Bookman Ann, Kimbrel Delia
Heller School for Social Policy and Management, Brandeis University, USA.
Future Child. 2011 Fall;21(2):117-40. doi: 10.1353/foc.2011.0018.
Although most Americans know that the U.S. population is aging, they are far less informed about the reality of providing elders with personal care, health care, and social support. Families-particularly women-have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care increasingly difficult. Ann Bookman and Delia Kimbrel show how changes in both work and family life are complicating families' efforts to care for elderly relatives. Because almost 60 percent of elder caregivers today are employed, many forms of caregiving must now be "outsourced" to nonfamily members. And because elders are widely diverse by race and socioeconomic status, their families attach differing cultural meanings to care and have widely different resources with which to accomplish their care goals. Although the poorest elders have access to some subsidized services, and the wealthiest can pay for services, many middle-class families cannot afford services that allow elders to age in their homes and avoid even more costly institutional care. Six key groups--health care providers, nongovernmental community-based service providers, employers, government, families, and elders themselves--are engaged in elder care, but their efforts are often fragmented and uncoordinated. All six groups must be able to work in concert and to receive the resources they need. Both employer and government policies must be improved. Although large businesses have taken up the elder care challenge, most small and mid-sized firms still do not offer flexible work arrangements. Social Security and Medicare have provided critical support to families caring for elders, yet both face significant financial shortfalls. The Older American Act and the National Family Caregiver Support Program have broadened access to elder services, but need updating to address the needs of today's employed caregivers and elders who want to "age in place." And just over half of the nation's workforce is eligible for the unpaid leave benefits provided by the Family and Medical Leave Act. The authors close by reflecting on the need for a coordinated, cross-sector movement to create an "aging-friendly" society in the United States-a society that values well-being across the life span and supports citizens from diverse cultures and income levels as they age.
尽管大多数美国人都知道美国人口正在老龄化，但他们对为老年人提供个人护理、医疗保健和社会支持的现实情况了解得却少得多。家庭——尤其是女性——在提供老年护理方面一直至关重要，但如此多的女性进入有偿劳动力市场使得老年护理变得越来越困难。安·布克曼和迪莉娅·金布雷尔展示了工作和家庭生活的变化如何使家庭照顾老年亲属的努力变得更加复杂。由于如今近60%的老年护理者都有工作，许多形式的护理现在必须“外包”给非家庭成员。而且由于老年人在种族和社会经济地位方面差异很大，他们的家庭对护理赋予了不同的文化意义，并且在实现护理目标时拥有截然不同的资源。尽管最贫困的老年人可以获得一些补贴服务，最富有的人能够支付服务费用，但许多中产阶级家庭负担不起能让老年人在家中养老并避免更昂贵的机构护理的服务。六个关键群体——医疗保健提供者、非政府社区服务提供者、雇主、政府、家庭和老年人自身——都参与到了老年护理中，但他们的努力往往分散且缺乏协调。所有这六个群体必须能够协同工作并获得所需资源。雇主和政府的政策都必须加以改进。尽管大企业已经应对了老年护理的挑战，但大多数中小企业仍然不提供灵活的工作安排。社会保障和医疗保险为照顾老年人的家庭提供了关键支持，但两者都面临严重的资金短缺。《美国老年人法案》和《国家家庭护理者支持计划》扩大了获得老年服务的机会，但需要更新以满足如今有工作的护理者以及希望“就地养老”的老年人的需求。而且美国劳动力中只有略多于一半的人有资格享受《家庭和医疗休假法案》提供的无薪休假福利。作者最后反思了在美国开展一场协调一致的跨部门运动以创建一个“对老年人友好”的社会的必要性——这样一个社会重视整个生命周期的幸福，并在公民老龄化过程中支持来自不同文化和收入水平的公民。
