Caring for the Elderly in America
Although the care of older adults has historically been provided either by the individuals themselves or by the family or community, in 21st century America there are a number of other options available to supplement or substitute for this care when necessary. Approximately two-thirds of older Americans remain in their own home or that of their children. However, the other third need the care of a long-term facility. Even most of those remaining at home need additional care and services from time to time as their health deteriorates. Improved longevity and declining birth rates combined with increasing costs of care make paying for elder care an issue of increasing concern. More work is needed to develop plans that can help all Americans receive the care they need and deserve as they age.
Aging & Elderly Issues
The truth is that most of us will need some kind of assistance in our later years. In some cases, people need nothing more than occasional visits from a home nurse, some light housekeeping, meals on wheels, and visitors willing to talk and run errands. In many ways, such aging in place is the ideal situation, with research having found that older adults who live independently rather than in nursing homes tend to live longer lives. While there is a movement to make aging in place possible for more people, it is not always an option. Dementia and other debilitating illnesses can require around the clock medical care and monitoring, things often more easily given in a professional facility than at home. Even in cases where taking care of an elder is theoretically possible through constant (or even partial) care by a family member, the realities of twenty-first century society are not necessarily conducive to this type of care from the family, particularly when the adult children of the aging parent work. The "sandwich generation" often feels caught in between concerns for their children and concerns for aging parents, and are often left with the feeling of putting their own lives on hold.
The realities of old age bring with them many concerns for aging adults ranging from the inability to be able to physically continue to take care of oneself and one's property as was possible earlier, fears of loss of cognitive abilities or the onset of dementia, and the need for long-term care. These are questions that virtually every adult needs to face as s/he continues to age. The fact that capabilities will decline in old age is accepted by most people. How they will accommodate such changes and how their care will be provided in such an eventuality, however, is a more difficult question. As discussed above, members of the sandwich generation often find it difficult to balance the demands of children, careers, and aging parents without feeling overstressed. In many cases, this means that other arrangements need to be made for the care of one's aging parents. In some cases, this is minor: eating together, doing grocery shopping for both households, running the occasional errand. Local area agencies on aging can often provide additional support services to take some of the burden off family members such as finding adult day care programs or finding help for the instrumental activities of daily living. But in other cases, long-term care requirements are more extensive and arrangements need to be made for other caregivers and services to support the aging adult. This is a major concern for many elders.
Aging in Place
According to the Centers for Disease Control and Prevention, aging in place is the "ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, and ability level" (2013). A 2010 national survey by the AARP found that seventy-five percent of Americans age forty-five or older strongly agreed that they prefer to age in place (Keenan, 2010). Advocates of aging in place say that aging in place is ideal for older adults who own their own homes and have the means to make them accessible, low-maintenance, and safe. The benefits of aging in place include living in a familiar home and neighborhood, and the independence of living on one's own. There is even a trend in technology and industry to accommodate the growing population of adults over sixty five who wish to live independently, with advances in senior-friendly tablets, smartphones, and robotic aids. The challenges of living in place include individual issues such as emotional isolation, difficulty detecting changes in nutrition, hygiene, and health, and vulnerability to abuse, as well as community issues, such as a lack of public transportation, supportive infrastructure, and home modification and maintenance programs for older residents. And, while the population of older individuals is expected to increase through the middle of the twenty-first century, the number of available caretakers is expected to remain stable, which may make aging in place more difficult to achieve (Redfoot, Feinberg, & Houser, 2013).
Long-term care consists of long-term aid given to individuals with personal or health care needs. The majority of long-term aid consists of non-skilled help with daily activities. Long-term care is intended to help maximize the independence and function of those with a chronic illness or disability. Although the concept of long-term care is often linked with care in a nursing facility, board-and-care facility, assisted living community, or hospice, two-thirds of the people requiring long-term care receive it in their own homes or in the home of a family member (Beers, 2004). In the latter cases, the primary caregivers are usually members of the person's family, although healthcare practitioners and other service providers may also visit and provide additional care. Whether long-term care can be performed in the home or if the individual needs to be moved to a facility depends on a combination of what the individual's needs are for medial, functional, social, and emotional care and the individual's preference, finances, and social support for other arrangements.
There are a number of options available for long-term care outside one's own home.
Assisted living communities are designed for people that can take care of themselves with a little help. These facilities provide meals, social and recreational activities, and help with daily activities for the older person needing long-term care. Typical living arrangements in assisted living communities comprise apartments in most cases, although some facilities only provide bedrooms with private baths. Meals are offered either in a communal dining room or in the person's room. Some assisted living communities also use intercoms and personal emergency response systems to monitor for emergencies or have available the services of nurses, physical therapists, or 24-hour supervision as necessary. Although in some states Medicare may help pay for the costs of an assisted living community, funding typically comes from either long-term care insurance or from private funds.
Board-and-care facilities (or rest homes) are another option for long-term care. As in assisted living communities, meals in board-and-care facilities are provided in common dining rooms or the individual's room. Board-and-care facilities also provide transportation to medical appointments or shopping, and offer social activities. Board-and-care facilities also offer help with personal care and, in some cases, help with taking medications. The typical living arrangement in a board-and-care facility comprises rooms along a common hallway. Funding for boardand-care facilities typically comes from private funds.
Life-care communities (or continuing care retirement communities) provide as much or as little care as the older individual needs, with care levels changing as the individual's needs change. These facilities are particularly good for those older individuals who want to move only one time rather than from facility to facility as their needs change. For example, within the same community, individuals might be able to live in their own cottage (perhaps with the proviso that they participate in a communal meal once a day to demonstrate that they are still functioning well), then move to an apartment in a central building as they need more help. Typically, life-care communities also have available assisted facilities and nursing home facilities all on the same property. Life-care facilities also typically provide transportation and social and recreational activities for their residents.
Although Medicare and Medicaid may pay for skilled nursing care when needed, the costs of life-care facilities are usually paid out of private funds.
Although the term "nursing home" is often applied to any long-term care facility, it is more properly applied to those facilities that are specifically designed to support individuals with chronic medical conditions that require skilled health care but do not require in-patient hospitalization. Nursing homes provide skilled care by trained medical practitioners in addition to other care. In addition to meals and help with daily activities, nursing homes provide 24-hour skilled nursing care and physical, occupational, respiratory, and speech therapy as needed. Nursing homes also provide hospice care including palliative care and services for the emotional, spiritual, social, and other needs of terminally ill patients. Rooms in nursing homes are typically arranged along a common hallway. The cost of a...
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