Future Nursing Home Shortages
The December 12, 2005, issue of USA Today (page 9D) featured a brief article titled "Crisis in elder care foreseen" by Janet Kornblum. The data cited gives us cause for concern in the future with an expected increase in American elders affected by Alzheimer's Disease swelling to about 16 million by 2025 (only 20 years or about one generation away).
Nursing homes and assisted-living facilities in many areas have major problems recruiting and holding onto the direct care and support staff they need to maintain adequate services and appropriate staffing. Stories abound in the media about nursing home residents receiving less than adequate care and the resulting family and/or public outrage about these incidents. Unfortunately, these cases and the ability of patients to find a nursing home that they can afford or even get into will continue to increase as the population of the United States ages.
The Baby Boomer generation's youngest members (born in 1945) have reached 60 years of age and this generation will be moving toward retirement in the next 10-20 years. Many of them will require nursing or assisted-living services for typical problems associated with aging, but a large number will required placement for cognitive changes related to Alzheimer's Disease or other forms of dementia (associated with living longer in general).
As we have seen on the news or other media, the proportion of retirees to workers will shift with fewer workers available to pay into the system of an expanding pool of retirees. The also means that the number of workers available to staff nursing facilities relative to the elder population will decline. The problems that these facilities have today will multiply over the next 10-20 years as these same facilities search for staff and new facilities are built to accommodate the increased demand for assisted-living and/or nursing home services.
Factors that will or may affect this future problem include:
1. Medical therapy for Alzheimer's Disease - I'm hopeful that a vaccine or effective pharmacological therapy to stop [not just delay] progression of this neurodegenerative disease will be found to mitigate the number of projected patients in 2025. This would reduce some of the projected staffing requirements. If we make no significant progress, the problem will get worse as people age (with about 1/3 of all 90+ year old patients affected by Alzheimer's Disease).
2. Medical therapy for other medical disorders - Advances in medical technology and pharmacology may stem the progression of diseases commonly affecting the elderly both directly and indirectly. They include heart & vascular disease, stroke, osteoporosis, arthritis, and others. Better therapy will hopefully result in a smaller percentage of physically and/or mentally disabled patients requiring nursing or assisted-living care.
3. Immigration - This is a hot topic, both politically and economically. We must consider whether our current US birthrate will produce enough workers in the next 20 years to fill projected job openings. These jobs do not pay very well, and if they do pay well, then the nursing homes are not very affordable for many who need them. New immigrants are often willing and eager to fill these positions as a step toward their American dream. Keeping them out of America might not be such a good idea (Remember: we are talking about low skill or semi-skilled nursing or caregiver positions, not professional jobs requiring higher education).
4. Money - Social Security will pay for it? - In the end everything in the US and most of the world comes down to money or "Who and how are you going to pay for this expensive care?" The Social Security Trust Fund is not really a fund at all. It has been tapped out to pay current government expenses. The Social Security system currently pays out all the money it receives to beneficiaries and what's left over is taken by the government (with an IOU to the SS Trust Fund) for other expenses. Medicare has similar problems as does Medicaid (a topic perhaps for a future discussion). With fewer working people paying into the system and more people collecting from the system sooner or later the system will go broke or insolvent. Various figures and dates have been discussed by economists, political figures, groups representing seniors, etc... But the end state will still eventually be the same - not enough money to pay for nursing and/or assisted living care that our aging population will require.
5. Money - Is it the government's responsibility to pay for nursing care? Or your own? - If you take an informal survey of many people approaching retirement age, a small number have saved their money for years and/or purchased long-term care insurance to cover their future projected expenses. A large number of people haven't saved or invested much at all to fund them after retirement, let alone enough to cover the high costs of nursing or assisted-living care. Are we to abandon them in their homes or apartments to the elements? Should they suffer the consequences of their poor planning, limited ability to save or invest, or bad luck? Should their children (if any) shoulder their responsibility to their parents and take them in? All good questions with no one-size-fits-all answer.
There are other factors that can be considered, but in the end this is a problem that requires us (meaning the people who may or may not need care in the future), our families (Do you have aging parents or in-laws?) , and our government to really sit down and consider in depth. Early planning and investments in the future (not just until the next election) will pay bigger dividends than last minute 'fixes' to the coming crisis in elder nursing care.
Issues to consider:
1. Nursing home bed availability and projected availability over the next 20 years.
2. Nursing home costs and projected costs per patient over the next 20 years.
3. Nursing home staffing shortages now and projected over the next 20 years.
a. Where do we find the nursing assistants and caregivers?
b. Will there be enough registered nurses to provide those needing skilled nursing services?
c. Is this an issue that immigration or immigration policies can address to meet our needs?
4. Long-Term Care Insurance - should all or just some of us get it? Who should pay for it - the worker, the employer, the government, or all three?
