Family Caregiving to the Older Population: Background, Federal Programs, and Issues for Congress

[Excerpt] Family caregiving to older individuals in need of long-term care encompasses a wide range of activities, services, and supports. Caregiving can include assistance with personal care needs, such as bathing, dressing, and eating, as well as other activities necessary for independent living, such as shopping, medication management, and meal preparation. In addition, family caregivers may arrange, supervise, or pay for formal or paid care to be provided to the care recipient. Family caregivers fulfill the majority of the need for long-term care by older persons with chronic disabilities in the United States. As a result of increases in life expectancy, as well as the aging of the baby-boom generation, demand for family caregiving to the older population is likely to increase. However, demographic trends such as reduced fertility, increased divorce rates, and greater labor force participation among women may limit the number of available caregivers to older individuals, as well as the capacity for caregivers to provide needed care. Although many family caregivers find caregiving for an older family member a rewarding experience, other life circumstances, in addition to caregiving, may increase caregiver stress. For example, family members may not live in close proximity to the care recipient, they may face the competing demands of child care and elder care, and they may have to manage work with caregiving responsibilities. As a result, family caregiving can lead to emotional and physical strain and financial hardship. These effects are more likely to be felt among those caring for persons with high levels of disability or cognitive impairment. Caregiver stress has been linked to nursing home admission for the care recipient, thus interventions that can reduce stress may also reduce nursing home placement. Recognizing family caregivers as an important part of the nation\u27s long-term care delivery system, the federal government has established programs and initiatives that provide direct supports to caregivers, such as respite care, education and training, tax relief, and cash assistance. These benefits are targeted at family caregivers to reduce stress and financial hardship, and to improve caregiving skills, among other things. Other federal programs and initiatives provide home- and community-based long-term care services and supports to the care recipient. These programs can indirectly benefit caregivers in relieving caregiver burden by either supplementing the informal care they are providing or substituting with paid support. Three sets of policies that would provide direct assistance to family caregivers to older adults are briefly discussed in the last section of this report. These policy issues, which have been the subject of discussion among federal policymakers and other interested stakeholders, include the following: caregiver services and supports, flexible workplace accommodations and income security, and additional tax credits. This report will be updated as warranted

Assisted living: Trends in Cost and Staffing

Assisted living communities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. Trained individuals assist residents with activities known as Activities of Daily Living (ADL). The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Medicare does not pay for ALFs. Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The major reason for this cost increase is probably the increased healthcare needs of the baby boomers generation, but an increase in Alzheimer’s disease may also be a factor

How Secure Are Retirement Nest Eggs?

Life's uncertainties can upend the best-laid retirement plans. Health can fail as people grow older, or their spouses can become ill. Older people can lose their jobs, and often have trouble finding new ones. Marriages can end in widowhood or divorce. Health, employment, and marital shocks near retirement can have serious financial repercussions, raising out-of-pocket medical spending, reducing earnings, disrupting retirement saving, and forcing people to dip prematurely into their nest eggs. This brief examines different types of negative events that can strike near retirement. It reports the incidence of widowhood, divorce, job layoffs, disability, and various medical conditions over a 10-year period, and estimates their impact on household wealth. Data come from the Health and Retirement Study (HRS), a nationally representative survey of older Americans conducted by the University of Michigan for the National Institute on Aging. The survey interviewed a large sample of non-institutionalized adults ages 51 to 61 in 1992 and re-interviewed them every other year. The analysis uses data through 2002, the most recent year available. The results show that many people in their 50s and 60s experience negative shocks that threaten retirement security. Job layoffs, divorce, and the onset of work disabilities near retirement substantially erode retirement savings. The findings highlight the limitations of the safety net when things go wrong in late midlife. This Brief was written for the Center for Retirement Research based at Boston College

How Important Are Inheritances for Baby Boomers?

Due to a changing retirement landscape, many baby boomers are likely to have insufficient resources for a secure retirement.1 One potential source that could improve their situation is inheritances. This study quantifies the aggregate amount of inheritances that baby boomers – those individuals born between 1946 and 1964 – can expect to receive over their lifetimes, and the distribution of past and prospective receipts by household type. The discussion is organized as follows. The first section quantifies the aggregate amount that boomers will receive. The second section investigates who will receive how much. The third section considers the impact of the recession on inheritances, specifically the declining values of equities and housing. The final section concludes that, while inheritances will augment the resources of aging baby boomers, they will be insufficient to ensure secure retirements.

Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review

Assisted Living Facilities (ALFs), which provide a community for residents who require assistance throughout their day, is an important part of the long-term care system in the US. The costs of ALFs are paid either out of pocket, by Medicaid or by Long-Term Care Insurance (LTCI). Monthly costs of ALFs have increased over the past five years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the US to determine the impact healthcare on costs. The methodology for this study was a literature review and a total of 32 sources were referenced. Trends in monthly costs of ALF’s have increased from 2004 to 2014. Within the past five years there has been an increase on average of 4.1% in assisted living costs. Medicaid is one payer for residents of ALF’s while another alternative is the use of LTCI. Unfortunately, Medicare does not pay for ALF’s. Staffing concerns in ALF’s are limited due to each state having different rules and regulations. Turnover and retention rates of nurses in ALF’s are suggested to be high while vacancy rate for nurses is suggested to be lower. The baby boomer generation can be one contribution to the increase in costs. Over the years there has been an increase in Alzheimer’s disease which has had also an effect on cost in ALF’s

Will Employers Want Aging Boomers?

Explores the status quo of older workers; why baby boomers are likely to work longer; and how changes in needed skills, the characteristics of older workers, and labor force growth will affect demand for older workers. Includes policy recommendations

"Differing Prospects For Women and Men: Young Old-Age, Old Old-Age, and Elder Care"

Although elderly men and women share many of the same problems as they age, their lives are likely to follow different courses. Women are more likely than men to live into old old-age and are more likely to spend part of their young old-age caring for husbands or parents. By providing this unpaid care women might enter retirement earlier, rather than prolonging their working lives. Because they live longer, but are less likely than men to live with someone who will care for them, women are also more likely than men to require paid care either at home or in a nursing home. Proposals to reduce government spending on Social Security, Medicare, and Medicaid will thus have different implications for women and men. This paper evaluates changes in these programs, and describes alternative and innovative ways of providing and paying for eldercare in other countries as well as in the United States.

A Proposal to Finance Long-Term Care Services through Medicare with an Income Tax Surcharge

Proposes expanding Medicare to cover comprehensive long-term care services, including home care and custodial nursing home care, and financing this expansion of benefits with a surcharge on federal income taxes

End-of-Life Preparations among Lesbian, Gay, Bisexual, and Transgender People: Integrative Review of Prevalent Behaviors

Proactively making end-of-life (EOL) preparations is important to ensure high quality EOL care. Critical to preparation is the discussion of preferences with one’s primary health care providers. Lesbian, gay, bisexual, and transgender (LGBT) people often experience discrimination from health care providers that will detrimentally affect their ability to communicate their care preferences. Structural barriers, such as those based on sexual orientation and gender identity, may impede timely and quality care when one is most in need. The aim of this study was to examine the prevalence of EOL preparatory behaviors among LGBT people, with particular focus on transgender individuals. Eight survey instruments with 30 prevalence estimates found in the literature were analyzed. EOL discussions between LGBT people and their primary health care providers were rare (10%). Transgender people were found to be even less prepared for EOL; they were 50–70% less likely than their LGB counterparts to have a will, a living will or to have appointed a healthcare proxy. A need exists for future mixed-methods research focused on LGBT populations accompanied by the cultural sensitivity needed to ensure their wishes are honored at the EOL

Individuals with Dementia in Respite Care: Longitudinal Changes in Anxiety, Social Engagement, and Problem Behaviors

Individuals with Alzheimer’s disease (AD) and dementia commonly referred to as persons with dementia (PWD), often experience behavioral and psychological symptoms as a result of the disease process. With no cure for AD and no way to prevent the onset of this disease, studies are analyzing methods to manage the symptoms of this disease. Previous literature on the effect of social adult day models is limited, especially pertaining to particular symptoms linked to this disease. This study explored three presenting symptoms associated with AD: anxiety, problem behaviors, and social engagement. Using a secondary data analysis, a sample of 30 participants from Charlie’s Place were observed and analyzed to determine if this adult day center would have an impact on the PWD’s levels of anxiety, problem behaviors, and social engagement