In recent weeks, NBC Nightly News has begun a series of reports entitled "Trading Places: Caring for your Parents." The series began with the personal stories of NBC reporters like Brian Williams, Tim Russert, and Ann Curry, each of whom is dealing with an increasingly common question: what should I do with my aging parents? Baby boomers are beginning to experience sleepless nights as they worry about their mothers and fathers, and legislators should start to worry, too. The fact is that eldercare is already a national problem, and soon will become a national crisis.
The plight of elderly Americans is a top concern for the Center for a Just Society because this population is at significant risk of abuse and neglect. In my law practice, I have spent decades representing elderly men and women who have endured unspeakable nursing home abuse and neglect. Avoidable pressure ulcers, falls, fractures, infections, malnutrition, dehydration—all are common problems among the institutionalized elderly. Short staffing characterizes the operation of too many nursing homes and many corporate predators operating facilities put profits over people and revenue over residents. The care of the institutionalized elderly is becoming a national disgrace. If these conditions prevailed at Abu Ghraib or in our nation's daycare centers, members of both parties would be foaming at the mouth, calling for reform. However, because the abused and neglected victims are elderly and frequently "out of sight," the problem is all too often ignored.
As I have written in the past, three factors will soon place aging Americans at even greater risk in long term care facilities. Those factors are demographic, economic, and cultural.
Demographics: In the next thirty years, the number of Americans over the age of 65 is expected to double. More specifically, there will be an 83% increase in the number of men and women between the ages of 65-74. There will be an 119% increase in those aged 75-84, and there will be a whopping 143% increase in people older than eighty-five! A majority of these men and women will require long term care. Because most Americans are having fewer children, there will be far fewer young people around to take care of the older generation. Therefore, the demand for institutional care will rise sharply. Today there are 16.5 million people living in nursing homes; by the year 2035 that number is expected to double.
Economics: America is on the threshold of a national crisis when it comes to its old age social assistance programs. In its first year, Medicare had a budget of $1 billion. According to the most recent budget, the cost is now $394 billion. Likewise, the budget for Medicaid has gone from $1 billion in its first year to its current $276 billion annually. With the graying of America, these budgets will only grow larger in the coming years. All of this leads to the year 2018, when Medicare will likely run out of money. This will be far more than an economic crisis; it will be a human crisis. When government funds dry up, what will happen to millions of dependent elderly Americans?
Cultural: In addition to the "age wave" and the economic shortfall, there are also cultural changes in America that will put the elderly at increased risk. As we have discussed in many other contexts, our culture is shifting from a "sanctity of life" to a "quality of life" ethic. Increasingly, we are calculating the net worth of human beings based on cost-benefit ratios and quality of life calculus. The elderly—who cost more to maintain than they produce, and whose functional capacities have deteriorated because of old age or illness—do not score well under these standards. In the next 20 or 30 years, when the elderly are taking up valuable resources and are no longer deemed "useful," one shudders to imagine what "solutions" might be devised to deal with the growing problem of eldercare.
For a multifaceted crisis, we will need a multifaceted solution. First and foremost, however, Christians should start seeing eldercare as one of the great moral problems of our generation. Sometimes it is easy to think of Medicare reform as an economic problem and abortion and marriage as moral problems. However, more often than not, economic problems have real social impact. Christians should start working to convince the culture that the elderly--no matter how disabled or helpless--are fully human and entitled to be treated with dignity and respect. Our elders should have the same rights as everyone else. They ought not be victims of a sliding scale of dignity that erodes their protection as their faculties diminish. We need to be prepared to uphold the rights of the elderly as vigorously as we uphold the rights of the unborn.
The Bible is quite clear on this point. Of course, we already know that we are called to honor our mother and father. (Exodus 20:12) As Scripture says, children and grandchildren "should learn first of all to put their religion into practice by caring for their own family and so repaying their parents and grandparents, for this is pleasing to God." (1 Tim. 5:4) The Apostle Paul is quite adamant: "If anyone does not provide for his relatives, and especially for his immediate family, he has denied the faith and is worse than an unbeliever." (1 Tim. 5:8)
Christians must not ignore the needs of our frail elders. Surely they are to be counted among the "least of these" to whom we owe a duty of care and concern. (Matthew 25:40) Paul declares, "Do not rebuke an older man harshly, but exhort him as if he were your father. Treat younger men as brothers, older women as mothers, and younger women as sisters, with absolute purity." (1 Tim. 5:1-2) While our first priority may be to our immediate family, we should treat all older men and women as fathers and mothers.
Translating this into the public sphere, Christians should be at the forefront of ensuring justice for the infirm and the elderly. We should be in the vanguard of making and enforcing laws that protect the dignity of older men and women, especially those who are languishing in long term care facilities. The pro-life movement has done an incredible job establishing pregnancy care centers across the country to help women with crisis pregnancies. In a similar way, Christians should start thinking about how they might create an infrastructure to help protect the elderly in the coming years. It is our duty as Christians—and as citizens—who were nurtured and cared for by those who now need our help.