Many of the challenges facing Massachusetts and the United States have been been building for decades, whether they be climate change, the lack of affordable housing, or the decaying of public transportation. As a nation and a state we are only now beginning to confront these very foreseeable developments now that they have become crises.
We have another looming crisis coming our which which we can choose to plan for now or also wait until it is upon us — the huge need for long-term care services that we will need in about a decade when Baby Boomers start entering their later years.
The Reality of Demographics
We’re actually currently in a trough in terms of need for long-term care services. This is because 85 years ago, during the Great Depression followed by World War II, there were relatively few babies being born in the United States. Yet, despite the relatively small number of older seniors, anyone who has a family member needing a nursing home placement or seeking to hire care at home knows that we’re facing a long-term care crunch.
Most people don’t need care until they are in their late 80s. According to an Urban Institute report, 40% of Americans aged 85 and older have severe long-term care needs as compared with just 8% of those between 65 and 74. There are just 23 million members of the “Silent Generation” in the United States, who are today between the ages of 78 and 90. Their number is dwarfed by the 71 million Baby Boomers who today are aged 59 to 77. They will start crossing the age-85 threshold in 2031 and continue to do so until 2049. The U.S. Administration on Aging projects that the 85-and-older population of the United States will more than double from 6.7 million today to 14.4 million in 2040, and reach 19 million by 2050. This means that the need for long-term care services will also more than double over the next 17 years and almost triple by 2050.
Currently, Massachusetts ranks right in the middle of states in terms of the percentage of its population age 65 and above with 17.4% of our population in his cohort. Maine is the oldest state with 21.8% of the population 65 or older and Utah is the youngest with just 11.7% in this older category. But what really matters for long-term care purposes is the number 85 and over. According to the U.S. Census Bureau, there are currently approximately 160,000 Massachusetts residents aged 85 and above, or about 2.1% of the population. This number is dwarfed by the slightly more than one million residents aged 65 to 84 constituting 15.3% of the population.
Grappling with Our Disorganized Long-Term Care “System”
A report of the National Academies of Sciences concludes that “the way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented,
and unsustainable.” The picture for assisted living and home care is no different.
What are we going to do about our lack of preparedness for the tsunami of long-term care need coming our way? Robert Weisman describes in an article in The Boston Globe describes efforts “to boost long-term care insurance.” These can only scratch the surface of the needs we face. According to one report, only 10% of seniors have long-term care insurance. Ironically, given its cost, those with long-term care insurance are for the most part the seniors who have the least need for it. Tinkering with it will do little to solve the need coming our way.
Two states on the west coast have taken much more important and farsighted steps to meet the coming long-term care need. Washington has created the Washington Cares Fund, a long-term care tax that will go into a fund to provide up to $36,500 (adjusted for inflation) to pay for long-term care needs.
California is in the process of phasing out asset limits for Medicaid eligibility (MediCal in California and MassHealth in Massachusetts). Income eligibility limits will still apply. This in effect makes Medicaid, which pays for many long-term care benefits, a universal health care program for California residents without the onerous application process.
What About Massachusetts?
Over the centuries, Massachusetts has been a leader for the nation in many areas. It can also be a leader in the area of long-term care. In addition to considering the initiatives taken by Washington and California, we should:
- Increase the wages paid to caregivers whether at home or in facilities such as nursing homes and assisted living facilities.
- Increase training for caregivers.
- Provide more support to family caregivers, including more placement assistance when family members are discharged for hospitals or skilled nursing facilities.
- Welcome more immigrants to the state, since the reality is that a majority of paid caregivers are immigrants.
We also need to fix our transportation system and affordable housing crisis since caregivers need to be able to get to work and live in the commonwealth.
We have a new governor. Will she, unlike her predecessors, take this on?
Read my letter to the editor responding to The Globe article on long-term care insurance initiatives and my article in Investments & Wealth Monitor about “Preparing for the Impending Long-Term Care Crisis.”