The 1999 Groves Conference on Marriage and the Family

Late Life/New Life: Creative Aging in Changing Families and Communities

by Pat Nelson

Thank goodness, Groves keeps expanding my horizons! Outside of trying to maintain a basic knowledge of lifespan development, the topic of aging has never had a strong appeal for me. This year's Groves conference opened my eyes to exciting developments and opportunities for aging families and communities. Here are some of the highlights.

Jill Quadagno, Florida State University, outlined key issues for research and policy on aging and the family.

Entitlement spending has grown from a relatively small share of the federal budget to a much larger portion. Current trends are not sustainable. Eventually, the money spent on entitlements will be more than the tax revenues coming in. The budget surplus is taking some of the edge and urgency off of this coming crisis, yet new needs are being generated. We must question not only who will pay for the care, but who will provide the care. Many of the countries that are well beyond us in addressing aging issues have made some cuts in their entitlement programs. However, Germany and Austria have added new long-term care.

Projecting ahead is tricky. When you think back 30 years, we were enmeshed in the Vietnam War, and most people were clueless about computers and the Internet. Could we have predicted what we are doing and thinking in 1999? We can be fairly sure that we can not make linear predictions to the year 2030. (Remember that we were fairly hysterical about the budget deficit just four years ago.) Rather than putting a lot of energy into projecting the future, we're probably wiser to address current problems and try to solve them as well as we can.

In the past, Social Security has provided a framework to share risks across the whole society. Current proposals for addressing projected Social Security shortfalls have one theme: divesting the public responsibility and turning more over to individuals.

Historically, social security has been especially important to older women. Social Security is gender neutral and the benefits and risks are shared over the life course. Older women have lower rates of retirement income and higher rates of poverty.

Those sponsoring current proposals seem more enamored with the potential of the private sector in solving problems than with the impact the proposals will likely have on individual families -- especially women, the traditional caregivers for the frail elderly.

Stockbrokers, financial planners and investment counselors have been watching the proposals for individual investment in the stock market with great interest. Stockbrokers are dying to get their hands on the money, yet there will be many accounts they will not be interested in managing. Two percent of payroll contributions for someone making $20,000 will not be a lot of money to manage. Private investment counselors will be much more interested in managing the portfolios of those with higher incomes.

There are multiple issues surrounding health insurance.

When older workers lose jobs, they usually lose their health insurance.

The cost of health insurance is increasingly an issue for employers. Downsizings have forced a group of people in middle age to go into early retirement -- with the promise of health insurance for the rest of their lives. As new companies are formed in mergers and buy-outs, one of the first things eliminated is the health insurance for retirees -- it's a very expensive item.

When you look at those who are lacking health insurance in the population overall, there are no gender differences. However there are dramatic gender differences -- tied to marital status -- for those over 55. In all categories, men are more likely to have health insurance coverage than women. If women have health insurance it is usually tied to their husband's job. If they become divorced or widowed, they run a considerable risk of losing health insurance. Approximately 35% of divorced and 25% of widowed women have no health insurance.

Race is also a key factor in health insurance coverage. Black and Hispanic women have very high rates of noncoverage, as is generally true for Black and Hispanic men.

A reduction in allocations is squeezing Medicaid patients out of nursing homes. Many nursing homes accept only private pay patients, with -- at most -- 2-3 beds for Medicaid patients.

A number of states are moving toward home care, an attempt to reduce the forces that push people into institutions. This does not resolve the problem for families: who will provide the care?

Proposals to let people aged 54-64 purchase into the Medicare program are expensive ($300-400 a month), and it would not solve all the problems. Those who can't afford the cost now would be no more capable of affording the cost under the new proposals. However, most proposals would provide access for those who currently can afford to pay, but cannot get insurance because of a pre-existing health insurance problem.

Incentives (such as providing tax incentives for people to purchase longterm care) are popular solutions for Baby Boomers, but provide no help for those who are currently elderly and being turned down for longterm health care.

A panel focusing on Florida's innovative aging research and programming outlined their vision, goals and current progress.

Interdisciplinary researchers are using non-invasive screening techniques to target risk factors for successful aging with the hope that they will be able to identify individuals at very high risk for negative outcomes (such as Alzheimer's disease) decades before diagnosis.

Dr. Bill Haley has found that African American caregivers show much less depression than Caucasian counterparts. There appear to be no significant differences in social support and network size. Florida researchers believe the African American caregiver's resilience and strength may have been developed over decades of coping with adversity. As a result, African American families seem to cope better with the stress of giving care to a family elder. While white caregiver's satisfaction with life declines over time, African Americans report increased life satisfaction over time.

