STATEMENT BY SENATOR QUENTIN BURDICK Senator BURDICK. Mr. Chairman, I regret that I got to the committee late, but I ask that an opening statement of mine be made a part of the record. The CHAIRMAN. Your statement will be part of the record, Senator. Senator BURDICK. This is directed to either one of you. What kind of health professionals do you think need to be available to individuals in adult day care settings? Mrs. GLAKAS. The people, I understand, that are at the day care center now are nurses. The director is a nurse, and I think there are several people who help her on the staff, and they also have volunteers. Senator BURDICK. It is just nursing staff, then, at the present time? Mrs. GLAKAS. I think there is only one. They probably need more than one, but at the present time, there is only one full-time nurse. Senator BURDICK. In another area, how do you think the Federal Government can help address the need for adult care in rural areas? Mrs. GLAKAS. I suppose a van could pick up people in rural areas the same as they do in urban areas. Senator BURDICK. And take them to the professionals. Is that it? Mrs. GLAKAS. I think so. Senator BURDICK. Would you have any idea of how much this would cost to service? Mrs. GLAKAS. I have no idea. Senator BURDICK. That is all I have, Mr. Chairman. [The prepared statement of Senator Burdick follows:] Opening Statement from Senator Quentin Burdick on Adult Day Thank you Mr. Chairman. I commend you for your foresight in addressing the issue of Adult Day Care. Today, we have a rapidly increasing older population, especially in the age 85 and older category. Helping this population to manage with the chronic illnesses that often occur in the elderly remains a major challenge for the health care system in the next decade and beyond. While the federal government will continue its support of research designed to eliminate or minimize the effects of debilitating diseases, the cure for many chronic illnesses remains to be found. In the meantime, support services for our aging population, and their caregivers are absolutely essential, and the demand for these services will steadily increase. I believe that S. 1839, Senator Melcher's bill and one which I am pleased to Cosponsor, is an important step toward meeting these needs. The need for day care services is especially great in rural areas of our country. As Co-Chairman of the Senate Rural Health Caucus, I am dismayed by the many letters I receive and conversations I have with elderly persons residing in rural North Dakota and other states across the country. These individuals have strong ties to their land and wish to stay in the small communities and farms where they have lived most or all of their lives. THeir children also have roots in these rural communities. Unfortunately, when an elderly spouse or parent requires support services because of physical or mental impairment, such structured programs in much or rural america cannot be found. With some assistance, many of the rural elderly could continue to live in their homes or with their children. Without day care and respite care services, the option simply does not exist. The toll on the caregiver becomes unmaneagable; it is too great. As a result, elderly in rural areas have no alternative except nursing home placement. I think that this should be the alternative of last resort, not the first choice, as it currently is in rural America. Again, I thank you for providing the Committee with the opportunity to examine the tremendous potential that Adult Day Care may hold for our elderly and their families. The CHAIRMAN. Senator Domenici. STATEMENT BY SENATOR PETE DOMENICI Senator DOMENICI. Mr. Chairman, could I just take two minutes with a couple of observations? The CHAIRMAN. Certainly, Senator. Senator DOMENICI. First, I want to thank you for convening this hearing to explore the role that adult day care can play in providing for long-term care for the American elderly. There can be no doubt that this is one of the most difficult issues facing our nation today and one that Congress is trying to examine thoroughly. At a recent Senate Budget Committee hearing, we examined the long-term care problem and received some very useful comments, and I think today's testimony will add greatly to the discussion. We spend over $50 billion each year on various services that are rendered to those who are disabled or chronically ill. With our population aging and long-term care costs rising faster than inflation, the Congressional Budget Office estimates that American long-term care costs could jump to over $150 billion by the year 2030 to 2050. Given these prospects, obviously, we have to examine thoroughly the potential alternatives to institutionalization and their cost effectiveness and ability to help our senior citizens. So, we have to explore what should be a part of this whole continuum of long-term care. Adult day care is one of the types of services that needs to be examined closely. I know how important it is to many of the elderly in my own State that have been able to remain at home and be part of their communities even though they may need some form of health care. So, I personally look forward to these hearings. I am certain that they will be a part of our ultimate analysis and our final decisions as to how we can better serve our senior citizens with long-term health care. I thank you for the hearing, and I am hopeful that this record will reflect some real options and alternatives that will be meaningful. Thank you very much, Mr. Chairman. The CHAIRMAN. Thank you, Senator. And thank you, Jean and George Glakas, for your very insightful testimony. Mr. GLAKAS. Thank you. The CHAIRMAN. Our next witness is Ms. Lou Glasse, the President of the Older Women's League. Ms. Glasse. STATEMENT OF LOU GLASSE, PRESIDENT, OLDER WOMEN'S LEAGUE, ACCOMPANIED BY LAURIE SHIELDS, CO-FOUNDER, OLDER WOMEN'S LEAGUE Ms. GLASSE. Chairman Melcher, thank you so much for including the Older Women's League in this opportunity to speak to you about the need for adult day care and for care