Report Offers Blueprint for Future of Long-Term Care System

With the anticipated surge in the over-75 population just over the horizon and the potential caregiving crisis that may accompany it, a new report seeks to guide policymakers toward a better long-term care system.

Caring About Long-Term Care: An Ethical Framework for Caring, written by Lisa Eckenwiler for the Center for American Progress, presents a series of philosophical guidelines that she considers essential for creating a long-term care system that can adequately meet the needs of the country’s elderly population, their families, and long-term care providers.

As the report notes, there already exist severe inadequacies in the current system.  Assisted living facilities, residential care facilities, and adult day care centers are plagued by insufficient funding, shortages of experienced staff, and unsafe conditions.  Paid caregivers account for only 20 percent of long-term care while the vast majority of long-term care—80 percent—is provided by unpaid caregivers, usually family and friends.  Further, at least six out of 10 of these caregivers are also employed in the paid workforce, and 42 percent are over the age of 50 themselves.  Yet few employers have written policies regarding elder care, and even fewer subsidize any elder care benefits.  With America’s elderly population expected to double in the near future, these inadequacies may be dangerously exacerbated.

By exploring these and other issues raised by the current system, the report lays out an ethical framework which it hopes will serve as a blueprint for policymakers and other stakeholders to build a health care system that adequately meets the long-term care needs of the population.  This framework is presented not only as a means to discuss and understand long-term care, but also as a way to evaluate long-term care programs.  Specifically, the framework calls for the consideration of seven factors:

• An Ecological Ethic: Recognizing the interconnectedness of people, systems, and policies.
• Respect for Human Dignity: Respecting the unique worth of all people and their pursuit of a good life at all stages.
• Beneficence: Maximizing benefits, including health and security.
• Compassion: Demonstrating concern for the well-being of others, especially the vulnerable.
• Reciprocity: Appreciating and compensating those who give back to society.
• Temperance: Taking a long view rather than looking for short-term fixes.
• Social Justice: Treating all people fairly and equally and building just social institutions.

By approaching the problems surrounding long-term care from an ecological perspective, the report emphasizes the way in which our long-term care needs are tied to those of families and caregivers around the world, both for better and worse.  Decreases in the number of children per family may limit access to “informal” support, i.e., support from family and other unpaid caregivers, which accounts for the vast majority of long-term care.  And at a time when the U.S. and other nations are already experiencing a shortage of paid caregivers, the demand for their skills is rapidly increasing.  In low and middle-income countries, in particular,  the migration of women seeking paid work as caregivers—and ultimately better economic opportunity—stands to imperil the elderly and others left behind.  Without increased efforts to train and maintain caregivers where they are needed most, the report warns of a shortage of people to look after our aging loved ones.

Drawing upon an examination of this growing interconnectedness, the report suggests that the most effect policy strategies will be integrated, promote sustainability, and embrace progressive values in the related-realms of labor policy, immigration policy, and international alliances.  It urges policymakers to take the long view when formulating strategies for meeting the needs of the dependent elderly and their caregivers and refrain from embracing short-term solutions.  Such forward-looking policies, it asserts, would strengthen the country’s self-sufficiency, improve working conditions, and serve as a catalyst to improve the quality of elder care over time.

The report also focuses on the need to appreciate and adequately compensate workers, parents, and caregivers for their contributions. Even though caregiving is crucial to society’s ability to function (research estimates the national worth of caregiving labor at over $300 billion), it lacks social standing and garners little respect in the U.S. The report explores the highly gendered problem of undervaluing the work of those that serve the dependent elderly – the vast majority of whom are women – and concludes that this phenomenon renders invisible the needs of the vulnerable and those that care for them. The report suggests tax credits, direct subsidies or stipends, or perhaps credit time for Social Security, as a means to compensate caregivers for the valuable work that they do.

Modern medicine has succeeded in helping people live longer and healthier lives in the U.S. and around the world.  Yet this success is undermined by poor and inadequate care that many elderly receive.  Stereotypes about the elderly can leave them facing paternalistic treatment that fails to take their abilities and needs seriously.  The institutions that provide long-term care to the dependent elderly are plagued by a lack of funding and unsafe conditions.  And the elderly living outside of institutional settings often receive inadequate care.  The problem is compounded further by the fact that the vast majority of health care for the elderly is provided by people who have not received any training.  While not a solution in and of themselves, the seven ethical principles can serve as a useful guide for developing an effective and sustainable long-term care system, as well as evaluating that success of that system.  The ability of these principles to achieve these stated goals, however, is contingent on government and policymaker involvement, not only in applying this ethical framework to new policy but also to those initiatives already underway.  The result of such a principled foundation, the report concludes, would be a long-term care system which ensures that the country meets its obligations to the dependent elderly and their caregivers.

The report is available on the Center for American Progress website.