Musing over this issue has left me with more questions than answers. It has also prompted me to review my savings, investments, and long-term health insurance options to ensure that they will meet my current and possible future requirements. I suggest you do the same.
Nursing homes and assisted-living facilities in many areas have major problems recruiting and holding onto the direct care and support staff they need to maintain adequate services and appropriate staffing. Stories abound in the media about nursing home residents receiving less than adequate care and the resulting family and/or public outrage about these incidents. Unfortunately, these cases and the ability of patients to find a nursing home that they can afford or even get into will continue to increase as the population of the United States ages.
The Baby Boomer generation's youngest members (born in 1945) have reached 60 years of age and this generation will be moving toward retirement in the next 10-20 years. Many of them will require nursing or assisted-living services for typical problems associated with aging, but a large number will required placement for cognitive changes related to Alzheimer's Disease or other forms of dementia (associated with living longer in general).
As we have seen on the news or other media, the proportion of retirees to workers will shift with fewer workers available to pay into the system of an expanding pool of retirees. The also means that the number of workers available to staff nursing facilities relative to the elder population will decline. The problems that these facilities have today will multiply over the next 10-20 years as these same facilities search for staff and new facilities are built to accommodate the increased demand for assisted-living and/or nursing home services.
Factors that will or may affect this future problem include:
1. Medical therapy for Alzheimer's Disease - I'm hopeful that a vaccine or effective pharmacological therapy to stop [not just delay] progression of this neurodegenerative disease will be found to mitigate the number of projected patients in 2025. This would reduce some of the projected staffing requirements. If we make no significant progress, the problem will get worse as people age (with about 1/3 of all 90+ year old patients affected by Alzheimer's Disease).
2. Medical therapy for other medical disorders - Advances in medical technology and pharmacology may stem the progression of diseases commonly affecting the elderly both directly and indirectly. They include heart & vascular disease, stroke, osteoporosis, arthritis, and others. Better therapy will hopefully result in a smaller percentage of physically and/or mentally disabled patients requiring nursing or assisted-living care.
3. Immigration - This is a hot topic, both politically and economically. We must consider whether our current US birthrate will produce enough workers in the next 20 years to fill projected job openings. These jobs do not pay very well, and if they do pay well, then the nursing homes are not very affordable for many who need them. New immigrants are often willing and eager to fill these positions as a step toward their American dream. Keeping them out of America might not be such a good idea (Remember: we are talking about low skill or semi-skilled nursing or caregiver positions, not professional jobs requiring higher education).
4. Money - Social Security will pay for it? - In the end everything in the US and most of the world comes down to money or "Who and how are you going to pay for this expensive care?" The Social Security Trust Fund is not really a fund at all. It has been tapped out to pay current government expenses. The Social Security system currently pays out all the money it receives to beneficiaries and what's left over is taken by the government (with an IOU to the SS Trust Fund) for other expenses. Medicare has similar problems as does Medicaid (a topic perhaps for a future discussion). With fewer working people paying into the system and more people collecting from the system sooner or later the system will go broke or insolvent. Various figures and dates have been discussed by economists, political figures, groups representing seniors, etc... But the end state will still eventually be the same - not enough money to pay for nursing and/or assisted living care that our aging population will require.
5. Money - Is it the government's responsibility to pay for nursing care? Or your own? - If you take an informal survey of many people approaching retirement age, a small number have saved their money for years and/or purchased long-term care insurance to cover their future projected expenses. A large number of people haven't saved or invested much at all to fund them after retirement, let alone enough to cover the high costs of nursing or assisted-living care. Are we to abandon them in their homes or apartments to the elements? Should they suffer the consequences of their poor planning, limited ability to save or invest, or bad luck? Should their children (if any) shoulder their responsibility to their parents and take them in? All good questions with no one-size-fits-all answer.
There are other factors that can be considered, but in the end this is a problem that requires us (meaning the people who may or may not need care in the future), our families (Do you have aging parents or in-laws?) , and our government to really sit down and consider in depth. Early planning and investments in the future (not just until the next election) will pay bigger dividends than last minute 'fixes' to the coming crisis in elder nursing care.
Issues to consider:
1. Nursing home bed availability and projected availability over the next 20 years.
2. Nursing home costs and projected costs per patient over the next 20 years.
3. Nursing home staffing shortages now and projected over the next 20 years.
a. Where do we find the nursing assistants and caregivers?
b. Will there be enough registered nurses to provide those needing skilled nursing services?
c. Is this an issue that immigration or immigration policies can address to meet our needs?
4. Long-Term Care Insurance - should all or just some of us get it? Who should pay for it - the worker, the employer, the government, or all three?
Musing over this issue has left me with more questions than answers. It has also prompted me to review my savings, investments, and long-term health insurance options to ensure that they will meet my current and possible future requirements. I suggest you do the same.
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