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WHAT SYSTEM IS IN PLACE TO CARE FOR OLDER ADULTS?
People are living longer and needing increasingly complex levels of care
as they age. Originally, caring for the aged was primarily a concern of family,
neighbors and friends. Today this responsibility is borne by a complex system
involving government, private businesses and community based organizations
in addition to the original caregivers. As with any large system, the best
interests of the individual are at risk of being overlooked.
This chapter of the report considers the formal and informal systems that
are in place to help older adults access the services and supports they need
as they age. Initially the discussion is about the formal Long Term Care
System - the mechanism for financing and providing community based and institutional
care across all areas. The discussion focuses on how individuals access care
and the changes and trends at the national and state levels that impact access.
This is followed by a discussion about the informal long term care system
- family and friends that provide the vast majority of care for older adults.
Lastly, this chapter covers information about the local investment in care
and services for older adults.
THE LONG TERM CARE SYSTEM
The formal system that has developed over the years to address the needs
of older adults is commonly known as Long Term Care (LTC) and refers to a
range of services including medical, social, personal care and supportive
services that are used by individuals who do not have the ability to care
for themselves or maintain their households due to some type of chronic condition,
such as a physical disability or health problem. It is not possible to discuss
here all aspects of the long term care system. Rather, the point is to provide
an understanding of the key parts of the system and how it impacts older
adults and the community as a whole
Long term care services can help individuals who, without help,
may require institutionalization. As discussed, some individuals
need only minimal assistance to maintain their independence while
others need a wider array and more intense level of care (NAELA,
2000; THHSC, Jan. 1998).
Historically, public dollars have supported institutionalization
over community based care. However, in recent years expenditures
are shifting to community based support. The current LTC financing
system favors acute care over chronic care and historically has focused
on the most expensive, and possibly least effective, methods of care.
For example, Medicare, the most significant health care protection
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Types of LTC assistance:
- skilled nursing care
- sub-acute care
- physical/occupational therapy/rehabilitation
- respite for caregivers
- adult foster care
- home modifications
- nursing home care
- medical devices
- home delivered meals
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for older adults, covers bypass surgery (acute) but not care for diseases
such as Alzheimer's (chronic). Dependence is supported over independence
in that significantly more resources are allocated for institutional
care than home care (NAELA, 2000).
In the last 10-15 years, several changes on the national level have occurred
that are impacting the long term care system. These changes are having a
significant impact on the ability of older adults to maintain independence
and age in their own homes.
Changes on the National Level Impacting Long Term Care
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- Changes in Medicaid Spending. Medicaid, the number one
government source for financing LTC, has traditionally been used
to pay for institutional care. However, federal policy has changed
such that states can apply for Medicaid waivers1 (HCBC
waivers) that allow them to use Medicaid funds to pay for alternatives
to hospital and nursing home care. Between 1987 and 1997, the percentage
of Medicaid funds spent on home care nationally increased from 10.8%
to 24% while the proportion of Medicaid funds spent on nursing home
and intermediate care declined 15% (Coleman, 1999; NAELA,
2000). While states only spent 22% of Medicaid funds on Home
and Community Based Care (HCBC) waiver programs in 1987, by 1997,
60% of funds were spent on these programs (Coleman,
1999).
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- Rights for the Disabled. In 1997, the Supreme Court ruled
in Olmstead vs L.C. that under the Americans
with Disabilities Act (ADA) it is discriminatory to place persons
with disabilities in institutions without justification. As a result,
Texas established the Promoting
Independence Advisory Board to oversee the implementation of
the Olmstead decision and how Texas would respond to the challenges
it presented. The mission of the Board is "to provide guidance to
the Health and Human Services Commission in the evaluation and implementation
of the system of services and supports for people with disabilities
in order to assure that Texans with disabilities have access to alternatives
to institutional care when community care is preferable" (THHSC,
July 2000).
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- Balanced Budget
Act of 1997. This federal act made significant changes
in the Medicaid and Medicare programs. The intent of the BBA,
in part, was to stem the rapid growth in cost of these two programs.
The complex changes made by the BBA cannot be addressed here,
however, it is important to note some consequences of this legislation.
