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Faith in the Future

Healthcare, Aging, and the Role of Religion

TEMPLETON PRESS

CHAPTER 1

Our Aging Population: The Dilemma and Challenge

The most recent census data confirm that our elderly population is growing at an unprecedented pace. During the twentieth century, the percentage of the American population 65 and older more than tripled from 4.1 to 12.4 percent. Comparing the 1900 and 2000 census data is revealing in other ways: In 2000, there were eight times (18.4 million) more people in the 65–74 age group, sixteen times (12.4 million) more people 75–84, and thirty-four times (4.2 million) more people over age 85 than there were in 1900. That trend is accelerating: In the thirty years between 1965 and 1995, America's population age 65 and older grew by 82 percent.

The looming population explosion among older Americans is due in large part to those aged 45-64 today — who will reach 65 in the next twenty years — a "cohort" that swelled 34 percent in the 1990s. They are the 76 million members of the Baby Boom generation born between 1946 and 1964, whose sheer numbers have jolted the American social landscape and economy for over fifty years. As they age, the impact of their generation's size will continue to send shock waves through the country. The Social Security pension system and Medicare will be particularly challenged by the financial and healthcare needs of the Baby Boomers.

We need only to observe the current state of healthcare for the relatively smaller number of elderly today — compared to the huge post–World War II generation rapidly approaching retirement — to understand the dimensions of the problems that lie ahead. Advances in medicine now allow people with chronic conditions such as cardiovascular disease, cancer, diabetes, kidney failure, and Alzheimer's to live longer, but often with disabilities that require ongoing costly healthcare. This care typically includes repeated hospitalization or residential treatment, eventually in nursing homes funded privately or through state Medicaid. (Medicare does not fund nursing home stays except for the first one hundred days following a qualifying acute hospitalization. Overall, such care makes up less than 10 percent of nursing home costs; the remaining 90 percent of costs comes from the 25 percent that the patient funds out-of-pocket and the 65 percent that Medicaid pays after a person's assets have been exhausted.)

While medical advances in recent years have helped to decrease health problems among older persons, the relative number of people growing older with chronic disabling conditions has largely neutralized these improvements. Further, it is particularly disturbing that the disability rate among younger persons today is increasing even more rapidly than in older adults.

According to the U.S. Department of Health and Human Services, in 1998, 28.8 percent of people aged 65-74 reported at least one "limitation" in their life caused by a chronic health condition such as heart disease or diabetes. That figure almost doubled to 50.6 percent among those 75 and older. Over a third of all those reporting chronic conditions suffered "severe" disability, with many experiencing difficulty carrying out activities of daily living such as bathing, dressing, eating, and moving about their homes. These people needed help. They got it as best they could from family, friends, and public and private caregivers. But we have to bear in mind that this population group was both proportionally and numerically smaller than the Baby Boom cohort moving relentlessly along behind them on the demographic track.

We must also consider an important factor that has been neglected until quite recently. Today's predictable levels of mortality are not immutable: Projections of the future number of elderly are likely to be gross underestimates due to astounding breakthroughs in clinical treatment, including the emerging revolution in stem cell research that will allow the production of immunologically compatible organs almost at will. Also, the application of new techniques that alter genes and thus make the dream of practical, widespread genetic therapies for such chronic conditions as cancer, cardiovascular disease, diabetes, and kidney failure may easily extend the lifespan of many to well over 80 or possibly even 90 years within two or three decades. A biologic lifespan of about 125 years may even become possible for a significant number of people by mid-century if advances in these areas of medical research fulfill their complete potential. But will the quality of this extended life also advance, or will these "mega-elderly" spend their later decades in frail disability, putting even greater pressure on the overburdened healthcare system?

The issue of independent living will become increasingly important as the giant Baby Boomer cohort begins to reach age 75 in 2021. In 1960, 30 percent of older Americans lived with their children, who met their parents' daily care needs. By 1990, that figure had fallen to 15 percent, and it is still dropping today. In addition, the traditional pool of unpaid care providers for the elderly — married adult daughters — is fast shrinking as more women work outside the home. If the exploding elderly population cannot be cared for within private homes, growing numbers of older disabled people will need the support of institutions, both public and private. But, as Edward Schneider indicated, it is exactly such institutionalized care, including acute hospital stays, nursing homes, and assisted-living facilities, which is likely to become increasingly expensive and scarce in the coming decades.

