Baby Boomers’ Top Issue: Care For Elderly

An old friend called the other day, more in need of reassurance that he would survive than for advice on how to do so.

His father had had two strokes within two weeks. My friend felt overwhelmed by the unexpected quickening of an ordered life now careering into unknown territory.

It is a roller coaster that more and more of my baby-boom generation colleagues are being faced with, a ride that usually feels more like a one-way ticket to hell than something they will pull out of.

My friend feared that his parents would face financial ruin if his father were placed in a nursing home - and that the stress would kill his mother.

His parents live a thousand miles from him. He could see ahead only the dark, uncertain commuting between his past and his future.

There never have been any guarantees in life. But with the federal government’s new budget-wrangling over changes in Social Security and Medicare - two programs that never have secured long-term care coverage anyway - no longer may there be any safety nets in old age unless we wake up and smell the demographics.

It is this crisis in long-term care financing and planning that Fernando Torres-Gil, assistant secretary for aging in the U.S. Department of Health and Human Services, recently addressed in the Bay Area. He visited a few organizations that have dealt successfully with the need to put more emphasis on more affordable and more comfortable home-based and community-based services, rather than putting dollars into institutions where nobody wants to go anyway.

He cited them as outstanding models that respond to the ethnic diversity of the older population and as services that address the unprecedented shift in U.S. population in the next few decades - a doubling of the over-65 population as we baby boomers drift into old age.

Projections from the U.S. General Accounting Office show that by the year 2060, there could be some 25 million people needing long-term care, compared with only 7 million today. And these figures are based on old morbidity rates, so the numbers could be significantly higher. As people age, they are more subject to the disabilities of old age which require some kind of care-giving.

“If we don’t address these issues today,” Torres-Gil says, “it will be far more expensive 10, 20 years from now to build the programs. If we rely on nursing homes alone and expensive institutional care, we will find that we have misspent our dollars, and the public will demand that we correct the inactions of today.”

According to the Federal Council on Aging, minority populations will account for a third of those over age 65 by the year 2050, compared with only about 14 percent today. These figures include a rapid increase in the number of elders over age 85 and in the alarming number of poor minority women living alone - the group most frequently on the losing end of a lifetime of poor health and low-paying jobs.

These are the people who are least likely to have health insurance. They are less likely to have awareness of preventive health care - and the education and funds for it. They must rely on government entitlements to pay for treatment after a crisis is full-blown - the most expensive kind of health care.

Home-based and community-based services not only make good economic sense, but they also make good emotional sense.

The family is beginning to redefine itself as fourgeneration households are on the rise. Yet, families can’t do it all themselves, even though they try; only 5 percent of the over-65 population actually is in nursing homes at any one time.

“All of us do want to take care of our family members,” says Torres-Gil, “but we need a little help from government at all levels. We need the expertise at the state and local levels to administer these programs.

“While we wait for fiscal resources to become available, this is a good time to replicate these successful models. We’re not asking huge sums of new money - just enough to continue the best practices so that when we balance the federal budget, we know where the dollars can be spent best.”

Torres-Gil predicts: “Long-term care and home- and community-based care is going to be the top domestic issue in the next 20 years.”

I know that for my friend - and for all of us who have had to struggle with the guilt and confusion and drowning fears over elder care - it certainly already is the top issue today.