First, Medicare managed care service and home health care providers
are choosing to opt out of renewing Medicare contracts because
the reimbursement rates for services are too low. This year,
the primary local Medicare provider in Travis County, Seton Healthcare
Network, announced that it would no longer provide Medicare funded
managed care or home health services. Additionally, the BBA created
additional financial burdens for physicians who accept Medicare/Medicaid
assignment. As a result, more physicians are choosing not to
accept Medicare/Medicaid patients or limiting the number they
serve (Schneider, 1997).
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- Medicare Home Health Benefit. This warrants special consideration
because of the important role it plays in meeting the needs of older
adults. Originally, this benefit was intended for short term use
for individuals recuperating from acute illness and to provide a
less expensive option to institutional care. Legislative changes
resulted in a huge increase in usage of the benefit during the 1990's
and a huge growth in the number of private home health agencies.
For example, the average number of visits per client increased 220%
in Texas between 1990 and 1997. Federal changes to the benefit have
resulted in a decline in its use and closure of hundreds of home
health agencies in Texas (Health Care
Financing Administration, August 1999).
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1States apply to the federal government for Home
and Community Based Care (HCBC) waivers which give states the flexibility
to spend Medicaid funds for community based services, not just institutional
care.
As our society continues to age, the need for long term care services
will continue to rise as the problems associated with aging become
more prevalent. Medicaid expenditures for elderly LTC are projected
to more than double between 1993 and 2018 due to both the aging of
the population and the increase in cost of care (Wiener
and Stevenson, 1998).2
Nationally, it is estimated that 60% of all persons will require long-term
care sometime in their lives (NAELA,
2000). Some 23% of all people aged 65+ are functionally disabled or
currently need LTC (Tennstedt, 1999). It is estimated that in the year
2000 more than 13,000 Travis County residents ages 65 and older have
difficulty with some ADL's (Texas
Health and Human Services Commission, 1999, Selected Information).
Despite the high level of need, the vast majority of individuals are
not adequately prepared to access LTC when they might need it and are
confused about the financing of long term care. Most believe that Medicare
covers LTC
services but in reality Medicare covers only a small part
of LTC costs. Medicare primarily covers home health care related
to acute care. (See Appendix
E for more detailed information on Medicare and Medicaid).
Medicaid is the number one payer for LTC in the U.S., covering
40% of nursing home and home care expenditures in 1998. The
next most common source is personal or family finances, accounting
for 26% of nursing home and home care expenditures in 1998
(Feder, et. al., 1999).
Another financing option is long term care insurance, but it
is estimated that only 6% of individuals in the U.S. have purchased
long term care insurance policies in the past (Coleman, 1999; NAELA,
2000).
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Most common financing options for
individuals needing LTC:
- Medicaid - Many individuals must
spend down personal financial resources in order to qualify
for benefit.
- Personal financial resources § Medicare
Parts A & B and Medigap Supplemental Insurance
- Long term care insurance - Primarily
an option for people who have assets they want to protect.
NAELA, 2000
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In Texas, the majority of resources for LTC go to residential services
such as those provided in nursing homes. As is shown in Figure
22, of the individuals age 60 and older receiving LTC through
the State, 299,000 receive community based services at a cost of
$551 million while 59,000 receive residential services at a cost
of $1.2 billion (THHSC,
Dec. 1998). That means that 16.5% of those receiving services are
using 68.5% of the resources.
Figure 22.
Long Term Care Resource Allocation in Texas
Source: THHSC, December
1998
Of the approximately $1.8 billion allocated to LTC for individuals
age 60 and older, 61% comes from the federal government and the remainder
from State general revenue (THHSC,
December 1998). Although Texas expends a substantial amount on community
based services, the demand for these services is greater than the
supply. The federal government has approved Texas to serve more clients
through the HCBC waivers but the State has not allocated the resources
necessary to serve additional clients (Weiner,
et. al., 1998).
