The Hidden Co-Pay in Community Based Long Term Care

Allison Hoffman has an interesting post on the November 14th Health Affairs Blog on the Risk and Reform of Long-Term Care, stemming from a presentation given at Yale Law School's recent conference on The Law of Medicare and Medicaid at Fifty.

I admire the post for its discussion of the cost to "next friends" or caregivers in our increasingly home and family based system of long term care.  Yes, what could only be described as a return to family based long term care is significant both for what it tells us about nursing home occupancy rates (trending flat or slightly down) and the work of assisting the increasingly long-lived in home and community based care (disproportionately the work of women in either setting).

Yes, Allison Hoffman makes the connection that when we are talking about family based long term care we are talking about female caregivers — those who pay the "hidden co-pay" of diminished life and retirement chances by providing these services.  But she fails to note that, when we talk about institutional long-term care, we are also talking about female caregivers — as nursing home and skilled nursing facility staff are overwhelmingly made up of female low wage workers — and also female residents.  You see, the odds of your ending up in a nursing home are much higher if you are female, not just because American women still outlive American men but because families are more likely to place Mom in institutionalized care.

"Hidden co-pay" — as marvelous as it is — may not do justice to the real story of the impact of family based and institutionally based long term care on women.   One of the  most common nursing home resident stories is one about the institutionalization of a former female caregiver, herself, after all. 

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