For a while now, I’ve attempted to fact check the reasons people give for how and why caregiving has become a crisis. Care is arguably one of the most essential aspects of being human, so how could it become a problem?
One of the common explanations is that more people survive to old age than before, thanks to modern medicine. Thus, more people require care and it has become an overwhelming task.
If you’ve heard people refer to the Silver Tsunami, you know what I’m talking about.
In The Way We Never Were: American Families and the Nostalgia Trap, Stephanie Coontz notes:
“Many commentators claim that the crisis of rising health costs in America is a direct, inevitable result of the aging of our population...This leads to a zero-sum approach in which we blame the deterioration in the well-being of America’s children on the gains that elders have made, instead of recognizing the stake that each generation has in the well-being of other generation.”
This seems like the sort of thing that’d be easy enough to confirm or deny. Find the life expectancy of people at various times in the past and compare it to the life expectancy today (which has, by the way, been falling in the US since before the emergence covid-19).
Alas, it’s not so simple.
BBC Futures recently took a crack at figuring out if Europeans today really live longer than their European ancestors.
“it’s common belief that ancient Greeks or Romans would have been flabbergasted to see anyone above the age of 50 or 60, for example.
In fact, while medical advancements have improved many aspects of healthcare, the assumption that human life span has increased dramatically over centuries or millennia is misleading.”
“Life expectancy is an average. If you have two children, and one dies before their first birthday but the other lives to the age of 70, their average life expectancy is 35.”
The historical record suggests that a 30-something in ancient Rome was a young adult, just like a 30-something today. They were not an old man or a geriatric millennial.
“Taken altogether, life span in ancient Rome probably wasn’t much different from today.”
There’s also the issue of a lack of records. Perhaps you’ve heard the debates over how to get an accurate census. Perhaps you’ve heard that the best way to live to 100 is to be born in a country with lax record keeping.
In earlier eras, people often knew their birth cohort, not their exact age.
Ancient records existed for different purposes. The don’t make it easy for us to suss out what we’re looking for today, since that’s not what they were meant to be used for.
At one point my step-mom quipped that her long-term care plan was to have a heart attack and die instantly.
There’s the idea that in the ancient days, people died quickly once they became disabled. There were no long, drawn out deaths. To which I say…Tuberculosis. Syphilis. Or, more comically, all those depictions of pirates with hooks for hands and peg legs.
Pliny the elder put it more poetically:
“Nature has, in reality, bestowed no greater blessing on man than the shortness of life…The senses become dull, the limbs torpid, the sight, the hearing, the legs, the teeth, and the organs of digestion, all of them die before us…”
Saving for retirement, or whenever you were no longer able to work, is not a new responsibility, as Shulamith Shahar points out in Growing Old in the Middle Ages: 'Winter Clothes Us in Shadow and Pain':
“The idea has been put forward in social gerontological research that, during the Middle ages and later centuries until the nineteenth, people did not envision their own old age. In view of the high deathrate...they did not concern themselves with old age, nor did they take pains to secure themselves from want in later years since they did not expect to reach that stage. This idea is entirely erroneous. Didactic literature encouraged people to save for their old age, and whoever could afford to do so no doubt set aside as much as they could. People who did not save simply had not the means to do so.”
The Silver Tsunami is not even really unprecedented. Shahar explains how:
“for a period of about 100 years, in the fifteenth century, the percentage of over-sixties in most of Western Europe was much higher than in previous times, and higher than in later periods up to the twentieth century. This was because the plague of 1348 and its subsequent outbreaks...killed many children, and more young people than old.
Thus, in 1427, 14.6 per cent of the population of Florence were over 60, and in Ravenna 15.9 per cent. The same increase in the ratio of old people was taking place in other parts of Europe. This high percentage gradually declined during the period of recovery and the steady increase of the population from the late fifteenth century.”
Today “About one in every seven, or 15.2%, of the population is an older American”, according to the Administration for Community Living.
Perhaps we believe the old didn’t linger in the past because clinging to life was a sin. Shahar explains that for this reason, Religious miracle cures did not seek to cure the old.
