Aging US Population Requires Major Changes in Social Policy

As the average age of the US population continues to rise, the nation will need to improve and transform what is currently an inadequately developed and funded system of care. In The Age of Dignity, Ai-jen Poo, director of the National Domestic Workers Alliance, provides a blueprint for building a culture that supports and values the care of our elders. Order the book from Truthout now by clicking here!

The Age of Dignity: Preparing for the Elder Boom in a Changing America, by Ai-Jen Poo with Ariane Conrad, The New Press, $25.95 hardcover, 230 pages.

As World War II drew to a close, Americans celebrated the Allied victory, partying in the streets of New York City’s Times Square and lifting glasses in cities and towns across the country. Returning soldiers reunited with loved ones and new liaisons formed. The result became known as the baby boom, a shorthand reference to the 76.4 million babies born between 1946 and 1964.

According to the Population Reference Bureau of the US Census, by 2012, approximately 11 million boomers had passed on. Still, as Ai-Jen Poo writes in The Age of Dignity, every eight seconds an American turns 65, for a whopping 10,000 a day or 4 million a year. This, she writes, is unprecedented. One hundred years ago, only 3 percent of the population was aged 65 or older. Today the figure is 13 percent. Even more startling, Poo points out that there are presently 5 million people who are older than 85, and, if projections are correct, this number will skyrocket to 11.5 million by 2035. Equally stunning is this doozy of a statistic: In just 15 years, by 2030, a full 20 percent of the US population will be 65 or older.

Needless to say, the baby boom is quickly becoming an elder boom and Poo’s slim volume offers both a touching personal narrative about her family’s experience with aging family members and a clear-eyed and visionary – albeit somewhat limited – set of policy recommendations for how we can humanely and respectfully attend to the seniors among us.

Her ideas come from practical experience. As the co-founder of Domestic Workers United (DWU) in New York City, Poo has helped organize hundreds of in-home caretakers – nannies as well as elder aides – and is a fierce advocate for improving the salaries, benefits and working conditions of these typically isolated, and often exploited, workers. She now heads the National Domestic Workers Alliance (NDWA) and serves as co-chair of the Caring Across Generations Campaign, a 50-state effort to elevate the status of those who provide a slew of essential services. Poo writes that the campaign, a 2011 initiative spearheaded by Jobs With Justice and the NDWA, addresses two major social issues: widespread unemployment and demographic change.

From her perch, Poo argues that it makes good emotional and financial sense to keep elders in their homes for as long as possible, a conclusion supported by an AARP survey that found that 90 percent of elders want to “age in place” rather than in a nursing home. Making this possible, Poo continues, will require a battalion of trained caretakers. Indeed, today’s home care workforce – approximately 3 million people, most of them immigrant females – will need to expand by at least 1.8 million within the next decade, making it the fastest growing occupation in the United States. The reason? “Seventy percent of people aged 65 and over need some form of support,” she writes.

And herein lays the conundrum: The lion’s share of Americans believe that responsibility for elder care rests with family – or more accurately with wives, daughters, nieces and female cousins – to care for their own. This assumption, Poo writes, is as outdated as it is sexist. And it needs to change – fast.

For one, we know that more than 43 million people are already providing unpaid care for a loved one, shelling out approximately $10,000 in out-of-pocket expenses and spending more than 1,000 hours a year doing what needs to be done, typically to their own detriment. High stress levels, sleep deprivation, depression, weakened immune systems, and higher-than-usual rates of hypertensions and diabetes are common among caregivers who juggle paid employment and unpaid family support. In addition to the physical and emotional toll, tensions between relatives frequently erupt and – despite rising rates of male caregiving, the actual work still tends to be gendered, with women doing the hands-on toil of changing diapers, cleaning wounds and bathing their parents, grandparents, aunts and uncles, and men paying bills, dealing with doctors, lawyers and insurance companies, and searching for suitable assistive devices and equipment.

These folks are already stretched to the max and cannot be expected to do more – or to assist those in need for years on end. What’s more, not everyone has a family or has family members living close enough to help. Still other families remain haunted by parental abuse or neglect, making caregiving by a daughter or son extremely unlikely.

The solution, Poo posits, is to train and pay a professional cadre of in-home workers to deal with the plethora of medical and psychological issues facing seniors. In this way, healthy families can concentrate on making sure meaningful conversations take place and end-of-life details are dealt with.

That said, Poo understands that most people cannot afford to buy the care that will be necessary should they live long enough. So what to do? “Medicare almost never covers long-term care, whether it is needed at home or in a facility,” she writes. “Medicare’s fee-for-service payment model – and also the culture in which many physicians operate – is that continuity of care is not supported. In the ideal scenario, caring for an elder would be a team effort, with participation from and communication among a general physician, nurses, medical specialists, and other health care professionals such as psychologists, physical therapists, and nutritionists alongside caregivers [both professional and family.]”

The Age of Dignity does not dwell on Medicare reform – a significant shortcoming – but does discuss long-term care insurance as well as Medicaid, and points health-care providers in the direction of needed change. “Too often medical care for people near the end focuses on costly, high-tech, life-saving procedures when what is actually needed is comfort and management of ongoing conditions, also known as palliative care,” Poo writes.

That Medicare does not pay for palliative treatments, forcing people to go into the hospital for pain management, tortures the patient and wastes a ton of money; this and other gaps in Medicare coverage will likely leave readers of The Age of Dignity shaking their heads and, perhaps, agitating for change.

To her credit, Poo does offer numerous policy recommendations and makes clear that the United States should take its cue from two countries that do far more for seniors than we do: Germany and Japan. She touts both nations for taxation policies that raise the revenue necessary to pay for caregiving, as well as for promotion of efforts to ensure that seniors are able to age with dignity – models she believes the United States could easily emulate. In addition, she recommends revisions to the Fair Labor Standards Act, passed in 1930, so that the farm and domestic workers who were left unprotected by wage and hour laws when the act was promulgated can finally get the coverage they deserve.

Poo further asks us to revisit the undervaluing of caregiving. Ending the low regard placed on this work is imperative, she writes, so that in-home laborers are given their due: decent pay, vacation and sick time, and health insurance. On top of this, she urges the US body politic to spend time thinking about how we can better honor intergenerational relationships rather than discarding the old as out-of-touch and unworthy. “Discussion about aging and death need to become part of the fabric of family life,” she concludes. “Care should be a responsibility that’s shared by all of us as a nation . . . It’s a moral, practical and economic necessity.”

After all, she adds, as a country we spend a lot of intellectual capital debating the pros and cons of different models of public education. Of course, this is important. But not everyone has children, while everyone has had parents. Isn’t it high time we gave the end of life the attention it merits?