The US Doesn’t Have a Plan for its Elderly Population

Humberto Gallego

Every day until 2030, 10,000 Baby Boomers will reach the age of 65. By the start of the next decade, there will be more individuals over retirement age than under the age of 5, and the healthcare system is woefully underprepared to adequately deal with this increase in senior patients, a challenge that the COVID-19 pandemic illustrated.

When it comes to dealing with the aging population, assisted living and in-home care programs have grown in popularity, especially as more options enter the market. Traditional nursing homes have lost some market share as they become increasingly unpopular due to their understaffing, under-paying and under-training of existing staff, and deteriorating infrastructure, but nursing home beds remain relatively occupied across the country. 

A relatively new entrant to the market, Assisted Living Facilities (ALFs), aim to create a higher quality of life experience than is typically provided by traditional nursing homes while maintaining a high level of medical support for patients. As a result, they are the most popular and fastest-growing form of long-term care in the US, but there are higher costs for the increased standard of living associated with ALFs.

But the costs associated with these services are ballooning dramatically, and as a result, many Americans are priced out of this type of care. The costs of skilled nursing homes can easily exceed $100,000 annually for a single patient, and it is not surprising that nearly nine in ten adults say that the costs of long-term care would cause serious financial difficulties.

This is partially to do with the fact that many long-term care facilities are run by for-profit companies, investment firms, and commercial chains which directly limit the facilities’ ability to properly care for their patients. At the same time, the industry is receiving billions of dollars in government relief to prevent facilities from shutting down due to pressure from the COVID pandemic. Despite the influx of cash, however, there have been no substantial changes in staffing levels, because there is no limit on the amount of funding that long-term care facilities can allocate to executive salaries and profit numbers. These facilities prioritize their bottom line over patient quality of care at every turn, and as a result, patients suffer.

In-home care services provide more flexibility and comfort for patients, allowing them to continue living at home, but naturally, more intensive care means more costs, leaving families between a rock and a hard place when it comes to finding good care that they can afford for their elderly. Nursing homes, the cheapest option of the three, are commonly associated with abuse and poor conditions for workers and patients alike. The first COVID-19 case and mass outbreak in the US was at a nursing home in Seattle, in fact, and nursing home patients around the country felt that they did not receive the care that they needed from their nursing home facilities. Failure at such a basic level is concerning.

Outside of long-term care, the only option that remains for most is family care. Children caring for aging parents is common in many countries outside of the US, but the US’ work-centric culture and the prevalence of commuting longer distances to work makes it difficult for many families to justify taking care of a loved one at home.

But outside of the US, counties have legislated better solutions to the problem. Singapore’s Proximity Housing Grant program is particularly exemplary: first-time applicants to the program can receive up to $90,000 (S$120,000) when buying an apartment that would house them and their parents, and provisions exist to provide grants at slightly lower dollar amounts to applicants who purchase an apartment within 4km of their parents.

The program aims to reduce the friction that many families face when caring for their elderly relatives, and it incentivises families to stick together. This concept of filial piety extends across East Asia: in Japan and Korea, a majority of adult children live with and care for their elderly parents, and in China, adult children are legally required to visit their elderly parents often, and they could face jail time or fines if they fail to do so. However extreme this example might seem, the sentiment behind the law clearly seeks to address the deep social, emotional, and financial isolation that the elderly face around the world.

Western European countries have also slowly begun to legislate on this issue: France has required since 2004 that children “keep in touch” with their elderly parents in response to rising suicide rates in lonely pensioners.

It should go without saying that family care is far from perfect, and countless lives are saved every year due to the diligent work of medical personnel at long-term care homes, but these programs remain expensive and isolating for most. Legislation that encourages adult children to live closer to, or even with, their elderly parents could help address not only the crisis of loneliness that the elderly face in this country, but it could help Americans better pay for the care that the elderly deserve.