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Statement on Long-Term Care by Jeanetter C. Takamura
Assistant Secretary for Aging
U.S. Department of Health and Human Services

Thank you, Senator Reed, for the opportunity to testify before the Senate Special Committee on Aging hearing on long-term care and the role of family caregivers. I am pleased to discuss the Administration's long-term care proposals, including the proposed National Family Caregiver Support Program, and to hear Rhode Island's perspective on an issue that is so important to American families across the nation.

At the outset, I would like to commend you, Senator, for your leadership as a member of the Senate Special Committee on Aging as well as the Senate Committee on Health, Education, Labor and Pensions, which has jurisdiction over the Older Americans Act programs administered by the Administration on Aging. We are most grateful for the support you have provided toward the reauthorization of the Older Americans Act and for your strong support of our nation's family caregivers.

I would also like to recognize Barbara Rayner, the Director of the Rhode Island Department of Elderly Affairs, and her able staff and commend them all for their continued work on behalf of older citizens of your beautiful state. This is my fifth visit to Rhode Island since I was sworn in as Assistant Secretary in 1997. I have been impressed each time by the level of commitment and dedication of Rhode Island's aging network and by the interest and enthusiasm of your older citizens.

Senator Reed, the opening days of the year 2000 are less than 100 days away. We stand on the threshold of an extraordinary time in our country's history. In the next century, we know there will be more older persons, more caregivers, and greater generational and ethnic diversity in America than ever before. Rhode Island's over-65 population alone is expected to increase by 26.2% by the year 2020, and its over-85 population by over 66% (since 1993). These demographic realities present our nation and its leaders with a myriad of challenges, possibilities and opportunities.

I come before you today to talk about an issue that is at the heart of all national public policy discussions related to long-term care; how we as a nation, as communities, and as family members can and will care for our older loved ones. As you know, earlier this year President Clinton unveiled a four-part initiative to support Americans of all ages with long-term care needs and the millions of family members who care for them.

First, the President proposed a $1,000 tax credit for people with long-term care needs or their families. As a first step, this proposal supports rather than supplants family caregiving and would provide financial support to about two million Americans, including 1.2 million older persons.

Second, the Administration has proposed a national campaign to educate Medicare beneficiaries about long-term care coverage and about how best to evaluate their options. Nearly 60 percent of Medicare beneficiaries are unaware that Medicare does not cover most long-term care needs.

Third, the President is calling upon Congress to allow the federal government to use its market leveraging ability to offer quality long-term care insurance as an option for federal employees.

And finally, the President unveiled the proposed National Family Caregiver Support Program. If this new nationwide program is enacted by Congress and funded at the requested level, it would provide $125 million per year in federal funding to support families who are caring for older relatives with chronic illnesses or disabilities. Under our proposal, states would provide:

• Critical information about health conditions, resources and community-based long-term care services that might best meet a family's needs;
• Assistance in securing appropriate help;
• Counseling, support groups and caregiver training to help families make decisions and solve problems;
• Quality respite care so that families and other informal caregivers can be temporarily relieved from their caregiving responsibilities; and
• Supplemental long-term care services on a limited basis.

This unprecedented new proposal recognizes that more than seven million people-spouses, adult children, other relatives and friends-are informal caregivers providing unpaid help to older persons living in the community. Family caregivers have always been the mainstays in the provision of long-term care in this country. Ninety-five percent of all older Americans in the community with limitations in their activities of daily living have family members involved in their care. This degree of caregiver involvement has remained fairly constant over more than a decade, bearing witness to the remarkable resilience of the American family in caring for older relatives, despite increased geographic separation, greater numbers of women in the workforce, and other changes in family life.

According to the HHS National Long-Term Care Survey, if the work of these caregivers had to be replaced by paid home care staff, the cost to our nation would be $45 to $75 billion per year. The costs to the caregiver--in time, physical and emotional stress, and financial costs--can be significant. We also know that:

• Caregivers dedicate an average 20 hours per week providing care and even more time if an older person has multiple disabilities;
• Caregiving is physically demanding and physically strains caregivers, many of whom are older themselves;
• Caregiving responsibilities place a heavy emotional strain on the caregiver and often this results in depression; and
• Two-thirds of working caregivers report that there are work conflicts resulting in unpaid leaves of absence or rearranged work schedules.

The Administration's proposed National Family Caregiver Support Program is designed to help families with these challenges. Senator Reed, we believe that it is good government to treasure and support family caregivers, so that they do not make themselves vulnerable in the long run; can continue to work without sacrificing their futures; and can continue to be supportive of the younger members of their families as well.

If Congress enacts the proposed National Family Caregiver Support Program, the Administration on Aging will work closely with the national aging network, including Rhode Island's Office of Elderly Affairs, to plan, coordinate and provide supportive services to meet the unique needs of caregivers across the country.

Our proposal for the National Family Caregiver Support Program is part of the Administration's proposal to reauthorize the Older Americans Act, as well as part of the President's budget proposal for FY 2000. If fully funded, Rhode Island will receive over one-half million dollars for caregiver support and services.

We are very pleased with the bipartisan support the proposed National Family Caregiver Support Program has received thus far in Congress. Just three weeks ago, the House Committee on Education and the Workforce reported out H.R. 782, a bill sponsored by the bipartisan leadership of the Committee, to reauthorize the Older Americans Act which contains major components of the Administration's National Family Caregiver Support Program as well as our requested $125 million authorization level. We are also pleased with the level of support our proposal is getting from the Senate Committee on Health, Education, Labor and Pensions, and the Senate Special Committee on Aging. We are hopeful that progress will continue so that we will have a National Family Caregiver Support Program to support families today and in the future.