Indeed, Gerald of Wales expressed the popular idea that only sinners wished to postpone death and those who did found “the punishment awaiting them in hell...For the virtuous, a short life was to be desired, the sooner to reach eternal joy in heaven.”
Why does the myth that caregiving has become a crisis because of increased longevity persist if there’s little evidence to bolster it?
It just feels right. It places the crisis as an inevitable side effect of an unquestionable blessing. What sort of monster would bemoan longevity and progress? Certainly not a saintly caregiver.
There’s also the coincidence that record keeping expanded dramatically at a time of rampant exploitation, malnutrition, overwork, and other life-shortening factors. As the BBC points out:
“They argue that if we think we’re living longer than ever today, this is because our records go back to around 1900 – which they call a “misleading baseline,” as it was at a time when nutrition had decreased and when many men started to smoke.”
Another common myth to explain the current caregiving crisis is that prior to the modern era, people with disabilities didn’t survive very long. People born with disabilities died as children. People who acquired disabilities didn’t survive long after injury, without modern medicine to keep them alive.
This is another misconception that’s impossible to conclusively disprove. There’s just not enough data on disability rates going back much more than 100 years ago.
In Remedy and Reaction: The peculiar American struggle over health care reform, Paul Starr recounts how:
“[I]n 1914 the Life Extension Institute, an organization associated with the [life] insurance industry, began offering checkups through panels of physicians around the country. Health examinations helped to foster the belief that Americans needed more medical care and health supervision, for they almost uniformly showed that very few people were healthy and normal. The results of the draft physicals during World War I were considered especially persuasive evidence. Of 3,760,000 men examined, about 550,000 were rejected as unfit; and of the 2.7 million called into service, about 47 percent were said to have physical impairments (Starr, 1982, 193).”
“Among five thousand citizens of Framingham, Massachusetts, examined as part of a Metropolitan Life insurance demonstration project to control TB, 77 percent were recorded as ill with some disease. Two thirds of defects were allegedly preventable (Starr, 1982, 193).”
It was these mass screenings that began a push for health examinations of the supposedly healthy, gaining the endorsement of the American Medical Association in 1922.
Prior to that, if you had an invisible disability or were able to work in some capacity, you weren’t diagnosed and weren’t disabled. Disabled meant blind, lame, feeble-minded. It meant something very different than it means today.
Which is, perhaps, why we assume disable people didn’t exist. They existed; they just didn’t count.
There are factors that have increased the number of disabled people who are alive today:
A reduction in rates of infanticide and neglect leading to the death of children born with disabilities
Critical injuries caused by modern weaponry and vehicles
A standardized built environment engineered to meet the needs of a hypothetical 6ft tall man without any disabilities or dependents
A life where expectations of educational and bureaucratic demands have led to newly relevant diagnosis such as ADHD, dyslexia, and Asperger’s syndrome
There are factors that have decreased the number of people who are living with disabilities:
Improved nutrition, access to clean water, and climate control
Corrective surgeries, treatments, and devices that eliminate a disability
Treatment and prevention of STIs reducing rates of blindness, neurological disabilities, and dementia
Workplace protections reducing the number of acquired disabilities (maybe?)
Just as the media skews our perception of crime rates, our impression of medical progress is skewed by fundraising campaigns for specific diseases. The quintessential example of this cystic fibrosis.
Cystic fibrosis is a diagnosis that shifted from foretelling the death of a young child to a chronic illness, supported by decades of intensive caregiving support.
To complain about the burden of care is tantamount to complaining that your beloved child did not die as a toddler and instead is a boisterous teenager who requires hours of exhausting treatments every day.
To complain about the burden of care is tantamount to saying you’d rather your parents be dead than foot the bill for a home health aid to watch over them while you’re at work.
This is why it’s such a popular story line. It’s difficult to imagine a better way to get people who are exhausted by compulsory unpaid labor and broken by the financial strain of caregiving to shut up and stop complaining.