THE WOMEN'S ISSUE OF LONG TERM CARE-THE NUMBER ONE WOMEN'S ISSUE !!!"The Silent Crisis" -- Part 1
This series of articles, "The Silent Crisis," illustrates many of the issues associated with aging demographics, health care utilization, and the socio-economic problems facing women in America. It also provides solutions to some of these problems, and offers thoughtful dialogue for each American family. Even though the information is alarming, and in fact, somewhat depressing, please don't think I am a pessimistic person. I'm not. I am an optomist, who sees hope, through logical remedy. Part of the remedy is available with proper Long Term Care Insurance and Medicare Supplement or Medicare Advantage insurance policies, and I make no apology for pointing this out.
The real numbers associated with these issues, which we have known about for a long time, needed to be developed from a statistical reference point-of-view. I have compiled them for you, with much research from women's organization publications, caregiver publications, and government census/health care data. I have tried to present these "hard facts" in a clear and concise manner, without the sophistication of an academic rendering--something hard to do when dealing with statistics. The seriousness of the women's issue, in its' simplest form, is a national problem, and every American--women and men--needs to be aware of the problems that the disparity creates. Until we accept the viewpoint that several things must be done to address and rectify the inequities associated with again, healthcare, and wages, for the women of this country, the crisis will remain "silent." And the solutions will go overlooked and ignored. None of us can afford that. Hopefully, this series of articles will enable us, as a nation, to "outshout" the silence, and to accept that we need to prepare now for sensible solutions. Don't shoot the messenger. You won't be very happy with most of what you read. But, let's start by saying that all of the issues discussed here have a greater impact on the female population, than they do on their male counterparts. One more thing--I dislike statistics, and perhaps you do too, but to accomplish the objectives of this writing, proof is needed, and we have the statistical proof. So please humor me, as we work our way through the information relative to the content of the women's issues we are going to discuss. Let's start by itemizing the various components of the overall picture. For some, the information will not be news, but the updating will reinforce what we have known for some time. For other readers, much of what develops will be new surprising, shocking, and startling information, or will at least include a new and complete understanding of the problems of women, and the inequities associated with the process of aging, as well as the current disadvantages associated with employment. 1) The demographics of the women's issue--the basis of the problem.
2) Medicare utilization as a measure--of the imbalance of longevity.
3) Nursing home and assisted living utilization--another measure.
4) Informal caregiving--wherein women provide the largest share.
5) Holding down a job--and holding the family together.
6) Salaries, Finances, and Social Security--wherein disproportion, disadvantage, and disparity, are brutal realities, which must be changed. FIRST, THE DEMOGRAPHICS OF THE WOMAN'S ISSUE The first factors deal with demographic issues. We've known for years that women outlive men. Traditionally, the numbers have been regarded as a seven-year spread, with women outliving men, during the last quarter of the twentieth century, by about seven years. By the end of the '90's, that spread was reduced to about five and a half years, but the difference is still dramatic. What are the hard numbers, then? Let's use the actual population statistics of men and women age 65 and over in the United States, and provide a backdrop for the disproportionate problem that women face with longevity. For the vitals, we go to the US Census Bureau, and the Census of 2000. Take a quick look at the tables below, as we diagnose these elderly gender disproportions.