Beginning in the 1990's, Texas increased its effort to improve the
current delivery and administration of long term care services. Current
state efforts include:
Changes at the State Level Impacting Long Term Care
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- STAR+Plus
Pilot Project - Currently operating in Harris
County, this Medicaid managed care pilot is designed
to integrate delivery of acute and long-term care services
covered under Medicaid and Medicare. This project is
partially funded by a grant from the Robert
Wood Johnson Foundation as part of the Medicare/Medicaid
Integration Program (University of Maryland 2000). A
status report on this project will be presented to the
Legislature in January, 2001. If successful, the program
could be expanded to additional service areas or implemented
statewide.
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- HCBC
Waiver Consolidation - The State is currently
seeking approval from the federal government to start
a pilot project that would consolidate 8 HCBC waivers.
The goal is to streamline administration of the programs
under these waivers which are currently administered
by three separate state agencies. This process is also
intended to improve service delivery. The state is applying
to the federal government to start a consolidation pilot
project in 2001.
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- Integration of LTC Services (SB
374 -76th Legislature) - In 1999 the State Legislature
passed SB 374 which seeks the consolidation of all state
LTC programs and the administration of these programs
under a new agency on aging and disability services.
The intent of the legislation is to improve the delivery
and administration of services. Additionally, the Health
and Human Services Commission, the Department
of Human Services and the Texas
Department on Aging are directed to assist local
communities in developing systems for the delivery of
LTC services (Broden and Angel, 1999).
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For older adults, the most significant action the state could take
is to increase the funds for services provided through HCBC waivers.
This would enable more individuals to receive services that support
independent living.
Although the federal and state governments play a significant role
in making services available to older adults through financing and
service systems, they cannot match the contribution of the individuals
discussed in the next section.
Table 15.
Findings and Recommendations
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FINDINGS
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RECOMMENDATIONS
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- LTC resources are shifting from institutional care to
community based care. However, the vast majority of resources
still go to institutional care.
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- Support federal and state efforts to shift resources to
community based services. Lobby the state to increase the
slots available through HCBC waivers.
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- Many individuals do not understand the financing of LTC
and are not adequately prepared to access the services they
need. Sixty percent of all individuals will at some time
need LTC services.
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- Educate older adults and their families about the options
for paying LTC services and how to prepare in advance to
protect resources and ensure that sufficient resources are
available to purchase services.
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- Changes in federal financing of Medicaid and Medicare
services are negatively impacting the ability of individuals
to access community based and in home services.
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- Lobby the federal government to increase the reimbursement
levels and allowable expenditures under various programs.
Expand and leverage state and local resources to fill the
gaps.
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RETURN TO TOP
THE ROLE OF CAREGIVERS
Caregivers are the backbone of the long-term care system. Yet,
it is only recently that the term "caregivers" has become integral
to the discussions about older adults and long-term care. Caregivers
assist older adults with all types of needs, including transportation,
house cleaning, cooking, personal care, and health care, for example.
There are two types of caregivers: formal and informal. Formal
caregivers
include individuals who are employed by an agency or take on a
formal volunteer commitment through an agency. Informal caregivers
are family
members or other laypersons (friends or neighbors) who provide
assistance without pay. The focus will be on informal caregivers,
as the contribution
they make is not considered in the valuation of the formal LTC
system.
Traditionally, as individuals aged and were no longer able to care
for themselves, family members, friends and neighbors stepped in
to help. Chances were that adult children lived nearby and that the
daughter or daughter-in-law began to provide help to the older family
member in need. Additionally, neighbors knew each other and people
generally had stronger ties to their communities. Overall, a solid
network of individuals who could provide help to an aging adult existed
within a community. Often, elderly parents moved in with their adult
children and their families. This was the expectation supported by
our cultural and societal norms and our living situations.
A number of transformations in our way of life have changed the
nature of providing care. Family and community ties have weakened.
Families are spread across the country or the world, unable to readily
provide help. In more families than not, both parents work. There
are more single parent families juggling work and child rearing.
People are working more hours. Despite these changes, family members
are still the people most likely to care for older adults, but with
greater consequences.
