Every day, 12,000 Americans turn 65. In 2022, 58,000,000 were over 65 – 17% of the population – and estimates are that by 2040, seniors will make up 22% of the population.
While most people over 65 are healthy, as we age illnesses and frailty become increasingly common, and growing numbers need at least some care in their daily lives. How do they get that care?
Unlike many other western countries, the United States has no organized program to help seniors who are unable to live and function independently. In many cases, particularly for those over 80, the choices come down to placement in a nursing home or a lot of help at home to allow them to avoid that dreaded option.
Many elders and their families are surprised to learn that Medicare does not pay for anything but short-term rehabilitation, either for nursing-home stays or home healthcare. If you have a hip replaced, Medicare will cover a week or so at a rehab facility and a few weeks of home physical therapy and visiting nurses, but if you are simply too frail and sick to live independently, you are on your own.
Long-term care insurance is available, but it is very expensive and frequently does not cover the full cost of nursing homes or extensive home care.
To get the care needed at home, home health aides are available, but this “system” is full of problems. Such care is generally provided through agencies that hire and vet the aides. They charge the patient a lot and pay the aides very little. Most home health aides get minimum wage for very demanding work, resulting in a huge turnover. Why lift and clean an elder when you can earn the same hourly wage at McDonald’s?
In the end, it often falls to family members to provide needed care, difficult at best when families are scattered around the country and often trying to hold down a job while assisting their parent(s.)
Medicaid will pay for nursing home care, but to be eligible, the recipient must spend down most of their assets and become impoverished. They cannot give away assets to their family – this is carefully scrutinized. Moreover, Medicaid rates are generally so low that you will not find many “upscale” homes willing to take you.
What can you do? Don’t get old. Seriously, one important factor is to stay as fit as you can to avoid the need for help. While exercise increases longevity, its more important benefit is to keep you independent longer.
If you can afford it, investigate long-term care insurance. Be very careful in reading the policy and assessing the likelihood that the policy will cover your needs.
While you are healthy, begin to make your home more “aging-friendly.” Get grab bars in the shower, railings on all stairs, better handles on doors and cabinets and put shelves lower.
Write to your state and federal legislators and ask them to start working on a plan, either at the state or national level, to improve the care we offer our frail elders. Part of any such plan must include better pay for home health aides to encourage people to make this a career.
By Dr. Ed Hoffer
Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.