Medical care costs in general are high for elderseven with Medicare, elders and their families pay more than a third of their health care costs out of their own pockets. Persistent, Consistent, Widespread, and Robust? The first half of the paper reviews the literature and logic that suggest that aging in general, and long-term care services in particular, will represent an overwhelming economic burden on society by 2030. 10.1034/j.1600-0560.2002.56.x. 1998). Of course, expansion and contraction of nursing home beds respond more slowly to market forces because of the durable capital aspect of nursing home care. Schoeni, Freedman, and Wallace's analysis of NHIS disability data reports a 1.1 percent average annual decline in disability between 1982 and 1996. Inclusion in an NLM database does not imply endorsement of, or agreement with, Such rulings are putting pressure on public programs to rethink the balance between nursing home services and community-based services. The Baby Boom cohort, by contrast, grew up among much better health, economic, nutritional, and educational conditions. According to a study by Health Services Research, the real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active a. Search the for Website expand_more. Keeping the number of frail constant at 2000 levels must be the goal of every community to keep costs affordable. Rovner BA, Katz IR. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care. The image that most elders will move to a retirement village away from their communities is the exception rather than the rule. In 1995, almost 85 percent of elderly Medicaid long-term care expenditures were for institutional care and only 10 percent were for home care services (Wiener and Stevenson 1998). 3According to demographic projections, the ratios continue to moderately worsen between 2030 and 2050 as Baby Boomers reach very old ages. Source: Georgetown University Institute for Health Care Research and Policy preliminary analysis of data from the National Health Interview Survey and the National Health Interview Survey on Disability, Phase II, 19945. The IADLs include light housework, laundry, meal preparation, transportation, grocery shopping, telephoning, and medical and money management. Stone RI, Keigher SM. In the case of formal services, the financing options discussed previously are the source of expanded resources. In an age-integrated society, changes made to bring older people into the mainstream could simultaneously enlarge personal opportunities and relieve many other people who are in their middle years of the workfamily crunch (Uhlenberg 2000; Riley 1998). The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones,. From the Macarthur Studies of Successful Aging. 8The $150,000 amount is used to define a long-term shock because this amount would be needed to support a three-year nursing home stay in many parts of the country. Most relevant perhaps are trends in immigration. In New York State, for example, the Medicaid program pays for 80 percent of all nursing home costs; clearly, 80 percent of New York elders are not poor before they become frail. Much more must be done to facilitate better clinical care management of chronic diseases (Wagner et al. The two principal components of the model are the Pension and Retirement Income Simulation Model (PRISM) and the Long-term Care Financing Model. These investments should lead to advances in earlier detection of disease or genetic predisposition to disease, more rational drug design, and possibly even gene therapy. Proceedings of the National Academy of Science; 1998. pp. 2001). See footnote 1 for assumptions used. The assumptions used follow the principles of the middle estimates of the social security forecasting model: economic growth averaging 1.3 to 2.0 percent per year and real wage growth averaging 0.9 percent per year. The woodwork effect predicts that total expenditures could grow substantially if public and or private insurance expanded (Weissert, Cready, and Pawelak 1988; Kane, Kane, and Ladd 1998). Perhaps Americans, more so than other societies, are less mindful of the needs of aging due to a relatively age-stratified society. Much of this growth will be prompted by the aging of the Baby Boomers, who in 2030 will be aged 66 to 84the "young old"and will number 61 million people. How many people will require formal services in 2030? A sophisticated social marketing campaign might increase awareness and change attitudes about eating and exercising. So, in past eras life was viewed more as a circlethe Lion King image. Trends in healthy behaviors are not as encouraging as the socioeconomic statistics. U.S. S7_Caring+for+Aging+Baby+Boomers.pdf - The 2030 Problem Caring for Aging Baby Boomers James R Knickman and Emily K Snell Objective To assess the coming | Course Hero View S7_Caring+for+Aging+Baby+Boomers.pdf from EDUC MISC at George Washington University. Long-term care is an expensive item that most middle-class families are not prepared to pay, If some type of insurance planwhether voluntary or mandatory, whether public or privatedoes not begin to catch hold, the public sector is going to see its expenditures grow faster and faster. The paper was written while Dr. Knickman was Regents Lecturer at the University of California (UC), Berkeley. 