A glaring gap in the U.S. health care system — the giving of care at home — is burgeoning into a costly chasm. Pretty much everybody involved needs to pay close attention and finally act to deal with the nation’s failure to support home caregiving for the sick, injured, debilitated, and aged.
The consequences of inaction already are becoming clear, as the dearth of home care is smacking the recovering economy, “contributing to labor shortages around the country and playing a role in overall inflation,” the Washington Post reported, finding:
“At least 6.6 million people who weren’t working in early March said it was because they were caring for someone else, according to the most recent Household Pulse Survey from the Census Bureau. Whether — and when — they return to work will play a role in the continued recovery and could reshape the post-Covid labor force. For all the attention on parents — and mothers in particular — who stopped working to care for children during the pandemic, four times as many people are out of the work force, caring for spouses, siblings, aging parents, and grandchildren, according to the Federal Reserve’s latest Monetary Policy Report.
“Caregiving is the second-largest factor keeping people out of work, behind early retirements, at a time when job openings continue to outnumber potential workers … Roughly one-quarter of the workers missing from pre-pandemic levels are on the sidelines for caregiving reasons, according to the report. Overall, the economy is still short 1.6 million workers, two-thirds of them women, from early 2020.”
The newspaper interviewed Joseph Fuller, a professor at Harvard Business School whose research focuses on the future of work, who observed this of the nightmare too many Americans are experiencing in finding and providing support for the vulnerable:
“The pandemic has amplified a problem that’s been endemic in the labor force for a long time, which is that caregiving takes a very significant toll on both the amount of hours someone can work and the jobs they can take. Covid was so dangerous for seniors that it caused people — unfortunately mostly women — to reconsider work-life balance in ways we haven’t seen before.”
Experts long have warned that women were bearing a crushing load in taking care of others, with 43.5 million of them, as well as men, and increasing numbers of young people, shouldering $470 billion annually in unpaid care for the elderly, sick, and disabled. The pandemic only worsened this nightmare, as families sought to protect seniors by pulling them from or keeping them out of nursing homes and other long-term care facilities. Many caregivers, especially women, struggled to keep working from home (if they could), dealing with kids and families, and suddenly finding the demands on them escalating exponentially as tens of millions of Americans have been infected with the coronavirus, with a significant slice of them debilitated with medium or long Covid. As the Washington Post reported:
“The relationship between caregiving and work tends to be circular: People who are already out of work — as many were early in the pandemic — tend to take on caregiving roles. And once they do, they’re less likely to reenter the workforce, said Yulya Truskinovsky, an economics professor at Wayne State University who studies labor, aging and the economics of caregiving. And while employers are increasingly more accommodating of child-care needs — offering parents flexible schedules, in some cases, or on-site day care — that hasn’t been the case for adult care, which often becomes more labor-intensive over time.
“In most cases, Truskinovsky said, childcare is tough early on but becomes more manageable as children gain independence and go to school. With older adults, the opposite tends to be true. ‘Maybe [adults] can live independently at first, but then they have a fall and suddenly the picture changes. It’s much more unpredictable,’ she said. ‘Once you start caregiving for an adult, you’re probably not going to stop until your loved one moves into a nursing home or dies.’”
The newspaper also reported this:
“The pandemic added an extra layer of challenges to the already tenuous arrangements many families had in place to care for aging parents, sick spouses, and disabled siblings. As nursing homes went into shutdowns or weathered outbreaks, many families took elderly parents home to care for themselves. At the same time, a growing shortage of workers — both in nursing homes and home-care settings — has made it more difficult to secure outside help. Beyond those who have already quit their jobs, many more are at risk of leaving the workforce in the coming years if caregiving needs go unaddressed.
