Elder Care in the United States of America
In 2015, there were 47.8 million adults over the age of sixty-five in the United States.[1] That number is projected to rise to 98.2 million by 2060.[2] Care for the…
Introduction
In 2015, there were 47.8 million adults over the age of sixty-five in the United States.[1] That number is projected to rise to 98.2 million by 2060.[2] Care for the elderly in the United States is built on a foundation of modern medicine used to treat medical conditions until the end of life. According to the State Department, there are several types of professional care available.
Types of Elder Care
Aging in Place refers to complexes that have amenities like grocery stores, pharmacies, chauffeur services, and other features designed specifically for a geriatric population. These features include things like walk-in bathtubs, specialized handrails, and wheelchair accessibility.[3]
An example of a bathroom designed for seniors, the handles and non-slip floor help to prevent falling. These would be common in specialized senior housing.[4]
Alternatively, a family can choose to have the elder remain at home and various services ensure they are taken care of. The State Department can provide home care services where a trained professional lives with the elder and assists them with medication, bathing, food, and other needs. Additionally, food programs like Meals on Wheels can be used to deliver food to the elderly and save them the hassle of going to a store or preparing food.[5]
Dedicated housing communities for non-disabled independent elders are separated into coops, assisted living, continuing care communities, and subsidized housing. Coops are complexes explicitly dedicated for able-bodied elderly age fifty-five and older. A fee is paid for upkeep and maintenance, as well as an on-site medical center and a 24-hour emergency nurse. Assisted living centers are places where retired seniors can live if they need only minor assistance. These facilities provide a relaxing atmosphere, three meals a day, and hospitality services like general cleaning, laundry, and medical assistance. Continuing care communities are designed for independent seniors. These communities provide one meal each day, hospitality services, and access to shopping and cultural centers; medical care is included in the cost. The Department of Housing and Urban Development provides subsidized housing (housing at a reduced cost) for elderly populations. While no ‘round-the-clock care is provided, nurses are on station to check on residents and provide meals.[6]
If the family member requires more substantial medical care and is not considered independent, then nursing facilities are used. These are divided into skilled nursing facilities, which can manage serious health care needs up to the hospital level, and intermediate care facilities, which provide less robust medical services. Intermediate facilities are designed for elders who require a minimum of medical assistance.[7]
Nursing homes can provide a safe place for the elderly to receive the care and assistance they need. This is especially important for seniors with complex conditions like dementia or Alzheimer’s.[8]
If the elder has a terminal condition or is expected to die, then their physician may recommend palliative or hospice care. Palliative care is given during treatment of complex or life-threatening illnesses, and it is designed to improve a person’s quality of life by addressing emotional, social, spiritual, and medical issues that their treatment may bring up.[9] Hospice care is given after the treatment of the illness has stopped and if the patient is not expected to live longer than six months. The primary goal of hospice care is to treat pain and allow the patient to die with dignity while providing support for the family.[10]
An example of palliative care, this is medically intensive and designed to make the process of dying as easy and painless as possible.[11]
Paying for Elder Care
All of these treatments are expensive, and some elders and their families struggle to pay for them. In the United States, the federal government offers two social benefit programs to help offset the cost of health care.
Medicare is given to all citizens over the age of sixty-five and has two parts. The first part covers inpatient hospital care. The number of days that are covered depends on the diagnosis; the coverage stops once the discharge process is initiated. The second part pays for many medically-necessary services like doctor’s visits and pharmacy products; however, enrollees are required to make a monthly payment for this coverage to apply.[12]
The second program is Medicaid, which is designed to provide insurance for people at or below a certain income level. The program is managed jointly by the federal and state governments. This means that the specific income level at which one is eligible for Medicaid—and the specific rules and regulations—vary from state to state. Additionally, citizens may choose to purchase supplemental insurance which allows them access to additional facilities and services without having to take money from their holdings.
Social Consequences of Elder Care
In the United States, elderly parents are moved to some form of treatment once specific signs become apparent. The parent may fall and try to hide significant injuries, forget appointments, or withdraw from their social life. Additionally, there may be evidence of fires or mishandled appliances. All of these can be signs that the parent can no longer care for themselves and might need to Age in Place or be admitted to a community or home.[13] Socially, there is no stigma against moving parents into a home; it is seen as inevitable and that the child is looking out for their parent’s best interests. Elders can be reticent or afraid to move because they fear their independence will be taken away. At the same time, they fear falling and hurting themselves, or falling and not being found for days.[14] Most elderly fear going to the hospital because the odds of them never leaving are distressingly high. If the reason for their admittance does not kill them, then infection, sepsis, or pneumonia might.[15]
The American Association of Retired Persons (AARP) is a group that is dedicated to assisting Americans over fifty. They serve many important functions such as advocacy, education, and volunteering.[16] With millions of members, the AARP is one of the most powerful lobbying organizations in America.[17] They are non-partisan and neither endorse or donate to any candidate or party; rather they strive to improve life for all elders in America.
Do Not Resuscitate (DNR) Orders
Elders have the right to refuse resuscitation in the form of a Do Not Resuscitate order (DNR). The order instructs health care providers to withhold resuscitation in the event of cardiac or respiratory arrest.[18] The justification is that if the patient is terminally ill, then resuscitation will only buy them a small amount of time to live, usually at the cost of broken ribs and a reduced quality of life. For example, if a terminal patient with osteoporosis experiences cardiac arrest, the treatment is CPR and providing an electric shock to the heart. However, the CPR will likely shatter the sternum and, in the unlikely event they survive, they will still have a terminal condition and now additionally suffer from a broken sternum and possible pneumonia. A DNR is documented beforehand between a patient and their physician. If the patient is incapable of deciding due to illness, then their medical representative can make the decision. Once a DNR is issued, a family member cannot override it.
