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U.S. Population Increase; Healthcare Options for Older People

Aired July 16, 2005 - 08:30   ET


DR. SANJAY GUPTA, HOST: Good morning and welcome to HOUSECALL. I'm Dr. Sanjay Gupta. Important topic today. With all our advances in medicine and technology, we're living longer than ever before. In real numbers, that means while the U.S. population has tripled since 1900. The number of older adults has increased 11 fold and those numbers translate into millions of adult children acting as caregivers to their aging parents.

DEBRA HINKLE: Feeling OK today?

GUPTA (voice-over): Debra Hinkle visits her mother at her retirement community in Arlington, Virginia every day, before and after work and three times on Saturday and Sunday.

DEBRA HINKLE, CAREGIVER: I help her brush her teeth before she goes to bed. I make sure her hearing aid is OK, that her nails are clean.

GUPTA: She says she no longer has a social life and often has to work on weekends to make up for time lost during her visits.

HINKLE: It's a reshifting of priorities and feeling that my priorities right now are really taking care of my mom.

GUPTA: Debra isn't alone. Studies find that more than 44 million Americans care for another adult, often an aging parent. And more than half of them also juggle a full-time job.

ELINOR GINZLER, AARP: There's an immense balancing act going on today in America, balancing one's work life with one's family life, with one's care giving life.

GUPTA: That balancing act takes its toll and can be devastating financially. Without national coverage to pay for senior care, family members usually pick up the bills.


GUPTA: And we're going to be talking about those bills and ways to get help with them a little bit later in the show.

But first, let's bring in our guest Elinor Ginzler. She joins us from Washington, D.C. She's the co-author of the book called "Caring for Your Parents". She's also an expert on long-term care with the AARP. Welcome.

GINZLER: Thank you.

GUPTA: Listen, this is a topic that many people don't want to think about, or they put off, for example, your parents or loved one needing help. But it is better to deal with caregiving plans earlier rather than later, right?

GINZLER: It absolutely is. And you're so right, Sanjay. Most families don't like to think about this when everyone is well and everyone is healthy and happy and high functioning.

The problem is if you don't think about it during the good times, you're not prepared. And then you're usually operating in a crisis. And that would probably be the worst way to be starting these conversations.

GUPTA: Yes. And like so many other things, we tend to put things off. And when it comes time to make critical decisions about care, guilt can also be a huge factor for the caregiver.

We talked about this, something Susan in New York is struggling with as well. She writes us, "My father has lived with me, my husband and sons for six years. His dementia has progressed and he'll be in a home soon. I don't know how to prepare him for his new placement without him feeling abandoned and me feeling guilty."

Elinor, how can parents and caregivers deal with those feelings?

GINZLER: Well, I think -- I actually commend her for recognizing it. That's probably an important and critical first step. This isn't easy stuff. And she's been doing a yeoman's job, I'm sure, for many years. It's actually very healthy to recognize when, you know what, I've done as much as I can in this venue.

What might be helpful for her is to think about the fact that it's not like she's stopping the care she's giving for her dad. She's actually changing the way that care is delivered. She's still going to be a caregiver. She's still going to be engaged in his life. I'm sure she's going to -- the best thing to do is to visit him on a regular basis. And so, it's more that her role is somewhat changing. She's not giving it up, though.

GUPTA: Right. Important points. And a lot of people probably thinking about that this morning as well. When it comes time to make those decisions on care, you do have several options. Medical correspondent Christy Feig runs through what might work for you.


CHRISTY FEIG, CNN CORRESPONDENT (voice-over): When Cecilia Scarlata's parents were in their late 80s, living alone was starting to be a challenge, but they were not sick enough for nursing home care. And they didn't want to live with their children.

CECILIA SCARLATA, CAREGIVER: Not that she doesn't love her children. It's just that, you know, it's -- she wants to feel like she's still, you know, as independent to a certain extent.

FEIG: For them, assisted living was the best option. It is designed for people like Cecilia's parents, who need some help, but are not in need of around the clock care.

But it's only one option. Nursing homes are another. They are primarily for those who need skilled nursing care.

And for those who may want something in between, the facilities at many continuing care retirement communities include it all. Independent living, to assisted living, to full-time skilled nursing, allowing one to progress within the same community when they need more care.

When it comes to choosing the right place, experts say consider an unannounced visit at the location.

