Showing posts with label aging. Show all posts
Showing posts with label aging. Show all posts

Tuesday, July 23, 2013

China Requires Children to Care for their Aging Parents

 Dear GAA Blog Reader,

Do you think that your government should require children to care for their older parents?  Yes? No?    Well, China does!                              

In a Healthland Time.com article, the author says China’s government thinks so.  Why?  As the population of elderly in nearly every society starts to swell, such eldercare laws are becoming more common. But are they effective?
What kind of care and devotion is expected of adult children toward their aging parents? Not surprisingly, siblings can hold fiercely different positions about what they “should” do. Some make huge sacrifices of time and money to comfort and care for parents; others rarely show their faces even when parents pine for them. But if families can’t resolve these difficult issues, can governments do any better?

In China, a new law that went into effect this month requires children to provide for the emotional and physical needs of their parents, which includes visiting them often or facing fines and potential jail time. One woman who was found negligent in visiting her 77-year-old mother has already been charged under the Law on Protection of the Rights and Interests of the Elderly and was ordered to visit her mother at least once every two months, and on at least two national holidays a year.

Enforcing the law will certainly be challenging, and critics have raised the very real possibility that in an effort to alleviate some of the impending burden that 200 million people over the age of 60 represent for the Chinese government, the law may end up causing more familial strife and resentment toward elderly parents. While no government can legislate loyalty or love, more legislatures are finding it necessary to mandate responsibilities, especially those of the financial kind.
In Ukraine (and other former Soviet-bloc nations), says Katherine Pearson, a law professor at Penn State, children are “obliged to display concern and render assistance.” In practical terms, that translates to needy elderly being able to sue their children for financial support. And a sister can sue her brother for not paying his share of mom’s costs.

 Much closer to home, laws in 20 US states require family members, for the most part adult children, to support their financially needy relatives, which can include elderly parents who no longer have an income or disabled adult children who are unable to support themselves. Most of these statutes, which are among the original laws of the states, have not been in active use since the Great Depression. In fact, most states repealed them from the 1950s through ’70s when older people began reaping the benefits of Social Security and Medicare.

Since 1994, however, Pearson says lawsuits in Pennsylvania and South Dakota against adult children by a needy parent or a care provider like a hospital have required adult children to come up with the money for their parents’ care bills. Some nursing homes have used the laws to win judgments as high as $90,000 against adult children, says Pennsylvania elder-law attorney Jeffrey Marshall. “It’s a ‘gotcha’ law,” says Pearson, “because most people don’t know about it until after it goes wrong.”
Such statutes are a relic of the Elizabethan Poor Laws, which colonists from England introduced to America. They were enacted in the first half of the 20th century, at a time when it was more common for multigenerational families to live near each other, or even in the same house, and to be economically interdependent. Life expectancies were lower back then, however, so there were far fewer frail old people, and those few were usually cared for at home by a daughter.

The social revolutions of the 20th century changed this social landscape in the U.S. and in much of the world. Parents live much longer, often with chronic conditions for which they need medical care. Women as well as men are in the workplace, and adult children may live hundreds or even thousands of miles away from their parents. That’s what prompted the law in China; with so many of the younger generation seeking better employment and financial opportunities away from home, elderly parents are increasingly left behind to fend for themselves.

This collision of new realities with responsibilities to parents has struck even in Japan, a traditional Confucian society, where filial piety is a cherished value and the traditional role of a wife has been to care for her husband’s parents. But Japan has the world’s fastest aging population — nearly a quarter of the population is over 65, and in a sign that the silver wave is already washing over the nation’s shores, adult diapers are projected to outsell baby diapers by 2020, according to the Nikkei newspaper.
Huge numbers of caregivers are needed, but with traditional daughters-in-law now disappearing into the workforce, in 2000 the Japanese government created a universal long-term care program to help families pay for hired caregivers. And, despite the traditional reverence for elders, says AARP analyst Don Redfoot, women — many of them presumably daughters-in-law — lobbied against a provision that would have allowed the elderly to pay family members to care for them.

 More affluent European countries rely primarily on some sort of government support for eldercare, with varying degrees of potential family involvement. Norway provides universal long-term care to everyone. In France, the elderly receive a payment similar to Social Security, which increases according to the recipient’s income and care needs. In Germany, a social-insurance approach like Medicare helps pay for long-term care. Unlike in Japan, this money can be used to pay family members for care services.
But these insurance programs only provide financial support, and do little, if anything, to address what the Chinese call the “spiritual needs” of the old. China’s law, therefore, was intended to exert moral pressure on sons and daughters to attend to their parents — seeing retired parents, that legislation makes clear, is your job.

And what if that job becomes too burdensome, or even impossible to maintain? Even without laws, most children do feel some responsibility or even a positive wish to take care of their parents. The real problem, particularly in the U.S. and increasingly elsewhere, is that adult kids are caught between time, career, family and geographical demands that they can’t always resolve in favor of spending more time with grandma and grandpa.

