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My Turn
Other Views from Those in the Know
Gail Gottlieb
candidate for Florida House
Eldercare is a Family Value

The vast majority of elderly Americans want to stay in their homes rather than be sent to nursing homes to live out their last years. While this is not always possible, our society should do much more to make it easier for older people to “age in place,” in familiar surroundings with family members—and paid caregivers, if necessary—attending to their needs.

Instead, the Florida Legislature last year unsuccessfully tried to eliminate a key tool for helping the elderly and disabled stay in their homes when they can no longer live alone. This effort, which is likely to resurface, would have prevented adult children and other family members from entering into a personal services contract with their parents or elderly relatives to pay in advance for in-home care, delaying -- perhaps forever -- the need for nursing home residency.

For the last three years, my mother has been profoundly disabled by a massive stroke that left her in need of around-the-clock care, but otherwise healthy and interested in life. I have devoted countless hours to her care, happiness and hope of recovery—time that I hardly regret spending, but that also prevented me for a long time from working outside her home to earn a living. My mother and I are both extremely lucky that I have been sufficiently healthy and financially secure, and without young children, to be able to care for her. However, in countless other families, no relative can afford the sacrifices such care entails.

This is not simply an argument for long-term care insurance. My mother carried such insurance for years, but the cost of the premiums was more than she could afford each month, so she dropped the policy -- yes, probably unwisely. Most policies would have allowed the benefits to be used to pay a family member to provide in-home care, but—for better or worse—not everyone can afford long-term care insurance.

So why would some legislators want to prevent family members from being paid for providing this care through a personal services contract? Do they think that everyone can afford to just stop working to take care of their elderly parents out of filial duty? Millions of people like me are willingly doing this despite the financial sacrifice. A 2009 study by the National Alliance for Caregiving and Evercare puts the economic value -- and burden -- of such unpaid care provided by family members at $375 billion a year, nearly twice the combined spending on professional homecare and nursing home services combined ($158 billion).  

But sacrifice can only go so far if one has no income and cannot keep drawing down one’s assets. Precluding family members from being paid may encourage more people to carry long-term care insurance, but it is cruel to the elderly and disabled, who must exhaust their savings on expensive professional care and then be forced to enter a nursing home. It is equally cruel to the family members who, out of love for aging parents or disabled children, sacrifice careers and income, vacations and good nights’ sleep, and often their own health in order to provide in-home care.

Rather than putting up roadblocks to family care, our laws should recognize the value of family caregiving and provide incentives for doing so. These should include ways of better facilitating personal services contracts (while protecting seniors from relatives who might try to exploit them financially), providing tax credits for the imputed value of providing care to an elderly or disabled family member, providing adequate funding for adult day care centers, and making family leave policies more flexible.  And we need to do a better job of letting caregivers know what options are available to their loved ones. In the three years that social workers have been involved with my mother’s care, none of them mentioned the possibility of a personal services contract.

This issue is especially important to women for two reasons: First, women provide two-thirds of the care for family members.  Second, most of the elderly in need of care are women because the female-to-male ratio increases with age; by age 85 there are 2.06 women for every man. The typical U.S. caregiver is a 49-year-old woman who works outside the home but works an additional 20 hours a week in unpaid care for her mother, for an average of five years, according to AARP. 

Enabling family members to care for older relatives is not just a matter of decency but also one of economic good sense. Sending people who have exhausted their resources to nursing homes ultimately means that taxpayers will have to pay the tab.

Refusing to recognize the economic value of caregiving by family members may be good for insurance companies, home-health agencies and nursing homes, but it is bad for families both economically and emotionally. If we really care about encouraging family members to care for each other in sickness and in health, we must make it feasible for them to do so, without pushing them to the economic brink and making them sacrifice their hopes of being able to send their children to college and having a secure, dignified retirement for themselves.

If we are serious about promoting family values, as well as reducing health-care costs for the state, we need to do more to support—not hinder—the ability of adult children to care for their parents at home.

Gail Gottlieb is the Democratic candidate for Florida State Representative, District 59, which includes Brandon and parts of Valrico, Riverview, and Tampa. An attorney with a wide-ranging public policy background, she grew up in Brandon.

by Dr. Radut.