Abstract:

Standard socioeconomic & health statistics paint a progressively bleak existence for many Americans from the near to the oldest old, particularly, special populations of old, frail, single women, in rural & urban minority enclaves. Policy-relevant knowledge is lacking about the interplay of formal paid-for human & health service sectors with informal, unpaid personal care & communal support processes. The traditional way of aging well privately with insurance still underpins public welfare deliberations, & ironically, obscures the rising social phenomenon of the third & fourth ages of life, functioning as a renewable & sustainable resource for informal health care & social support. Unless the formal/informal human care resource unit of survival into old age is understood, policymakers cannot decide how to ration the supply or curb the demand for long-term services. These issues & their implications are examined, & the question of how to deal with the problems of misallocated public resources, limited private resources, inequity, & inefficiency is also addressed.