Friday, February 19, 2010

Feeling Sandwiched? Biden, the Middle Class Task Force and Elder Care

The Politics of Elder Care: An Ongoing Discussion of Stakeholders, Positions and Themes

Vice President Biden recently gave an introductory speech to the administration’s task force aimed at helping the middle class . And if his speech is any indication of what families caring for ill and disabled members can expect from the work of the Task Force they should brace themselves for great disappointment.

After reading about the task force. my hopes were up that after more than two decades of research documenting that the need for elder care far exceeds our present capacity to provide it, our government might finally be paying attention. For too long the excuse has been that if support were available the unpaid family caregivers would “come out of the woodwork” and expect the government to take over for them. Of course the so-called “woodwork” and “substitution” effects could not be demonstrated by research. The pseudo-economics behind the concepts were convenient hooks for policy makers and politicians who continued to argue against taking any action on family caregiving. The lack of alternatives and support to unpaid (and paid) caregivers is a looming social and economic disaster, and so far none of our political leaders have mustered up the courage to admit that it is happening.

In his remarks Biden did speak to the issue of elder care and at first framed it as a problem of affordability (it is much, much more problematic than that but affordable would be a nice start). You should know that this is a “trigger” issue for me so I’m hyperalert to anything politicians and advocates say or do about it. As an academic I study narratives about family caregiving but it is also personal (if it isn’t for you it will be soon, trust me). I was stunned by how the sum of Biden’s brief remarks revealed the divide between political talk and proposed actions. In this case Biden, being typically self-referential, was using political talk to show his empathy and to reassure us that the issue matters to the administration. Referring to himself and his wife Jill as part of the “sandwich generation” (more on that in another post) he tells how he and his siblings divided up the cost of caring for his elderly parents. His point was that because he made a very good salary the cost of care was “not a problem.” He then asked himself what it would be like for a family with two kids making $85,000, even $125,000 a year. How do they do it? he asked.

After making his point about the difficulty of affording care, I assumed that affordability would be the focus of the task force’s consideration of elder care, and indeed the only mention on the new web site of elder care is a short sentence buried in the text about child and elder care affordability. However, instead of following his family story with what might be done about affordability Biden went on to tell the task force members that the administration is proposing “more support for caregivers” – counseling, training, help with transportation and temporary respite care so that they are better able to balance work with caregiving. (Full disclosure here, I’m a social worker and though you would think I’d be in favor of counseling I’m not when I know it does nothing to address the much larger problem).

So Biden introduces the elder care problem as one of affordability, and then proposes—not compensation for family caregivers, an affordable continuum of care, or building the capacity of the caregiving workforce—but counseling, training, and temporary respite! Just what a stressed out caregiver needs, “training” (to do what?), and counseling (please show me the research that suggests that is high on the list of caregiver needs). How can this help when the main problem is lack of time, money, and available services? And speaking of “time” how will caregivers, particularly those who must work, find the extra hours to be trained and counseled? Oh, yes, and temporary respite, at best a stranger to pop in now and then so the caregiver can do some grocery shopping or go to the doctor. Even if a social work-type support program were devised, it would have to follow the model of the best case management programs, those where the social workers document the extent and complexity of the needs (not as gatekeepers who determine eligibility) and where there are ample and diverse services to which people can be referred. And of course for anything to be helpful to these families, whose needs are multiple and often rapidly changing, the relationship with the social worker has to be close and continuous with home visits and plenty of time to devote to the family.

Biden said that nearly 200,000 people will be served. What could this number possibly mean. There are an estimated 52 million formal and informal caregivers to ill and disabled adults over 20 years of age in this country Training and counseling for family members smacks of blaming the victim, and respite--even when available and reliable--is not acceptable to many families or the elderly themselves. Perhaps if 200,000 new good jobs for paid personal care workers were the target at least we would have the seeds of a pilot program. Some dollars for research on promising programs already out here might help too so that whatever policy and programs are developed there is some knowledge about how they work or don’t work.

John Podesta said a couple of days ago that Obama has lost control of the narrative, and if so this is a doozy of an example. No middle class person cares what well off people do to manage elder care and child care—they don’t have money to pay for private care and need options that are affordable, accessible, and morally acceptable. We all know that Biden can screw up just about any narrative, and he is probably at his worst when he does the “regular Joe” bit as he tried to do in this speech. Obama and Michelle both know first hand about the complex demands on middle and working class families who have to work and to care for an ill or disabled member. This is a narrative that Obama himself should take control of before it goes down the rabbit hole of this task force.

As far as affordable elder care I expect it to quietly fall off the agenda of the Task Force. Perhaps that would be preferable to proposing solutions that have nothing to do with the problem. Unless these work-family balance programs are fully informed by all the research and years of thinking about what is needed, those millions of unpaid, unsupported caregivers, whose numbers are growing exponentially, will have to look elsewhere for their hope.

Thursday, July 30, 2009

The 'Queerness' of sitting down for a beer at the White House.

