By 2050, the “Silver Tsunami,” consisting of individuals 65 years of age and older, will constitute more than 20% of America’s total population. When the tsunami hits, an estimated 40 million seniors will rely on Medicare to provide their health care and possibly care at home. Just as the Baby Boomers redefined what it meant to live, work and play in America, these aging boomers are expected to recast senior living as vibrant, empowered and full of options. Living longer has a price, however. The mind and spirit of the senior wants to be free, but the body of a senior often needs assistance to take care of the housekeeping and in managing the degenerative conditions that come with aging. Seniors need to be able to pay for housing that accommodates their needs and supportive care to remain at home.
A recent Washington Post article reveals that the Biden administration has proposed that government take on a larger proportion of the high cost of caring for the country’s seniors. Biden has included provisions for higher caregiver compensation and expanded Medicare coverage in the highly touted $2 trillion jobs and infrastructure bill now being debated in Congress. Specifically, the proposed infrastructure plan earmarks $400 billion to provide “home- or community-based care” for seniors and individuals with a disability. Approximately $50 billion alone is devoted to providing home care. Not only would this earmark increase American seniors’ access to care provided in their homes and communities, but it would also increase home care workers’ pay and benefits.
I want to take a minute to address why providing home care to eligible individuals is important to the U.S. economy generally. In Georgia, an individual who is appropriate for nursing home care may also be eligible for home care services under Medicaid waiver programs. Home care costs a fraction of the cost of nursing home care. Yet, home care services are underfunded, and the individuals who could be kept at home may end up receiving the more expensive nursing home care. Putting seniors into facilities when care can be received outside the facility places unnecessary pressure on an already strained public benefits budget.
The failure to provide home care also has a long-term economic impact as a whole. Women disproportionately become the caregiver for individuals who do not enter a nursing home but who need care. These caregivers will reduce their employment or quit their jobs completely to take care of this family member. The reward for staying at home to care for an aging relative is a reduction in their overall income, in their private and Social Security retirement benefits, a possible loss of eligibility for Social Security Disability Insurance, and a loss in career advancement. Because of the caregiver’s reduced income and job opportunities, the caregiver actually becomes a more likely candidate to receive welfare benefits like Medicaid in the future. Economists may prove me wrong, but I suspect that the investment in support services now will have a positive impact on the country’s long-term economic growth by allowing women to continue to grow their careers and provide for their own financial futures without government assistance.
While the recognition of the problem is important, the article points out that this bill faces significant challenges. First, the plan holds out the promise of money with no actual detailed plan for spending it. It contains no provisions for how to address the more than 800,000 people already on Medicaid wait lists for home care.
Second, Congress has already spent almost $2 trillion this year and has no budget left to fund this program.
Third, simply paying caregivers more doesn’t mean that there will be more caregivers. Caregiving is not a glamorous job and can involve the constant cleaning of bodily fluids. The seniors often treat their caregivers quite badly because the seniors don’t feel that they need help. Simply put, not many people are willing to wipe the bottoms of people who are abusive to them for minimum wage.
Unfortunately, I don’t have any suggestions as to how to resolve the problem as a whole, but I can make recommendations for what we can do as individuals to protect our own futures:
- Fund our retirement accounts and live within our means. Medicaid is supposed to be a payor of last resort and not the primary provider of long-term care. The only way to pay for your future is to not spend all of your money in the present.
- Reconsider homeownership. All homes, even new homes, are money pits. We spend money maintaining them and updating them. For our 20th anniversary, my husband and I got each other a new natural gas line for our house. (Romantic, isn’t it?) Move to a place that doesn’t require you to pay for a new roof or landscaping, and you will find a new freedom with the extra money in your wallet that you can save for retirement.
- Creative planning. The Golden Girls may be a TV show, but it demonstrates one way in which individuals can help keep costs down. Some individuals have gained notoriety for living on cruise ships, which can be much less expensive than owning a house. I have an older friend who found freedom living in a tiny house.
The Silver Tsunami is already upon us; it is not a problem 30 years away, as the article suggests. I remember when the Obama administration tried to tackle this issue and walked – no, ran – away from this exceptionally complex and expensive challenge. I commend the Biden administration for taking on this challenge and wish them the best of luck. They are going to need it.