In a January 15 Sunday Review article in the New York Times, “Bargaining for a Child’s Love,” Hendrik Hartog stated that the image from the early 20^th Century of adult children lovingly taking care of their parents during their decline has been somewhat romanticized.  Yes, the custom was for family members to provide long-term care for their parents, but since over half the US population died before age 65, the burden was often relatively brief.  But there were also either implicit or explicit bargains discussed – parents would pass on their homes and other assets to their family caregivers after their death.  These often informal promises could lead to family strife, however, after the parent’s death.  Hartog adds that “…of course what was at stake was never just an economic bargain between rational actors. Older people negotiated with the young to receive love, to be cared for with affection, not just self-interest.” 

He goes on, “Dependency and disability still confront us as facts of life. There is little happiness in the inevitable but unpredictable decline that awaits all of us. And many younger people still experience themselves as trapped by a sense of duty to care for older relatives.” 

Hartog argues that policy and bureaucratic supports such as social security, Medicare and Medicaid have softened the burden on today’s family members, but in a letter to the Editor on p. A20 in the January 19, 2012 New York Times (Caring for Elderly Parents) http://www.nytimes.com/2012/01/19/opinion/caring-for-elderly-parents.html?ref=todayspaper, Carole Levine cites dramatic statistics that many children provide long-term care for their parents with little or no assistance from government entities.  Citing Hartog’s claim “…that today middle-class family members don’t do the work of cleaning bedsheets, helping a parent into a bathtub, changing a diaper,” Levine counters that “in fact, according to the 2009 National Alliance for Caregiving national survey, this is exactly what at least 21 percent of the country’s 48 million caregivers do, as well as managing complex medications, arranging transportation, financial and legal affairs, and countless other tasks.” 

Levine correctly notes that “Most insurance, including Medicare, does not pay for this ‘custodial’ care,” and as I have pointed out many times in this blog, Medicaid provides funds only after families have depleted their own financial resources. 

Sadly, neither contributor mentioned LTCi as a wise and reasonable option that will provide funds to pay for long-term care and alleviate the family conflict and stress so accurately described.