The Forces Reshaping Healthcare
Kleyman, Paul, Aging Today
Keynoter Emily Friedman
The locus of care for chronically ill patients is moving to home and communitybased services-but this shift will place more responsibility on family caregivers.
Most elders are covered by Medicare or Medicaid-but many of their caregivers are uninsured or underinsured.
States are creating plans to extend kealthcare coverage to more people-but none of these measures cover long-term care.
These good news-bad news bulletins are some of the wide-ranging insights veteran health-policy analyst Emily Friedman offered in her keynote address, "Forces Reshaping 2ist Century Healthcare," which opened a special program on family caregiving held as part of the 2007 Joint Conference of the American Society on Aging (ASA) and National Council on Aging in Chicago in March. The special program was sponsored by the National Center on Caregiving and Family Caregiver Alliance in partnership with AS A.
Named one of the top 25 women in healthcare by Modern Healthcare magazine in 2005, Friedman is a contributing editor to Hospitals and Health Networks and a contributor to the Journal of the American Medical Association, as well as an adjunct professor of bioethics at the Boston University School of Public Health. Yet, it was her direct experience of family caregiving-not her considerable expertise-that initially arrested the attention of long-term care professionals attending the program.
"My stepmother suffered a stroke at the age of 75; my then 74-year-old father chose to be her primary caregiver," Friedman recalled. "Carrying her around for six years produced such stress on his back that within six months of her death he was confined to a wheelchair, in which he spent the last 10 years of his life."
Friedman also described the caregiving demands borne by numerous friends of hers. For example, Kelly, a single mother of two, gave up her position as vice president of a flourishing organization in Arizona to move to Wisconsin to care for her mother. Now Kelly is struggling to establish a freelance career "that will allow her to take care of both her children and her mom," Friedman said.
Another friend, Winston, recently moved his mother, after she had a severe stroke, from her Baltimore home to an assisted living facility in Chicago, near where he lives with his partner, Dan. Friedman said, "Despite the soft [housing] market, Winston and Dan were able to sell her home, which will pay for about six months' care. After that, they will have to go into their 401 (k)s."
Family scenes like these are occurring nationwide, mostly involving caregivers in their 405 and 505, people who "have a very long road ahead of them," Friedman said. She examined essential forces affecting people with chronic illness and their families-forces that, for better or worse, are reshaping Healthcare in the United States.
Because women in the United States outjive men by about six years on average, Friedman said, among those 65 and older/there are only 72 men for every ioo women. Among elders ages 85-plus, there are only 46 men for every ioo women. "Furthermore," she stressed, "far more women [than men] will be living alone and living in poverty." With mass longevity will come escalating numbers of people with chronic and disabling conditions.
Another consequence of population aging, Friedman said, will be a healthcare workforce "that is much older and whose scope of work, whose assignments and whose personal needs are going to have to be honored." She emphasized that the United States is still not facing the prospect of being dependent on nurses in their 505 and 6os, who will outnumber nurses in their 20s. Friedman said a shortage of homecare workers and other paid formal caregivers is likely.
Multicultural issues will also become increasingly important, she said. For example, additional constraints on immigration could further limit the supply of workers in home and community-based care (HCBC). …