Sunday, April 13, 2008

The Future of Elder Care, Part I

As my parents, friends and I myself age, I've been doing a great deal of thinking about the state of elder care in this country. The nursing home industry has indeed changed over the last few years, with the lion's share of changes having to do with offering specialized Alzheimer's and dementia care, assisted living, and palliative care for those in need. More and more long-term care facilities appear to be offering services which allow residents to move along a continuum from independent living to complete care, based upon an individual's changing needs. This is a welcome change, but there is so much more that can be done.

With the Baby Boom generation beginning to retire, I predict that the care of the elderly will be an enormous field with unlimited growth and employment potential over the next thirty years. Savvy and relatively wealthy, Boomers will alter the landscape of long-term care by demanding services that the marketplace will naturally bend over backwards to fulfill. For those in a position to finance and create specialized facilities for the care of the elderly, the adage of "build it and they will come" is incredibly apropos at this point in time when it comes to this burgeoning field of healthcare.

When this generation of elders begins to need care beyond what can be provided at home, facilities will indeed need to change in order to satisfy the needs of this new long-term care demographic. Gone will be the days of singing "Melancholy Baby" by the piano. Gone will be many of the entertainment and leisure activities enjoyed by the previous generations who came of age in the first half of the 20th century.

Boomers, having cut their teeth in the 1950's and 1960's, will have a whole new set of cultural sign-posts and icons under their collective belts, and their sensibilities and predilections will need to be honored and integrated as these individuals begin to enter long-term care. With James Dean, The Beats, Jack Kerouac, Woodstock, Richard Nixon, the Civil Rights Movement, The Beatles, the Women's Liberation Movement, and the sexual revolution as major cultural milestones as part of their collective consciousness, Boomers will need a new cultural environment within the long-term care setting which acknowledges their generational history.

As we can observe in many industries, the marketplace will follow consumer demand if a cohort of consumers has enough collective buying power to drive changes. I submit that the Baby Boom generation will do just that, and those of us savvy and caring enough to ride that wave will have the opportunity to provide specialized care to an enormous audience of consumers willing and able to pay for our compassionate services.

(I will be exploring this issue over time and welcome your comments and suggestions along the way. Stay tuned, and there will certainly be more to come.)


marachne said...

As a nurse who is getting her PhD with a focus on family caregivers at EOL and currently looking at the issues related to long-term care, here's just a few things to add to the mix:

1) Nursing Homes, as they are now designed and regulated are a disaster.

2) This disaster is being exacerbated by the fairly recent phenomena of large corporations buying up nursing homes FOR THEIR REAL ESTATE VALUE, and then doing everything possible to cut services to below regulation and safe levels

3) Another place where the gap between rich and poor widens: most assisted living is for-profit and, even if there are Medicaid waivers, the reimbursement is so low that it becomes mostly private pay. So, those w/money get the "nice" surroundings, those using public funding are in the NHs.

4) Looks ain't everything. the AL facilities often have great "atmosphere" but the staffing ratios are crazy and 99% of care is being done by unlicensed, untrained staff--is that who you want passing meds?

5) AL offers the promise of "aging in place" but cannot support that with care

6) Family caregivers continue to be expected to do more and more with less and less -- currently it is estimated that family caregiving is worth between $149 and $483 BILLION A YEAR. That doesn't include the costs of lost wages or the health costs that incur from providing care. And lets not get into the disparity between the number of people aging and the number of younger people able to care for them, or the role that our ability to mange chronic illness makes for more older, sicker people in need of care.

7) Negotiated risk. We "allow" 20-somethings to engage in all kinds of risky behavior, but insist, even when they are capable decision-makers, that older adults must stop doing things because they are dangerous. I'm not talking driving, which affects others, but things like living in their own home. Boomers are not going to go quietly or as dictated to.

8) Just to change things around a bit more, here's another social justice issue to think about: The combination of Globilization, Women's Migration and the Long-Term-Care Workforce (to steal a title from the latest issue of The Gerontologist (
More and more people (women) who are providing care in LTC settings are immigrant women...who are coming from countries with their own aging population.

As you can imagine, I could go on, but I'll stop here for now.

Anonymous said...

That's a rather bleak picture you paint.

Sure there are of problems with the geriatric care system, as well as the entire health-care system, but nothing's perfect, and nothing's unfixable. There are still plenty of ways to get good quality care, and plenty of ways to fix the system so getting quality care is easier.

Anonymous said...

Great post. We are in the process of building a mother-in-law suite in our house. My mom-in-law is a very active and healthy 71 years old. What's been interesting and challenging are the family discussions around this. I find that the family hovers between an attitude of offering to help her whenever she deems she requires it -- to an attitude that "we" (her children") know what's best for her (a rather paternalistic and occasionally insulting attitude).

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

This is a great conversation, one which I hoped my post would generate.

I agree with both Marachne and Reg----the system is somewhat broken and dysfunctional, but there still is decent care out there. However, in terms of "the haves" and "the have-nots", there is a huge difference in the quality of care available.

That said, I hope that this next elder generation will, 1) demand improvements, and 2) demand more equity for those who have less financial means. #2 is a rather idealistic notion that I think will go unfulfilled. However, with a relatively wealthy generation coming "of age", perhaps something good will emerge

As for the comment by "Anonymous", I encourage you to visit the website of the National Family Caregivers Association, linked on the first page of this blog on the lower right column. Thanks for your comments, and good luck!

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

BTW, the url of the National Family Caregivers Association is:

Anonymous said...

Sorry if this comes up twice. I tried to post this comment already and it didn't get through.

Check out this article on the problems in Minnesota with long-term care funding It's not just private institutions that have trouble.

marachne said...

To anonymous: informal caregiving is not all stress and burden, there are rewards, however one thing that is stated over and over again is that people tend to access help, respite and self-care after they've past the breaking point.

Find out what resources are out there, both for the MIL and yourself before you need them. The Caregiver's Alliance is a good starting place, also the National Family Caregivers Association (

And I'm not saying that there isn't good care out there, but it is a place of great health disparities for both residents and care providers.

Yeah, good conversation. Thanks Keith!

Anonymous said...

Nice post