CAROL EDELSTEIN, SUNRISE ASSISTED LIVING: What do you feel when you first go in, what do you smell, what do you see, what do you hear? You know, are the sighting and sounds what you would like for your mother?

FEIG: The cost of these facilities varies widely around the country. The catch is, Medicare pays for very little long-term care. Most of it is paid out of pocket or by Medicaid when your loved one runs out of money.

Christy Feig, CNN, Washington.


GUPTA: All right, Christy, thanks.

Sometimes less expensive option is home care. And we're going to get into the pros and cons of that later in the show.

Elinor, Christy explained the difference between these options. But I think the real question is how do you pick a facility that you and your loved ones can live with? And you know, you want the Cadillac of care for your parents, right, safety, the most loving caregivers. How do you find that?

GINZLER: Well, actually, I think that is so important to think of this as you're on a mission here. You really are becoming a detective and becoming an empowered consumer and figuring out what works best.

There's no one answer. So you need to start by thinking about what is it that your family member needs. You have to have a clear, thorough, complete understanding of the -- not just the level of care, which is one important part, but also what kind of setting is going be a good setting for them? That's where you have to match the individual person to the individual setting.

Assisted living may be an option, but then there's a lot of choices in assisted living. And if you've seen one assisted living facility, you've seen one assisted living facility.

So you know, is your mom very social and needs to be in a very social setting? Is she very unsocial? And if she's in a setting where it's expected that you are participating all the time in everything, is she going be miserable?

GUPTA: Right.

GINZLER: You've got to do that pairing up.

GUPTA: Really good advice. We're talking to Elinor Ginzler. Coming up on HOUSECALL, if nursing homes or assisted living doesn't work for you, maybe home care could. What you need to know about that after the break.


UNIDENTIFIED FEMALE: We had, you know, a little bit less space.


UNIDENTIFIED FEMALE: Millions of Americans care for parents in their homes. We'll show you the pros and cons coming up.

Plus, America's leading killer, heart disease. New research show what foods you need to eat to cut your risks.

But first, let's check the numbers with our quiz. What is the average cost of a nursing home per year? We'll add it up after the break.


UNIDENTIFIED FEMALE: Before the break, we asked what is the average cost of a nursing home per year? The answer? $70,000.

GUPTA: And that is a very huge number. Consider this: The median income of our older generation in 2002 was just under $20,000 a year, and that's for men. For older women, it's less than $12,000 a year.

So for financial as well as emotional reasons, the majority of American family's care for their aging relatives in their own homes. Many times while raising their children.

But juggling caregiving for both children and parents can be a very stressful thing indeed. Medical correspondent Christy Feig is back now with some tips to try to make it a little easier.


CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Earlier this summer, Diane Menditto Doyle moved her parents in with her own family when they could no longer safely live on their own. Caring for them is adding to an already full plate, a husband, three kids, two jobs and graduate school. It was an adjustment for the entire family. DIANE MENDITTO DOYLE, CARES FOR PARENTS: Because everybody had to shift bedrooms. We had, you know, a little bit less space. We haven't actually moved all their belongings in yet, but that will be a major shift when we do that as well.

FEIG: The AARP says three-quarters of the care that is given to older people in the U.S. is done by family and friends. Experts say it's a good opportunity to reconnect with parents, but life becomes a juggling act.

GINZLER: You're juggling your work life, with your elder care life, with your family care life. And then what ends up being put at the bottom of that list is care for yourself.

FEIG: Ginzler says if you don't care for yourself, it could jeopardize the care you give others. She recommends making use of short period of time when your loved one is napping, for example, do something you want to do. If possible, share the care with other family members or paid help so you can take a break, even if it's just for a couple of hours.

Adult daycare centers are another possibility. It gives your loved one a social environment and gives you time to focus on you.

Christy Feig, CNN, Washington.


GUPTA: All right, Christy. Thanks again.

Another option that some people choose, getting in home professional help. And this can be anything from making sure medicine is taken on a full-time basis, to full-time nursing services.

Now if you're considering this option, here's some things to consider while making your decision. Is the agency certified by Medicare and also licensed by your state? Also, are they bonded and insured? Make sure to ask about their level of training and if workers are supervised. Plus, are they available 24/7 on call in case of emergency? And finally, do check their references. Ask for a list of doctors and clients who have worked with the agency.

We're talking today with someone who has asked a lot of these questions herself, Elinor Ginzler. She's a director of Livable Communities for the American Association for Retired Persons. Welcome back, Elinor.

