Programming for Family Care of Elderly Dependents: Mandates, Incentives, and Service Rationing

Over a decade ago, the World Assembly on Aging convened in Vienna to bring attention to an emerging demographic imperative. The world's population is aging at an unprecedented rate, with the most dramatic growth observed in developing nations. The International Institute on Aging estimated that between 1985 and 2025, the aging population would increase 77 percent in developed nations and 207 percent in developing nations (Kosburg, 1992). These estimates are consistent with those developed by the United Nations (1988) and demographer George C. Myers (1990). The final report of the World Assembly noted the central role that families play in support of dependent elderly people (United Nations, 1982). Yet families in both developed and developing countries are experiencing changes that seriously limit the resources available for elder care. In developed countries women are entering the work force in unprecedented numbers. In developing countries economic growth draws young adults away from rural areas, leaving dependent elderly people to fend for themselves (Kosburg, 1992; Tracy, 1991). So although nations may vary in the degree to which cultural norms enforce the notion of filial piety, they have in common economic pressures that make fulfillment of this norm difficult for modern families. Caught between the increased need for care of dependent eiders and the diminished family capacity to provide such care, many have struggled to define the appropriate response of government. One notable result is the World Assembly's International Plan of Action on Aging (United Nations, 1982; United Nations Economic and Social Council, 1989), which emphasized the importance of policies that would strengthen family support for elderly dependents. As Hashimoto and Kendig (1992) noted, a 1989 review of the plan "revealed a sobering lack of progress" (p. 3). In a period of worldwide economic stagnation, it may be unrealistic to anticipate expanding social care for the elderly population, a group widely perceived as lacking in productive capacity. Nonetheless, both the International Federation on Aging (Nusberg, 1984) and HelpAge International (Tout, 1989) have identified a wide range of emerging program and policy alternatives. This article examines three approaches: filial support legislation, incentives for family care, and service rationing provisions. These methods were chosen for their ubiquity - they have been either contemplated or applied in many nations. They share a common intent: to place the burden of care for dependent elderly people on family instead of government. Material used is drawn in part from a survey completed by aging specialists in 33 countries throughout the world. International Survey The key informant approach was used to collect information about programs and policies throughout the world. Surveys were mailed to 137 organizations serving elderly people. The source of addresses was a directory prepared in 1988 by the American Association for International Aging, An International Directory of Organizations in Aging. The directory is divided into five sections: Africa, Asia and the Pacific, Europe, Latin America and the Caribbean, and North America. Respondents were selected to optimize geographic coverage and to ensure inclusion of representatives from both developed and developing nations. Table 1 shows the number of surveys sent, the number returned, and the response rate in each region. The overall response rate was 24 percent, with the highest rate in Europe and the lowest in North America and Asia. Table 2 presents a list of countries from which the author received responses. Table 1 Survey Response Rate by Region Surveys Responses Response Region Mailed Received Rate (%) Africa 22 5 23 Asia and the Pacific 47 7 15 Europe 41 15 37 Latin America and the Caribbean 20 5 25 North America 7 1 14 Total 137 33 24 Respondents were primarily professors and researchers from universities and institutes for gerontology (n = 14, 42 percent). …