Elder Abuse
According to the National Council on Aging, one in ten elders have experienced abuse, and approximately 60% of the abusers are family members.[19] Abuse can be classified as physical, sexual, emotional, confinement and willful neglect, or financial exploitation. In the United States’ medical system, EMTs and other medical personnel are required to report suspected incidences of elder abuse, at which point Adult Protective Services or the police will investigate. The United States government has several laws in place to protect elders against abuse, including the Elder Justice Act which allows for more funding and better training to various involved agencies to improve their services and expertise.[20]
Elder abuse is rampant in nursing homes. A survey of nursing home patients in the United States showed that up to 44% of residents had been abused and 95% had witnessed the abuse of others.[21] A study conducted by the U.S. General Accountability Office demonstrated that 70% of official state regulators and inspectors missed “significant deficiencies” and 15% missed actual harm of a patient[22]. In light of this data, all fifty states have passed anti-abuse laws to help empower victims but so far, abuse has continued unabated.
I see this frequently in my experience as an Emergency Medical Technician. Nursing home practitioners don’t care about their patients and the patient’s care suffers for it. It is not uncommon for nurses to look at us blankly when we ask for the location of a patient’s room or to simply hand us a stack of medical reports rather than reporting the patient’s current conditions and past history. On one shift, we received three calls from the same facility: one for a septic infection, one for gastrointestinal problems, and one for a fall. It is depressingly common to see altered elders dropped off at these facilities and only visited by their families once they are on their deathbed. One gets the impression that family members and caregivers alike are just waiting for the patients to die.
Elders in the United States typically live into their eighties and nineties, and have access to a wide range of specialized care. Furthermore, an elder’s family is expected to facilitate care rather than to provide it themselves, resulting in a disconnect between the family and their elders in the last years of life.
Works Cited
“AARP® Official Site - Join & Explore the Benefits.” AARP. Accessed November 26, 2017. http://www.aarp.org/.
Ann. St. Patrick’s Day Party at Nursing Home. March 15, 2013. Photo. https://www.flickr.com/photos/picturesbyann/12456887264/.
Bureau, US Census. “FFF: Older Americans Month: May 2017.” Accessed October 10, 2017. https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html.
“Confronted with the Face of Abuse, What Would You Do?” Air Force Space Command. Accessed July 4, 2018. http://www.afspc.af.mil/News/Article-Display/Article/249283/confronted-with-the-face-of-abuse-what-would-you-do/.
“Do-Not-Resuscitate Order: MedlinePlus Medical Encyclopedia.” Accessed October 12, 2017. https://medlineplus.gov/ency/patientinstructions/000473.htm.
dreamingofariz. G’ma in Hospital. October 20, 2008. Photo. https://www.flickr.com/photos/dreamingofariz/3089538095/.
“Elder Abuse Statistics & Facts | Elder Justice.” NCOA, May 17, 2015. https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/.
“Eldercare.” Accessed October 10, 2017. https://www.state.gov/m/dghr/flo/c23133.htm.
“National Center on Elder Abuse, What We Do, Policy, Federal Laws.” Accessed October 12, 2017. https://ncea.acl.gov/whatwedo/policy/federal.html.
“Nursing Home Abuse - Elder Abuse, Neglect & More.” Accessed November 26, 2017. http://www.nursinghomeabuseguide.org/.
“Photo Gallery - Billara Building and Maintenance.” Accessed July 4, 2018. http://www.billara.net.au/photos/.
Rauch, Jonathan. “The Hospital Is No Place for the Elderly.” The Atlantic, December 2013. https://www.theatlantic.com/magazine/archive/2013/12/the-home-remedy-for-old-age/354680/.
RexxS. English: A Medical Alert Bracelet, Engraved: September 27, 2017. Own work. https://commons.wikimedia.org/wiki/File:Medical_alert_bracelet_2.jpg.
“Signs That Tell You It’s Time for Assisted Living.” Accessed October 12, 2017. https://www.agingcare.com/articles/time-for-assisted-living-139755.htm.
“Ten Common Fears of Senior Citizens.” Accessed October 12, 2017. http://www.bocahomecareservices.com/blog/ten-common-fears-senior-citizens/.
“The 2015 Power & Influence Top 50.” Accessed November 26, 2017. http://www.thenonprofittimes.com/wp-content/uploads/2015/07/8-1-15_Top50PI.pdf.
“What Is Palliative Care?: MedlinePlus Medical Encyclopedia.” Accessed October 10, 2017. https://medlineplus.gov/ency/patientinstructions/000536.htm.
Bureau, “FFF.”
Bureau.
“Eldercare.”
“Photo Gallery - Billara Building and Maintenance.”
“Eldercare.”
“Eldercare.”
“Eldercare.”
Ann, St. Patrick’s Day Party at Nursing Home.
“What Is Palliative Care?”
“What Is Palliative Care?”
dreamingofariz, G’ma in Hospital.
“Eldercare.”
“Signs That Tell You It’s Time for Assisted Living.”
“Ten Common Fears of Senior Citizens.”
Rauch, “The Hospital Is No Place for the Elderly.”
“AARP® Official Site - Join & Explore the Benefits.”
“The 2015 Power & Influence Top 50.”
“Do-Not-Resuscitate Order.”
“Elder Abuse Statistics & Facts | Elder Justice.”
“National Center on Elder Abuse, What We Do, Policy, Federal Laws.”
“Nursing Home Abuse - Elder Abuse, Neglect & More.”
“Nursing Home Abuse - Elder Abuse, Neglect & More.”
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