The Caretakers of an "Old" Society - Child Week


By Timothy Dillon

One way of judging a society is by how they care for their most senior of citizens. As simple a requirement as it sounds, this criteria has recently become increasingly difficult to manage for two of the world’s super powers: The United States and China. With issues ranging from infertility to an increase in life expectancy, our elderly are living longer and are in greater need of care.

Both cultures pride themselves on being respectful to their elders, but with American presidential debates centered around the future of Medicare, paired with the cost of health care in China exceeding the capabilities of the socialized system they used to have, the twilight years of our seniors’ lives may be more bleak than peaceful. Who is stepping up to take responsibility? We are, one way or another.

Photo courtesy of James McTaggert

The Numbers

Part of this problem lies in how it all adds up. The baby boom lead to a massive increase in the United States population. After 1964, the birth rates began to stabilize but the “damage,” so to speak, was done. Since 2008, the 76 million baby boomers have started retiring. The youngest of this demographic are looking to exit the work place around 2029, and economists expect that with their spending coming to an end, the cost of the aging population is expected to increase dramatically.

This is why we have Medicare, right? Sure, that is the purpose of Medicare, but it was never meant to handle a generation this size, living this long, that was going to cost so much. In fact, when Medicare was originally passed in 1965, the life expectancy was considered to be about 70, with a lucky few outliers. This meant if you retired at 65, the government was expecting to pay out at least five years worth of benefits. Today, the life expectancy has increased to 78, and with improvements in medical care and treatments for elderly diseases, the federal government is expected to pay out at least 13 years of benefits.

Maya MacGuineas, President of the Committee for a Responsible Federal Budget, recently called for raising the eligibility age for Medicare benefits from 65 to 67 over the next two years. Numerically speaking, this would seem to solve the problem of spending and costs of an aging generation, but not everyone agrees.

Aaron Carroll, MD is an associate professor of pediatrics and the Associate Director of Children’s Health Services Research at the Indiana University School of Medicine. Dr. Carroll submits that while this may seem like a fix, it is in fact a rouse. While some people are living longer, the distribution is not the same.

In his reply to Ms. MacGuineas’s opinion, he cites a 2007 study that demonstrates that while people in the top half of the income bracket saw a greater increase in life expectancy, the bottom half saw barely a year. Thus, raising the age of eligibility would actually punish our less financially secure senior citizens. Fiscally it adds up, but practically it leads to more costs in the long run due to patients waiting for Medicare to receive treatments, and the costs that will be put on families in the interim.

In China they are facing a similar problem. By 2030, more than a quarter of the population is expected to be around the age of 65. With a projected population of 1.6 billion, that means 400 million possibly dependent elderly. This problem is unique though; the United States is dealing with an increase in the longevity of its citizens, but China’s problem starts at the other end of life.

“The major reason that you have an aging population, is fertility decline,” Nancy Riley tells BTR. Riley is a Professor of Sociology at Bowdoin College and has spent a great deal of time in China researching issues related to family, gender, and population. “Even though, in fact, mortality decline has contributed, the major influence is, in fact, lower fertility. So the one child policy and other population policy the government has instituted, has in fact lead to the higher older age population,” she continues.

While the origin of this dilemma is a result of government action, the practical effects are the same. With an increase in the elderly population, the Chinese government has had to address the health care costs directly. What was once a completely socialized, free health care system, is now a pay-as-you-go program for many seniors, with responsibility falling to the family. However, the culture of China is inherently different than that of the United States. In the U.S., we have numerous assisted living facilities and nursing homes, but in China these are scarce and are widely considered last resorts.

“The only thing that is good enough is for that father to live with his son. But the households, the houses themselves, are not really big enough. They are not big enough for these sorts of families,” Riley tells BTR. It would seem that the very infrastructure of the country lacks accommodation for this problem, this may lead to an increase in the types of facilities that offer senior care, but in all likelihood, it will lead to a much greater cost to the family unit itself.

The famous inverted pyramid chart

The Result

What happens when the baby boomers grow old and the senior population in China balloons? What happens is we all feel the burden; many have already. Abby Wolfe, RN, has worked in three assisted care facilities.

“I first started working with veterans, and their families had all but abandoned them,” Wolfe tells BTR. In her time as a nursing student and nurse she notes that there has been an increase in people coming into homes, and they are living there longer, but that might not be what is truly needed. “The staffing is really bad. It is such a difficult and demanding job, and you don’t get a lot of money. Some patients established a stable situation but it depends on the level of social connections they have. Not many people outside of families visit seniors. If family members were to take care of their seniors at home, I think the community would help. I know that’s not true for everyone, but it was what was true for me.”

The expectation in the U.S. is that if you can’t bring an aging parent into your home, it is best to put them in an assisted care facility. Wolfe notes that it changes with each generation. “We are a very self-involved generation,” she says. With 16,100 nursing homes in the U.S., she isn’t wrong. In China, there is no room to be so self-involved.

“A married couple, they have four people to take care of, both the husband’s parents, and the wife’s parents. It use to be that the wife, that her brother would take care of their parents. Now, all of the responsibility is on very few older adult children. The burdens are quite severe. One of the things you have in China is women having to deal in this sandwich generation, that is taking care of their kids and their elderly parents. Women in particular are shouldering the burden of family care at both ends of the age spectrum,” Riley tells BTR.

What happened is that the care of our seniors has shifted across the board. Families are going to need to be more proactively involved with the care and health of their most senior members. Children are growing up not only to raise their own children, but also care for their parents. Medicare will not provide sufficient means for our seniors to care for themselves or the facilities they require.

The responsibility has always fallen to the family, but here in the U.S., this will change what the tradition of the past 40 years has been. It is not a new phenomenon, but the impact the aging generation is going to make will be felt a lot closer to home than anyone could have previously expected. So if you’re a young couple thinking of moving into a new apartment or home, be sure to tack on an extra bedroom for either set of your in-laws. You’re probably going to need it.