Eldercare in the United States

February 19th, 2020

The graying of America

Every day 10,000 people turn 65, and by 2030 older people will outnumber children for the first time in U.S. history. The baby boom is quickly becoming a “Silver Tsunami,” a term used in a March 2019 Healthcare IT News article. As those born between 1946 and 1964 age, government officials warn about the stresses being put on government programs for the elderly like Social Security and Medicare while families wrestle with how to care for the growing needs of this population. While the need to support elderly family members isn’t a new issue, the required scope of care and sheer numbers are relatively new challenges in human history due to increased life expectancy over the last century. This problem is only exacerbated as families become more transient and geographically separated.

Although a slight decrease in life expectancy in the United States over the past few years (partially attributed to opioid overdoses) raises concern, the long-term trend shows that life expectancy has dramatically increased all over the world. People today can expect to live nearly twice as long as they did two centuries ago, with the average life expectancy increasing from around 30 years to 72 years, according to the Our World in Data site.

To attribute this only to lowered infant and child mortality would be misguided, as life expectancy at all ages has improved. Individual medical innovations such as vaccines and antibiotics are partially responsible, as well as public health measures like improved public sanitation and publicly funded health care. These developments, along with the modernization and industrialization of society, have led to increases in life spans across all regions, genders and economic classes in the 21st century.

In higher-income countries in particular, not only do individuals enjoy more healthy years during their lives, but they’re also able to live longer with disabilities and illnesses such as cancer or diabetes. While these are obviously all good developments, it also means that our society now includes a larger segment of the population dealing with the physical and mental limitations that aging brings, as well as dealing with these issues for a longer span of time. 

Eldercare: yesterday and today

In previous eras, eldercare was generally left to the family, particularly the unpaid women in the family. However, there were always those who didn’t have either family or the means to provide for their own care. In the 19th century, European and North American governments realized they had a duty to ensure that indigent seniors had somewhere to live and something to eat. The construction of “workhouses” or “poorhouses” placed seniors alongside orphans, disabled people and the mentally ill. Overall, these were not pleasant places to live, and the residents were often referred to as “inmates.” The atrocious conditions in poorhouses led to religious and benevolence societies opening their own homes for the elderly as alternatives to state-run institutions. Some of these are still in operation today.

Around the turn of the 20th century, governments began instituting social welfare programs that provided income for elderly citizens who could no longer work. The Great Depression provided the impetus for the United States government to pass Social Security in 1935. Medicare and Medicaid followed in 1965, giving seniors access to medical care regardless of their means and prompting the rise of nursing homes.

Today, there are a number of options for seniors in postretirement life, varying from independent living in community to assisted living to full-scale nursing care. Even aging at home has become more viable with renovations or the installation of equipment such as stairlifts and an increase in access to in-home care. For those who are no longer able to live alone, many institutions offer specialized care for patients with dementia and Alzheimer’s, as well as in-house rehabilitation facilities and hospice care. Some communities require that partnered couples be at the same level of care to live together, which can create difficulties, and with the growing elderly population, more desirable facilities have waiting lists for spots.

Despite 20th-century improvements in social welfare, Social Security and Medicare are often not enough to pay for lower levels of care. The mistaken belief that Medicare pays for more than it actually does can leave individuals unprepared and in a difficult place financially. Long-term care insurance fills some of the gaps left by Medicare, but it too is not cheap. Beyond this, care for our aging citizens, once again, falls primarily on the backs of women and people of color who are often paid low wages for important and difficult work. This creates not only an issue of equality, but it also makes it difficult for facilities to retain quality staff.

The effects of aging on individuals and families

As people age, families are faced with many difficult decisions. The decline of physical and mental abilities can create dangerous situations for those who are intent on maintaining the status quo. In a society that places a heavy emphasis on independence, being forced to rely on someone else to help with daily tasks such as getting dressed, going to the bathroom, and preparing meals can lead to feelings of shame.

Additionally, seniors contemplating a move into a long-term care facility may also be dealing with the loss of their longtime home, their pets, and their community. Even though today’s care facilities are significantly better than 19th-century poorhouses, the fear of being put away and forgotten with all of the other old people remains, and the institutional nature of even the ritziest facilities can be cold and disheartening. These decisions can also trigger guilt for families who may desire to help their loved ones age in place but are overwhelmed by both their own obligations and the physical needs of their family member.

As many congregations age, these conversations are happening inside the church walls as well. When individuals move into care facilities, some congregations work to provide them with transportation so they can continue to be a part of the worshiping community. Visiting and taking Communion to the homebound are other ways of keeping them connected. Though people might fear being forgotten and isolated as they age, part of the church’s ministry is ensuring that people at all stages of life know they’re loved and valued by God. 

Be sure to check out FaithLink, a weekly downloadable discussion guide for classes and small groups.

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