Is it just me or does the idea of Obama, Gates, & Crowley sitting down for a beer today seem queer (in the broad queer theory sense of being outside socially constructed 'norms'). I am white and female, and my image of guys having a cold beer after work involves some kind of (safe, third space?) social setting (a bar) with some (safe?) reason/excuse for sitting down together (a game) so that you don't have to really go too deeply emotionally or solve problems any bigger than the Red Sox and steroid use. I like going for a drink after work to wind down and shoot the sh*t as they say. But if it means having drinks with people I don't know in the most power-drenched setting in the world, and then taking on some weighty, politically fraught subject like the Gates arrest I'm going straight home.

As an opener I suggest 'How 'bout them Sox?' Lots of luck guys but you can count me out.

Wednesday, September 10, 2008

Is Parental Alienation Child Abuse? It can be.

I haven't been able to unearth the details about why the judge in Palin's sister's divorce case was concerned about child abuse but my guess that the judge saw evidence of psychological harm to the children. It was an acrimonious divorce case and Sarah Palin's sister and her family may well have been putting the children of the divorcing couple through hell. I'm a social worker and a child of divorce. In my case my parents tried (not always completely successfully) to stay respectful of one another. Yet it was still difficult for me not to feel some distancing from my father.

Divorce is hard enough on kids but too many parents make the children suffer terribly by doing everything they can to make the child despise and fear the other parent, including enlisting his/her parents and siblings in the war for the children's affection and trust. This is parental alienation. It's a continuum but anyone who has been subjected to this as a kid knows how life-scarring it is. When other members of the family get into the fight, the child has no safe harbor and is forced to take sides and "lose" the other parent. Child abuse? It can be.

Monday, August 18, 2008

McCain Cheated at the Saddleback and here's the proof.

I actually did not think that the Saddleback Civil Forum was going to be that compelling but wanted to hear how Obama managed because I care about his faith and how he expresses it. So I Tivoed it and watched it Sunday evening. Now I have it recorded and I can go back to it when I need to because it was the most revealing picture of McCain’s character I’ve seen yet. When I watched it casually, I had the strong sense that something was “off.” Well, it certainly was. I’m a college professor and I know cheating when I see it and McCain out-and-out cheated. It doesn’t even matter how he did it but he had the questions beforehand.

First let me say, Obama and McCain did not get the same test. Warren introduced the Forum by saying that the candidates would get the same questions. They did not get the same questions. They were asked in very different ways and with different introductions by Warren. So Warren is implicated here and he needs to pray for forgiveness for his part in all of this.

Second, Warren did not call McCain out when he jumped on the questions almost before Warren finished asking (see McCain about 1:50 in the video on education for example, “Yes, yes, and yes”), and indeed answered two of them well before they were asked (see below). Warren warned Obama not to use his stump speech but let McCain gleefully launch into his “drill now” thing. The guy was showing off that he knew the questions and he manipulated the audience (shame on them for falling for it) with his Christianism-speak.

I was dumbfounded at what Warren let McCain get away with while he held Obama’s feet to the fire. We all know now that there was no “cone of silence” but Warren implied that McCain was in a room waiting with no access to what was being asked. McCain reinforced the impression that he was in a secure room by joking that he “trying to hear through the wall.”

McCain does not answer the question Warren asks about a position he held 10 years ago and changed his mind about, McCain launches into his stump speech on drilling and security and basically answers one of the questions that hadn’t been asked yet and Warren says,

WARREN: Well, you just took the — I had that question later on but now we don’t have to ask it.

Later, many minutes before Warren asks about the Supreme Court Justices the following exchange takes place.

WARREN: OK, we don’t have to beleaguer on that one. Define marriage.
MCCAIN: A union — a union between man and woman, between one man and one woman. That’s my definition of marriage.
Could I — are we going to get back to the importance of Supreme Court Justices or should I mention –
WARREN: We will get to that.
WARREN: You’re jumping ahead (inaudible).

Obama was respectful of the audience and of the setting and gave thoughtful, authentic answers. But McCain is in the end zone doing his victory dance on this one. Are we going to let him get away with this?

Thursday, June 26, 2008

Bush's ol' fashioned racism

Bush managed to insult the President of the Phillipines this week by commenting that he appreciates the cooking of Phillipine-Americans in the White House. Filipino President Gloria Macapagal Arroyo, who was in Washington while her country tries to recover from a typhoon that devastated coastal areas and flipped a ferry carrying over 800 passengers last week. Before discussing aide for the Philippines, Bush couldn't resist beginning the sober meeting with a quip about a Filipino member of his kitchen staff.

PRESIDENT BUSH: Madam President, it is a pleasure to welcome you back to the Oval Office. We have just had a very constructive dialogue. First, I want to tell you how proud I am to be the President of a nation that -- in which there's a lot of Philippine-Americans. They love America and they love their heritage. And I reminded the President that I am reminded of the great talent of the -- of our Philippine-Americans when I eat dinner at the White House. (Laughter.)


PRESIDENT BUSH: And the chef is a great person and a really good cook, by the way, Madam President.


Then there is this photo of him taken in Iowa. I guess Po' ol' Massah just doesn't know that rubbing the head of a black child (or an adult) is a deeply repugnant act and a racial insult. Makes you shudder to think what he'll do to Obama at the Inauguration. It helps that Obama is tall and may well be wearing a hat.

Friday, May 9, 2008

You Spin me 'Round 'Round

I've been in Toronto at a conference and heard James Pennebaker comment on the words that candidates use. This analysis is about spin. Check it out.