by Jeffrey Marshall
Life expectancy has expanded since John Lennon and Paul McCartney came out with their great song, “When I’m 64.” The question now, for baby-boomers, is who will feed me when I’m 94.
The Caregiver Deficit
We all understand that the risk of needing long-term services and supports (LTSS) rises rapidly with age. “Among people age 85 and older, half need some long-term care.” Who Needs Long Term Care, Georgetown University Long-Term Care Financing Project, May 2003).
In the United States, the majority of LTSS are provided by the families of the care recipients. “Family caregiving was estimated to be worth $450 billion in 2009, as compared to $211 billion in spending on all paid caregiving in 2011.” Report of the Long Term Care Commission (September 30, 2013).
The reality of our nation’s LTSS system for the elderly is reliance on unpaid family caregiving especially by recipient’s children. The care needs of our age 80+ seniors are being met largely by their children – members of the baby boomer generation.
But what will happen a few years from now when the baby boomers transition from care providers to care recipients? Baby boomers who are now reaching age 65 face a 70% chance that they will need LTSS at some point during their remaining lives. Will they be able to count on the next generation to give them the care and support they will need? Probably not.
The Growing Caregiver Gap
As the over 80 population increases rapidly during the next 20 years, “the number of people in the primary caregiving years (ages 45 –64) is projected to remain flat, due in part to changing family size and composition. As a result, the availability of potential family caregivers (mostly adult children) to arrange, coordinate, and provide LTSS is expected to decline dramatically and overall care burdens will likely intensify especially as baby boomers move into late old age.” The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers (AARP Public Policy Institute, 2013).
Policy analysts refer to this demographic reality as the decline in the Caregiver Support Ratio. The Caregiver Support Ratio is defined as the number of potential family caregivers (mostly adult children in the 45 to 64 age group) who are available to care for those who are over age 80.
This ratio is set to decline steeply, from 7 to 1 today (2013) to only 4 to 1 in 2030. It is expected to fall to below 3 to 1 thereafter. Just when the baby-boomers will be most in need of care assistance, the potential source of that assistance will have dried up.
The recent Report of the Long Term Care Commission (September 30, 2013) acknowledges the growing problem of a lack of caregivers (as well as the problem of the inadequate support caregivers receive):
Family caregivers today provide the majority of LTSS. Those who take on this unpaid role risk the stress, physical strain, competing demands, and financial hardship of caregiving, and thus are vulnerable themselves. Due to declining birthrates that will result in fewer family caregivers than in years past, there could be greater reliance on fewer family caregivers and the availability and quality of paid caregivers will become increasingly important. Report of the Long Term Care Commission, page 49.
The Commission Report makes a number of recommendations to enhance the ability of family caregivers to fulfill their role as a focus of services and supports. These include the suggestion that the Department of Health and Human Services develop a national strategy to support family caregivers, similar in scope to the national strategy developed to address Alzheimer’s disease.
But none of the Commission’s recommendations seems likely to dramatically increase the number of human caregivers who will available to provide LTSS in 2030.
Is there any answer to our growing caregiver deficiency?
Duck and Cover
I remember those atom bomb “duck and cover” drills we had when I was in grade school in the 1950s. At that time it seemed that technology was my enemy and nuclear weapons would likely prevent me from ever reaching my “golden years.”
But the world has so far avoided Armageddon. And I’ve now made it past 65. I no longer need to worry about dying young, and being cheated out of my life. Instead, I’m worried about who will take care of me as my needs increase with my advancing age.
Is the oncoming caregiver deficit destined to put overwhelming burdens on my children and damage the quality of my life?
Or could it be that technology will become my benefactor? Will I be able to rely on devoted electronic caregivers? Will technology affordably provide me with the long term assistance I am most likely to need?
Current Technological Supports
There are already a lot of technological devices to help seniors age in place. A report by Laurie M. Orlov for Aging in Place Technology Watch divides current tools into four categories:
Communication and Engagement. E-mail, chat, web surfing, Facebook, Smartphones, video games, web cameras, and texting allow seniors to be in touch with family and other supports and stay involved in the outside world. These tools can provide companionship and ease loneliness, which are especially important concerns for the 40% of the 85+ population who live alone.
Safety and Security. Security systems, mobile personal emergency response systems with passive fall detection, and sensor-based home monitors help monitor and reassure both seniors and caregivers.
Health and Wellness. From medication reminders, to games like the WiiFit, to systems that remotely monitor chronic diseases like diabetes and congestive heart failure, technology is helping seniors maintain wellness.
Learning and Contribution. Computers, including smart phones and tablets, are allowing seniors to read, learn, take courses, and contribute through work and volunteering. Elite Universities like MIT, Stanford and Yale are making many of their courses available for free online. (See, 25 Colleges and Universities Ranked by Their OpenCourseWare).
But the use of technology to care for the elderly is only just beginning. According to Orlov, the marketplace for technology to assist aging adults will grow sharply from $2 billion to more than $20 billion by 2020 and will include an explosion of smart phone and tablet applications for caregiving of older adults.
What about Hands-on Caregiving
The current technologies are great aids that can help seniors maintain their independence and quality of life. But they do not yet provide the hands-on caregiving services that are often required. Will robots and other technological tools become available that can help seniors with the more physical tasks of daily living?
Already service robots (like the vacuum cleaner Roomba) are being widely marketed. But while we are specifically designing robots like Hector to provide companionship and assistance to the elderly, we are not yet close to developing a true robotic nurse’s aide. We still need people for hands-on care like assistance with toileting, bathing, dressing and feeding.
Overall, I’m hopeful. Technology has advanced in ways that I could never have predicted when I was in school, or even when my children were in school. There is tremendous promise for long-term low cost support that remains patient and tireless in the face of constant demands.
So, while my kids are not completely off the hook, I think that it is likely that robots and other technology will be critical supports for me as I grow to need more assistance.
Given the dearth of future human caregivers, it is clear that we need to maximize technology centered care. I can’t wait to see what has developed by the time I (hopefully) reach my 80th birthday.
Further Reading
The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers (AARP Public Policy Institute, 2013)
Technology for Aging in Place, 2013 Market Overview (Aging in Place Technology Watch, July 2013)
Can Robots Help Care for the Elderly? (Psychology Today, June 17, 2013)
Robots: The future of elder care? (CNN’s “What’s Next” blog)
Grandma and Her Robot (Over 65 Blog, Sept 30, 2013)
Age and Sex Composition: 2010 (US Census Briefs)
SeniorNet.org (computer and Internet education for adults over 55)
Open Courseware (free online course materials)
25 Colleges and Universities Ranked by Their OpenCourseWare
[About Jeffrey Marshall: Jeff Marshall is founder of the law firm Marshall, Parker and Weber. He is past President of the Pennsylvania Association of Elder Law Attorneys. Jeff is listed in “Best Lawyers in America” and is author of the award winning book “Elder Law in Pennsylvania” published by PBI Press.]