Guiding readers through long-term health care's maze

	Laura Olson has frequently written about long-term care of the elderly.

Health care was a frequently discussed topic during the course of the presidential election, as voters and observers struggled to understand how the candidates’ proposals would impact their family and their bottom line. But according to Laura Olson, professor of political science, one of the most pressing health-care issues was surprisingly absent from much of the discussion: long-term care.
With an aging population, and as the first wave of baby boomers hit 60, the demand for long-term care services is increasing.
According to the U.S. Department of Health and Human Services, about 9 million men and women over the age of 65 will need long-term care this year. By 2020, that number will rise to 12 million.
While many of the nation’s elderly—over 80 percent—are cared for by friends and family, a large portion of the population will need nursing home care and paid assistance at home.
“This is going to be one of the key issues of my generation. Who is going to take care of mom and dad? In my earlier years the issue had been theoretical for me,” says Olson, who has extensively researched long-term care of the elderly. “Now, with a frail mother-in-law and an ailing mother, it is a reality.”
Olson has written frequently on the topic, and has published the books The Not So Golden Years: Caring Labor, the Frail Elderly and the Long-Term Care Business Enterprise, Age Through Ethnic Lenses: Caring for the Elderly in a Multi-Cultural Society, and The Graying of the World: Who Will Care for the Frail Elderly?
Her most recent book, Handbook of Long-Term Care Administration and Policy, provides a foundation for understanding the fragmented service delivery system and a guide through the maze of long-term health care. The book is intended for a broad range of interested parties, including administrators, care takers and students of health care.
The book addresses many of the issues confronting the provision of long-term care, including public perception and attitudes, policy decisions, alternative models of care, ethical concerns, quality of services, diverse funding mechanisms, and the role of informal and formal caregivers.
For the elderly who lack family caregivers, the options are slim. For those with limited financial means, Medicaid becomes the only option. Designed for people with low incomes and limited assets, the program mostly funds institutional care, though there has been a small shift towards at home assistance in a number of states.
”A significant percentage of the Medicaid program finances long-term care,” Olson says. “But you have to impoverish yourself to become eligible for benefits. A lot of buildings are going up for assisted-living facilities, but they’re only for people with money.”
Olson also addresses another issue of growing concern—a lack of adequate care. She said the situation is worsening as hospitals, aware of costs and demand, are sending people home “quicker and sicker.” Even worse, those who land in a nursing home may find themselves in a situation she simply describes as “dismal.”
“Many nursing homes are warehouses for the elderly,” she says. “If you don’t have family, you’re in trouble. Nursing homes are big business, and many of them neglect and mistreat their residents.” In fact, she says, a huge part of the nursing industry is owned by real estate investment trusts, putting the actual care of the elderly low on the priority list.
Olson also just completed a book project on Medicaid that examines the federal and state programs—a system she says that is complex, constantly changing and entails numerous stakeholders. At this point, the manuscript is under consideration for publication.
Moving forward Olson believes long-term care is a topic that the incoming administration is going to have to address. “What we need is a national health care system that includes long-term care. It would be hugely expensive,” she says.
“The tipping point is when adult children say ‘no.’ But I’m not sure they will do that. As long as women—who are typically the caregivers—are willing to pick up the slack, the government is off the hook.”
--Tricia Long