Who Will Care For Us

"An important contribution to the on-going national dialogue concerning the need for planning for an increasingly aged population and its impact on our social, political, medical, economic institutions." --Wisconsin Bookwatch "Based on their assessments of the levels of need for the long-term care among African-American, Latino, and non-Latino white older persons, the authors offer viable and attractive possible alternatives to institutionalization in the long-term care of the elderly." --Nurse Practitioner "A major contribution. Should be a part of every course on social gerontology, long-term care, the demography of aging, or formal/informal support networks of the elderly." --Robert Joseph Taylor, Institute for Social Research, University of Michigan America is getting older. By the year 2010, almost one in five Americans will be 65 years of age or older.The combined forces of low fertility and longer life spans among all racial and ethnic groups have resulted in a disproportionate increase in the number of individuals over 65 and an even faster increase in the proportion of those individuals over eighty-five. As a result, the nation faces an unprecedented challenge in addressing the economic, medical, and long-term care needs of this older population at the same time that it assures the welfare of the young. The growth of the cost of the long-term care of the elderly is one of the major forces behind recent increases in Medicaid expenditures, and any reformed health care financing system will have to find ways of providing high quality long-term care to older Americans at a reasonable cost. In a racially and culturally diverse nation like the United States, official policy regarding the care of the elderly simply cannot be based on the assumption that the elderly are a culturally and socially monolithic population. The cultural, social, and economic situations of the elderly simply differ too greatly and the family's role in their care is affected by important cultural and social factors. In Who Will Care for Us? Ronald J. and Jacqueline L. Angel argue that policies based on the assumption of a homogenous population will fail to take advantage of the opportunities that ethnic and cultural diversity offer for the long-term care of the elderly. The authors examine the great racial and ethnic diversity among the elderly in the contemporary U.S. in terms of living arrangements, economic well-being, and reliance on formal and family-based sources of support. Based on their assessments of the levels of need for long-term care among black, Hispanic, and non-Hispanic white older persons, they offer viable and attractive possible alternatives to institutionalization in the long-term care of the elderly.

The number of elderly and disabled adults who require assistance with day-to-day activities is expected to double over the next twenty-five years. As a result, direct care workers such as home care aides and certified nursing assistants (CNAs) will become essential to many more families. Yet these workers tend to be low-paid, poorly trained, and receive little respect. Is such a workforce capable of addressing the needs of our aging population? In Who Will Care for Us? economist Paul Osterman assesses the challenges facing the long-term care industry. He presents an innovative policy agenda that reconceives direct care workers’ work roles and would improve both the quality of their jobs and the quality of elder care. Using national surveys, administrative data, and nearly 120 original interviews with workers, employers, advocates, and policymakers, Osterman finds that direct care workers are marginalized and often invisible in the health care system. While doctors and families alike agree that good home care aides and CNAs are crucial to the well-being of their patients, the workers report poverty-level wages, erratic schedules, exclusion from care teams, and frequent incidences of physical injury on the job. Direct care workers are also highly constrained by policies that specify what they are allowed to do on the job, and in some states are even prevented from simple tasks such as administering eye drops. Osterman concludes that broadening the scope of care workers’ duties will simultaneously boost the quality of care for patients and lead to better jobs and higher wages. He proposes integrating home care aides and CNAs into larger medical teams and training them as “health coaches” who educate patients on concerns such as managing chronic conditions and transitioning out of hospitals. Osterman shows that restructuring direct care workers’ jobs, and providing the appropriate training, could lower health spending in the long term by reducing unnecessary emergency room and hospital visits, limiting the use of nursing homes, and lowering the rate of turnover among care workers. As the Baby Boom generation ages, Who Will Care for Us? demonstrates the importance of restructuring the long-term care industry and establishing a new relationship between direct care workers, patients, and the medical system.

This book is an important contribution for all United Methodists concerned that their denomination is approaching irrelevance. Within its pages Dr. Lavender offers a Biblical, Wesleyan and means-tested approach that both saves the lives of millions of orphans and vulnerable children and inspires evangelical hope for the church.

It is amazing to realize that much of the Western medical community is in a love/hate relationship with the economics of medicine. Quality-Adjusted Life Years (QALYs) is one of the primary methods of guiding many medical decision-makers in the allocation of limited medical resources. Herein lies the problem of medicine and economics. It seems that deciding who will receive limited medical resources is a task filled with moral and ethical difficulties, even for those depending on the information obtained from QALY calculations. These moral and ethical difficulties are beyond the scope of sound bites that tout the benefits of universal health care, affordable insurance, or the safety of the free-market economy. The breadth of the difficulty is found in the widespread disagreement concerning how the health-care system should be distributed or fixed, since most will agree that there is a problem with distributing medical resources. It seemed obvious that some difficult decisions will need to be made that few are both willing and able to make. This difficulty is particularly true in decisions about health-care allocation, and that is where QALYs have been found useful and problematic. Limiting medical care for the elderly based upon their age did not occur until the mid-twentieth century possibly because the elderly held a unique position of respect in the Western community. It is no longer the case that the elderly are given a unique position of respect and dignity. Rather, it seems that with the increased use of QALY calculations, the elderly are in danger of receiving less medical care than they are warranted. It is imperative that Christians respond to the ethical implications of significant models of resource allocation that currently assist decision-makers in the allocation process, such as QALYs.

Who Will Care for You in Your Time of Need . . . Formulating a Smart Family Plan to Age-in-Place: The Reckoning Whether youre nearing retirement or have decades before you enter retirement, you will be confronted with four inevitable lifestyle crises: 1) How will you manage your own care when your independence is in question? 2) Will you have the resources and assistance to help manage your care? 3) Will you have one or more chronic health conditions/disabilities that will jeopardize your future independence? 4) In addition to your care, will you be responsible for the care of an aging parent, family relative, or friend? This book aims to direct people of all ages to start thinking early about your future life by developing and formulating a smart family plan to live healthy and stay in your own home (aging-in-place). The goal is simple. Formulate early a smart aging-in-place plan for a future lifestyle of health, senior independence, and a safeguarded quality of life.