Pauline Boss' research [Pauline is not a Florida researcher - but she contributed this during our discussion] suggests that Native Americans do not see caregiving as a burden. Whites find the lack of mastery and ambiguous loss inherent in caregiving especially difficult. In Boss' words, "Highly mastering oriented people have the most trouble with a situation they can't fix."

Gregor Paveza's study of violence and aggression in family caregiving involving a patient with dementia or Alzheimers is suggesting that 57-67% of all dementia patients will exhibit aggressive behavior. About 1-4% of caregivers engage in abusive behavior. Researchers are looking at the risk for violence in patient-caregiver dyads, and the potential for various conflict resolution styles at various stages in the advancement of dementia. Researchers find that patient attributes are not good predictors of violence - and that the two best predictors of violence are caregiver depression and patient living with family without their spouse.

The projected increase in the over 85 population will prompt a doubling in the need for long-term care by 2010. According to Dr. Larry Polivka, Director of Policy Studies for Older Populations, "If we're going to develop a long-term care system, we need to take dramatic steps now. Currently, we have a disaster. Eighty-five percent of publicly supported longterm care is provided in institutions (which is the same situation we had in 1985). There was a national model (in which churches played a major role), but not now." According to Polivka, research supports superior cost-effectiveness of home and community care, and elders strongly prefer it.

Learning about the challenges various participants have faced as they addressed elder care and aging issues was sobering and stimulating.

During the 20^th century, we've basically doubled the lifespan and added a generation to the family experience for most people (Bengston, 1998). At the conference, we were given numerous examples of the gap between the resources available to elderly individuals and their care needs - and the excruciating choices this presents to their families. The challenge is considerable in developing sustainable systems to allow individuals to "age in place" and remain vital resources within their communities.

In his Plenary Address on organizational change, Charles E. (Gus) Whalen, President and CEO of the Warren E. Featherbone Company, reminded us that true leaders help people move from where they are to where they need to be -- and still enjoy the trip.

In a humorous overview of the history of his company, Mr. Whalen emphasized how the periodic crises that had confronted his family and company were the basis for their success. He reminded us that the Chinese see crisis as a normal growth stage, and believe that if you are alive, you'll be in crisis.-- and if you're really alive, you'll be having a lot of crises. …Often, the base of the crisis is the solution, if you can look at your threat differently… You can always find your way out of a crisis -- most often by using the threat itself."

Interdependence is the by-word of the future. Consolidation is a major threat to many small companies. How do you survive in a rapidly consolidating environment? Build partnerships -- often with people who are your competitors. The Boeing company's motto says it perfectly: No one flies alone.

Partnerships are built with a virtual integration of the supply chain so the partners behave in a way that they are one. Nobody wins or loses until the customer buys the item. We are competing with Europe and Asia based on how successfully our products are delivered to the customer. We are not independent. We are interdependent. It is the natural order of business and living.

The Warren Featherbone Foundation raises public awareness of the importance of interdependent connections in business and throughout society. Their Connecting the Generations initiative started with a simple idea and has consumed the company. With the assistance of Dr. Roma Hanks, they have provided grandparenting seminars in their company and distributed the grandparenting book written by Roma in 107 stores. With the assistance of AARP and Georgia State University's Grandparent Center, they are producing a PBS special on grandparenting. They also sponsor a series of radio programs called Connecting the Generations, which has been great for business because Featherbone's customers are mostly grandparents. The Connecting the Generations philosophy: Life flows through connections.. When we connect, we truly live. Children are living messages we send to a time we will not see. Our job is to make sure that those messages/connections are full of hope.

Hearing Marvin Sussman talk about the Groves Conference over time was humbling and inspiring. It was invigorating to imagine the energy that must have characterized the early conferences as the small, tightly knit world of family scholars and researchers emanating from Ernest Groves convened in at least annual reunions to reconnect and share information. It was intriguing to hear about early visions for the Groves Conference, and to learn of the practical challenges Groves has faced over time.

The Don CeSar in St. Pete Beach, Florida was an outstanding conference site. The food was overly tempting and the opportunities to renew and expand collegial ties were rich. The conference planning committee, headed by Dr. Roma Hanks, deserves special credit for putting together the perfect Groves renewal and reconnection experience.

Reference

Bengtson, V. L. (1998). Families and aging at the turn of the century. Burgess Award Presentation and Address, National Council on Family Relations Annual Conference. Milwaukee, WI.