Who will take care of us when we are old?


By Sondra Shapiro

We have been committed caregivers for our elderly relatives. But it turns out it could be slim pickings by the time we baby boomers need looking after, if a new study is the last word.

It has been well publicized that our financial security is shakier than that of the generation before us. And now we are learning that the pool of family and friends available to take care of us in old age will be less than half as deep as it is today. Very troubling, yet not insurmountable.

When we turn 80, AARP findings predict, the ratio of potential family caregivers to elders needing care will plummet from today’s seven caregivers for each person over age 80 to fewer than three caregivers.

shapiro_hsFamily caregivers — including family members, partners and close friends — are a key factor in the ability to remain in one’s home and in the community when disability strikes, according to the new AARP report. That means while most people’s preference is to age in a community setting, without friend or family support we will require more costly and less desirable institutional care.

Such “reliance on fewer family caregivers to provide home- and community-based services could also add to costs borne by family members and close friends — in the form of increasing emotional and physical strain, competing demands of work and caregiving, and financial hardships,” the report states.

“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,” said Lynn Feinberg, AARP Senior Policy Analyst and one of the report’s authors, “but this confidence is likely to deflate when it collides with the dramatically shrinking availability of family caregivers in the future.”

The number of people turning 80 will increase in the next 20 years as the population of primary caregivers remains flat. In 2050 there will be three times as many people age 80 and older as there are today — 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 percent when boomers reach their 80s. In 2010 the caregiver support ratio in Massachusetts was 6.4; by 2030 it will be 4.4 and by 2050, 3.2.

The ratio is primed to shift “from a slow decline to a free fall,” to quote the report.

According to AARP, “In 2009, about 42.1 million family caregivers in the United States provided care to an adult with limitations in daily activities at any given point in time, and about 61.6 million provided care at some time during the year. The estimated economic value of their unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007.”

The “average” family caregiver is a 49-year-old woman who works outside the home and spends about 20 hours per week providing unpaid care to her mother for nearly five years. Nearly two-thirds of family caregivers are female (65 percent). More than 8 in 10 informal caregivers are caring for a person over 50.

The shift stems from the fact that compared to our parents’ generation, our 78 million demographic has had fewer children, divorced at higher rates, remained single in larger numbers and is living longer.

The report concludes this country needs more affordable homecare options and public policies that support informal caregivers.

“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 supports,” said Feinberg.

Over the years, Congress has organized various commissions to address the cost of long-term care. The latest, which just finished its work, heard from experts on ways in which Medicaid, Medicare and private long-term care insurance could be strengthened to more effectively finance long-term services and supports. While the exercise is noble, history suggests nothing will happen as a result.

Though these numbers seem dire, there are some promising signs.

There are several examples of how the boomer generation is finding its own way to address the looming care issue. True to this generation’s inventive character — and a harkening back to its flower power roots — boomers have been proactive in terms of housing arrangements that offer built-in care for its residents. Among the options are co-housing, a type of community made up of private homes supplemented by common facilities; and roommate arrangements, where peers move into a home or apartment together.

Towns are also thinking ahead. One successful solution is the Naturally Occurring Retirement Community (NORC), geographic areas where a large concentration of older people can age in place with the help of programs and services. Beacon Hill Village in Boston is one such arrangement; its “Livable Community Program,” was one of the first in the country.

Assisted living facilities are also morphing into boomer-friendly environments that offer comfortable apartments along with programs and services that promote independence and provide even the most age-denying boomer a welcoming place to call home.

Though the options mentioned are a sampling, the point is AARP’s study and others like it help shed a beacon of light to keep the country focused on the caregiving issue and thus allows boomers, communities and lawmakers to create ways to address the problem. At this point, as Congress muddles its way through the problem, it looks like grassroots activity is already beginning to flourish. So, if the question is: Who will take care of us? The answer should be: We are working on that. Ingenuity will ultimately win over statistics.

Sondra Shapiro is the executive editor of the Fifty Plus Advocate. Email her at sshapiro@fiftyplusadvocate.com. And follow her online at www.facebook.com/fiftyplusadvocate, www.twitter.com/shapiro50plus or www.fiftyplusadvocate.com.