Who Will Care for Us? : Aging and Long-Term Care in a Multicultural America

by Angel, Ronald J.

• ISBN13: 9780814706831
• ISBN10: 0814706835
• Format: Paperback
• Copyright: 1999-06-01
• Publisher: New York University Press

Summary

"An important contribution to the on-going national dialogue concerning the need for planning for an increasingly aged population and its impact on our social, political, medical, economic institutions." --Wisconsin Bookwatch"Based on their assessments of the levels of need for the long-term care among African-American, Latino, and non-Latino white older persons, the authors offer viable and attractive possible alternatives to institutionalization in the long-term care of the elderly." --Nurse Practitioner"A major contribution. Should be a part of every course on social gerontology, long-term care, the demography of aging, or formal/informal support networks of the elderly." --Robert Joseph Taylor, Institute for Social Research, University of MichiganAmerica is getting older. By the year 2010, almost one in five Americans will be 65 years of age or older.The combined forces of low fertility and longer life spans among all racial and ethnic groups have resulted in a disproportionate increase in the number of individuals over 65 and an even faster increase in the proportion of those individuals over eighty-five. As a result, the nation faces an unprecedented challenge in addressing the economic, medical, and long-term care needs of this older population at the same time that it assures the welfare of the young. The growth of the cost of the long-term care of the elderly is one of the major forces behind recent increases in Medicaid expenditures, and any reformed health care financing system will have to find ways of providing high quality long-term care to older Americans at a reasonable cost.In a racially and culturally diverse nation like the United States, official policy regarding the care of the elderly simply cannot be based on the assumption that the elderly are a culturally and socially monolithic population. The cultural, social, and economic situations of the elderly simply differ too greatly and the family's role in their care is affected by important cultural and social factors.InWho Will Care for Us?Ronald J. and Jacqueline L. Angel argue that policies based on the assumption of a homogenous population will fail to take advantage of the opportunities that ethnic and cultural diversity offer for the long-term care of the elderly. The authors examine the great racial and ethnic diversity among the elderly in the contemporary U.S. in terms of living arrangements, economic well-being, and reliance on formal and family-based sources of support. Based on their assessments of the levels of need for long-term care among black, Hispanic, and non-Hispanic white older persons, they offer viable and attractive possible alternatives to institutionalization in the long-term care of the elderly.

Table of Contents

List of Tables and Figures	xi
Preface: Ethnicity and Aging in the Contemporary World	xiii
The Social Transformation Of Old Age	1	(22)
The Institutional Challenge	4	(3)
A Heterogeneous Older Population	7	(2)
The Changing Social Context of Aging	9	(3)
The Declining Significance of Marriage	12	(4)
The Loss of Women as Full-Time Care Givers	16	(3)
Cultural Change and Options in the Care of the Elderly	19	(4)
A Longer and Better Life: Who has Benefited Most from Improvements in Health?	23	(23)
The Differential Prevalence of Chronic Conditions	26	(2)
The Meaning of Health and Functional Status	28	(7)
Disability and the Social Environment: Active Life Expectancy	35	(3)
The Health of Mexican American and Black Elderly: Some Recent Findings	38	(6)
A Longer and Better Life?	44	(2)
Group Differences in Income and Wealth in Old Age: The Role of Public and Private Pensions	46	(17)
Employment Status and Retirement Income	52	(3)
Social Security	55	(4)
Supplemental Security Income (SSI)	59	(1)
Women, Minority Americans, and Social Security	60	(3)
Medicare, Medicaid, and Private Insurance: Group Differences in Health Insurance Coverage	63	(25)
Health Insurance in the United States	65	(1)
The Health Insurance---Employment Nexus	66	(3)
Medicare: Universal Health Coverage for the Old	69	(3)
Medicaid: Publicly Funded ``Medigap'' Insurance	72	(1)
Falling through the Cracks: Insurance Coverage among Blacks and Hispanics	73	(4)
Health Insurance Coverage in the Years before Retirement	77	(4)
The Future of Health Care Financing: Implications for Minority Americans	81	(7)
The Role of the Family in the Informal Support of the Elderly	88	(25)
The Cultural and Social Context of Social Support	92	(2)
Systems of Social Support	94	(1)
Cultural and Social Class Differences in Social Support	95	(2)
The Composition of Informal Networks	97	(3)
Living Arrangements and Social Support	100	(3)
Rural/Urban Differences in Social Support	103	(2)
Migration/Age at Immigration	105	(5)
Race, Ethnicity, and the Future of the Family in the Care of the Elderly	110	(3)
A Refuge of Last Resort: Culture, Social Class, and the Use of Institutional Long-Term Care	113	(21)
Does Formal Support Replace the Family?	114	(3)
Options in Institutional Long-Term Care	117	(1)
Continuing Care Retirement Communities (CCRCs)	118	(1)
Variations on the CCRC	119	(2)
Paying for Long-Term Care: The Role of Private Insurance	121	(3)
Medicaid and Long-Term Care	124	(2)
Group Differences in the Use of Nursing Home Care	126	(4)
Institutional Alternatives or Alternatives to Institutionalization?	130	(4)
Staying at Home: New Options in the Community Care of the Elderly	134	(24)
The Nursing Home or Community Care?	136	(2)
What Is Community Care?	138	(1)
The Potential of Induced Demand for Home-Based Care	139	(2)
National Policy and Program Options in Community-Based Long-Term Care	141	(1)
The Older Americans Act (OAA) and Other Federal Community-Based Programs for the Elderly	142	(1)
Transportation	143	(2)
Case Management	145	(1)
Nutrition	145	(1)
Respite Care	146	(1)
Adult Day Care	147	(1)
Other Residential Options	147	(1)
Housing Programs and Services	148	(1)
Reverse Equity Mortgages: Gaining Access to One's Home Equity	149	(1)
On Lok: The Ultimate Community-Based Model	150	(3)
Can We Afford Community-Based Long-Term Care?	153	(5)
The New Pact between the Generations: Intergenerational Exchanges in a Multicultural Society	158	(31)
The Old-Age Welfare State and the Possibility of Intergenerational Conflict	162	(1)
The Consequences of Heterogeneity among the Elderly	163	(3)
Is the Modern Welfare State Equitable?	166	(1)
Inequalities in Health Care	167	(1)
Intergenerational Exchanges and the Rise of the ``Third Age''	168	(4)
A New and Informed Public Discourse	172	(1)
The Consequences of Various Proposed Reforms of Social Security for the Poor, Minorities, and Women	173	(4)
The Moral Foundation of Our Interdependence: A Policy Agenda	177	(3)
An Opportunity for Imaginative Experimentation: Specific Recommendations	180	(9)
Bibliography	189	(34)
Index	223