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It is obvious that securing adequate healthcare for the elderly will remain one of the greatest challenges our country will face in coming years. The United States, however, is not alone in its struggle to meet the health needs of a fast-graying population. In fact, America is ranked thirty-third among developed countries in terms of the proportion of older adult citizens. Around 2050, over 40 percent of the population in many European countries will be over 60 years of age. Even more troubling, due to declining birth rates, within fifty years the ratio of people aged 65 or over (retired) to those age 18–64 (working) will drop from the current level of approximately one-to-five to one-to-two in many developed countries.

Thus, the impact that aging populations will have on societies worldwide will be enormous, placing incredible pressure on young workers and on young families trying both to raise children and care for elderly parents. And whatever the sense of personal obligation younger people feel toward their parents, the governments of countries that have built welfare states to solve social problems (e.g., the European Union) will, no doubt, resort to imposing an increasingly heavy tax burden on younger citizens to meet the growing needs of their older populations.

The world's leading economists and demographers agree that the unprecedented population shift from young to old is now spreading from the developed world to the more affluent developing countries. The United Nations designated 1999 the "Year of the Older Person," reaffirming a recognition that the confluence of lowered fertility and improved health and longevity has generated growing numbers and proportions of elderly throughout the world. In the short term, the older population in developing countries will continue to depend heavily on the traditional support of the extended family to meet their financial, housing, and medical needs — even when there is an adequate healthcare system in place.

To explore the extent of this global challenge, the United Nations convened the Second World Assembly on Aging in Madrid in April 2002. The assembly's findings were predictable, but still sobering: By 2050, the number of people 60 and older worldwide will triple to total 2 billion, or one-in-five of the world's projected global population. Most will be living in rural poverty. United Nations demographer Mohammed Nizamuddin compared the situation in the developed and developing worlds. "In Europe," he said, "countries became rich before they became old. But in the developing world, countries are growing old before they become rich."

Although accurate, his view fails to consider the fact that the United States, Japan, and the European Union do not possess limitless wealth to meet the social and healthcare needs of their expanding elderly populations. And, ironically, it is in the most affluent countries of the developed world that older citizens perhaps face the greatest jeopardy — because they do not have the human safety net of a large traditional family to care for them as they age.

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This social separation between generations is usually caused by two factors: Adult children who once might have remained in hometowns follow their professions from one location to another, leaving their parents behind. And even if these elderly parents settle in retirement communities — most of which are in the Sunbelt — they often do not forge the human bonds they enjoyed when they were raising their families. A sense of painful isolation, what social psychologists call "anomie," can grow, potentially leading to depression, substance abuse, and loss of purpose and meaning among the aging. This problem is especially acute among the inner-city minority who are already cut off from mainstream society. But religious communities can fill the role of the missing family among the psychologically isolated and physically infirm elderly.

The caring congregation of a church, synagogue, or mosque makes the newly arrived older member welcome and eases the transition to the new community. Congregational programs such as parish nurses and Meals on Wheels sustain the older member, body and spirit.

In the case of retired older people who remain in their hometowns, the comforting presence of a close and loving congregation with its familiar ritual and liturgy provides invaluable emotional support. Many of these religious elderly are themselves caregivers for an even older generation, afflicted by stroke or Alzheimer's. Increasingly, as the older population grows with the aging of Baby Boomers, congregations will have potential volunteers to provide needed respite for caregivers such as these.

What should motivate healthy religious elders to take on the volunteer role? Among Christians, there is a biblical imperative to do so: "The Church should take loving care of women whose husbands have died, if they don't have anyone else to help them" (1 Timothy 5:3, Living Bible) is just one of several scriptural references that urges such action by the religious community.

* * *

For the millions of older Americans well enough to live independently, finding or retaining affordable housing will also become an increasing challenge. The mathematics involved are starkly inflexible: Whether homeowners or renters, 39 percent of today's elderly spend more than a quarter of their income on housing, compared to 36 percent of homeowners of all ages. But the number of elderly living on a small fixed income is growing. As out-of-pocket healthcare costs absorb a greater proportion of older people's Social Security and private pensions, the need for subsidized low-income housing — a national infrastructure investment that has not kept pace with elderly population growth — will only increase.

