Sharing the Financial Responsibility of Caring for Parents

摘要: THE EXPERIENCES OF “M” FAMILY DESCRIBED BY Ritchie et al in this issue of JAMA are the topic conversations among many baby boomers coping with aging parents who can no longer manage to live on their own. Although assisted living facilities or continuing care retirement communities attractive options for individuals recognize that they slowing down, such paid out pocket; those cannot afford them either receive unpaid help from family friends, pay in-home which only a portion may be covered by insurance, enter nursing home and spend down Medicaid—at great cost government taxpayers. Encouraging adults remain homes families would seem desirable an individual societal perspective. However, as explain, emotional, physical, social, financial costs caring older high. Many these occur whether move adult children supervise provided elsewhere. The particular staggering, adding emotional stresses both parent child. small share elders have high costs. In United States, example, 69% age 65 years estimated need some type long-term assistance before die. Most use informal, but often substantial, relatives friends. while average lifetime expenditures (excluding informal care) projected $47 000 (in 2005 dollars), 16% will more than $100 dollars) expenditures. These receiving high-cost especially likely 2 years; annual 2006 was $72 000. Medicaid pays 40% all longterm expenditures, 22% directly, cases exhausting savings then qualifying Medicaid. England, roughly 10% people at £100 (equivalent about $160 July 2011). wide variation skewed distribution (with paying very costs) show why risk is nontrivial. A private insurance market might expected thrive situation. Yet it does not—in States any other industrialized countries. primary explanation there uncertainty surrounding exactly expensive what 20 30 now. US Community Living Assistance Services Supports (CLASS) plan, voluntary, publicly administered program established Affordable Care Act 2010, address issue, appears unlikely survive efforts reduce budget deficit. With becoming aware needs potentially elder care, how 19% Americans 2030 old could major focus national health debate. Other countries been having debates past decades—in part because higher shares population were already aged 64 older. For instance, 20% Japan, Germany, Italy older, 15% Sweden, Spain, France, Netherlands—in proportion 13%. wrestling same issues States—how provide quality elderly activities daily (ADLs) not impoverishing families. costly social funded through general revenues assistance. Scandinavian rely taxes raised local levels; Netherlands, Japan programs mandatory participation. had place since 1960s (Sweden late 1940s), implemented 1994.