's look at the Times column a bit more closely.
Before the kitchen table conversation -- who ARE we talking about? I think it would be helpful to get it right on the dimensions of family (and other) caregiving in the home when it comes to advanced age. Here's my beef: the article referenced the 'small number' of the total elderly population of 40 million aged 65+ as living in nursing homes. This is quite misleading, first of all considering the above skipping and dancing non-poor aged 65-84 folks (see, now there's a line drawn in the aging sand). Now consider that there are 5.5 million seniors aged 85+ according to the latest census. Consider that most nursing home residents are 85+ in age. The nursing home population is approximately 1.5 million, or 27% of the 85+. Over the past ten years, nursing homes have increasingly become the destination of those who cannot afford (or can no longer afford) assisted living. Another million or so live in assisted living (a murky state-by-state definition) but the average move-in age is now up to 86. Finally, there are nearly 2 million in-home care workers (40% of whom are on Medicaid and Food Stamps themselves) -- and many of whom are likely caring for many of the remaining 3 million seniors aged 85+ who need help with activities of daily living.
How many of the aged 85+ seniors are on today's version of Medicaid? This is not to diminish the army of family caregivers, many of course providing unpaid support. But in my view, it would be a far more useful 'mad as hell' initiative to study what Congress has up its sleeve to cut all kinds of reimbursement for senior services -- check out Howard Gleckman's Forbes column on the subject. Here's a rhetorical question for MetLife, Leading Age, ALFA, AARP et al. who survey and collect data about age-related trends and data from skilled nursing and assisted living facilities: How many residents of nursing homes or assisted living facilities are in locked memory care units? How many aged 85+? How many on Medicaid? How have these numbers changed? Unless some level of vocal activism kicks in soon, what's going to happen around the corner, to reply to Ellen Goodman, is that today's financially secure and moderately fit boomers and seniors are going to be aging far longer than they can imagine on their own increasingly meager dime, without a backstop of affordable and stable services to help their family caregivers or themselves.