Care Options for the Elderly

AMERICANS must remember our ``contract'' with our elderly citizens. We need a comprehensive elderly-care plan now to avoid a catastrophe later. The number of the elderly in our nation is rising fast, and soon almost every family will have an aged member to care for. Currently, 30 million Americans - 12 percent of all citizens - are over 65. By 2030, the over-65 elderly will number 65 million, or 21 percent of the population. More important, the 85-plus generation - those most in need of long-term care - is the fastest growing population segment in the US.

Moreover, our life expectancy is steadily increasing: from 1950 to 2020, the average life span will change from 65 years to 74 years for men, and 71 years to 82 years for women.

What can we do to prepare ourselves for the future? When debating Medicare funding, we have forgotten that the senior citizens have a daily life beyond doctors and hospitals. The following programs will require emphasis to mitigate suffering of the needy elderly.

First, a large number of the elderly can be managed by adult day-care centers. These centers provide daytime care, an alternative to institutionalization. Many elderly people simply need custodial care rather than medical care; this involves help in dressing, eating, bathing, and other everyday activities. The family members are capable of providing these basic needs at all times except during working hours. They are afraid of leaving infirm relatives at home by themselves. When they do, they frequently use office time to call home. Or they miss work. Their productivity suffers. A survey of 7,000 federal workers by the Department of Health and Human Services showed that nearly half had to take care of dependent adults, and 50 percent of these people missed nine to 80-plus hours of work in a year.

Adult day centers are ideal places for these families. It relieves the family members of 24-hour responsibility, especially when they have full-time jobs. A family may leave the relative at the center at, say, 7:30 and take him or her home at 5:30 p.m. while returning from work.

A good day center is not just a ``sitting service.'' It has comprehensive programs consisting of rehabilitative and social services. Besides, these centers cost about half as much as nursing-home care.

Community groups, churches, and voluntary organizations have been in the forefront in supporting these programs, but without a commitment from the federal government, the programs cannot succeed and grow. The Older Americans Act provides $1.2 billion a year for homemaking, meals-on-wheels, and adult day-care centers, but the funding has barely kept up with inflation. I know a number of elderly men and women who wouldn't have a decent meal unless provided by the volunteers from the meals-on-wheels.

Second, home companion care is another important program. Persons who are well enough to stay home but limited in capabilities are helped by the companion-care services. Many old people don't need expertise or equipments. They need physical assistance, which can easily be provided by the kindly aides. These aides are much less expensive than professional nurses and help individuals with physical limitations to live with dignity in their own surroundings.

Third, nursing-home care will be necessary for a large number of the elderly. Currently, 1.3 million older Americans live in nursing homes, at an average cost of $22,000 a year for each person. And with the rising number of the aged, the costs will escalate.

Money must be found for the debilitated aged. Our parents and grandparents sacrificed for us, and because of their sacrifices, we have choices today. Unfortunately, families have to wipe out their lifetime savings to qualify for federal nursing-home coverage. And many fall through the cracks in the system; they have ``too much money'' to qualify for financial assistance, but too little to support themselves. It is painful to watch them groping their way through the economic hardship. Some even have divorced their spouses to be eligible for Medicaid. It's not the affluent elderly who suffer, but the poor and disadvantaged. Cutting the social program will hit the most needy the hardest.

President Bush has said very little about our contract with the elderly. We would be better served if he showed as much zeal for our needy citizens as he has shown for foreign affairs.

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