As millions of Americans reach old age, millions will experience the frailty that accompanies that time phase of life. And that price, really, can be a sticker shock when writ large over the lives of millions.
People over the age of 65 account for a fair amount of the nation’s healthcare costs. For example, 13% of the population was over the age of 65 in 2002, and yet this group represented 36% of healthcare costs that year—spending an average of $11,089 per year in costs, compared to $3,352 spent by working age adults. (AHRQ, 2006) People over the age of 80 represent even higher costs in the healthcare system: although they were 3% of the population that year, they accounted for 14% of the 5% of the top healthcare spenders. (AHRQ, 2006) Many of these costs are the result of the multiple chronic health conditions that accompany old age, and that are expensive to manage. Expenses for people with one chronic condition were twice as great as for those without any chronic conditions. Spending for those with five or more chronic conditions was about 14 times greater than spending for those without any chronic conditions. (AHRQ, 2006) Persons who have five or more conditions also have high hospital expenditures.
At the same time as people experience an increased rate of disability, they also contend with increasing healthcare costs and burdens. Those with severe, advanced chronic conditions, such as Alzheimer’s and other dementias, heart disease, or diabetes, are likely to experience real challenges in self-care, the day-to-day activities that enable people to live independently. As a result, in addition to burgeoning healthcare costs, these people face the collateral costs of disability, such as adding wheelchair ramps to the home, updating the bathtub to prevent falls, or purchasing a special chair for help with sitting and standing. Although Medicare/ Medicaid cover some of these costs, the majority are paid out of pocket.
These out-of-pocket expenses are not trivial, and can have a significant burden on families. How does one cover all the health care costs associated with multiple chronic illnesses? How does one afford to upgrade a home to make it safe for an aging loved one? How do people coordinate necessary outings for an elderly loved one who cannot drive? How do you afford a home health aid or nurse to help someone with dementia? For now, families and loved ones cobble it together, paying for services that bring in food or home aides or occasional transportation.
Families also bear the costs of caregiving. Almost 30% of American adults provide some level of care to a family member. By some estimates, that caregiving is work about $450 billion dollars in unpaid contributions. These caregivers, the majority of whom are working women, also shoulder the cost of lost wages and benefits, as well as social isolation, and negative health and emotional consequences. Caregiving is particularly difficult for those providing full-time, daily care to adults who have multiple advanced chronic conditions, especially dementia or Alzheimer’s disease.
Living to be quite old has its rewards and happiness. But it also has important challenges for individuals, families, and communities. MediCaring builds on a person-centered approach to care through a community-oriented response to care, and offers one possibility for living to and through that time with meaning, dignity, and safety.
The High Concentration of U.S. Health Care Expenditures: Research in Action, Issue 19. June 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/costs/expriach/index.html
Key words: Joanne Lynn, Dora Hunter, Janice Lynch Schuster, MediCaring book, eldercare, healthcare costs