According to the 2000 census, in 1999, there were about 22 million households headed by older persons. Eighty percent owned their homes, and 20 percent rented. Most of the elderly renters aspired to home ownership — or at least to being able to afford a better class of rental property. Among elderly homeowners — including the chronically ill and disabled — the desire to remain living independently in their houses, condominiums, or mobile homes as long as possible was virtually universal. But the median annual family income for both older homeowners and renters, $22,500 and $12,500 respectively, hovered at or below the official poverty level.

Unfortunately, the recent collapse of the U.S. stock market has seriously eroded the private retirement savings on which millions of older Americans planned to supplement their small Social Security income (on which 44 percent of retirees in 2002 said they depended as their sole source of income, according to the Employee Benefits Research Institute). Economists point out that the "younger elderly" (aged 50 to 65) may be able to weather the current economic storm, remain in the work force a few years longer than planned, absorb their losses, and wait for the market to rebound. But for untold millions in the traditional elderly age group, 65 and older, the stock market upheaval was tantamount to financial disaster. According to the Social Security Administration in 1999, 62 percent of retirees supplemented their Social Security pensions with investment earnings, generally private stock portfolios in 401(K) plans or traditional bank savings. Those who have invested heavily in equities face the greatest financial insecurity.

And now, with the burden of healthcare costs steadily growing heavier, the elderly must increasingly make the difficult decision of spending their limited resources on health or on housing expenses such as rent, mortgage payments, or property taxes. Unless older people have younger family members willing and financially able to help maintain their property, their housing conditions can rapidly deteriorate, especially when they suffer a chronic illness or disability.

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However, all this does not mean that the senior housing picture is totally without hope. Indeed, there has been a phenomenal and rising groundswell of faith-based volunteer efforts nationwide to assist older people in need so that they can live independently with dignity in decent, affordable housing.

Habitat for Humanity is probably the best known of these programs. Founded in 1976 by Millard and Linda Fuller, Habitat for Humanity had its roots in the small, interracial, Christian community of Koinonia Farm, near Americus, Georgia. One of the leaders of the community was Clarence Jordan, a farmer and biblical scholar who believed in living the teachings of the Gospel in all aspects of daily life. The Fullers were at a personal crossroads when they met Jordan, having sold their successful business in Montgomery, Alabama, and turned their backs on an affluent lifestyle to embrace a life of simple Christian service to those in need.

Millard Fuller and Jordan jointly developed the concept of "partnership housing," in which the poor would join volunteers to build simple but decent homes. The person receiving the house — who normally would not qualify for a commercial mortgage — would be expected to contribute "sweat equity" by laboring side-by-side with the volunteer builders. Material costs were covered by a revolving Fund for Humanity, which was replenished by new homeowners' small, interest-free house payments, charitable donations, and community fundraising. With these resources, the Fund for Humanity has been able to finance more than 100,000 houses.

Although the majority of people who benefit from Habitat for Humanity are younger than 65, the houses the organization funds and the owner-partners help build are the homes they will occupy for the rest of their lives. Thus, Habitat for Humanity literally provides a solid foundation on which the future elderly can live independently as long as they are physically able to do so.

Karen Williams, 62, of Eudora, Kansas, was typical of this group approaching retirement age with only the hope of a minimal Social Security pension. In itself, this prospect would not have been so grim: She could have continued living in her rented two-bedroom mobile home until she qualified for low-income housing for the elderly. But in 1999, her three grandchildren, Amanda, now 12; Adam, 9; and Kelly, 7, moved into her cramped quarters. During the day, while the children were in school, Karen used one of the small bedrooms as an improvised day-care center for several neighbors' children. At night, she and Amanda shared one bunk bed, the two boys the other. The situation was far from ideal. Then Karen received permanent custody of her grandchildren in October 2000. Although happy to have become their legal guardian, she had to face the fact that their living arrangements were clearly inadequate.
(Continues...)

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Excerpted from Faith in the Future by Harold G. Koenig, Douglas M. Lawson, Malcolm McConnell. Copyright © 2004 Templeton Press. Excerpted by permission of TEMPLETON PRESS.
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