CHARACTERISTICS OF INFORMAL CAREGIVERS
In 1997, there were an estimated 24 to 27.6 million caregivers
in the U.S. (Arno, Levine, & Memmott, 1999). There are roughly
over 50,000 informal caregivers in Travis County. Caregivers are
spouses,
adult children, other relatives, friends, and neighbors. If an
individual is married, the spouse is the one most likely providing
care followed
by adult children, usually daughters.
Individuals from racial and ethnic minority groups report a higher
incidence of caregiving than the general population, with Asian-Americans
reporting the highest (31.7%), followed by Blacks (29.4%), and Hispanics
(26.8%) (Tennstedt, 1999).3
Twenty-five percent of caregivers are between 65 and 75 years of
age and another 10% are over 75.
Figure 23.
Caregivers in the United States by Relationship to Older Adult
Source: American
Society on Aging, 2000
Twenty percent of caregivers reside with the care recipient, while
another 55% live within 20 minutes of the care recipient (Tennstedt,
1999). Twenty (20%) to forty (40%) percent of caregivers are in
the "sandwich
generation", caring for both children under 18 and disabled older
adult(s) (ASA,
2000).
RETURN TO TOP
PATTERNS OF CAREGIVING
Possibly, the most important pattern to recognize is that, in general,
caregiving is reactive, not proactive. Caregivers typically do not
anticipate and plan for the need to provide care, and as a result,
are caught off guard when the need arises. Additionally, they underestimate
the time commitment required. Those expecting to spend six months
providing care spent one year, and those expecting to spend one to
two years spent four or more years providing care (National
Alliance for Caregiving, 1999; Tennstedt, 1999).
One person, the primary caregiver, assumes the majority of caregiving.
Support may be provided by a secondary caregiver but this tends to
be sporadic and less consistent, or offered only when the primary
caregiver is unavailable (Tennstedt, 1999).
Overall, the majority of care is provided by informal caregivers
with only a minority using any formal care. Research indicates that
care provided by families is stable and that the overwhelming majority
of caregivers do not voluntarily exit their caregiving roles. Institutional
or community based care may be used to replace informal care in the
absence or loss of the primary caregiver, but only temporarily. Most
families will resume responsibility for the care when possible (Tennstedt,
1999).
Figure 24 shows the number of hours caregivers
spend per week providing care. The majority spend less than 8 hours
per week, but almost one-quarter spend more than 40 hours per week.
Figure 24.
Distribution of Caregiving Hours Per Week in the U.S. - 1996
Source: Arno, et. al., 1999
Johnson and LoSasso (2000) found that
children are more likely to help parents when the parent is in poor
health and lacks other social supports, such as a spouse or other
adult children. The financial situation of the parent does not appear
to impact whether or not children provide assistance. Adult children
are more likely to provide care to mothers than they are to fathers.
The type of care provided is correlated to gender. Women are more
likely to provide personal care, tend to housekeeping tasks, and
prepare meals while men are more likely to provide transportation,
attend to home repairs and manage the money (Tennstedt, 1999).
Research shows that the majority of expenditures for both informal
and formal care go towards housekeeping, personal care and meals,
in that order. This suggests that formal care purchased by caregivers
is used to augment the care they provide informally rather than to
add more types of support (Tennstedt, 1999).
RETURN TO TOP
COSTS OF CAREGIVING
Nationally, it is estimated that informal caregivers provided 22
to 26 billion hours of caregiving in 1997 with an estimated value
of $196 billion. In comparison, national expenditures for formal
home care total $32 billion and nursing home care $83 billion. For
Texas, it is estimated that 1.79 million informal caregivers provided
1.667
million hours of care valued at $13.6 billion in 1997 (Arno
et. al., 1999). Published estimates of the cost of
caregiving are not available for Travis County. However,
a rough estimate was derived for this assessment. For Travis
County, the estimated number of hours of work hours lost
due to caregiving is 360,570 with an estimated value of
$2,621,342.5
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In 1997, informal caregivers in
Texas provided 1.7 million hours of care valued at $13.6
billion.
Arno, et .al., 1999
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Many caregivers are employed outside the home - between a third
and two-thirds. However, caregiving impacts employment with 9% leaving
employment
because of caregiving demands (ASA,
2000). In fact, research shows that employed caregivers adjust employment
to accommodate caregiving rather than the other way around (Tennstedt,
1999).