GINZLER: Thank you.

GUPTA: And we've talked about this topic, but I think it's so important. You want the best care possible for your loved ones. How do you find it? And specifically, are there little things, you know, inside baseball, this is what you do, what little tips can you share?

GINZLER: Well, especially when you're talking about home care, and especially if you're in a scenario where the care that's going into the home is going into your parents' home, and their - it's your effort to try to keep them in their home for as long as possible, so you're not necessarily living with them.

Really, really important to visit, to drop by, to be totally, totally erratic in the time periods that you're going into that house so that you can get a snapshot every Friday at 4:00 on how care's going. That's not necessarily the same picture you're going see if you drop by Friday at 4:00, Saturday at 9:00 a.m., Monday at 12:00 p.m.

So, I really want to become -- you want everybody to know it's not like you're snooping. It's -- you're involved. And so the more you're there, and the more different times you're there, the better picture you're going to have of what's going on in that house.

GUPTA: And it might keep everyone there more alert and doing their jobs better as well.

GINZLER: Without a doubt.

GUPTA: Good advice there.

Let's head to our mailbox now again. A question from Michael in Pennsylvania. "My brother and I have been caring for our mother. She is 79-years old with dementia and has a host of physical problems. It's difficult providing her with the care she needs while simultaneously trying to care for our families and continuing to earn a living. Our experiences could fill a book. Where can we turn for help?

And Elinor, I'm sure this is a story you hear far too often.


GUPTA: Where are some simple places people can find help?

GINZLER: Well, you know, his remark about his experiences could fill a book is absolutely so true. And in fact, when Hugh Delahanty (ph) and I wrote our book "Caring for Your Parents: The Complete AARP Guide," it's filled with stories. His might even be in there because it really is -- care giving is all about stories.

I think it's real important if he has not yet connected with his local area agency on aging, that's an aging office that's scattered, there are offices on aging throughout the United States at the local level, over 640 of them right now. They have services that they can make available to families who are dealing with care giving issues.

Could be respite. Could be education and training. Could be information and assistance. But there are some services that are known at a local level. And he can find out what other things are out there that can help him.

GUPTA: And I think that the first thing you said as well, he's not alone. I think a lot of people watching this morning might feel a little isolated, but a lot of people going through this. Half of those at-home caregivers are also full-time workers. And we received lots of comments about the struggle between work and care.

Here's just one from Ariane in New York. "In taking care of elderly parents, the caretaker must be prepared to face obstacles in the workplace which make it nearly impossible for him/her to hold down a full-time job. The workplace today is not conducive for allowing an employee to care for the elderly."

And Elinor, is there a strategy legally, something else to try and make this work?

GINZLER: Well, you know, I do think that this is an issue that our entire nation is facing. And I actually like to think about it this way. If you think back about 25 years ago, and look at the workplace setting, and how the workplace setting addressed child care, that's where we are today with elder care.

And let's flash forward. Now today, child care services made available to staff through the employer. You know, whether it's leave policy or referrals to child care providers or flexible leave for child care needs, that's almost become an acceptable thing.

I think we're going to have that happening now as elder care takes into account and sort of goes into the same pathway that child care issues have been facing for years now.

So, I think it's also important for American business to recognize there is a dollar figure bottom line that they're going pay if they don't care for their employees and give them flexibility they need.

GUPTA: Right.

GINZLER: Billions of dollars are lost in productivity every year because of workers' issues on elder care.

GUPTA: Just really important points there. And just by the numbers alone, it's going to have to change, the system is. Important topic we're talking about today. More HOUSECALL coming up after the break. Stay tuned.

UNIDENTIFIED FEMALE: The cost can be staggering, but there are steps you can take to cut those bills by thousands of dollars. That's after the break.

But first, this week's medical headlines in "The Pulse."

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Obese women may be more physically fit than obese men, according to a report by Dutch physicians. The researchers tested the fitness levels of 56 severely obese men and women scheduled for weight reduction surgery. And found the men had a harder time tolerating exercise because of the way fat is distributed on their body.

And the nation's first lawsuit related to the painkiller Vioxx is now under way. Carol Ernst is suing the drug manufacturer Merck over the death of her husband Robert in 2001. Ernst was a 59-year-old personal trainer who used Vioxx to ease hand pain, but died suddenly after six months of taking the drug.

