In November, the Longevity Project, supported by the Stanford Center for Longevity, held The 2023 Century Summit, a 2-day event covering the global challenges of aging. Sessions featured leading professionals discussing such issues as healthcare, financial aspects of retirement, building community and more. You can view videos of all the sessions here.
While I learned many important things, I was particularly interested in one session: "Home, Place and Where We Will Live Our Longer Lives." It took on special relevance for me as an older Boomer since I had recently made the decision with my wife to downsize and relocate across the country to live near our daughter and new granddaughter.
It also struck a chord because in August, my mother-in-law reached her 100th year and then passed away in October. She had transitioned in her final years from independent living to assisted living to rehabilitation from a fall in a skilled nursing facility and briefly to hospice. I got to witness the full spectrum of end-of-life care.
This Century Summit session, in combination with my own recent experiences, prompted me to acknowledge a cold reality: The U.S. is simply not ready for aging Boomers. During the session I referenced, moderator Amy Yotopoulos, President and CEO of Avenitas, spoke with Dr. Terry Fulmer, President of The John A. Hartford Foundation and Seth Sternberg, CEO of Honor. (Rather than explain what these organizations do I have linked to them.) The discussion centered largely around in-home care.
As you may know, about 55 million Americans are over 65 years of age. You may also know that an overwhelming number of them (more than 90 percent) want to age in place.
The disconnect is caregiving.
Seth Sternberg made it clear: "The biggest barrier to in-home care is affordability." According to Sternberg, people who are well off can afford in-home care and people who are poor can apply for Medicaid to cover in-home care -- but that leaves "the middle," who typically have to rely on caregivers made up of family, friends and neighbors. One of the main problems with the caregiving industry itself, says Sternberg, is that it is "hyper fragmented," making it difficult to offer any kind of scale that results in affordability.
Terry Fulmer agreed, adding that very few of us who are over 65 "are getting the type of caregiving they want." Fulmer pointed out that a lot of this is based on payment structure. "We pay for things one disease at a time," says Fulmer.
How caregiving expenses are covered is also problematic. For example, if someone over 65 has hip surgery, Medicare will pay for hospital care and rehabilitation at a skilled nursing facility. But if that individual needs longer-term assistance, such as in-home care, assisted living or even a return to skilled nursing, health insurance coverage becomes far more complicated.
Fulmer cited some statistics that surprised me. She said only 800,000 people in the United States are in assisted living, and only 1.2 million are in skilled nursing facilities, with around 500,000 of them in skilled nursing for rehabilitation purposes. The PACE program, lauded for offering dining, recreational and daycare services to seniors who remain in their homes, serves only about 67,000 people.
It seems to me these numbers are stunningly low for a population in the tens of millions. With only 800,000 seniors in assisted living facilities, why should companies that operate them improve them, make them more affordable or even build more of them? The same goes for skilled nursing facilities if a little over half a million seniors are permanent residents there.
The North Carolina assisted living facility at which my mother-in-law resided cost close to $8,000 per month, while the skilled nursing facility she was about to enter as a permanent resident after rehabilitating there was closer to $10,000 per month. Without a combination of Social Security income, a few modest pensions and long-term care insurance (for which her children paid the premiums), she never would have been able to afford living at either facility long term. In fact, she remained living independently far longer than she should have, with my wife serving as her primary caregiver.
It may be possible for some seniors to remain in their homes, but for many it is an unrealistic scenario because their home is not conducive to aging in place. In addition, paid in-home healthcare is either too expensive or too inferior in quality. This is why millions of family members and friends act as unpaid in-home caregivers. This often leads to inadequate care and/or caregiver burnout.
The alternative -- assisted living -- is often unaffordable, as is the long term care insurance that helps offset the cost. If a skilled nursing facility is required, the cost is even higher. Only the wealthy can afford to pay privately for a decent skilled nursing facility. For anyone else, it is unaffordable, except those with assets less than $2000. These poverty-level individuals can apply for Medicaid, which will cover the cost of a skilled nursing facility that agrees to accept Medicaid residents.
What will millions of Boomers who are living longer do when they need care in their later years and our society isn't ready to provide it?