According to Juggling
Act, a study on the caregiving and work dilemma (National
Alliance, 1999), 84% of respondents made at least one adjustment
to their work schedule to accommodate caregiving. Adjustments
include using sick leave or vacation time, decreasing work hours,
taking a leave of absence, moving from full to part time work,
leaving employment and retiring early. For example, Johnson and
LoSasso (2000) found that for men and women between the ages
of 53 and 65, 100 hours of assistance to parents in a twelve
month period
Informal
caregiving costs the United States $11-29 billion annually in lost productivity.
National
Alliance, 1999
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translated into a reduction in annual labor supply of 460 hours. Additionally,
many reported passing up career enhancing opportunities such as training
or promotions. Consequently, caregiving impacts earnings. Although no
definitive number exists, the Juggling
Act
study estimated that the average loss in total
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wealth over a lifetime was $659,139 which includes lost wages, Social Security
and retirement contributions (1999 dollars). Employees are not the only losers
in this deal. It is estimated that employers lose $11-29 billion annually
in lost productivity (National Alliance,
1999).
Caregiving can also exact a toll on physical and mental health. Research
indicates that caring for a disabled older adult can increase stress, depression,
and morbidity. A study reported in JAMA in 1999 found that caregivers who
provide support to their spouse and report stress from providing care are
significantly more likely to die earlier than non-caregivers (Schulz & Beach,
1999).
RETURN TO TOP
CARING FOR CAREGIVERS
In the last couple of decades, it has become apparent that caregivers need
support along with the older adults. Because caregivers are such an important
resource, it is essential that any plan that addresses the issues facing
older adults includes the issues of caregivers.
Public policy has begun to shift in support of caregivers. The most important
change in policy is the passage of the Family
and Medical Leave Act (FMLA) of 1993. This federal law requires that
certain employers provide 12 weeks of unpaid leave for eligible employees
to take care of family members with a serious health condition. Most recently,
Congress reauthorized the Older Americans Act which included a new program,
the National Family Caregiver Support Services Program. The initial authorization
is $125 million (Email from Francisco Acosta, November 2000).
Additionally, employees may receive help from employers through employee
benefit programs. However, the 1998
Business Work-Life Study found that only 23% of companies with 100 or
more employees offer resource and referral for elder care. Nine percent (9%)
offer long term care insurance, and only 5% make financial contributions
to community based elder care programs (Galinsky & Bond,
1998).
TRENDS AND THE FUTURE OF CAREGIVING
A number of societal trends are impacting the ability of families to provide
care for older adult relatives. These issues are important to consider in
planning for the future.
Trends Impacting Caregiving
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- Rise in the number of divorces and remarriages - Increases the
complexity and obligation of familial relationships - more parents
have responsibilities to more than one set of children. Increases
the likelihood that those starting a second family will be caring
for both young children and older adults concurrently.
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- Increase in geographic mobility and long distance caregiving -
Relatives are less likely to live close by and may not be familiar
with resources in the community where older adult resides. Managing
the care of older adult from long distance is much more difficult.
May necessitate increased reliance on formal caregiving that, in
turn, may increase the personal financial burden.
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- Decrease in family size - Fewer relatives available to care for
older adults. If primary caregiver is unavailable, there are fewer
options for a secondary helper to assume responsibilities.
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- Increase in delayed child bearing - Contributes to the rise in
number of sandwich generation caregivers with responsibility for
both young children and older adults.
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- Increase in the number of women in the workforce - As most caregivers
are women, this will serve to increase the strain as women try to
balance work, family, and caregiving. It also means that more families
may have to turn to formal caregiving to meet their needs (ASA, 2000;
Johnson, et.al., 2000).
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RETURN TO TOP
CURRENT EFFORTS
Respite - The Texas Department
of Human Services (TDHS) and the Area
Agency on Aging (AAA) of the Capital Area currently offer respite care,
allowing caregivers to take a break from caregiving. An exact number of
Travis County residents receiving services is not available. However, in
1998, TDHS served 8,800 individuals per month (includes those caring for
older adults and disabled individuals in Region 7, a 30 county area, which
includes Travis County). In 1999, the AAA served two people.6
Caregiver Support Groups - Four groups serve the Austin/Travis County
area, some of which are specifically for individuals caring for those with
Alzheimer's.
