Can Aging `Boomers' Avoid Nursing Homes?
Stucki, Barbara R., Mulvey, Janemarie, Consumers' Research Magazine
Access to long-term care services can profoundly affect the quality of life for older Americans, as growing numbers of middle-income families have come to realize. Many baby boomers, concerned about impoverishment and institutionalization in old age, are starting to look for new ways to ensure their retirement security. Careful planning is needed to make resources cover the costs for Americans to "age in place"--whether at home or in the home-like setting of an assisted living facility.
This report examines the promise and challenges of aging in place as an alternative to nursing home care. While this new approach to disability holds much hope for the future, it is an ideal that many will find hard to achieve. When the last of the baby boomers reach age 65 in 2030, the number of severely impaired elders at risk of institutionalization could almost double to 6 million. At the same time, rising longevity will make it harder for baby boomers to predict the availability of family support. To enhance their ability to age in place and avoid overwhelming their caregivers, aging baby boomers will need to supplement help from family and friends with paid long-term care in the home and community.
But analysis shows that, at current rates, the cost of services such as personal care, adult day care, and assisted living could quadruple by 2030. Total national expenditures for services that promote aging in place are projected to reach $193 billion in those 30 years. Out-of-pocket costs will also climb, by 369%, to $112 billion.
Relying on government to pay for these services is risky, because public programs restrict the number of clients they serve in the home and community and set strict eligibility requirements for middle-income elders. For example, only about one in three severely impaired elders receives help with daily activities from a home health aide through Medicare. The Department of Veterans Affairs provides service at home or in the community for only 2% of veterans who need long-term care. And Medicaid pays the cost of care for just 7% of residents in assisted living facilities.
Long-term care insurance can make these services affordable to middle-income families. Consumer out-of-pocket costs for services that promote aging in place could decline 51% ($57 billion) by 2030 if private insurance coverage becomes more widespread.
Promises of Aging in Place. Baby boomers (born between 1946 and 1964) are beginning to think about their future long-term care needs as they approach retirement. Having cared for their aging parents, many realize that the nursing home is appropriate only for people who require specialized medical care or round-the-clock supervision. Instead, today's caregivers are looking for alternatives that will enhance the physical, emotional, and social well-being of those who primarily need assistance with personal care and other daily activities. Aging baby boomers are also less willing to change their living arrangements for the sake of adapting to a chronic condition; they would rather continue living in their homes or a home-like setting for as long as possible. Baby boomers' growing desire for choice coupled with their individualism is forcing the nation to rethink long-held notions of aging and dependence.
One new approach, called aging in place, promotes independent living. This type of long-term care strengthens the family support system and enables older people, through home modifications and services, to live in their homes. It helps assure that older people will not have to move from their community despite declining mental and physical abilities. Services that support aging in place include personal attendants, homemakers, home health aides, adult day care, and assisted living facilities.
In some ways, the notion of aging in place represents a new way of achieving an old-fashioned ideal. The concept builds on the traditions of family support that have sustained older people for generations. …