The 2030 Caregiving Crisis
The 2030 Caregiving Crisis
The United States lacks a long-term care system. The closest it has is Medicaid, a safety net program for the very poor. According to the U.S. Department of Health and Human Services, at least 90% of older persons receiving help with activities of daily living (ADLs) in 2011 relied on some "informal" care, from family members and friends. About two thirds relied on only informal care. Family and friends collectively provided 75-80% of total care hours in non-institutional settings (Spillman, Wolff, Freedman, & Kasper, 2014). Help with ADLs involves one or more basic daily functions, including dressing, self-feeding, grooming, toileting, bathing, transferring (e.g., into and out of bed) and moving from one place to another.
Keeping an older adult in the community using round-the-clock formal care is an expensive proposition. Community Medicaid will pay for some custodial care at home, but rarely beyond six hours daily. With most states in budget crisis, even limited services are difficult to access and long waiting lists are common. When paying privately for care is unaffordable, family members assume the burden by default. Older adults without available family help are consigned to nursing facilities or risk health and safety by remaining alone in their homes.
Most family caregivers today are motivated by an intense desire to keep loved ones out of the understaffed and under-resourced nursing homes they see as little more than warehouses for disabled and demented older adults waiting to die. Even when they can afford elite nursing facilities, family members still face the emotional distress that inevitably accompanies this late-life transition. It is not surprising that the number of people residing long-term in nursing homes has dropped over recent decades, even as the number of older adults needing care at this level has remained the same (Redfoot & Houser, 2010).
The situation is about to get worse. The tidal wave of baby boomer retirement is upon us along with the "birth dearth" that followed. Family caregivers, adult children in particular, face bleak prospects. Adult children of boomers, Generation X and early Millennials, will be dealing with work obligations, their children's college expenses, the effects of the recent recession, and ongoing economic stagnation. They will be hard-pressed to take on the extent of caregiving that will be needed by the huge boomer generation.
This book makes the case for recruiting and training millions of additional personal care aides as boomers age into their 80s and face chronic illness and severe disability. The aides will be needed to assure safety and emotional well-being and to relieve overburdened family members. They should be deployed into private homes, senior residences, and even nursing homes to ensure quality person-centered care for up to 24/7. Medicare, or a new insurance program, should make such assistance universally available.
The 2030 problem
We are well aware that the retirement and aging of baby boomers over the 40-year period from 2010 to 2050 will present problems to advanced nations, including the United States. Some call it the Silver Tsunami. Demographers, epidemiologists, economists, and sociologists have been digging into the numbers and a large literature has emerged describing the many potentially serious social and economic problems that are likely to accompany a rapidly aging population. The scale and pace of aging is unprecedented for modern advanced societies and is already reaching into developing nations, notably China.
This book argues that most of the analyses and predictions used in policy discussions in the U.S. underestimate the extent and depth of what we will be facing. In particular, they do not appreciate the implications of what some refer to as the "2030 problem". 2030 is when retired boomers start becoming octogenarians in large numbers. Between 20