This paper examines the major social, legal, and financial challenges facing elderly Americans. It traces the origins and current significance of Social Security, discusses the political power of senior advocacy groups such as the AARP, and explains the importance of advance directives and living wills for end-of-life planning. The paper also surveys the rapidly growing field of elder law, outlines the risks of financial exploitation and abuse, and analyzes age discrimination in healthcare and mental health settings. Drawing on government data, peer-reviewed research, and legal scholarship, the paper argues that while society bears no strict legal obligation to seniors, it does hold a compelling moral and ethical responsibility to protect this vulnerable and growing population.
The American population is growing older — due in large part to the aging of the baby boomer generation — and the issues that surround the aging process, including the services and legal ramifications linked to getting older, are coming into focus more often and with greater urgency. This paper delves into Social Security, death and dying issues, laws that impact the elderly, discrimination against older people, and financial issues as well.
As to the question of whether society has a legal obligation to its senior citizens, the answer is "no" — with a qualification. Many leaders, politicians, clergy, and ordinary citizens believe that society has a moral and ethical obligation to provide certain important health and financial resources for senior citizens.
When Franklin Delano Roosevelt (FDR) came into the presidency, he believed it was his duty first to try to dig the country out of the Great Depression, and second to set the wheels in motion for future financial protections for the elderly. Roosevelt pushed Social Security legislation through Congress and signed the bill into law in 1935. Monthly taxes began to be collected from workers' paychecks in 1937, and benefits began being paid to enrolled seniors in 1940 (Social Security Online, 2011).
In one of his 1935 "fireside chats" (Buhite, 1992, p. 66), FDR said, "We must begin now to make provision for the future and that is why our social security program is an important part of the complete picture." FDR saw Social Security as an "old age pension" designed to provide income for the elderly, but he also foresaw that it would make it easier for older people to "give up their jobs and thus give to the younger generation greater opportunities for work" (Buhite, 66).
Moreover, FDR told the nation through his radio broadcasts that Social Security checks would not only help guard against the financial hardship that comes during layoffs — guarding "against dependence upon relief" — but would help sustain the "purchasing power of the nation" and "cushion the shock of economic distress" (Buhite, 66). FDR also said Social Security would give an "incentive" to employers to plan more carefully so that unemployment may be prevented by stabilizing employment itself (Buhite, 67).
The Social Security Administration (SSA) released a fact sheet in August 2010 reflecting that: (a) the SSA paid benefits to about 57.6 million people in 2009; (b) for about 64% of aged beneficiaries, Social Security checks were "at least" half their total income; (c) women accounted for 56% of adult Social Security beneficiaries in 2009; (d) in 2008, some 88% of married couples and 86% of non-married persons aged 65 or older received Social Security benefits; and (e) Social Security was "90% or more of income for 21% of aged beneficiary couples and 43% of non-married beneficiaries" in 2008 (SSA, 2010).
Do senior citizens wield political power as a bloc of voters concerned about the central issues of their health, prosperity, and well-being? The answer is yes. The most important form of political power that senior citizens have in the United States today is "electoral bluff" (Binstock, et al., 2010). The electoral bluff occurs when legislation is proposed that may affect Social Security — especially when that legislation is perceived as potentially harmful or threatening to recipients. A clear example is when President George W. Bush introduced the idea of privatizing Social Security and made it a major proposal of his administration. In the end, seniors' opposition to privatization hurt Bush politically.
Binstock recalls that Bush had a "long history of ideological distaste for Social Security" and notes that while in business school, Bush had "denounced President Franklin Roosevelt as a socialist, and specifically identified Social Security as one of several New Deal programs that he opposed" (Binstock, 273). Organized labor and the American Association of Retired Persons (AARP) came out strongly against the Bush proposal, which would have required seniors to set up private accounts into which Social Security payroll taxes would be funneled. Supposedly it would have given older people flexibility and the opportunity to choose their own investments, but seniors favored the existing program, and Bush retreated.
When united behind an advocacy organization like the AARP, seniors can pack a powerful punch in Washington, D.C., Binstock explains (270). The AARP demonstrated its influence by spending "millions of dollars of the organization's wealth on ads in nationwide and state media venues," and in the case of the Bush privatization scheme, the money was put to good use (Binstock, 274).
The AARP watched the bitter battle of ideologies, personalities, and budgets play out in the debate over raising the debt ceiling in 2011, and CEO Barry Rand offered comments for AARP's millions of members on August 2 of that year. Rand said he — like the majority of older people — was glad the country did not default on its debts, which would have hurt nearly every aspect of the economy, including older people. He also said he was pleased that the deal cut between the White House and Congress did not cut Social Security or Medicare in that first round of deficit reduction.
