population decline

Most Americans have at least a sense that our nation’s population is undergoing an aging spurt as the Baby Boomers retire. But the story isn’t as simple as a demographic bulge inching steadily along a timeline and inflating successive brackets. Not only were birth rates higher in the postwar years, but people continue to live longer. As a result, the fastest-growing age groups belong to the oldest of the old which are having a tremendous impact on our systems, especially health care.

Today in the health care reform debate and our countries economic woes, social security and Medicare expenses are being blamed. Clearly, as the Boomers age, there will be more demand on all systems, but as in the past, the Boomers will change the way we do things in order to accommodate the increasing numbers.

Aging is also occurring in the work place or at least it was up to the current economic recession.  Work is critical in surviving our longer life span, since the boomers are not financially prepared to live 18 or so years beyond retirement at 65 or 66. Many layoffs have occurred with unemployment at record levels. The older worker has suffered the most. There are many reasons, but I firmly believe that major “ageism” is occurring across the country and it needs to be corrected.

To accommodate the age wave we need to adjust our thinking and plan for the demands. For example, there is a lack of trained health professionals in geriatrics and gerontology. An Institute of Medicine study found only about one percent of the health care professional workforce are trained to care for our nations elders, which is critically deficient.

Much has been made of how Boomers will not enter their dotage without a fight. They’ve seen “old” and refuse to become it. They want or even expect, to remain vigorous and youthful forever. Many possess the means for the cosmetic surgeries to look the part and a huge industry has blossomed. The big fad is the “anti-aging” movement, to look younger. But the real challenge is how to have quality of life as we get older, even if we have some type of physical or mental or cognitive disability.

In terms of living arrangements with physical or cognitive impairments, Boomers won’t settle for nursing homes. That prediction is not much of a stretch, however, considering that even today fewer than 5 percent of elders end up institutionalized. The rest remain at home, getting by with visits from relatives, friends, and neighbors. Others practice the time-honored tradition of moving back in with their children. These patterns will continue. Boomers in need of more professional assistance will increasingly opt for community living. More attention is being paid to environmental safety, home modifications, and home care services to facilitate this so-called “aging in place.”

In one respect, Boomers face reduced living options. Because they had fewer children on average than their parents, they have fewer informal caregivers to which they can turn. Here technology can help fill the void. Future monitoring will be able keep track and aide in promoting independence and it is not just blood pressure and glucose levels but balance, and other changing health conditions. Medication dispensing with sophisticated reminders and caregiver notification is already available. My center can help with providing Lifeline’s Personal Emergency Response System and Prescription Medication Dispensing service in the home.

The boomers have lived to work and now are working for insurance and meaningful challenges. Boomers have stopped buying into the American dream of retirement and many have been economically forced into having to work to live. Many that still have pensions or other sources of income are willing to accept less pay for more interesting work or seek civic engagement. However, please note that at least 60 percent of those over 65 in Nevada depend upon Social Security as their primary source of income.

Safety net or entitlement programs such as Social Security, Medicare, Medicaid, and the Older Americans Act helped reduce poverty in older persons from 70 percent in the 1930s to 12 percent today. But by 2030, these programs will be largely gone or, if they still exist will be changed so much we won’t recognize them.

The reason? The older persons who wielded their political power and established the programs are passing from the scene. And with them is going the notion that the government could do good and the willingness of the electorate to pay taxes for things that benefit others and do nothing for you. This shift is change from a belief in collective responsibility, the underpinning of the New Deal safety net, to individual responsibility. Individual responsibility means that – I am responsible for myself. I will earn my own money. I will keep my own money and spend it the way I think it should be spent. I will refuse to pay taxes for anyone else, and I don’t think Medicare or Social Security will be there for me. I will take care of myself, and others will have to take care of themselves, and we’ll just hope for the best.

This isn’t necessarily bad. The United States has always been a nation that believed in independence and self-reliance. But it means people will have to save more money for their longer life expectances. If they don’t – tough. And we are not! Therefore, if these attitudes and policies continue, we will see higher levels of poverty among the Boomers as they become “old” and retirement of the past will disappear.

“What are we going to do?” Some (including this author) believe the Boomers will solve the problems of an aging society and rescue the safety net themselves. They have the track record of accomplishment – why not again?

Rather than New Deal-era programs, how about just out-of-the-box thinking.  One example is elder co-housing. This would bring older persons together in a common living community that could support one another. They could pool resources to, for instance, hire a driver if none of them were able to drive any longer. Another possibility would be to train some older Boomers who are looking for part-time work to become transitional health coaches and help their peers move through the health care system. These ideas would help solve problems and not increase the burden on society, yet save the safety net programs for those who need it.

Thinking of the challenges ahead reminds me of the poem “The Old Sailor” by A.A. Milne, best known for his Winnie the Pooh stories. The poem tells of a shipwrecked man. He continually frets over all the tasks he has before him in order to survive to the exclusion of actually tackling any of the imperatives. The poem concludes:

            And so in the end he did nothing at all,
            But basked on the shingle wrapped up in a shawl.
            And I think it was dreadful the way he behaved –
            He did nothing but bask until he was saved! 

We cannot do nothing at all until we are saved because – guess what? – we will not be saved.”