During my early years in bioethics I paid a first-time visit to a nursing home. After talking with the director of the home and visiting the patient’s rooms, something caught my eye and I decided to ask him about it. “It’s mainly women here,” I said, “where are the men?” “Oh, they are outside,” he responded, “in the cemetery.” That was my introduction at first hand to the longevity gap between men and women and to the fact that, though living longer than men, that benefit is offset by having poorer health in old age. It just does not kill women so soon. I will leave moot the question of whether that should actually be called a “benefit” or not.
Now, however, the problems facing women in old age are becoming much worse and have yet to be fully grasped. There is a two-pronged hazard. Women in general and single women in particular have an emergent double threat, imposed upon a sobering baseline. That baseline is that women generally go into old age with less income than men. One of hazards is that Medicare copayments and deductibles average $3,000 – $5,000 a year. The other hazard is that they must be paid out of money from social security and whatever savings and pension plans they may have. That is a big chunk, estimated to take 18% of the latter funds. The average annual Social Security income for women over 65 is $12,700 (compared with $16,500 for men). It is also the only source of income for close to 40% of unmarried women, including the divorced, widowed or never married.
There is no way to make the math of those figures come out to anything good. If one adds to that picture the even more difficult situation of minority women, or those needing long-term care, or those responsible for the care of their grandchildren (some 6 million), it paints a bleak future, and possibly intensified if life expectancies continue to rise, using up earlier savings. I should in fairness to my own gender add that while the situation of women is worse than men, it is not good for them either.
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I am afraid someone will now ask, well,what should we do about it all? And in the face of some inevitable threats to the Medicare program, that largest of all federal budgets? My only honest answer is that I don’t know. But my guess is that it would be unwise to hope for greatly expanded federal budgets to fill the gaps. Nor to hope that the post-retirement incomes of women will dramatically rise because of earlier personal savings to meet the problems. Instead, I would see as most feasible an effort on the part of women to share their lives in private small communities of mutual responsibility for the welfare of all and the saving of money that would come from such a life in a commune. Small federal grants to get them going might even be possible. Those communes might graciously include a few stray males, those not yet in the graveyard. They won’t be around too long.
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Long-term care is populated by women. Not only are the residents mostly female, but also the workers, poorly paid women, often women of color. Aging is an issue of class, race, sexuality and gender. Some solutions may be at the individual or group level as Callahan suggests. However, the foundational issue is one of justice. The women Callahan witnessed had more than likely spent a lifetime caring for their children or parent. However, those he saw were the lucky ones who could have some assistance. However, many women face old age alone with little or inadequate care. Aging is a public health issue and one that needs to be addressed by institutional reforms, the first one being how to make good care accessible to all citizens as they age. This goes beyond concerns of funding, it asks us to rethink the manner in which we view one another and how we, as a society, define our duties towards all citizens, young and old.
I am writing from a British perspective where despite the National Health Sevice and Scotland having ” free personal care”, there are still major funding issues which are only going to increase.
The current thinking is to put the issue back into the community setting, which is possibly in line with Dans thinking. It does tend to work in the rural setting but I wonder about large urban areas.
I do agree this is a wider issue of social justice. One of the major issues seems to me to be the way in which the elderly are viewed which is usually as a burden. The press is periodically headlined with, ” Dementia Time Bomb” or ” Burden of the Babyboomers”. It’s a question of attitude.
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