Waldo Klein, a professor at the School of Social Work, is chair of the School’s focused area of study, Social Work Practice with Older Adults, and vice chair of the Connecticut Commission on Aging.
Over the years, his research has spanned a wide range of topics, often with a focus on long-term care, including the preparedness of nursing homes to receive residents who are HIV+, and the use of beverage alcohol by nursing home residents. His interest in primary prevention among older adults is reflected in his book (with Martin Bloom), Successful Aging: Strategies for Healthy Living.
He has also conducted a number of community-based surveys in Connecticut to better understand the specific interests, activities, and service needs of older adults. Data from these surveys has been used to shape programs and services for older adults in those communities.
He sat down recently with staff writer Sherry Fisher to talk about aging issues. This is an edited transcript of a longer interview.
Also: Related article, November 26, 2007 Advance.
This article includes audio.
Q: Why is it important for us to be discussing aging right now? What are we facing?
A: It’s important to be thinking about and talking about aging because it is a reality in which we’re embedded.
When we talk about aging, we’re talking about what you or I experience as individuals, and at the same time we’re talking about the reality that we are in a larger society that is aging itself.
Our mean age is going up. What it means to be old is changing. We need to speak up about these things to make us comfortable with them.
Q: What is happening now with the baby boomers?
A: Baby boomers are people born between 1946 and 1964. At that time, FHA loans and veterans’ benefits provided an encouragement and support for families to grow. Now those people are moving towards their older adult years.
Q: There’s a lot of talk these days about long-term care. Can you speak about that a little?
A: Long-term care is much more inclusive than ‘nursing homes.’ It’s family care and community based services as well.
And when 78 million baby boomers are knocking on the door of advanced old age – 80 or 85, and older – that presents a very significant social issue with which policy makers are currently wrestling.
The baby boom is perhaps the biggest single dynamic that pushes this, but our longevity contributes to it as well.
There are simply going to be older adults who are going to need more services. Among older adults, chronic illness and other long-term issues are much more profound considerations.
Long-term care needs to be understood not as something that happens in a place, but rather as a set of services that are designed to help people meet their maximum functional ability.
Whether that happens in an institution like a nursing home, whether one is living in his or her own home with professional support, or whether that long-term care is provided through the loving attention of family members can vary.
So the best long-term care insurance, I tease my students, is a daughter, and the second best is a daughter-in-law! But in fact I really should amend that, because the most significant single group of informal long-term care providers is spouses.
In our society, women have tended to marry men older than they, and women tend to be in better health. Consequently, you often end up with this advanced-age couple, where he experiences the kind of frailties and needs for care that we’re talking about, and she becomes the informal caregiver.
It’s estimated that between 65 percent and 80 percent of all long-term care is provided informally by family and friends. This is huge.
| Waldo Klein, professor of social work and vice chair of the Connecticut Commission on Aging, during an interview.
|Photo by Jessica Tommaselli
Q: Who pays for professional long-term care?
A: People don’t understand that the average private-pay nursing home rate in our state costs $109,000 a year. So when people say, “I’m saving for my long-term care,” they might mean that they have $5,000 or $20,000 or $40,000 or $50,000 set aside. This is not going to begin to address the need.
In this state, we are fortunate to have the Connecticut Partnership for Long-Term Care, which is the state, in cooperation with the private sector and the federal government, creating a long-term care insurance product that has a number of significant benefits.
Q: What about Medicare?
A: Something in the neighborhood of half the folks in a recent survey in Connecticut conducted by researchers at the UConn Health Center indicated that they were counting on Medicare to pay their long-term care needs.
They are mistaken. Medicare is a federally-funded insurance program for people who are 65 years of age and older or who are disabled, but it does not cover long-term care.
It will cover 100 days of nursing home care following a qualifying acute hospitalization. But it will not be there for you for your chronic care needs. It wasn’t designed that way.
So what happens is that people go into a nursing home and they start paying their own way, and given the rates of nursing home costs, they very quickly deplete their resources. They become, in a word, poor.
Once they are poor, they qualify for Medicaid, a combination federal and state program that provides health care services to people who are poor. The asset limit for Medicaid participation is $1,600 dollars – that’s poor.
Q: What does the immediate future hold?
A: In the state of Connecticut, we are currently advancing the conversation; the shorthand for it is “rebalancing the system.”
Right now, with our Medicaid program, both nationwide and in Connecticut, we spend about one-third of our dollars for home and community-based care for a little over half of the people; and we spend the other two-thirds of the dollars for nursing home care for a little less than half of the people.
Overwhelmingly, people prefer to get services in their own homes. Yet we have chosen a policy path here that has a very strong institutional bias, and this is not said at the expense of nursing homes.
Nursing homes have a very, very important place in the long-term care continuum, but so do community and home-based services. Rebalancing is about bringing those two pieces of the long-term care pie back into some more reasonable relationship.
Q: When should we start planning for aging?
A: Certainly, by the time a graduate takes that first job out of an undergraduate program; for the traditional student, we’re talking about the young 20s.
For the price of a few lattes, they should begin saving for retirement. The future value of money saved that way will be great. It’s the magic of compounding.
When young people take that first job, if they pay attention to the 401Ks or the 403bs or other retirement saving opportunities that are there for them, their future children and their future grandchildren will say thank you. And they as individuals will be better able to live the kinds of lives in their old age that they would like.