1996) and encourage healthy aging. A community's social and economic systems need to become attuned to arranging services to meet the needs of an aging society in natural, informal ways. Most states direct the lion's share of Medicaid dollars to nursing homes as opposed to home care. International Journal of Geriatric Psychiatry. Assessing Knowledge of Retirement Behavior. 6All comparisons were done using 2000 dollars, with projected inflation adjustments. The idea of elders as an economic burden or as frail and weak is a twentieth-century construct. A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society. When the pessimistic literature on the burden of an aging society was published, the economy was growing at anemic rates and inflation rates were relatively high. Berkman LF, Syme SL. National trends in healthy behavior have been mixed, with stagnation in exercise, increases in obesity, and decreases in smoking. By contrast, the present value of lifetime out-of-pocket prescription drugs costs averages $12,000, uncovered medical care comes to $16,000, and uncovered private insurance premiums come to $18,0001 (Table 1). In fact, if the Baby Boom generation is healthier than past generations (as argued later in the paper), it very well could be that the young elderly might work longer and thus be considered producers. The elderly of 2030 will be much better educated, with a college graduation rate twice (and high school drop out rate one-third) that of the current generation of elderly (U.S. Department of Education 1998). Two million of them have no social network at all. Average life expectancy at age 85 was six years in 1980, and, by 1997, had increased by less than four months (U.S. Census Bureau 2000). If the economy grows at a steady, healthy pace, the overall burden of long-term care will be moderate. Growing numbers of senior citizens coupled with shrinking budgets may force society to find alternatives to nursing homes, predicts a Des Moines geriatrician. Despite aggressive attempts by the insurance industry to develop a private market for long-term care, the growth of this market has proceeded slowly. If long-term care costs increase at 2.3 percent above inflation, the distribution of the population not able, barely able, and able to pay for long-term care would remain almost identical to the distribution today. This interpretation is bolstered by the fact that many moderate-income elderly who could benefit from long-term care and could afford to pay for some services choose to make do on their own. Since the sheer size and energy of the Baby Boom generation has led to other dramatic social shifts, some experts see hope that a new imagery for aging is possible. It is possible, however, to think about restructuring nursing homes to make their living environments and caring style more attractive to elders and their families (Allen and Mor 1998). It should be noted that because of the United States approach to financing these services, aging shocks represent burdens borne by individuals more than society. To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Estimates calculated using the Lewin Long-Term Care Financing Model indicate some good news about the future financial viability of elders.9 (See the footnote for an explanation of model.) Crossref Medline Google Scholar; Lum T.Y.-S. (2013). "Data from the 2020 Census will show the impact of the baby boomers . When resources expand, new services develop quickly, and when resources contract, capacity can also shrink quickly. Gottlieb AS, Caro F. Extending the Effectiveness of Home Care through Low-Cost Adaptive Equipment, Health Care Financing Administration. Recent policy revisions including the Home Health Prospective Payment System and the Balanced Budget Refinement Act, along with projected strong growth in out-of-pocket spending by individuals and families, cause many analysts to believe that home health care spending will rise again in the coming decade (Heffler et al. Clearly, these elderly are at high risk for unhealthy aging. Importantly, most communities rely too much on nursing homes as the source of formal care, at least for Tweeners and the Medicaid Bound populations. In principle, Medicare does not cover custodial long-term care, but in practice it is an ongoing challenge for Medicare and providers to distinguish custodial care and rehabilitative care. Russell LB. 1999). Arno PS, Levine C, Memmott MM. Recalculating dependency ratios using these new principles (see Table 4) indicates improvements rather than deteriorations in the adult to dependency ratios, especially when the year 2030 is compared to 1960 when children were present in the population in peak numbers. Such efforts to support family care-giving also represent an important aspect of community capacity to support elders. The uncertainty leads insurers to keep prices high and makes elders nervous about purchasing a private insurance policy. As with all simulations and forecasts, the estimates into the future depend on key economic assumptions. And, the willingness of seniors and their families to allocate private resources to long term care and related services will determine the scope of caring features in twenty-first century communities. National: NIH Publication - 2030 Problems on Caring for Aging Congressional Budget Office based on data from the Social Security Administration and from Eduard Bos. This lack of connection between Medicare prevention efforts and savings is a current barrier to better integration of prevention efforts into Medicare. Although some towns have seen a trend toward senior-only housing, others are exploring options in integrated apartment buildings. Factors Important in the Purchase of Partnership Long-Term Care Insurance, Miller EA, Weissert WG. What can be done to change these trends? Available at, Walsh MW. The 2030 problem: Caring for aging baby boomers. 