Other Services - A number of other non-profit agencies provide services
that assist caregivers by providing direct client services. Such services
include transportation, home delivered meals, home health aides, and homemakers.
(See Appendix
A for more information.)
Table 15.
Findings and Recommendations
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FINDINGS
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RECOMMENDATIONS
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- Many caregivers of older adults are older adults themselves. Caregiving
stress for older adults can be life threatening.
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- Recognize the needs of older adult caregivers. Ensure that sufficient
programs are available to provide support and assistance such as
in home and respite care.
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- Caregiving is reactive not proactive and caregivers underestimate
the amount of time required and the impact on their lives.
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- Provide information to potential caregivers about planning for
the need to provide care to an older adult. Planning should include
recognizing the impact on employment and family life and the need
to anticipate necessary adjustments.
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- Caregiving exacts a high cost on employment resulting in lost
work time and wages.
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- Encourage employers to offer more family friendly benefits including
support related to eldercare.
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- A number of societal trends are impacting the ability of families
to provide care for older adults. As the number of older adults increases
the need for caregiving will increase accordingly.
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- Community planning should address the changes in population size
and societal trends when developing plans for providing services
to ensure that the capacity is available to meet the need.
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Best Practices
Several programs around the country are considered "best practices" in
providing support to family caregivers.
These programs all share certain key characteristics that are considered
essential to supporting caregivers:
- The term caregiver is recognized in state statute
- Each program offers a range of service options
- The caregiver is the client
- Assistance is available to middle and low income families
- Programs employ wide eligibility criteria (Feinberg and Pilisuk, 1999)
- Caregivers have identified services that are helpful:
- Information about and referral to available services
- Individual counseling
- Support groups
- Training to help families with decision making and problem solving related
to caregiving (AOA, 2000, Caregiver Support)
RETURN TO TOP
THE ROLE OF THE LOCAL COMMUNITY
The contribution at the local level to care and support for older adults
is a critical piece of the system. The funds and services described in this
section help fill in the gaps in services that are not covered by other resources.
A comprehensive assessment of the community's investment in services for
older adults is not available. Most agencies collect information by type
of service provided, not by population served. Also, many times, services
for older adults are combined with services for individuals who are disabled.
Thus, the information provided here does not provide the complete picture.
Table 16 shows a sample of public and private non-profit
investments totaling more than $2.8 million during the 1999-2000 fiscal year
(includes both amounts for services provided directly to individuals and
those purchased from other service providers). Despite this seemingly large
investment, providers must turn away individuals needing services due to
a lack of capacity. Many providers have waiting lists for services.
Table 16.
Older Adult Services Investments by Selected Major Investors - 1999
to 2000
Funding Agencies
|
Annual Expenditures
|
Percent
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City of Austin Direct Services (Parks & Rec
Senior Svcs*)
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$2,207,763
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77%
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Austin and Travis County Joint Social Service Contracts**
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$128,680
|
5%
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Travis County Direct Services (RSVP)
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$284,191
|
10%
|
United Way/Capital Area***
|
$234,000
|
8%
|
TOTAL
|
$2,854,634
|
100%
|
*Includes Senior Activity Centers, Transportation Services,
Congregate Meals Program, Old Bakery and Emporium, and Employment Program.
**Contracts
with Family Eldercare and Services
for the Elderly - 12 months. ***Includes Meals
on Wheels and Family Eldercare.
These funds purchase a range of services that address the needs
of older adults, including respite care, employment assistance,
guardianship, transportation, and social activities. This figure does not
reflect
the millions of dollars worth of volunteer time that is dedicated
to programs that serve older adults. In addition, many programs
are not specifically designated as "elderly" programs, even though a
percentage of the population they serve includes the older adult
population. For example, Austin/Travis
County MHMR Center does not have programs that specifically target
the older adult, although some of their clients are older adults.
The figures shown represent programs that are specifically for older
adults in Travis County.