_____________________________________________________________ U.S. POPULATION BY AGE
AND GENDER, 2000 (rounded) AGE BRACKET MALE FEMALE DIFFERENCE U.S.TOTAL 138 MIL. 143 MIL. +5.0 MIL. FEMALE 65+ TOTAL 14.4 MIL. 20.5 MIL. +6.1 MIL. FEMALE 65-69 4.4 MIL. 5.10 MIL. +0.7 MIL. FEMALE 70-74 3.9 MIL. 4.95 MIL. +1.0 MIL. FEMALE 75-79 3.0 MIL. 4.37 MIL. +1.3 MIL. FEMALE 80-84 1.8 MIL. 3.10 MIL. +1.3 MIL. FEMALE 85+ 1.2 MIL. 3.01 MIL. +1.8 MIL. FEMALE
Source: U.S. Census Bureau, 2000
_____________________________________________________________ Let's use the figures for the year 2000 above as a foundation. According to the 2000 census, we had a total population of over 281 million, (In 2007, the nation's population hit 300 million) about 138 million males and 143 million females, for a 5 million female majority, or nearly a 96% male to female ratio. When we look at the 2000 age 65+ total above, we find close to 35 million people. (Incidentally, this age bracket was comprised of 31 million people in 1990, a 12% growth in this age group over the past ten years.) When we review the 85 and over bracket, we find about 4.2 million people in 2000, (compared to 3 million in 1990), or an incredible 37.6 percent growth in the 85+ age band! Starting to get the picture? Extended longevity has started to go rampant in only ten years! Now let's analyze the 35 million people in the age 65+ bracket by gender, and see what happens. - In essence, right from the get go, the numbers are already dramatic, with females outnumbering males 20.5 million to 14.4 million. That is roughly 141 women for every 100 men, in the total age 65 and over population.
- The imbalance occurs beginning in the first age bracket (65-69) where we see 5.1 million females to 4.4 million males. Fairly significant so far, with less than a million difference.
- At 70-74, the gap widens, with 4.95 million females and 3.9 million males, or something over a million difference.
- At age 75 to 79, the numbers start their steep climb with a ratio of 4.37 million females to 3.04 million males, or a 1.3 million female majority.
- The age 80 to 84 bracket the ratio remains about the same, with 3.1 million females compared to 1.8 million males, or still holding at about a 1.3 million majority. But what is this age group (80-84) beginning to reflect? It reflects the male population beginning to die, and the female population continuing to live. Which leads us to 6), wherein we find a huge difference.
- The final analysis presented by the Census Bureau reflects the 85+ age group, and herein you will be startled. Look at this. At age 85 and over, we have a female population of slightly more than 3 million, while the male population has declined to about 1.2 million! Now we see a tremendous disparity in female to male ratios. As a matter of fact, look at it this way. At age 85 and over, for every four people living, three are females and one is a male!
These numbers alone indicate that the problem is not going to go away, and in fact, when compared with 1990, we see the problem with extended longevity worsening. So, fact number one is established. Women have been living longer than men. Women are continuing to live longer than men. And, it appears that this trend, for whatever biological reason, will continue. These demographic statistics illustrate the basis and foundation of the long term gender situation, and set the stage for the following scenarios.
MEDICARE UTILIZATION AS A MEASURE
One of the ways to relate to the imbalance in longevity and female to male ratios, is to cite statistics on the utilization of Medicare. Again, as in the census figures, let's take a look at the total number of the elderly Medicare population and then establish the male and female recipients by age. Look particularly at the male to female ratios in the last line in the following table.
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AGE AND GENDER OF ELDERLY
MEDICARE POPULATION, 1996 AGE BRACKET TOTAL MALE FEMALE
65-74 18.4 MIL 45% 55%
75-84 12.0 MIL 40% 60%
85+ 4.2 MIL 29% 71% Source: Kaiser Family Foundation 1999
__________________________________________________________ We use the above table to set up the discussion regarding utilization of Medicare. But for the moment, notice that in all age bands above, the female gender far outnumbers the male gender in Medicare Population, again due to the imbalances of female to male longevity. First, look at the Age Bracket 75-84 above and below (you will see a slight variation), and see proportions of roughly 60% for women, to 40% for men. Then compare that category with the 85+ Age Bracket, which shows roughly a 72% to 28% ratio, a very significant spread of female over male Medicare populations. We will discuss this in greater depth on the next page, but the table is set. Martha H. Phillips prepared a significant report entitled "A Primer on Medicare," for the Concord Coalition, a highly respected "think tank" that watches and influences national policy making in Washington, DC. We want to refer to the resource of the tables below, which were developed in the Phillips "Primer," and which identify the importance of understanding the differences in "Utilization of Medicare." Keep in mind that the statistics sometimes vary slightly depending on the source of the study, the years involved, and the purpose of the study. What I am saying, is that if you look at the following Concord Coalition study it will vary slightly with the preceding Kaiser Family Foundation study referred to above. Makes no difference. While the variations are slight, keep in mind that the message is the same-that women significantly outnumber men in these older age brackets-and that is where our concerns lie.
