The Looming Shortage of Family Caregivers
With 10,000 baby boomers turning 65 each day, our senior population is skyrocketing. Who will care for these seniors? A new report from the AARP is a wake-up call to prepare for a future that looks quite different from today’s elder care scenario.
How well are Americans aging? Harvard economics professor David Cutler thinks there is reason for optimism. He recently released a study showing that seniors today are helped by advances in medicine, and are taking better care of themselves to prevent physical and cognitive decline. "With the exception of the year or two just before death, people are healthier than they used to be," Cutler explains. "Effectively, the period of time in which we're in poor health is being compressed until just before the end of life. So where we do see people who are very, very sick for the final six or seven years of their life, that’s now far less common. People are living to older ages and we are adding healthy years, not debilitated ones."
However, Dr. Alexander Smith of the University of California, San Francisco cautions that we should be prepared for health challenges that accompany our increased longevity. Reporting in JAMA Internal Medicine, he said, "Our data do raise the question of whether it makes sense to sell the public a view of aging that purports that it is reasonable to expect to both live a long life and remain free of disability throughout life." He defined disability as needing help with at least one of the activities of daily living: dressing, bathing, eating, transferring, walking across the room and using the toilet.
The message is that while we are living longer and experiencing on average more years in good health, we also are likely to need care in our later years. Today, the lion's share of senior care is provided by family members and friends: According to the American Medical Association, family caregivers provide 80 percent of elder care — valued at $450 billion. Will this scenario continue to be the norm? No, says a recent demographic projection by the AARP.
The Caregiver Ratio Shrinks
"The Aging of the Baby Boom and the Growing Care Gap," released in August by the AARP Public Policy Institute, offers some sobering statistics. Says AARP senior policy analyst Lynn Feinberg, "As the number of people over the age of 80 increases in the next 20 years, the number of people in the primary caregiving years will remain flat." Today, the relatively smaller group of people age 65 and older is receiving care from the very large baby boomer population. Feinberg reports that today’s average senior has an average pool of seven people who can help. But as the boomers themselves begin to need care, the balance will shift alarmingly. "By 2050, the caregiver support ratio, which was 7.2 in 2010 when boomers were in their peak caregiving years, is projected to drop to 2.9 when the boomers reach their eighties," said Feinberg.
This shifting ratio isn’t the only factor to consider. The children of the boomer generation also are in a less optimum situation for providing care. Many are having their children later in life. Many took longer to establish their careers and are less able to take off time to care for elderly relatives. Women, who were traditionally the caregiving sex, are today more likely to work outside the home. Young people are continuing the trend of moving away from their parents’ community upon adulthood. A more and more common scenario is an only child trying to provide care for divorced parents who live on opposite sides of the country.
In the face of this situation, how should people plan for the care they may need in their later years? Says Feinberg, "More than two-thirds of Americans believe they will be able to rely on their families to meet their needs when they need long-term care. But this confidence is likely to deflate when it collides with the dramatically shrinking availability of family caregivers in the future." She stresses that we need to think about long-term care in a different light: "Rapidly increasing numbers of people in advanced old age and shrinking families to provide support to them demands new solutions to financing and delivering long-term services and support."
Finding Solutions to the Caregiver Crunch
What can we do to address this situation? On a national level, we can let our lawmakers know that long-term care is an important concern. We can urge our local, state and federal governments to focus on this coming crisis. This year, the new Commission on Long-Term Care was directed by Congress to develop recommendations for the establishment, implementation and financing of an effective system of elder care support. This bipartisan commission has been hearing testimony from an array of leaders in the field and is in the process of presenting a comprehensive report.
On the family and individual level, we can educate ourselves and prepare for whatever the future may bring. Nobody likes to dwell upon the possibility of their future physical and cognitive challenges — but even the healthiest person can face disability down the road. Taking a realistic approach, ask questions like …
Are my financial affairs in order? Have you saved enough to pay for care if you need it? Would long-term care insurance be a good choice? Learn about Medicare, Social Security and the other benefits to which you are entitled. Elder care attorneys, financial planners and geriatric care managers can help you with these issues.
Will my community be a good place to age? Find out how "age-friendly" your neighborhood and city are. Will you be able to access medical facilities, senior centers and meal programs? Does your community provide transportation for citizens with disabilities? Are there housing choices that would work for you if you decided to move to a retirement community, or needed skilled care in a nursing home?
Will my home be a good fit for me as my needs change? Many people decide to downsize or move to a retirement community once they retire — but many others would prefer to stay in their home, near familiar friends and services. A poll in the May 2013 issue of Caring Right at Home found that almost half of the respondents have already made safety and accessibility changes to their home to support the well-being of senior residents. Anticipate your future needs and make smart home modifications that will be in place when you need them.
Professional Home Care Will Play a Larger Role
Most boomers state that they would prefer to receive care at home if it is needed, rather than in a nursing home or assisted living facility. With the shrinking pool of family caregivers, more of this care will come from professional in-home caregivers. The boomer generation, accustomed to massages, pedicures, and calling in consultants and professionals for so many aspects of life, will be increasingly likely to see professional home care as a way to preserve dignity and maintain the normal family relationships. Today’s home care agencies offer everything from skilled nursing services to less-costly companion care tailored to assist clients with any tasks they can’t handle on their own. In-home caregivers provide:
Assistance with personal care. Arthritis, osteoporosis, the effects of a stroke, visual changes, memory loss and many other health challenges can make it difficult for seniors to bathe, dress and perform other hygiene tasks. In-home caregivers can come to the home for a few hours to full-time to keep clients safe and well-cared for.
Housekeeping and laundry. When the changes of aging make it difficult to keep up with the house, in-home caregivers can keep the home environment clean and in good order. This is beyond the scope of a traditional housekeeping service; for example, professional senior care providers are trained to understand the devastating impact falls can have on an older adult, which enhances the caregiver's ability to spot and remove fall hazards.
Support for health management. In-home caregivers provide medication reminders, ensure that clients get to medical appointments, and help them follow the healthcare provider’s recommendations.
Supervision and companionship. Seniors risk entering a cycle of decline when mobility or sensory challenges make them afraid to be active. In-home caregivers provide the measure of confidence to encourage physical activity, mental stimulation and socialization.
Transportation. When a senior can no longer drive, isolation often follows. In-home care doesn’t take place only in the home!
Do Your Home Care Homework
If you think you would want to receive care in the home — or if you already need care or are serving as a family caregiver — learn about the home care services available in your area. Should you hire a caregiver yourself, or go through an agency? Some families have hired from Craigslist or through a referral from a friend. But given the burden of finding, hiring, training and functioning as an employer, going to an agency provides several advantages. An experienced caregiver arrives pre-screened, trained and under the supervision of the agency. Families don’t have to worry about tax withholding, or liability. And if the caregiver doesn’t arrive, it’s the agency’s responsibility to provide a backup.
Read the entire "Aging of the Baby Boom and the Growing Care Gap" report on the AARP website.
Find a useful graphic representation of the future of long-term care for seniors created by the Kaiser Family Foundation for the Journal of the American Medical Association.
See the Harvard Gazette to learn more about Professor David Cutler's study of life expectancy.
For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.