Academic journal article Journal of Marriage and Family

The Not-So-Golden Years: Caregiving, the Frail Elderly and the Long Term Care Establishment

Academic journal article Journal of Marriage and Family

The Not-So-Golden Years: Caregiving, the Frail Elderly and the Long Term Care Establishment

Article excerpt

The Not-So-Golden Years: Caregiving, the Frail Elderly and the Long Term Care Establishment. Laura Katz Olson. Lanham, MD: Rowman & Littlefield. 2003. 301 pp. ISBN 0-7425-2831-6. $29.95 (paper).

Throughout her career, Laura Katz Olson has delivered a pointed political economy perspective on aging policy in the United States. This tone of this recent book is even stronger, I think, fueled as it is by her concern with the prevailing trend toward dismantling welfare in general and the old age welfare state in particular. This book provides both a thoughtful historical account of the expansion and retraction of various old age supports and a clear and hard-hitting analysis of current policy efforts.

This book focuses on the world of long-term care, a sphere inhabited primarily by older women who are more likely than older men to both provide care and need care. Katz Olson's book provides a much-needed update to works that decades ago described the emergence of the old age medical industrial complex. The face of the long-term care system has changed dramatically over the years, as various components have risen and fallen with their funding streams, but the medical industrial complex itself is alive and well. It is a system, she argues, in which provider profits consistently outweigh human need.

Basing her arguments primarily on data from dozens of official U.S. government reports, Katz Olson shows how long-term care service providers, just like other health care providers, follow the money. When the 1980 Omnibus Reconciliation Act expanded coverage of home care, for example, home care providers flourished. But when the 1997 Balanced Budget Amendment restricted home care coverage, the number of home health care agencies plummeted by 20% in just 5 years. Over those same years, the steady drumbeat of an expanding frail older population with growing home health care needs went unheard.

In what is unquestionably an ambitious effort, Katz Olson explores the workings and impact of the system from many different perspectives including policymakers, older people and their families, paid long-term care workers, and so on. Though the perspective of each chapter changes, the basic story line is consistent. The U.S. long-term care system was not designed to provide long-term care to the frail elderly. …

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