1998). This is a result of Medicaid's attempts to focus on the most frail, who tend to be in nursing homes. The 1986 General Social Survey indicated that twenty percent of the elderly (6.4 million people) are so socially isolated their health is at risk. The 2030 problem: caring for aging Baby Boomers. The services can vary from informal care delivered by family and friends to the formal services of home care, assisted living, or nursing homes (see Table 2). A Survey of Leading Chronic Disease Management Programs: Are They Consistent with the Literature?, Waidmann TA, Manton KG. To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Firms are integrating workforces through programs of unretirement or by hiring retirees as temps, consultants, and part-time workers. By Mike Schneider / AP. This overreliance on nursing homeswhat some people call an unbalanced long-term care system (Kane, Kane, and Ladd 1998)may be changing with help from the federal court system. 2001). The simple messageand the intangible goalis to recognize the give and take of all parts of society. The https:// ensures that you are connecting to the In fact, 42 percent of people who live to the age of seventy will spend time in a nursing home before they die (Murtaugh et al. James Knickman, author of "The 2030 Problem: Caring for Aging Baby Boomers" analyzes how by 2030, the Baby Boomer generation will be 66 to 84 and number about 61 million. In 2030, $210,000 is the minimum amount necessary for independence. Health Serv Res, 37(4):849-884, 01 Aug . All of these ratios change in unfavorable directions between 2000 and 2030, but the changes are not substantial.3 The key point is that the United States prospered through the 1960s with dependency ratios less favorable than will be experienced in 2030 and the burden did not overwhelm the economy. The opinions and conclusions are the authors and are not meant to reflect those of the sponsoring institutions. To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Every elder has to prepare for four key aging shocks: uncovered costs of prescription drugs, the costs of medical care that are not paid by Medicare or private insurance, the actual costs of private insurance that partially fills in the gaps left by Medicare, and the uncovered costs of long-term care. Objective. The sooner alternatives to the current Medicaid-based financing system emerge, the less painful the costs of the new system will be. Even a moderate decline in disability would have dramatic impacts on the economic burden of long-term care. Available at. Long-term care includes a broad continuum of services that address the needs of people who are frail or disabled and require help with the basic activities of everyday living. Twenty-four percent of people aged 60 and older are obese and current obesity trends among younger cohorts indicate that this number will only increase (U.S. Department of Health and Human Services 2000). The numbers are slightly different if one assumes that long-term care insurance does not become more common, but the stark upward trend remains. The disability prevalence rates used in the model were calculated using data from the 1994 National Long-term Care Survey (NLTCS) while assuming that the overall period during which an individual is likely to have a disability will remain stable. Many elderly alive today matured during the two world wars and the long depression period, when malnutrition and vitamin deficiencies were still common. The model uses a Monte Carlo simulation methodology. The Past and Future of Home and Community-Based Long-Term Care. In thinking about community capacity, three stages of community aging can guide planning: the healthy-active phase, the slowing-down phase where the risk of becoming frail or socially isolated increases, and the service-needy phase when an elder can no longer continue to live in the community without some active service in and around the home. Perhaps the most important challenge of the healthy active phase of aging is for a community to learn how to tap the human resources that elders represent in the community. If efforts at healthy aging are successful and if informal caregivers and volunteers can help to meet the needs of elders, the total number of frail who need formal services in a community in 2030 could be quite similar to the number in 2000, even though the number of elders will more than double. Options strong on this criterion tend to be weak on another desirable criterion: the assurance that a financing approach does not result in people becoming a public burden if they fail to prepare for long-term care needs. The site is secure. What type of economic burden might be considered overwhelming? Health Services Research, 37, 849-884. The discussion has significant implications for public policy and for private actors focused on developing an effective care system for the midtwenty-first century. The Tweeners: This is a group whose lifetime