However, Rand pointed to the uncertainty ahead for older people, because part of the legislation that raised the debt limit created a "super committee" of members from each party tasked with recommending further cuts to the federal budget. Rand worried that using a Congressional committee to decide what gets cut would deny Americans "a voice in the discussion about critical tax, health and retirement issues" (AARP, 2011, p. 1). If the "super committee" could not reach agreement, AARP feared that the "trigger" built into the deficit reduction legislation would "arbitrarily cut provider payments under Medicare, which could unfairly shift costs to seniors" (AARP, p. 1). The AARP pledged to "continue to raise the voices of millions of Americans who rely on their Social Security and Medicare benefits and oppose benefit cuts for deficit reduction," Rand concluded. Not cutting Social Security and Medicare was a position that President Barack Obama articulated numerous times during that contentious debate over the debt ceiling (AARP, p. 2).
The bottom line for older people today is that they cannot totally rely on Congress to do what is right for them, given that the House of Representatives has carried a majority of conservatives who have shown they are not shy about cutting federal entitlement programs — notwithstanding the social and financial pain seniors would have to endure.
The National Institutes of Health (NIH) provides a number of services and links to important agencies for older people through a series of "advance directives." The advance directives are designed to help people as they age make decisions about what kind of end-of-life care they wish to have. The NIH suggests that older people should create a "living will" that explains in legal terms to healthcare professionals what they want done should they become too ill or otherwise unable to articulate their wishes. If a person is seriously injured and cannot breathe on their own, do they want to be resuscitated and placed on a breathing machine? Do they wish to have their organs donated? These are questions the NIH urges people to address through an advance directive while they are able to, so there will be no confusion when they may be incapacitated (NIH).
The Family Doctor healthcare website explains that a "living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill" (Family Doctor). It is an advance directive. Another advance directive is granting power of attorney to a family member or spouse, so that whenever a person is unconscious or mentally unable to make medical decisions, the designated individual makes those decisions based on what has been legally agreed upon in the living will.
Family Doctor assures older people that they do not need to fill out "complicated legal documents" to make their advance directive official. A person can write down his or her wishes on a piece of paper, date it, have it notarized (not required but always advisable), and keep it in a safe place. It is also wise to have it reviewed by a doctor or attorney so that what you wish to have done if you become incapacitated is "understood exactly as you intended" (Family Doctor).
Advance directives are sensitive and private documents, and they can be controversial. It is therefore wise for older people to know the law and understand the facts. Rumors and falsehoods have been spread about the advance directives contained in the recent overhaul of the healthcare system. Former governor of Alaska Sarah Palin made news in the summer of 2009 by asserting that the advance directives in the healthcare overhaul created a "death panel" of bureaucrats who would "decide, based on a subjective judgment of their 'level of productivity in society,' whether [certain older people] are worthy of health care" — or should simply be allowed to die (Malcolm, 2009).
In fact, there are no death panels. For her politically motivated claim, Palin's assertion was voted by an online contest as "the biggest political lie of the year" (Malcolm, p. 1). The non-partisan site PolitiFact.com, an independent fact-checking site run by the Pulitzer Prize-winning "Truth-O-Meter" (published by the St. Petersburg Times), explained that Palin's claim "stood out from the rest" (Malcolm, p. 1). Palin is not the only politician who has made untrue or uninformed statements about senior citizens' healthcare. The passage of the Affordable Care Act has also been attacked as a "government takeover of healthcare," and accusations have been made — incorrectly — that seniors will lose access to Medicare Advantage plans.
The Affordable Care Act is designed in part to help older people live longer and healthier lives. As of September 23, 2011, the Act was set to provide (in most cases at no cost to seniors on Social Security and Medicare) preventive services such as blood pressure, diabetes, and cholesterol tests; cancer screenings including mammograms and colonoscopies; counseling on weight loss, quitting smoking, treating depression, healthy pregnancies, and reducing alcohol use; vaccines against measles, polio, and meningitis; and more (HealthCare.gov).
"Growing field of legal services for seniors"
"Financial exploitation and age bias in healthcare"
As author Elizabeth Collier explains, much of society views the world through the lens of a "younger person's culture" (45). Older people face institutional discrimination, the possibility of a family member abusing power of attorney, and enormous financial and health-related challenges. But as this paper points out, there are strategies older people can employ to stay healthy, remain financially secure, and protect themselves from financial exploitation. In the future, groups like the AARP will need to continue lobbying Congress and the White House to ensure that Social Security and Medicare are not cut, and advocacy organizations will need to reach out to struggling senior citizens and help provide the services they truly need.
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