They are a delightful couple both over 85, slowly declining, she faster than him. They want to stay in the home they have had for over 50 years, though he is increasingly unable to lift her when she falls or meet her other physical needs after his recent heart attack. The family is uncertain how to handle this.

In another family, the wife is diabetic, in her early 80s and not sure how to manage her 79-year-old husband who is increasingly demented with paranoia that the television is talking to him and convinced that she has a boyfriend. Their married daughter is involved in the family but works full-time to support her children.

These stories demonstrate one of the many challenges facing our health care system, namely how to provide and support caregiving for an aging population. Octogenarians, those in their 80s, are the fasting growing demographic in our country. For families, this means caring for loved ones with increasing disabilities, frailty and often cognitive decline.

A vast and largely unpaid workforce used to care for these vulnerable elderly: women at home. Be they daughters, daughters-in-law, or younger wives, even grandchildren; changes in society and the workforce have affected this dynamic.

Typical is a daughter in the “sandwich generation.” She is a middle-aged-or-later adult woman who works full-time. She has an aging parent with increasing needs, as well as children and even grandchildren who need her support. Her income and her husband’s aren’t enough to put the parents into a senior care facility.

This puts middle-class families into a tough dilemma. Keep grandma at home by quitting work thus straining the family budget or cover care at an institution which can run thousands of dollars monthly.

Partially filling this gap are increasing numbers of already poor men and women, some of them undocumented immigrants, who accept $10-15 an hour without benefits to care for these older adults.

An incredible disconnect here is that Medicare and Medicaid do not cover in-home care. This is despite research demonstrating benefits of aging in place such as reduced costs, decreased hospitalizations, improved autonomy and better familial and social connections.

Caring Across Generations is a nonprofit taking on this issue. Their agenda includes a variety of common sense initiatives. Caring Across Generations proposes forming a national holistic long-term care system. This would increase access to home-based care by recruiting, training, and retaining care workers. They advocate for paid caregiver leave, deinstitutionalization of eldercare, and income credits toward social security for caregivers. Revising asset management rules to qualify a relative for Medicaid is sorely needed. Other proposals include training family caregivers, raising wages of underpaid professional home care workers and providing a path to citizenship for undocumented immigrant home care providers. Those under 18 who provide care for family members need training while balancing their own educations and careers. Hawaii, Maine, Minnesota, Illinois and Michigan have started such eldercare programs or are evaluating legislation to do so. Texas should do so as well.

Preventing an impending eldercare crisis requires local, state and national initiatives to support families. Such plans could save money, provide better quality of life for elders and could create higher quality jobs. Bringing such a policy together positively would reform health care, taxes, immigration and education in compassionate and practical ways.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family professor of Integrative Medicine and professor of Family Medicine at UTMB.

(1) comment

Christine Hopkins

This is a really important issue. People are living longer and many want to stay in their home.

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