Paul Kusuda’s column
Aging has its worries--Part 2 of 2
Paul H. Kusuda
long-term care will cost an average of about $91,000 for men and double that for women, because they live longer…across
the U.S., many can’t afford that, so they turn to Medicaid…This includes middle-class Americans, who often must spend
down or transfer their assets to qualify…About 1.4 million people are in nursing homes nationwide, and about 62 percent of
those beds are paid for by Medicaid.”  Thus, costs are another variable of concern to both care recipients and caregivers.
As long as assisted-living or nursing-home resources are not used, care recipients depend primarily on family members,
relatives, or friends to help them remain in their place of choice, own home or apartment.   However, those resources will
diminish as a result of the history of smaller family size, children moving away from parental homes, declining marriage
rates, and rising divorce rates.  Some families can afford to purchase formal caregiver services for set numbers of hours
per day, but at some point, part-time caregiving will not suffice.  I was surprised to read that someone (I don’t know the
source) noted that caregiving can last from less than a year to more than 40 years.  I hadn’t previously thought about how
long such responsibilities might last.

A University of Washington article Study Reveals Surprising Truths about Caregivers, June 16,2015, pointed out that
“…almost one-third of the U.S. population are informal caregivers and collectively provide about 1.2 billion hours of unpaid
work weekly, the equivalent of about 30.5 million full-time care aides…elderly people were frequently being cared for by
spouses, not their adult children…Overall, women continue to shoulder the bulk of caregiving burden in most
situations…The study estimates the value of unpaid care nationwide at $691 billion of the country’s GDP… The increased
demand…could be partially addressed through more flexible workplace policies and tax breaks or other incentives…”
The AARP Public Policy Institute’s article The Dual Pressures of Family Caregiving and Employment, May 2016, noted:  “The
majority (60 percent) of family caregivers caring for adult relatives or friends worked at a paying job at some point during
their caregiving experience in 2014…On average, employed caregivers work theequivalent of a full-time job (34.7 hours per
week)…About one in six…family caregivers is self-employed or works in his or her own business to better fit care demands
and have greater job flexibility.”  

The article pointed out that “…one in three (34 percent) employed caregivers are in high-burden situations (based on hours
of care provided and the number of daily tasks performed)…More than one-third (37 percent) of employed caregivers
consider their caregiving situation to be highly stressful emotionally…one in four (24 percent) find it difficult to get affordable
supportive services in their care recipient’s community.”  Of course, having simultaneous responsibilities of paid
employment and unpaid caregiving pose numerous needs for adjustment of personal time and activities.  All results in
inevitable strains and stresses, the toll may well be hidden for a while; however, effects cannot possibly be conducive to
physical and emotional well-being.

Many caregivers are thrust into situations without adequate internal or external resources to help cope with problems they
face.  Social agencies such as the Area Agency on Aging of Dane County (Wisconsin) recognize the issues and provide
avenues of assistance through such mechanisms as issuing monthly Caretakers Chronicles, providing resource materials
accessible through public libraries, and making available at nominal cost (with scholarships on request) special training
opportunities for caregivers.  Although those public agency efforts are helpful and useful for caregivers, unfortunately, they
fall short.  Some caregivers may have difficulty reading and using information because of reading level, lack of proficiency in
English, transportation problems, lack of time to avail themselves of opportunities, etc.

Solutions are not easily found, an obvious obstacle being public funds that must be provided on a long-term and continuing
basis.  In the 18th and 19th centuries, there were peripatetic preachers who moved from town to town giving their religious
messages, teachers had one-room schools, businesses were locally owned.  In the early 20th century, pediatricians often
made home visits to get a feeling for home conditions while helping parents take care of sick children.  The primary focus
was on one-to-one relationships.  Then, in the later 20th century, society became involved in massive changes, most to
better the quality of life.  The impact of those changes includes a distancing of persons one from another.

One way to mitigate stress placed on caregivers is to develop solutions by returning to the one-to-one relationships of
helping one another.  For example, caregivers are generally homebound.  One successful approach has been to provide
respite care opportunities; however, costs are involved.  Another is to provide relevant written resources and training
opportunities, but obstacles are present.  An alternative, though funding may be an insurmountable problem, would be to
train professionals, possibly Certified Nurse Assistants, to become specialists in helping caregivers learn best-practice
ways to help caregivers, ways to reduce personal stress, efficient ways to meet caregiving situations, etc.  Such specialists
could help individual families by going from home to home.
By Paul H. Kusuda

Last month, my thoughts ended with “…plans to meet the to-be-growing need for caregiving
services must include considerations involving both care recipients and caregivers.  Yup,
there
's much to worry about.”  Will it be possible to handle both ends of considerations?  Will
we have to stumble around and not have the where-with-all to deal fairly with the presenting
problems?  Will the grinding impact of burgeoning population-proportion of aged and
consequent reducing population-proportion of working-age (and help-providing) pose a non-
resolvable dilemma?  Is an appropriate and equitable solution possible?  I’m not sure that
even with optimal advance-planning efforts, a realistic answer will be possible.

In reviewing a few considerations regarding care recipients, I neglected to add that the
alternative of using either assisted-living or nursing-home facilities has to be postponed
because of cost considerations.   According to the Kaiser Health News article by Anna Gorman
and Barbara Feder Ostrove (August 1, 2016):  “Experts estimate that about half of all persons
turning 65 today will need daily help as they age, either at home or in nursing homes.  Such
To reinforce knowledge
transmitted on a one-to-one
basis, technique-review sessions
could be reproduced on
videodiscs and made available to
caregivers together with small
DVD machines available at less
than a hundred dollars apiece.  
Hands-on instruction with
opportunity for questions and
answers should be effective and
long-lasting.  Also, that method
can meet the problem of ability to
read, regardless of reason,
through provision of CNA services
in different languages when
appropriate.