“One in 5 workers are balancing paid work with part-time care duties, putting them at heightened risk of resigning, according to the Rosalynn Carter Institute for Caregivers. ‘It’s the biggest driver of inequality that nobody talks about: The caregiving burden falls almost completely on the shoulders of women,’ said Ai-jen Poo, co-founder and executive director of the National Domestic Workers Alliance, a nonprofit advocacy group. ‘We have massive demand for care and the only people doing the work are women, whether they’re trying to juggle it with paid work or are being paid poverty wages to help with care.’”
The Biden Administration has put a priority on trying at least to start dealing with the home care mess, with the president asking Congress to pass a $150 billion plan to increase the pay, training, and supply of aides who can provide a lifeline to those trying to help family and friends who are aged, sick, injured, and unable to live on their own. Because the Congress is so riven by political party, the Biden home care proposal and other health-related plans have sunk in partisanship and Republican, reflexive opposition.
Even as the Washington Post rounded out its latest news article on with telling people stories about the problems with home care, the independent, nonpartisan Kaiser Health News service, separately, delved into a major complication members of Congress have encountered as they try to fix the big issues in nursing home and other long-term care facilities: Who actually owns and runs these facilities?
That may seem like a simple enough matter. But KHN reported that lawmakers, regulators, and others involved in the industry struggle to determine the tangled finances of institutional care:
“The exponential growth in … private equity investments in [long-term care facilities in] recent years ‘has been associated with a host of trends that are negatively impacting the American people’ — including an increase in nursing home mortality rates, wrote Pascrell, who chairs the Ways and Means Oversight Subcommittee. He noted the need to ‘better understand’ the consequences of private equity’s involvement in health care and ‘the far-reaching impact’ of ‘bankruptcies or closures following PE buyouts.’”
As KHN reported, the digging into this issue will be tackled by the U.S. Government Accountability Office (GAO), which says it, as a “congressional watchdog,” is an “independent, nonpartisan agency that works for Congress. GAO examines how taxpayer dollars are spent and provides Congress and federal agencies with objective, nonpartisan, fact-based information to help the government save money and work more efficiently.”
GAO has dug into long-term care facility ownership and finances before, and urgently must update its research, KHN reported:
“From 2010 to 2019, there was a large increase in private equity companies buying up nursing homes, along with other investments in health care. An exact figure is elusive because private purchases are difficult to track, but it’s estimated that such groups own anywhere from 5% to 11% of nursing homes nationwide. A growing body of research shows that health outcomes in private equity-owned facilities are worse than in those under other ownership. A February 2021 study from the National Bureau of Economic Research found that going to a facility owned by a private equity firm increased the chance that a resident would die by 10%, compared with living in another type of facility. That study was conducted from 2005 to 2017. A November 2021 Cornell University study found that residents of private equity-owned nursing homes were more likely to have emergency room visits or be hospitalized than residents of other for-profit homes. Both studies found that Medicare’s costs per resident were higher, meaning more taxpayer dollars were being spent in private equity facilities. Industry trade associations dismissed these findings, saying the studies don’t show the whole picture of how care at private equity-owned homes might differ from that at other facilities.”
In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care facilities. The pandemic laid bare the increasing failures in the long-term care industry, and, while coronavirus deaths in facilities are hitting new lows, too many residents and loved ones still struggle with the tough choice of potentially pursuing justice and remedies in the civil system for unacceptable wrongs in nursing home care.
The administration has taken important steps to deal with a profoundly troubled industry, in which, by the way, experts estimated in 2017 that more than half of us will spend some time.
In a graying society where more of the vulnerable, especially seniors, may not have the resources or loved ones or friends to assist them as they age, what are the options? As the Washington Post reported:
“Older Americans, including the baby boomer generation, are hitting retirement age at a rate of 10,000 people per day. In the next 20 years, the number of Americans older than 65 will more than double, and those over 85 will quadruple, said Poo of the National Domestic Workers Alliance.”
We have much work to do to sort out the best ways that our nation can best support the aged, sick, and debilitated and those who provide them with sustained, crucial care at home and at tremendous cost to themselves and their lives.
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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
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