Additional investors include State and Federal agencies, as well
as local non-profit, faith based, and public/private partnerships.
These include, but are not limited to:
- Area
Agency on Aging of the Capital Area - The Agency on
Aging receives funds from the Texas Department on Aging (through
Title III of the Older Americans Act), the USDA, and some state
General Revenue funds. The total amount that they spend in
Travis County is $777,417. This includes funding for transportation,
home delivered meals, case management, personal assistance,
legal assistance, and benefits counseling, all of which are
services provided through contracts with local providers (This
does not include rural transportation services provided by
CARTS).
- Capital Metro -Special
Transit Services spent $7,754,000 in FY2000, providing 500,824
trips for elderly and disabled City of Austin residents.
Capital Metro also spent approximately $63,892 in 1999 for half-priced
transportation passes, and gave away approximately $206,280
in
free transportation passes to clients of all ages (distributed
through the United Way/Capital Area).
- Meals on Wheels and More -
Provides a variety of in home services to home bound individuals
and older adults including home delivered meals, daily phone
calls, rides to medical appointments, grocery shopping assistance and
minor home repair. In 2000, approximately $2,087,000 was
budgeted
for all services.
- Family Eldercare -
Family Eldercare operates a variety of community-based services
and develops partnerships supporting older adults and people
with disabilities. In 1999, they spent $2,071,769 on Guardianship, In-Home
Care, Aging in Place, Eloise's House, the Summer Fan Drive,
Consultation
and Referral, Elder Shelter, and Texas Money Management Programs.
- Faith based organizations - faith-based organizations
also provide assistance to older adults. It is not possible
at this time to identify the amount of aid they provide.
- Services
for the Elderly - Homemakers or home health aides
assist in cooking, cleaning, personal care and medication
reminders
for low-income clients. Services for the Elderly had
a total annual budget of $2,013,000 in 1999. Approximately
49% of this
total budget is budgeted for the Primary Home Care/Family
Care program, which is devoted primarily to serving the
elderly
population.
- Housing Authority of the
City of Austin (HACA) - Approximately 15% (388)
of HACA Section 8 housing vouchers are used by people
age 62 and
over. Older adults live in approximately 20% (300) of
HACA's family public housing units. Of these 300 units,
one-third
are in apartment complexes designated for elderly & disabled
individuals. HACA's annual budget for Section 8 vouchers
is $19,286,920 and $7,997,204 for Public Housing Units.
Again, this is just a sample of the investment being made in Austin
and Travis County. As evidenced in the current efforts sections throughout
this report, numerous organizations and services exist to support
this group. For a comprehensive list of organizations and services,
see Appendix A. The Current Efforts Table offers information about
community based, governmental and private programs that are serving
older adults. One large group of providers not included is faith
based organizations. They play a significant role in providing basic
needs such as food and clothing to older adults and others in the
community.
2 While LTC applies to individuals who are younger
than 65, such as those with mental retardation or developmental disabilities,
60% of the individuals using LTC services are aged 65 and older. The vast
majority of LTC funds (80%) go to care for individuals with MR/DD (Coleman,
1999). Care for individuals with MR/DD is substantially more expensive than
care for non MR/DD elderly.
3 Although numerous resources on caregiving
are available, the bulk of the information provided here comes
from one source, a report on caregiving by Sharon Tennstedt that
was presented at the U.S. Administration on Aging Symposium: Longevity
in the New American Century, in March of 1999. Tennstedt's report
is an up to date detailed review of the research on caregiving.
4 This estimate is based on the assumption
that there were 25.8 million caregivers providing care valued at
$8.18/hour. The low range estimate for total value is $115 billion
and the high estimate is $288 billion - depending on assumptions
about the number of caregivers and the per hour value of care.
5 Please see Appendix D for the calculation
of this estimate.
6 The Area
Agency for the Agency stated that the low number served is
not due to funding or a lack of need, but rather the fact that
caregivers are sometime wary of hiring someone, even for a few
hours, to care for their loved one. Outreach and education may
increase the numbers, as may the recent passing of the Older Americans
Act, which contains an initiative on caregiving.
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