Services for Seniors in the United States

an LTC policy included in the Canada Health Act. It is argued that LTCs should be integral to the continuum of care in the national health care system, providing accountability, transparency and uniformity of care.

By Margo MacVicar Whelan and Rachel Reed Dushoff

In the United States, the issue of eldercare and programs addressing the needs of seniors is a multi-layered challenge. In contrast with most other countries there are enormous variations across the nation as many resources and regulations concerning senior care are determined at the state level.

Studies show that the majority of American seniors prefer to remain in their own homes as long as possible. When this is no longer viable, options include assisted living facilities, skilled nursing facilities, board and care homes, and continuing care retirement communities.

Only 11 percent of the senior population can afford costly long-term care insurance which covers the options above including care services at home. Paying with one's own resources may result in exhausting family funds.

In 1935, President Roosevelt introduced the Social Security Act as part of his New Deal. The new Act created a social insurance program for retired workers. Today, qualifying for Social Security at age 62 requires 10 years of work or 40 work credits. The maximum monthly Social Security benefit that an individual can receive per month in 2021 is $3,895 (by waiting to file at age 70). Social Security calculates the average indexed monthly earnings during the 35 years in which one earned the most. Some seniors survive, with hardship, on a minimal Social Security benefit as low as $650.

In 1965, President Lyndon B. Johnson extended the level of social protection by creating the Medicare and Medicaid programs. At age 65 individuals qualify for Medicare with options for medical and/or hospital care. Seniors who have a 10-year work history, pay no premiums for Medicare Part A, which covers hospital stays, skilled nursing, hospice and some home health services. Part B, which covers outpatient care and medical supplies, has a standard monthly premium of $148.50 (in 2021), although higher earners pay more. Examples of services not covered are dental, long term care, and hearing aids. Those unable to afford Medicare may qualify for Medicaid, a federal-

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state assistance program designed for people with limited income of every age. Each state program has varied levels of benefits and regulations and extreme variations exist in the level of financial participation by the state. Medicaid provides essential care for 7 million seniors. Benefits include hospital services, physician services, laboratory and x-ray services, and home health services. Patients usually pay no part of costs for covered medical expenses. Medicaid also provides care in nursing facilities and care homes although individuals must co-pay using their Social Security or pension funds.

Senior care is a complex issue in America. Ideally, ageing individuals learn to navigate the decision-making process themselves arriving at an outcome best suited for them. However, in many cases the complexity of the options and financial arrangements requires the support of family and professional advisors.

AARP (formerly the American Association of Retired Persons) has 38 million members in the U.S. Its publications offer information about housing, finances, health, insurance, etc. It entitles its members to benefits and discounts, and it also lobbies the government on behalf of its constituency. Many seniors also frequent senior’s centers which offer both recreational and counseling opportunities.

It is interesting to note that many of these centers are partially staffed by senior volunteers. Indeed, 4.5 million U.S. seniors volunteer in myriad environments including tutoring and support staffing for non-profit organizations.

More broadly, as many as 17 percent of Americans over the age of 70 are gainfully employed – a figure which has been mounting steadily. This may be the result of the need to pay for increasingly expensive health support as well as the known health benefits of staying active in one’s community.