PSYCH M140 Chapter Notes - Chapter 5: Social Exchange Theory, Welfare Dependency, Blaser
CONTROVERSY 5: SHOULD FAMILIES PROVIDE FOR THEIR OWN?
Aging and the
American family
• More than half of all Americans over age 65 are married
o But advanced age frequently brings a need for caregiving
o And older spouses are likely to be impaired
• Exchange theory of aging—the idea that interaction in social
groups is based on reciprocal balance
• The overwhelming majority of care for older relatives is still
provided by women
o Sandwich generation—describes the impact of such caregiving
responsibilities on middle-aged women (i.e., taking care of older
parents and taking care of young children)
• In cases of extreme frailty or dependence, family members may
become so burdened that they “burn out”
Abandonment or
independence?
• The common stereotype that older people are abandoned by
their children is largely inaccurate
o Nearly half of older adults reported that they lived or expected to
live in proximity to their children, two thirds within 30 minutes of a
child
o Three-fourths of older adults talk on the phone at least weekly
with their children, and more than 40% talk to them daily
• But patterns have changed over the past 50 years
o e.g., sharing a household in an extended family is dropped off
significantly
o “World-we-have-lost” myth—idealized image of the “golden
age” of pre-industrial society
o Nuclear family—only parents and children in the household;
Western societies have trended toward this
• Families today typically remain in close and frequent contact
o “Intimacy at a distance”—reflects a common desire by older
people to live independently and yet still remain close enough to
have regular contact with grown children
• One reason for the change in living arrangements over the last
century is that more people are living into advanced age, and thus
require help with ADLs
Family responsibility
• Long-term care has remained largely a family responsibility in the
United States
o Spousal responsibility is deeply embedded in our culture as a
matter of both ethics and law
§ Many states have laws on the books that could require adult
children to support their aging parents—but these are rarely enforced
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o If a spouse is unable to provide care, then other family members
such as children or siblings take responsibility
• “Filial responsibility” refers to the expectation that family members
will care for each other
o It is an implicit cultural assumption that is often interpreted
ambiguously in the context of law, custom, and ethics
o Commonly taught in some cultures, sometimes to the extent of
expecting adults to provide care for aging parents over their own
children
• How can government best support the strong sense of responsibility
many families have for their elders?
• How should government respond to the high cost of paying for the
care of older adults who need help?
Medicaid and long-
term care
• Medicare—a U.S. health care system that provides near-
universal coverage for acute diseases among the old; rarely
covers long-term care
o Pays only 2% of nursing home costs
• Medicaid—a joint government program supported by federal and
state funds; created in 1965 to provide health care for the poor
o Pays for 36% of nursing home costs
o Created to provide healthcare to the poor, but has become a key
factor in nursing home coverage for middle-class older adults
Financing and long-
term care
• The cost of nursing home care continues to increase each year.
• Medicaid determines eligibility based on income and assets
• Medicaid is the fastest-growing component of state budgets and
has become the public program of last resort to pay for nursing
homes
• However, studies have shown that while government-funded home
care may be more desirable, it doesn’t necessarily save money
o Woodwork effect—government policy-makers are afraid of
people “coming out of the woodwork” to demand services that
families have been providing
Medicaid planning
• As individuals and families have become more aware of the cost of
long-term care, some middle-class families have found ways of
qualifying for Medicaid
o Medicaid spenddown—impoverishing themselves by spending
all income and assets to qualify for Medicaid coverage
o Divestment planning—appearing to be poor by taking advantage
of legal loopholes to “avoid the Medicaid trap”
• Unknown how many families do this, but there are enough people to
sustain a rapidly growing body of “elderlaw” attorneys
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find more resources at oneclass.com
Document Summary
United states o spousal responsibility is deeply embedded in our culture as a matter of both ethics and law. Strauss and lederman outline the purpose of medicaid and the steps required to apply for it. Discuss the key feature of medicaid and how it supports or doesn"t the financing of long term care. A public assistance grant program, the twin great society benefit signed into law along with. A major payer of long-term care for those unable to afford the average yearly cost of at least. Of medicaid spending goes to home health services and long-term nursing home care. Provide coverage for long-term nursing home care not covered by medicare. Cover home health care services, medical supplies, and equipment. Pay for at-home services supplied under state plans for people who would otherwise be constitutionalized, covering part-time skilled nursing, home-health, and homemaker services provided by certified home health agencies. Various planning strategies using statutory exemptions, spousal protections, and asset transfers.
