While I was reading an article for class on international comparisons of long-term care I noticed little was mentioned on women specifically. We are aware that women live longer and utilize more long-term care services then men, in addition to being more likely to be the provider of care regardless of whether it is formal or informal. I found a few short articles looking at this topic. One is an issue brief by the Kaiser Family Foundation looking at Medicaid’s Role for Women and examining long term care as well. The second is an AARP Fact Sheet specifically focusing on Women and Long-Term Care.

The Kaiser Issue Brief sets the stage for our discussion. It discusses how most people with disabilities receive Supplemental Security Income (SSI) and therefore qualify for Medicaid since they are already deemed to have a severe disability. The other way to qualify is to “spend down” assets to meet the state’s income threshold and obtain Medicaid coverage. This is essentially making people spend away all income and assets, pushing themselves into poverty before the government will give assistance. Lastly, in some states if medical expenses are very high they may meet the state’s “medically needy” income standard and be eligible for Medicaid. The issue brief tells us that over 4 million low-income elderly women have Medicaid paying for their long-term care services. This is no surprise as women comprise the majority of seniors on Medicaid (70%), they live longer than men, and are disproportionately poorer. Women live longer then have a higher rate of chronic illnesses and disability than men, obviously translating to some required long-term care. The article tells us that nearly 75% of nursing home residents and 66% of people receiving home health care are women. This costly expense may be devastating for these older women on fixed incomes. It is common for the husband to go through a costly illness and pass first, leaving the widow behind with what is left of their assets. She cared for him during his illness and saw to his long-term care needs, utilizing their funds as necessary. However, she is now left with little funding and no one lives with her to provide care if she starts to lose daily functioning. It is a blessing for those few women who have family or friends who can act as caregivers.

The AARP fact sheet goes into more detail about the major challenges women face as they get older, but this article also addresses the fact that women are also the primary providers of long-term care in both the formal and informal settings. Almost 66% of formal and informal caregivers are women. AARP addresses the issue of payment and that a major factor affecting income is marital status. We know, partly because men do not live as long, that almost 70% of women over age 75 are divorced, widowed, or never married. Only about 30% of men over 75 are in this category. This difference in marital status greatly affects the number of women who live alone. Statistics also show that these women living alone are on average more likely to have a lower income than men living alone or couples.

An interesting thing to mull over is the treatment of these women care providers. Currently there is no payment, pensions, or tax break for these women. Therefore it is perpetuating the long-term care system. More than 60% of women caregivers who were employed made sacrifices at work that ranged from cutting hours, refusing promotions, losing benefits, taking a leave of absence, working late or unusual hours, or choosing an early retirement. All of these resulted in one major change in the woman’s life; lower income. Not only are they unable to accumulate as much income as they could have had they no caregiving responsibilities, but they are also loosing Social Security income, and benefits like health insurance coverage if they choose early retirement or cut hours below a 40 work week (where many jobs do not provide benefits for part-timers). All of these sacrifices also lead to less possible savings for the future. They will most likely not have the income for a CCRC or home care, so when they are in need of long term care they too will need the help of a family member. Most likely another woman who is taking time off work to help. Moreover, we cannot forget the formal caregivers which are made up of almost 90% women, who are getting low pay, uneven hours, and often few benefits. Many employers even hire these caregivers on on-call schedules making it difficult for the provider to plan for her future.

I honestly don’t know what to do about this gender-based issue, but it is clear from my readings in class that no one is really talking about the long-term care crisis’ impact on this sex and the vicious cycle this system has them in. At least can we have some discussion on the subject?