« PreviousContinue »
Prepared Statement of Mary Gardiner Jones
Good morning. I am Mary Gardiner Jones, member of OWL's board and chair of OWL's Public Policy Committee. OWL is a national non profit membership organization that addresses the special concerns of midlife and older women. OWL's goals are to achieve economic and social equity for midlife and older women, to improve their image and status and to provide mutual support for its members. OWL has 18,000 members and more than 110 chapters in 36 states.
As part of its work on behalf of midlife and older women, OWL has focused its research and resources on the needs of women for long term care, on the lack of access of women to health care, on the problems of long term care workers in our economy and on the lower social security and pension benefits available to yomen as compared with men. This work plus its contacts with its members and their experiences coping with the onset of aging and also with caregiving have given it special insights into the home care needs of Americans in the United States.
The need for home based services is a growing issue of universal concern in the United States. It is a family issue affecting all generations- the elderly who need assistance with their daily living activities and families of aging relatives who are finding it increasingly difficult to give them the care they need. A 1988 AARP and Villers Foundation survey found that over 60% of the families surveyed had some experience with the need for long term
Elaine Brody of the Philadelphia Geriatric Center described the people who called her Center for help on a typical day:
an exhausted 70 year old woman who could no longer go or
The elderly are the fastest growing population group in the country. One in eight Americans is over the age of 65. By 2031 one in five Americans will be over the age of 65. In the District of Columbia, it is estimated that the number of residents over 75 as of 1980 will double by the year 2000.
women make up the great majority of the elderly. At age 75, women outnumber men by a two to one ratio. For individuals who reach 85, lengthening life expectancy increased 24% between 1960 and 1990 and is expected to increase another 44% by 2040.
But for many, increased life expectancy can be a mixed benefit. As people live to increasingly advanced age, more and more need care and companionship. And as they age, they confront increasing problems of illness, disability or frailty. Women more than men are prone to debilitating diseases such as strokes, heart disease, arthritis, osteoporosis and alzheimer's. Moreover, the prevalence of non life threatening but frequently disabling conditions increases with age- one study postulated that for each good active year added to life expectancy, about 3 to 5 compromised years may be expected.
Tragically, a large proportion of women have to cope with their advancing age alone. Seven out of 10 women live without a spouse or are totally alone. Forty one percent of the frail elderly live alone. In 1986, a total of 8 million citizens over the age of 65 were living alone of whom about 80% were women. Ironically, the sick and elderly are more likely to be living alone than those who are well. Nearly one half of those persons reporting illness or disabilities lived alone in contrast to only 26% of the well who lived alone.
Medical research shows that isolation is a prime cause of illness and death, and that activity, both mental and physical, can delay or reduce deterioration among the elderly. Providing services to the frail elderly would cut their death rate and reduce the high cost of their medical care.
A significant portion of midlife and older women nave woefully inadequate incomes to see them through their last years. In 1984, for women aged 65 and older, their median income was $6020 compared to $10,450 for men.
Many elderly in need of in home assistance are not acutely ill. They cannot look to medicare or medicaid to provide them with the type and range of personal services they need to remain in their homes. Help with bathing, dressing, toiletting and eating can make the difference to whether an elderly person can remain in her home or must face institutionalization.
AARP's survey of the elderly underscored their virtually unanimous desire to remain at home as long as possible. For many, without help in the home the option to remain at home is simply not available. Surveys in virginia and Minnesota found that 20 to 30% of clients in nursing homes could have been cared for in the community.
is not only costly, it is too often unnecessary and always the least desirable alternative to the elderly involved. As one Oregon Social Services administrator put it: "Most of [his clients] just cant do what they need to do, whether its getting dressed or taking their medicine. Long term care is not a medical problem but too often we put them in nursing homes where they have less control over their lives and less freedom than the average prison inmate."
Not only is home care the more humane solution, it is also the most cost effective. It is well documented that home care costs significantly less than skilled nursing care. In fiscal 1988, medicaid reimbursed an individual's home care at $3408 as compared with $34,500 annually for an intermediate bed and $43,475 for a skilled bed. Providing personal services to the elderly is substantially less costly than either of these options.
Americans are devoted to a belief in self help, volunteerism and family values. We are a compassionate people. These characteristics of Americans have operated to generate substantial voluntary care giving activities. But these voluntary activities can no longer meet the care giving needs of the elderly.