income and wealth are adequate but who cannot handle a long-term care shock. Table 118. However, the estimated savings rate for prefunding starting at age 55 is almost four times that of prefunding starting at age 35 and would also be quite sensitive to interest rates (Lucas 1996). A Health Services Research Study, The 2030 Problem: Caring for Aging Baby Boomers outlines four key "aging shocks" every elder has to prepare for, namely: 1) uncovered costs of prescription . Declines in the nursing home population, particularly among the oldest old, have accompanied these disability trends (Bishop 1999). Manton KG, Corder L, Stallard E. Chronic Disability Trends in Elderly United States Populations: 19821994. With the legacies of the divorce boom getting older, the percent of the elderly who are divorced or separated is projected to double for men and triple for women between now and 2030. Bethesda, MD 20894, Web Policies Society's understanding of what the health system needs to do to encourage prevention and clinical care management of chronic diseases has improved tremendously in recent years. Much of this growth will be prompted by the aging of the Baby Boomers, who in 2030 will be aged 66 to 84the young oldand will number 61 million people. Thevast majority of working age, middle-class peoplewho comprise the Tweenerswould experience between a 15 and 25 percent reduction in the costs of insurance premiums after tax deductibility. If the 65- to 74-year-old cohort is considered productive and enters the numerator, the dependency ratio becomes substantially more favorable in 2030 than it was in 1960. Long-term care, financing, Baby Boomers, community-based delivery system. Their concern focuses on the large growth in the number of elderly over the coming years, from 35 million in 2000 to more than 80 million in 2050 (Figure 2). World Population Projections, 199495 Edition. sharing sensitive information, make sure youre on a federal Creating a finance system for long-term care that works, Building a viable and affordable community-based delivery system, Investing in healthy aging in order to achieve lower disability rates, and. But, since the Victorian Age and especially during the twentieth century, as more people have lived to old age, the linear interpretation of the life cycle has become dominant. Approximately 10,000 baby boomers turn 65 years of age each daya trend that will continue until 2030. Institutions (1) 01 Aug 2002-Health Services Research (Health Serv Res)-Vol. Changes in the Prevalence of Chronic Disability in the United States Black and Non-black Population above Age 65 from 1982 to 1999. 1561822. Trends in Health and Ability to Work among the Older Working-Age Population, Crimmins EM, Saito Y, Reynolds SL. Expected Lifetime Costs of Significant Aging Shocks for a 65-Year-Old Today. Half a million people age fifty and older have gone back to college (Riley 1998). . Freedman VA, Martin LG. And, home care costs can be just as high for a frail elder wanting to live at home. government site. Volunteers can provide services in a manner that makes elders continue to feel connected to a community and not dependent on a formal care system. Unfortunately, the criteria tend to conflict with one another, forcing stark trade-offs. 2001), additional interventions are necessary to improve health care services for the elderly. In addition, in considering macroeconomic burden, the other group of dependents in societychildrenshould be included in the denominator with the elderly, as both groups are dependent on the adult population. It is important to begin developing such options on a large scale in the coming 10 to 20 years. A more conservative estimate for declines in disability rates would be an average annual decline of 0.13 percent between 1994 and 2030. Imbedded within the woodwork issue is the real social challenge of determining how best to allocate limited resources. In the case of community-based changes beyond formal services, the give and take of the political process will shape how high a priority health-promoting community programs become among the range of local priorities. In addition, the door-to-door sales approach by individual agents adds to the costs of long-term care insurance. Out-of-pocket costs finance about 36 percent of long-term care, but the burden of these payments is very unevenly distributed. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes. In addition to the Baby Boomers, those born prior to 1946the "oldest old"will number 9million people in 2030. A final part of the argument for concern about long-term care costs comes from unsettling survey results reported by Curran, McLanahan, and Knab (in review) suggesting that children who experience divorce may be less willing or able to care for their aging parents. Finally, tax cuts and a sluggish economy could completely eliminate the funds needed for any new social programs. Obesity is a risk factor in the elderly for arthritis, lung dysfunction, hypertension, diabetes, cardiovascular disease, and certain forms of cancer (Kotz, Billington, and Levine 1999). First, it is worth reassessing the responsibilities and assets of elders. Medicare and Medicaid expenditures on nursing home care were $9 billion in 1980, more than doubling to $25 billion by 1990, and doubling again to $54 billion by 1999. 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