Fifteen Eighty Four

Caring for aging parents is a reality that many people face, or will face, as their parents age and need more support and care. My book, Caring for Mom and Dad, analyzes public policies that either required or encouraged support of aging parents in financial need throughout the twentieth century. I discovered responsible relative laws in public assistance programs in my first book analyzing Michigan’s efforts to reshape its relief system in the 1930s. The enforcement of support by adult children for parents receiving Old Age Assistance was a very small part of that study, but it motivated me to explore how parent dependency policies, as I term them, shaped support of aging parents with financial need.

This book is the result. Such programs span the different tracks of social policy, from means-tested public assistance to earned benefits like social security to federal tax benefits. The key programs I analyze include Old Age Assistance and survivor benefits under the Social Security Act and federal tax benefits. Barriers to equity and access are key continuities in the operation of these programs. As I shared my research with colleagues and friends, their own narratives of aging parents emerged. Some helped with errands and medical appointments and others paid medical bills or mortgages. Such help often falls on one son or daughter; others are too far away to provide in-person help, lack the resources to help financially, or simply leave it to their sibling to do so.

As I write this I am struggling to help my father as he faces his most major health crisis at the age of 90 – almost 91. My efforts to navigate the health care system, including hospital care and rehabilitation, and how best to position him to return to his independent – and cherished – life intersect with many struggles in the book: how family members balance their own family responsibilities with their parents’ needs, juggling care responsibilities and full-time employment, the limited public provision for care, and the need for significant resources to access that care.

Historicizing these trends demonstrates that some assumptions about who provides for aging parents are not always rooted in reality. This study shows the critical role – both historically and today – that the Social Security Act plays in the financial well-being of aged parents, regardless of the programs’ significant limitations.  As more Americans accessed social security benefits via employment or survivor benefits, the need for public assistance diminished but never disappeared. While the gaps in those programs are evident, social security benefits, Medicare, and Medicaid are crucial to the ability of aging Americans to secure some measure of independence and support. And yet these programs have not replaced family support, whether formal or informal, and family members remain critical providers of both care and financial support. Conversations to reduce those benefits do not recognize their importance in the lives of aged Americans and the profound effects cuts would have. Reducing those benefits would make it even more difficult for senior citizens (and their families) to live with dignity and some measure of security.

Tax benefits (detailed in chapter 4) are the most ridiculous in terms of provisions of the three policy areas. What was a $600 tax deduction in 1966 is now (57 years later) a $500 tax credit – and when converted to today’s dollars the benefit is ridiculous ($600 would be $5,800). And anyone claiming the dependency tax benefit has to provide one half of the family member’s support – for a $500 benefit. Few social policy provisions are as ludicrous as that.

Federalism also plays a significant role in this story. Old Age Assistance was a federal-state partnership and thus states had discretion in how the program was administered, within the bounds of federal requirements. This is a significant part of my analysis in chapters 1 and 2, and had profound impacts on recipients and families – where they lived determined if family support was required and if so, how it was investigated and determined. The uneven expansion of Medicaid under the Affordable Care Act is another example of how geography shapes access to benefits; an aged parent in one state may be eligible for Medicaid benefits but a parent in a different state is not.

Our system of care for aging senior citizens, whether parents or not, needs fundamental rethinking, as with so many policy arenas. It is difficult to imagine that such re-visioning is possible in today’s polarized political times. In the meantime, I hope my research fosters some conversation about how we have provided for aging parents with financial need, and their families, and awareness of some of the paths to avoid.