Most of today's caregivers are women. It is estimated that women spend an average of 17 years caring for their children and 18 years caring for aging parents or relatives. They are constantly trying to juggle their caregiving and work place responsibilities. One out of five employees over 30 provides care for an elderly person. Some women find they have to quit their jobs, transfer to part time or pass up promotions in order to keep up with their care giving responsibilities. An AARP study found that 14% of part time workers had quit full time jobs to care for elderly person.
Caregiving is exhausting emotionally draining work. Frequently, care givers carry that burden alone and isolated. They have no time to meet their own needs for companionship, support and occasional diversion not to speak of shopping and the myriad of other activities required to manage a household. The result is that they often lose their health benefits, jeopardize their own health and earn lower incomes which translates into lower social security and pension benefits when they reach 65.
An OWL member wrote to us about her sister's experiences with trying to care for her elderly parents. She wrote:
For ten years my sister gave up her own personal life
Her situation is unfortunately all too typical of the impossible situations in which caregivers find themselves. As one caregiver put it: "When you have some one in your home who needs constant care, there is no day nor night."
The need for respite care for caregivers is as essential providing personal care services to the elderly themselves. A New Jersey woman tells of the relief she felt when a health worker came to her home for 2 hours a day twice a week. "It may not sound like much, she said, "but it's made all the difference. I couldn't lift my mother-in-law to bathe her... and care for her terminally ill father as well. I couldn't, I physically couldn't manage any more. It's a Godsend. Without it, I might have had to put her in a nursing home."
The needs are enormous. The number of people who will need some form of in-home services is projected to triple by the year 2030. Yet we cannot even meet today's needs. Adult day care centers can't begin to meet the demand. Waiting lists abound for all services. At the same time, the pool of caregivers available to provide unpaid care is shrinking. More women as they grow older are alone- either never married, or widowed or divorced. Gone are the families with four children. An increasing number of their children live in other cities or are in the labor force and unable to carry the dual burdens of caregiving and employment.
As a nation we have refused to come to grips with the implications of our rapidly growing elderly population and the increasing life expectancy which medical science and nutrition has made possible for all of us.
The Older Americans Act is the only program that the elderly can look to to help them live out their lives with dignity and independence. The Older Americans Act is the only federal program which provides a broad range of community based in-home services which literally make the difference for the elderly of living out their lives in loneliness and despair or of being able to enjoy a basic quality of life in their own community with dignity and self respect.
The Older Americans Act has recognized the pride and independence which is such an integral part of Americans and especially the elderly. It does not force the elderly to demean themselves and proclaim their lack of means or outright poverty before it will lend a helping hand. The elderly contribute what they can to the services provided. Speaking for one home care agency in the District with which I am connected, the contributions suggested by the agency are paid by 80% of our clients. But we also know that many of our elderly clients would rather go without a meal than have to document their inability to pay for it. We know that the hot lunch program provided by one of our Senior Centers in the District would be largely unattended if we changed our voluntary contribution policy to comply with a mandatory cost sharing policy in which eligibility to attend would have to be documented.
It is essential that we continue the current rationale of the Older Americans Act. Self pride and independence are sometimes the only things that the elderly can hang on to. We cannot as a nation disserve them and ignore their basic humanity.
Nor should we attempt to dictate to the states which of the broad range of community based in-home services should be given priority. One of the major contributions of the Office on Aging is its flexibility and its wisdom that only the states and local area offices can really know what groups in their communities are most in need of services and which services are most essential to meet these needs.
The Offices on Aging are truly public private partnerships of federal, state and local governments and the volunteer non profit sectors in their communities working together to meet the needs of both the elderly and the voluntary caregiver. We must maintain the Act in its present structure and provide it with sufficient funds so that it can continue to be an effective catalyst to the thousands of communities in this country that are trying to meet the needs of their older fellow citizens.
OWL, "Failing American's Caregivers: A Status Report on Women Who Care", May 1989.
OWL, "The Picture of Health For Midlife and olderwomen in American", May 1987.
OWL, "The road To Poverty: A Report on the Status of Midlife and Older Women in American, May 1986.
Grace Weinstein "Help Wanted: The Crisis of Elder Care" MS, October
The Commonwealth Fund Commission on Elderly People Living Alone, "The Old, Alone and Poor", 1987.
The Pepper Commission, "Access to Health Care and Long Term Care For All Americans, March 2, 1990.
AARP and Villers Foundation, "The American Public Views Long Term Care", 1987.
George Grier, Growing Older In Greater Washington,
Leopold G. Selker, Testimony before Select Committee on Aging, U.S. Congress, March 4, 1991.