_________________________________________________________ UTILIZATION OF MEDICARE
TOTAL AGE 65 AND OVER ENROLLEES-
YEAR 1997-
33.7 MILLION TOTAL ENROLLEES AGE BRACKET TOTAL FEMALE MALE 65-74 18 MIL. 55% 45% 75-84 12 MIL. 61% 39% 85+ 4 MIL. 73% 27%
Source: A Primer on Medicare, 2000 Update, The Concord Coalition
_________________________________________________________ First of all, the list of tables for utilization of Medicare manifests the demographic problem for women rather significantly. Of the "age 65 and over enrollees" receiving Medicare, the age bracket 65-74 indicates that there are about 55% female recipients, in comparison to 45% male recipients. So, as before, with the Census numbers, through age 74, we see some disparity, indicating an overwhelming female to male ratio. But, it gets more disparate! In the age bracket 75-84, we find that about 61% of the recipients are female, and 39% of the recipients are male. Are we starting to see the trend here? Yes. Now look at the age 85+ table, where we see an even more astonishing female to male ratio imbalance of 73% female to 27% male! Does this information indicate that men are more healthy than women, because their utilization of Medicare is so much less? Absolutely not! It indicates, just as the preceding census figures did, that there are more women alive in these older age brackets. Obviously, then, utilization of Medicare becomes a necessity for far more women than men, because there are more of them. It's just that simple. Statistically, women outlive men by a greater amount, and yet, not always in the best of health, as indicated by the numbers referred to above. That's what nursing homes have been telling us. That's what home health agencies have been telling us. That's what Medicare, Social Security and Medicaid have been telling us. That's what hospitals, senior organizations, women's groups and associations, and, yes, even Long Term Care insurance people have been telling us. And that's what the nation's women must prepare for. Simply, the numbers prove they are going to live longer than men. The facts are there. The demographics are there. They cannot be changed to protect the innocent, which in this case, happens to be the women of this country. They are facts of life (no pun intended) and need to be paid attention to, in order to prepare for even more serious utilization problems, which, in turn, will be exacerbated by the "ready for delivery" oncoming baby boomer generation. Now, this longevity and extended longevity for women may not seem to be a severe problem, until you tie the costs of long term care and related medical care into the picture. It is no secret that the costs of care and medicine can be far greater in the last few years of one's life than in the total years of their preceding lifetime. That scenario is not unusual. But aging experts are informing us that this life expectancy, itself, is lengthening, and has been since the early 1800's. So to be brief, not only are we faced with longevity and extended longevity, but, in addition, life expectancy continues to increase! If that is true, then, how do the last few years of today's fifty year old lady play out? Does it mean that an additional year or so of questionable health and care needs will descend upon today's middle age woman? An article in "BMJ" Volume 324, May 18, 2002, seems to summarize this dilemma by saying, "increases of just a few years in life expectancy can have an enormous impact on health and social services." Indeed, when the label has been read, the dosage becomes clear. Prepare for your future, as well as you can today, because, the needs have already been calculated by your predecessors. Use the message created by statistical proof to your advantage, and provide yourself with all the protection you can afford, with an eye towards the expected utilization of Long Term Care Insurance, and normal, natural medical needs, with sufficient Medicare Supplement Insurance.
The Silent Crisis--The Women's Issue of Long Term Care (Editor's note: This content is adapted from the book, "Guarding Your Gold II," by Ronald J. Iverson, Copyright, 2004. Even though some of the statistical content is dated--1996 to 2000--the basic premise of the chapter, that of women's issues regarding Long Term Care, remains the same.) |