That means that from China to South Korea to South Carolina, governments may create programs to mandate care for the elderly, but, says Lori Brown, a sociologist at Meredith College in North Carolina, they are often still isolated and alone. “And the most isolated elderly,” she says, “have the most depression, lower quality of life, and die earlier.”
 
If legislating such loneliness away isn’t the answer, what is? Some social programs reduce elders’ loneliness by visit from volunteers. Many children arrange for their parents to attend day programs for the elderly, where they will have the chance to interact with others and engage in activities to stimulate their social and cognitive skills. And they are increasingly hiring aides who not only can help older people perform daily tasks but serve as companions for them as well. In Japan, for example, companies that provide “companions” for the elderly are flourishing. Home Instead Senior Care’s Japanese franchises have grown at an average rate of over 10% since 2006. It’s no substitute for a child’s companionship, but the reality of current financial and social demands makes it an acceptable stand-in for many people. “We might not want to pass laws like the one in China, but we could certainly do with some awareness campaigns about caring for not only our family members who are older but everyone who is elderly,” says Brown. Especially if we remember that one day each of us will find ourselves in need of such societal support and attention.

 What do you think?  Please respond on our Blog.
Best, Susanne Paul for Global Action on Aging

 

 

Wednesday, April 10, 2013

How Does Depression Wreck Your Life?

All too often stereotypes cast older persons as “grumpy.” Many people think that being down and depressed is normal in old age. Attention!
It is NOT a natural part of aging. 

Depression can happen to anyone at any age and is common among older adults and seniors. Some 15 out of 100 adults over the age of 65 suffer from depression in the US. Who are these older adults and why do so many of them suffering from depression? Studies show that the disorder affects people in nursing homes and hospitals in even greater numbers. Recognizing depression among old persons is not always easy. Depressed elders may find it difficult to describe their feelings. Many fear revealing their sadness since they may associate it with being “crazy” or lacking self-control. In the youth of today’s elders, they learned that depression often was associated with being “crazy” or weak-minded. Today, we know hat depression is a fully treatable medical or biological illness.



The Movie Grumpy Old Men


Aging, HIV and Depression
Experts have discovered a link between HIV-positive older adults and depression. To find out more about this development, I met up with Stephen Karpiak to talk about HIV positive older adults and seniors. A PhD, Karpiak joined ACRIA (AIDS Community Research of America) in 2002, as Assistant Director of Research. He served as primary investigator at the agency's new behavioral research effort, including conducting groundbreaking Research on Older Adults with HIV(ROAH) study. Earlier, he had worked for over 20 years at Columbia University's Medical School as a research scientist in neurobiology and immunology. Karpiak also started a Phoenix, Arizona, project to provide housing for homeless people living with HIV/AIDS. Dr. Karpiak has documented over 250 articles in scientific journals and books, and has been holding lectures all over the world.

 Dr. Karpiak

Karpiak told me that the ROAH goal focused on understanding the situation of those over the age of 50 who are living with HIV. ROAH sought answers to identify their psycho-social needs and determine how to support them most effectively to live longer, healthier and happier lives. ROAH assessed a 1,000-person cohort in New York City, examining a comprehensive array of issues, including health status, stigma, depression, social networks, spirituality, sexual behavior, and substance abuse.

ROAH showed that stigma, isolation and depression are the major problems for this group. The stigma against HIV/AIDS and is usually associated with homophobia, racism, ageism, etc.

ROAH demonstrated that by repressing the immune system, depression may render people more vulnerable to infectious diseases. Stress and depression have a harmful effect on cellular immunity, including those aspects of the immune system affected by HIV. Body cell mass depletion is associated with significant increase in fatigue, global distress and depressive symptoms, and reduced life satisfaction. Elevated symptoms of depression associated with a faster progression to AIDS and a higher risk of mortality.

Stigma often leads to isolation, depression and loneliness. Older HIV positive adults who are depressed are more likely to have financial problems, have fewer people to turn to for support, lack critical HIV-related information, live alone, have thoughts of suicide, and experience greater levels of stigma related to HIV and aging as compared to older adults who are not depressed. Depression may also stop persons from getting treated, avoiding doctor visits, social activities and other relationships. ROAH found that aging HIV-positive adults experience significant levels of depression, at a rate at least five times higher than the general New York City population.


Dr. Karpiak and Sanna Klemetti

Solutions?
I asked Dr. Karpiak what has or can be done about this situation. As a matter of fact, successful projects exist. One example is the MacArthur Foundation Model that expects participants to make one phone call every week to ask the HIV affected person how he/she is doing. The effect of this simple and effective program has been great. Another ACRIA project is The Go 4 Part Program, funded by Mac AIDS fund. It's a two day HIV – aging training program. Around 25 educators visit about two cities per year, to bring AIDS, health and aging organizations together to educate them about these issues. They also introduce ideas on how to reduce the problems. They usually invite one person from the meetings to New York to see the work carried out at ACRIA.

More about ROAH

Sanna Klemetti
s.klemetti@globalaging.org