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People Leaving the State, How Do We Pay for Elder Care?

Two recent articles in The Boston Globe reported on the outmigration of people from Massachusetts, especially those of working age between 25 and 44. According to one article, since the pandemic 110,000 more people have left Massachusetts than have moved into the state. This appears to be largely a reaction to high housing prices and the new ability to work remotely, but also the cost of childcare and time lost in traffic.

Since the pandemic, people can keep their jobs and move to more affordable parts of the country. Massachusetts also has among the highest childcare costs in the nation. And Boston ranks as the world’s fourth most congested city after London, Chicago, and Paris.

It Could Be Worse

On a percentage basis, Massachusetts is not doing as poorly as some other states, having lost just 0.11% of its population during the year between July 2021 and July 2022. Rhode Island lost 0.3% and New York a whopping 0.91%. In fact, up until the pandemic, Massachusetts was growing in population. From 2010 to 2020, the Massachusetts population grew 7.4%, the same as the nation as a whole. An article in The Economist about the downward spiral experienced by mostly rural areas of the country losing population contains the following map that shows where population in the United States was moving prior to the pandemic. (Red indicates loss of population and grey its growth.)

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But those overall favorable numbers mask some disturbing trends. As explained by a Boston Indicators report, the only reason the Massachusetts population was growing prior to the pandemic was due to international migration. In fact, from 2010 to 2020, the number of births in Massachusetts steadily declined and the number of deaths steadily grew, as did the number of U.S. citizens leaving the state. The fact that few immigrants were coming to the United States and Massachusetts during the pandemic is a large part of the explanation as to why the Massachusetts population dropped after 2020.

A Tick Up, Except for 25-44 Year Olds

But there’s good news in terms of a lot of these trends since last year. International migration is back up. Domestic migration out of the state has slowed down. Births are up and deaths are down. And we’ve seen a net gain of young people between the ages of 18 and 24.

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Still, the increasing loss of 25- to 44-year-olds is especially disturbing in terms of what in means with respect to the workforce and the dynamism of the state. We could begin to see the downward spiral The Economist article describes in other parts of the country. As Baby Boomers retire, there will be fewer workers. Tax revenues will decline making it harder to provide adequate services. As a result, more people who can will leave the state. Businesses will follow their employees, accelerating the decline.

Impact on Elder Care

This could have a deleterious effect on elder care as well as other services. As I have been reporting, in about 10 years when the oldest Baby Boomers reach their late 80s the need for elder care will start growing, more than doubling by 2050. The Donahue Institute at the University of Massachusetts has developed population forecasts that predict that the number of Massachusetts residents aged 85 and above will grow from 161,000 and 2.3% of the population in 2020 to 324,000 and 4.4% of the population in 2050. To pay for their care, Massachusetts will need a strong base both of caregivers and of taxpayers.

It’s not news that the way to reverse the deleterious populations trends is through investment in housing, mass transit, and high-quality childcare. We know the way. Do we have the will?

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