SEPTMBER 8, 1997 VOLUME 5, NUMBER 10
Two recent studies about the care of elders in the last years of life defy widely-held stereotypes. It turns out that more of us are becoming family caregivers over time (though we may each be providing less care than our predecessors). And the proportion of medical costs incurred in the final year of life is not increasing after all.
In one study, for the National Alliance for Caregiving, researcher Donna Wagner of Towson University asked whether household members were providing care for an older relative. In ten years, the number of households with at least one caregiver tripled, although the elderly population increased by only 21%. In other words, family care is more prevalent today than in 1987, despite the widespread belief that elders are increasingly consigned to nursing homes or other public institutions.
Other studies do suggest, however, that the amount of care provided by each individual caregiver is declining. In other words, more family members are involved in providing care, but it may be that they are sharing the responsibilities more evenly. In a recent article in the Wall Street Journal, commentator Sue Shellenbarger speculates that this may be true because family members are increasingly likely to be employed, and because the high costs and uncertainty of government coverage for nursing home care are forcing families to plan their caregiving more efficiently.
Another recent study looked at the medical costs incurred by the federal government in the last year of patients' lives. Twenty years ago, Medicare was spending about 30% of its expenditures on patients in that last year; according to the Alliance for Aging that proportion has remained steady for two decades. In other words, the image of an increasingly high-tech, desperate and ultimately doomed effort to maintain dying patients is no more reality than it was in the mid-1970s.
An interesting side-note from the Alliance for Aging's study: hospital care for the "old-old" tends to be less expensive. 90-year-olds who were hospitalized during the last year of life incurred, on average, about $7,000 in hospital bills, while 60-year-olds averaged nearly $17,000.