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‘Silver Surge’: Who Will Take Care of Aging Boomers?

Our health care system is facing major challenges - Bold changes are needed

It’s often called the “silver tsunami”—a tidal wave of 78 million boomers who begin turning 65 less than three years from now and, according to recent reports, threaten to overwhelm a health and caregiving system ill prepared to cope with them. 

The phrase is catchy but overly pessimistic, experts say. “A tsunami is an unexpectedly large wave that occurs suddenly,” says Richard Suzman, director of behavioral and social research at the National Institute on Aging. The boomer generation “is also a huge wave, but it builds slowly, allowing for decades of adjustment, rather than minutes.” Nonetheless, he adds: “This is a huge demographic, economic and social shift. The world has never seen anything like it.”

The boomers—defined as Americans born between 1946 and 1964—will join the ranks of Medicare beneficiaries slowly but with gathering momentum. Their coming of age is more like a silver surge than a tsunami. In 2011, the first wave of 2.7 million will turn 65, and each succeeding year the swell gets higher until it peaks in 2025 with 4.2 million new 65-year-olds, according to U.S. Census projections.

It’s the cumulative effect of that surge—plus the fact that people are living far longer then ever before—that poses a looming crisis for the health care system. By 2030, when the youngest boomers have become seniors, the number of Americans 65 and older is expected to be more than 70 million, nearly twice as many as in 2005 and a jump from 12 to 20 percent of the whole population, according to a new report from the National Academies Institute of Medicine (IOM).

“They will face a health care workforce that is too small and woefully unprepared to meet their specific health needs,” the IOM said. “If our aging family members and friends are to live as robustly as they can and in the best health possible, we must have a workforce of adequate size and competency to take care of them.”

The IOM report, Retooling for an Aging America: Building the Health Care Workforce, calls for “bold initiatives” to start training health care providers and family caregivers immediately for the coming demand. Some highlights:

  • A serious shortage of doctors, nurses and other health professionals. By 2030, at least 3.5 million more will be needed, a 35 percent jump from current levels. Providers themselves are aging. By January 2007 nearly one-fourth of active physicians were already 60 or older. By 2020, half of registered nurses will be 50-plus.
  • An acute shortage of geriatricians: Only 7,100 doctors are now certified in geriatrics (all-round care for older patients), one for every 2,500 Americans over 65. By 2030 the likely number will fall far short of the 36,000 specialists needed.
  • Geriatric training for all health professionals: Many doctors who treat large numbers of older patients are not required to have any training in geriatric care. Direct-care workers, such as aides in nursing homes, often receive fewer hours of training than dog groomers, manicurists and crossing guards.
  • Higher salaries for specialists in geriatric care: Geriatricians earn less than other specialists, despite longer training and more challenging work—around $163,000 on average compared with $175,000 for general internists and $300,000 for dermatologists. Many direct-care workers earn wages below the poverty level, causing high turnover in their jobs.
  • Training family members and other voluntary caregivers: More than 90 percent of older Americans who receive care at home rely on family, friends or other unpaid volunteers. Training programs—perhaps by nonprofit hospitals as a way of earning their tax-free status—could help caregivers provide proper assistance and alleviate their stress.
  • Changing Medicare’s approach: Medicare “hinders the provision of quality care” by paying providers too little, focusing on treating acute health problems instead of chronic conditions and failing to cover enough preventive services. The agency should adopt new models of care delivery—such as interdisciplinary teams of providers—to improve patients’ health and lower costs, the report said.

Who Will Care for an Aging America?

The IOM and other organizations have issued similar warnings over the past 30 years about coming shortages of health professionals, but now there’s a sharper sense of urgency. Although Congress has done little to address the issues in that time, Sens. Susan Collins, R-Maine, and Barbara Boxer, D-Calif., last month introduced legislation designed to attract and retain health care workers who are trained to care for older patients. The Caring for an Aging America Act is supported by AARP, which also helped fund the IOM report.

The report specially calls for much more emphasis on geriatric care in the health system because as people age, their health needs change. They often develop more than one chronic disease, such as high blood pressure, diabetes, heart problems, cancer, bronchial problems or arthritis. About half of people age 75 and over have two or more chronic conditions, and 26 percent have at least three, according to “Growing Older in America”, a recent National Institute on Aging report.

Taking care of multiple conditions, seeing how they affect the whole body and making sure that treatment for one condition doesn’t make another worse are special concerns of geriatric medicine. Geriatricians look at how a patient functions as a whole, says John Murphy, M.D., president of the American Geriatrics Society and professor of family medicine at Brown University’s medical school. “So I may be measuring their blood pressure and managing their kidney disease, but I’m also looking at whether they can get to the grocery store, get in and out of the tub, manage their finances.”

It’s a job that ideally needs a team—not only doctors and nurses but rehabilitation and nutrition specialists and social workers—to be done effectively. “Social services need to be integrated with health care services,” the IOM study says. “Providers need to be trained to work in interdisciplinary teams.”

How Healthy Will Older Boomers Be?

One big unknown is how much care boomers will actually need in old age. Will they be healthier than previous generations? Will their own attitudes and lifestyles shape the kind of care they need?

Research shows that boomers are better educated, wealthier, more open to new technologies and less likely to smoke than their parents were—all promising pointers for better health and the ability to function into old age. Chronic disability rates among older Americans have also dropped in recent years, even at the oldest ages.

But one cloud has appeared on the horizon. “Some initial analyses of the 55 to 64 age group have found evidence of deteriorated health or lack of improvement,” says Suzman of the National Institute on Aging. Although more research is needed, he says, “that’s not great news. And if we were to point to a possible factor, it’s going to be obesity and related diabetes. We need to watch this potentially ominous trend closely.”

Yet even if the decline in chronic disability continues among boomers, the IOM report says, “the size of the future older adult population is so large that, overall, the total need for services can be expected to increase.”

This raises another characteristic of boomers—they have fewer children, which translates into a smaller family caregiving force in the future. Offsetting that may be the fact that boomers are the first generation to have experience of taking care of their parents en masse, says Suzanne Mintz, president and cofounder of the National Family Caregivers Association.

“People forget that in 1900 people died at the age of 47 from infectious diseases,” she says. “Now they’re living so much longer and dying from slow, degenerative, chronic diseases, which creates a totally different scenario.”

One of the earliest boomers herself—born in February 1946—Mintz thinks that the caregiving experience of so many millions of her generation may make a difference. “Boomers tend to be a noisy group,” she says. “So I hope that having gone through what they’ve gone through, they’ll speak up for their rights and help bring about much-needed change.” That includes training for family caregivers and recognition of the financial burdens, especially for those who give up jobs, incomes and benefits to care for aging parents.

Boomers, even more than their parents, may resist the idea of going into nursing homes, and new technologies such as electronic “smart” houses may help more of them to age in their own homes. But much depends on how long they’re likely to live. At present, nearly 20 percent of people 85 and older live in nursing homes—the costliest kind of care.

Census projections show that more than 500,000 people will be 100 or older in 2038, with more than one million centenarians in 2050. “Some demographers think that any baby born today has at least a fifty-fifty chance of reaching 100,” says Kevin Kinsella, director of aging research at the U.S. Census Bureau. “If we have people living well into their 90s and 100s on a large scale, imagine what that’ll do to the need for care workers.”

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