The Availability of Care for Late-Middle-Aged Adults With Chronic ...

Spousal assistance may be weighed against a depletion in savings and potentially a loss of health insurance coverage if the spouse must leave the workforce to provide assistance, scenarios less likely for an older couple who is likely already retired and covered by Medicare. Indeed, people in late middle age in general are at high risk for being uninsured as they transition out of work but are too young for universal coverage under Medicare (Pol, Mueller, & Adidam, 2000).

Cohort differences may exacerbate problems in access to helping resources for late-middle-aged adults with disabilities at the turn of the 21st century. They are the baby boomers and pre-boomers, characterized by a higher rate of divorce and a lower rate of remarriage, a lower rate of fertility and later child bearing, and a higher proportion of women with extensive work histories than today’s older cohorts. Thus, on the one hand, both life stage and social cohort effects may compound the problem of family availability to provide help to people with functional limitation in late middle age. On the other hand, the increased labor force participation of women may potentially allow for more paid assistance. How these life course issues actually play out in terms of differences in care arrangements has not been studied.

Clearly, work in this area was long overdue. The merging of the Health and Retirement Study (HRS) and the Assets and Health Dynamics of the Oldest Old (AHEAD) data sets, the premier sources of information on resources, health, and well-being, made it possible to examine these questions. We made use of the 2000 survey, a representative sample of noninstitutionalized adults aged 50 and older in the United States.

The final two sections of this chapter provide a road map for the rest of the book. We first provide definitions that are critical to the understanding of the entire discussion. We end this chapter by outlining the chapters that follow.