givers. I am Lou Glasse, President of the Older Women's League which is an organization that is devoted exclusively to the concerns of mid-life and older women. You have received a copy of my testimony. I refer to a number of studies in it. I know because of the limitations of your time, however, that I need to limit my testimony. So, if you don't mind, Senator, I am going to give some highlights in our testimony and make a few comments about the hearing thus far. I would like to begin by introducing to you Laurie Shields who is co-founder of the Older Women's League and co-author of our recently published book, "Women Take Care: The Consequences of Family Caregiving in Today's Society." In researching the book, Laurie and her co-author, Tish Summers, who was also a co-founder of the Older Women's League and the OWL Task Force on Caregiving interviewed over 400 care givers. One of the editors of that book and also on our task force is Linda Crossman, a day care director who is in your committee hearing this morning. Let me say that our founding meeting in Iowa in 1980 the need for support for family care givers was paramount among the women who attended that first meeting. Daughters and wives were desperately trying to provide adequate care for their family members and at the same time, were often desperate for assistance in providing that care. In the 8 years since the Older Women's League was organized, we are gratified with the increasing attention that has been given to the issue, and I am especially pleased that you have called this hearing today. Services like adult day care, respite care, and in-home services are critical not only to the health of the cared-for but also to the health of the caregiver. Family caregivers are the unpaid workers in this nation's system of health care for the frail and dependent elderly. As our nation has adopted cost containment measures to try to reduce Medicare costs, this has resulted in a greater shifting of responsibility to the families of our Nation requiring them to spend more and more of their time, energy, and money on the aged. This shift of greater responsibility for the family has occurred at a time when more and more women are entering the work force out of economic necessity. So, the combination of the public policy of shifting discharged Medicare recipients into the home while, at the same time, more women are having to enter the work force is creating dilemmas for millions of women. Women traditionally have been the care givers of both young and old. Almost three-quarters of the caregivers of the elderly are women, totalling over 1.6 million. One thing, sir, that most people don't realize is that the average woman today can expect to spend as many years caring for a dependent parent or spouse as she did in caring for a dependent child. Laurie Shields recently told the Board of the Older Women's League about a woman who wrote that she was a 75-year-old woman caring for her 100-year-old mother and had been doing so for 20 years. The women wrote that what she desperately needed and wanted most was one night's unbroken sleep. Yet, women are expected to and do adjust their work schedules, their lives, to provide aid to their relatives. Most people are doing that, lovingly, willingly, regardless of the cost to themselves. For many of them, this is indeed a treasured time which they wouldn't give up at all, as Mrs. Glakas so clearly illustrated. But also for many of them, it is a time of great pain and struggle and exhaustion not only physically but emotionally and financially which also Mrs. Glakas illustrated in her testimony. Many caregivers are isolated, housebound, become depressed, and financially depleted. We know from studies that the health of many caregivers suffers as a result. All of us, I think, know of some caregivers who have risked their own health to care for their loved one. However, the economic effects of caregiving can be equally devastating for women, and this has long-term implications that I hope your committee will consider, not only when they are thinking about the lesser cost of day care in contrast to skilled nursing home care, but also consider the long-term effect of the caregiver being out of the work force and what this means for her current income and future income. We know from studies, that examined income of the aged over the next 30 years, that the poor old of tomorrow will be mostly women. Sir, this is largely due to women being in and out of the work force primarily because of family responsibilities. We know that, on average, women take 11 years out of the work force because of their family responsibilities whereas men have an average of only 1 year out of the work force. This has a direct result upon their future income including vesting, pension policies, and their Social Security coverage. We know that a large percentage of women who take time out to provide care are those who are working at minimal income. At the same time, there are some studies that indicate how much the income is that they give up annually in order to provide care to the aged. Increasingly, some corporations are concerned about employees who are caregivers. Corporations that have looked at their work force, between 12 and 22 percent of their employees are providing care and this of course has a tremendous effect upon the individual productivity of the workers. There are variations in these studies, but some companies are beginning to promote policies to sponsor adult day care, care giving fairs, provide flexible work hours, and take other approaches to make sure that they help their employee caregivers. Most care givers like Mrs. Glakas are reluctant to seek services even when they are available or affordable. But, many times, services are not used because caregivers don't know about them. However, often, these services are not available or not affordable. Also, we know that waiting until a crisis erupts before looking for services means that the choices will probably be more limited and the stress on both patient and caregiver will be greater. |