Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are family caregivers of someone age 65 and older who needs help because of a limitation in their physical, mental, or cognitive functioning. As a society, we have always depended on family caregivers to provide the lion's share of long-term services and supports (LTSS) for our elders. Yet the need to recognize and support caregivers is among the most significant overlooked challenges facing the aging U.S. population, their families, and society. For decades, demographers, gerontologists, health researchers, health care professionals, economists and other experts have called attention to the nation's rapidly aging population. However, little action has been taken to prepare the health care and LTSS systems for this unprecedented demographic shift. By 2030, 72.8 million-more than one in five U.S. residents-will be age 65 or older. The greatest growth will be in the numbers of the "oldest old," the population that is most in need of help because they are the most likely to have physical, cognitive, and other functional limitations. The increasing diversity of older Americans may further increase the demand for caregivers because data indicate that older African-American and Hispanic adults have been more likely than white adults to have functional impairments. In less than 15 years, nearly 3 in 10 older Americans will identify as a member of a minority group. Differences in culture, along with differences in income, education, neighborhood environments, lifetime access to health care, and occupational hazards will have a significant impact on the need for care, the availability and willingness of family caregivers to provide it, and the most effective and appropriate ways to provide caregiver support. Developing programs and services that are accessible, affordable, and tailored to the needs of diverse communities of caregivers presents significant challenges. While the need for caregiving is rapidly increasing, the pool of potential family caregivers is shrinking. Families have fewer children, older adults are more likely to have never married or to be divorced, and adult children often live far from their parents or may be caring for more than one older adult or their own children. In the past, families could rely on women to provide what is often referred to as eldercare, especially daughters, daughters-in-law, and wives who were not in the workforce. Today, the typical caregiver is still female. But that caregiver is almost as likely as a male caregiver to be employed, to need employment income, and to have limited schedule flexibility to juggle caregiving, work, and other responsibilities.
Community health centers (CHCs) are in a strong position to meaningfully contribute to health promotion, early detection, and improvement in health care outcomes for some of the most vulnerable person in the nation, since almost one in three users of federally funded CHCs was uninsured in 1994. The purpose of this article is to compare uninsured CHC users with uninsured people nationwide. Data for the analysis came primarily from two population-based surveys: the 1994 National Health Interview Survey (NHIS) and the 1995 Community Health Center (CHC) User Survey.
This article reports findings from an assessment by the Office of Technology Assessment (OTA), an analytical arm of the U.S. Congress. In brief, OTA found the conventional wisdom that American adolescents as a group are so healthy that they do not require health and related services is not justified. Even more disturbing, U.S. adolescents often face formidable barriers in trying to obtain health care. OTA suggested that Congress could act to 1) increase adolescents' access to health care, most effectively by supporting school- or community-based comprehensive health services specifically for adolescents, 2) restructure and reinvigorate the federal role in adolescent health, most visibly by creating an office of adolescent health in the U.S. Executive branch, and 3) improve adolescents' social environments, by providing more support to the families of adolescents, limiting adolescents' access to firearms, supporting the expansion of recreational opportunities for adolescents, and further supporting opportunities for community service. Congressional actions taken since the release of OTA's report are summarized.
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