Merck says there is no evidence Vioxx was associated with Ernst's death. Merck voluntarily pulled Vioxx off the market last September after a study showed that it increased the risk of heart attacks, strokes and death.

Christy Feig, CNN.


GUPTA: And that is a great resource for comparing long-term care facilities.

Now once you've decided, though, we've talked about the cost involved. Get this. $70,000 or more for nursing home care every year. $30,000 for assisted living. And much of that is going to come out of your own pocket unless you qualify for Medicare or Medicaid.

However, there is another option for you -- long-term care insurance. A policy you pay premiums on annually. And in exchange, they would pay for a portion of your nursing home or assisted living cost.

Now critics charge the insurance can be too expensive. And who's to say the insurance company will even still be around when you need them? Important topic.

Helping us work through this is Elinor Ginzler. She's co-author of the book called "Caring for your Parents" and an expert on long- term care.

Now Elinor, whether it's in home care or living in a facility, we're talking about a lot of money here.

GINZLER: Absolutely.

GUPTA: Is there someone who benefits from buying this type of insurance?

GINZLER: Yes, there probably are some people who benefit from buying this insurance. What's really important to remember is, it is probably the most complex and complicated kind of insurance that's out there these days.

And I actually want to emphasize the word, it's an insurance policy. So when you are buying it, you need to be aware that different policies are going cover different types of services. So you have to think through what kind of long-term care do I think I'm going to need. You have to evaluate your own health status. You have to look at some of the family history that you've got going. How long do my family members tend to live?

Real important to have a sense of that as you're going into the process of selecting an insurance policy.

GUPTA: Right.

GINZLER: You also want to be aware that, and this is sort of that catch 22, the cost of this insurance changes over time. The older you are when you buy it, the higher your premiums are. And you can get to a point in time where actually you may be considered not appropriate because you are too old. And if you have too many medical conditions, you might not be able to get the insurance. You might not be able to get coverage.

So it's best for people who are not too old and who have significant assets that they want to protect.

GUPTA: Good advice. And you know, just having heard about - done some homework on this, I know workplaces, your workplace, your job may offer some long-term insurance as well. Worth looking into if you're still employed right now. Is that right?

GINZLER: Absolutely. And more and more, if you can get a policy through a workplace environment, you are likely going to be able to get a somewhat better deal because they can negotiate a group rate.

GUPTA: Good advice. We're talking to Elinor Ginzler. Lots of advice here. And you're going to spend some time thinking about this. Grab a pen. When we come back, we're going to give you the resources necessary to help you and your loved ones make some tough decisions.

UNIDENTIFIED FEMALE: What do garlic and wine have in common? They could save your life. Our "bod squad" tells you how after the break.



HOLLY FIRFIR, CNN CORRESPONDENT (voice-over): Taking care of your heart just got delicious. Garlic, fruits and vegetables, fish, wine, and chocolate. Consider it a recipe to fight heart disease.

A recent study in the British Medical Journal found these seven super foods lowered cholesterol, blood pressure and other risk factors for heart disease. And researchers say working all seven into your diet could reduce your risk of heart disease by as much as 76 percent.

So how much do you need to eat to reap those benefits? Let's sprinkle a little garlic in meals. Just a couple of teaspoons a week reduces risk by 25 percent.

Eat your fruits and veggies. Five or more daily servings packed with powerful antioxidants cut risk by 21 percent. Go fishing at the grocer. Paying for four ounces of fish four times a week. It's rich in Omega 3 fatty acids, which helps to slow the artery clogging plaque and lowers risk by 14 percent.

Wine, savor a glass with dinner. The antioxidants in the grapes reduce risk by 32 percent.

And dark chocolate, go ahead and indulge your sweet tooth. One large candy bar contains polyphenols, which lowers risk by 21 percent.

Holly Firfer, CNN.


GUPTA: All right, Holly, thank you very much.

Now if you're looking for resources to help in decision making, try clicking on You're going to find articles there on how to make decisions as a family, as well as community organizations that might help.

Also try the National Family Caregivers Support Program at There you're going to find links to caregiver agencies in your area.

Really important topic today. Unfortunately, that's all the time we have for. Elinor Ginzler, thank you so much for joining us this morning.

GINZLER: My pleasure.

GUPTA: Thank you all at home as well for all of your questions. Make sure to tune in every weekend for another edition of HOUSECALL.

And don't forget to e-mail us your questions at

Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.


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