REVIEWED BY SUSAN McDONOUGH
Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America's Most Urgent Health Crisis
By Howard Gleckman
St. Martin's Press, 2009
320 pages, $24.95
www.us.macmillan.com
As someone who has spent nearly her entire professional career in aging services, I was somewhat skeptical that I would find a book about elder care to be informative. However, my skepticism was unfounded. Reading Howard Gleckman's Caring for Our Parents convinced me that I should buy this book for all my friends and colleagues. It is a well-written and researched book which would serve as a primer for anyone facing caring for an older adult or planning for his or her own future.
In many instances, those of us in health or elder care believe that we are prepared to deal with the complexities of managing and paying for care for older adults. However, few of us who are in the business have long-term care insurance, and even knowledgeable people find themselves frustrated when trying to arrange care or services for an older adult within their own family or circle of friends.
Gleckman's book provides four distinct perspectives. The first looks at arranging care for older friends or relatives from the viewpoint of the caregiver. The second explores the barriers that disabled younger people encounter when trying to arrange care. The third examines the ways in which people currently pay for long-term care. The fourth provides information on approaches to paying for long-term care in other countries, and here the author offers his own thoughts on the future financing of long-term care.
Caring for Our Parents includes real life experiences of people who have taken on the role of caregiver for an older adult, whether for a spouse, parent or grandparent. Mr. Gleckman, like many middle-aged children, found himself acting as a caregiver for his father, mother, and his wife's parents, all within a short period of time. His own frustrating personal experiences add value to this book. Like many, he was confused about how to pay for his father's care. (Studies repeatedly indicate that most Americans believe Medicare will cover their long-term care needs.) Few are well equipped to deal with one specific health event that transforms a vigorous older person into a frail older adult in need of ongoing care.
Mr. Gleckman provides a balanced view of long-term care providers in this country. While not singling out Catholic providers, he conveys the frustration that organizations, particularly those that are not-for-profit, experience when trying to provide the right care at the right time in the right place. Few in Catholic long-term care would argue with the point that the current reimbursement system does not always allow for the flexibility in providing the care we consider to be appropriate. We have all dealt with the frustrations of consumers who have invested in long-term care insurance and found that the insurance they purchased does not cover what they need in the setting they prefer.
Many Catholic long-term care organizations have developed programs that respond to a wide range of care that older adults may need in the course of their aging process, including in-home services, adult day care, assisted living or boarding care, as well as skilled nursing care. Several Catholic organizations, including Alexian Brothers, were early innovators in care models such as PACE (Program of All-inclusive Care for the Elderly), which Gleckman cites as a comprehensive program. He also points to the need to have excellent hospice care, which Catholic health care has long made a priority.
Having worked with the Catholic Health Association and the American Association of Homes and Services for the Aging for several years to advocate for a new approach to long-term care financing, I was delighted to see that the author, having researched different models of care in Europe and Japan, reached a similar conclusion: that the current Medicaid model for long-term care is unsustainable. He further identified the "CLASS Act," sponsored by the late Sen. Edward M. Kennedy and supported by CHA and the American Association of Homes and Services for the Aging, as offering some real potential.
The author also makes an important point regarding the demographics of the United States and the current lack of formal and informal caregivers. He believes that the situation will be exacerbated if the United States government continues its current approach to immigration. Today, the author notes, it is increasingly difficult to persuade U.S.-born workers to do these difficult jobs, and approximately 20 percent of the aides in this country are foreign born. Lacking solid alternatives to the current system, these workers will be expected to work even harder in the future and will expect better wages and benefits, thus driving up the overall cost of long-term care, Gleckman notes.
The author does point to some encouraging innovation. Among these are the training programs offered at the Schmieding Center in Arkansas to caregivers for older adults. Another is developing technology that makes it possible for older adults to live longer independently in a variety of settings. He adds his voice to those of millions in this country who understand the need for research to cure Alzheimer's disease, recognizing that dementia care is complicated and costly for both individuals and public reimbursement programs.
Caring for Our Parents is an excellent read, accessible for both professionals and the general public. My only wish is that the author had been more forceful in suggesting that baby boomers take an active role in ensuring that there is a change in the financing of long-term care. This is not an issue where we baby boomers should sit back and hope that Congress provides for us, or that our 401(k)s will miraculously be sufficient to pay for years of care. Baby boomers, in particular, will find the information useful, whether dealing with a parent in crisis or planning for their own futures. While the boomers are going to live longer with less frailty, they will not be satisfied if the current options are not improved.
— Susan McDonough, vice president, strategy and system development, Covenant Health Systems, Lexington, Mass.
Copyright © 2009 by the Catholic Health Association of the United States
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