Thursday, November 18, 2010

Eldercare needs may affect the "social contract" in ways few see yet

There is a lot of talk about the Pew Report on the decline of (traditional) marriage, as in this direct link. Nevertheless, living in a social unit regarded as “family” is still very important to a majority of people, who will consider a number of committed social arrangements as families, even though in modern society the monogamous commitments are of a more serial nature. And many people (a significant minority of adults) spent much of their adult life economically productive while “standing alone” and prefer it that way.

But the exponentially growing need for eldercare may turn the tables on the uncommitted life. Think back about a half century, when many families were larger than they are today. People who didn’t marry and have children (often mainly women) were expected to remain close to home to become available to take care of their parents and other blood relatives. The pejorative term for such an arrangement was “family slave”. While such family members were taken for granted, the demands for eldercare tended to be short term; once the elderly were ill, they tended to not live long, and end of life was a natural and expected result. Medicine was less advanced, and lifestyles (smoking, high fat diets, etc) tended to limit lifespans. Of course, over decade, things changed, as women sought and won equal opportunities in the workplace (and exceeded men in school), and as LGBT were forced, somewhat by older legal sanctions, to make the single lifestyle work, which it often did in a wealthier and more tech-oriented society. But extended families began to break apart in Diaspora, while life spans increased, because of both better medicine and better health habits. Extended life spans could mean longer lives without disability (we all expect Jimmy Carter and Queen Elizabeth to make it to 100 fully active), it also meant that many seniors would be incapacitated and need many more years of long term care than they would have in past generations, when they just would have passed away sooner. Not all of this is the result of desperate and expensive life-extending treatments; much if it is accomplished simply, by much closer management of medications, many of which have become less expensive.

The media has reported dire predictions of increase in Alzheimer’s Disease, partly because many people will not die of other things sooner, and partly because lifestyle and social habits may be exacerbating the appearance of dementia at advanced age. All of this means a potential impact on the “social contract” that goes beyond merely calculating the math of long term care insurance, Medicare and Medicaid (and government deficit spending). The need to have people around to physically deliver the care and become open to the emotional bonding and “joining in” will grow rapidly, perhaps uncontrollably. Like it or not, the “religious right” may be doing a service with the talk of “demographic winter.”

This column has already noted that many states with pressed budgets are likely to notice the filial responsibility laws on their books. That can certainly mean that adult children of parents without adequate long term care insurance or savings have not choice but to give up or sacrifice their own lives t perform care themselves (it gets beyond the talk of the “sandwich generation”). But in practice, it’s likely to lead to a rethinking of the way we view our basic rights to select our adult relationships and give or withhold consent to bonding and intimacy. Other cultures have certainly regulated people’s inner lives (arranged marriages) and even ours has, not too long ago, viewed parenthood within marriage as a vehicle for imposing demands of loyalty and affection on others within the family, a power which they achieve only by carrying on lineage within marriage themselves.

Adults today value their rights to selectivity in choosing significant others, more on the basic of psychological polarity than older notions of adaptive complementarity as laid out for them by others (their own family and parents and church) That can sometimes lead to resistance to relating to those who are less intact until we make a conscious decision that we want to (usually by having our own children, sometimes adopting). But eldercare may force us back to the view that “complementarity” is a basic moral obligation of every one in a community, transcending the act of an individual choice (with its libertarian, modern interpretation). Elders and other disabled individuals may be able to “survive” much longer than we had thought if others are willing to sacrifice some of the “calling of their own shots” to remain bonded to them in extended family units, as they had been understood in the past. That could even affect the way filial responsibility is implemented in the future.

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