Health Journalism 2008: How will retiring boomers affect the national health agenda?

By Benj Vardigan
Independent health writer, Oakland, Calif.

Today, 37 million Americans are over 65. By 2020, this number is predicted to reach 53 million. That, combined with a recent RAND study that found "vulnerable" older adults receive the "minimum standard for acceptable care" only half of the time, suggests that if eldercare isn't already an urgent concern, it soon will be. As panel moderator David Gulliver of the Herald-Tribune in Sarasota, Fla., put it, "If [this issue] hasn't hit your community yet, you can be sure it will."

At the Friday afternoon panel, Daniel Perry, executive director of the Alliance for Aging Research, placed the issue in a broad context, summing up the staggering costs of health care for various conditions most likely to affect seniors: $448.5 billion was spent on cardiovascular disease and stroke in 2007 alone; another $174 billion on Alzheimer's. By 2030, he said, we'll be spending $16 trillion on health care, with 171 million people managing a chronic condition. With these and an array of other alarming statistics as a backdrop, the panelists discussed what needs to be done to prepare for the 78 million baby boomers set to begin retiring in just a few years.

Perry and the other panelists touched on the need for increased geriatric training, while explaining the disheartening trend of health care professionals moving away from the specialty and medical schools directing most funding toward high-tech fields. Geriatrics, he said, is "low-tech, high-touch." Today, less than one percent of nurses are certified in geriatrics, a situation Perry described as a "great untold story."

Joshua Wiener, senior fellow and program director of Aging, Disability and Long-Term Care at RTI International, focused his presentation on the shifting attitudes toward long-term care. While long-term care may equal "nursing home" in some people's minds, there are far more individuals in paid home care (2.2 million compared to 1.2 million in nursing homes). Given this, there has come about a "bipartisan agreement" in the U.S. to shift more focus to home- and community-based care instead of institutionalized care. Discussing the high turnover and low pay of geriatric health care workers, Wiener said, "We have to figure out some way to get many more people into the long-term care workforce than are there now."

AARP president-elect Jennie Chin Hansen centered much of her talk on the "hidden burden of cost" that falls on "informal support," or the family and friends who often wind up doing a great deal of the long-term care giving. 80 percent of care, she said, is "informal" and more than 90 percent of people give up work to become a caregiver at some point in their lives. This results in incredible financial strain as people often give up their entire income for extended periods of time.

She addressed efforts being made in different states (particularly California) to test cash benefits for these informal caregivers. Easing the economic burden on family caregivers is one obvious benefit of this policy, but there also seems to be greater continuity of care. Not to mention, in families where English is a second language, "you have more cultural and linguistic compatibility" when family members are able to be primary caregivers.

During the brief Q & A session, a public health nurse asked the panel about the rise of nursing homes overseas. She referred to some homes in China that have been described as "five-star hotels," and wondered what the panelists thought about "exporting our parents" to other countries for more affordable long-term care. Hansen said the idea makes sense from a pure dollars standpoint, but cautioned that regulation and monitoring could be a concern. Wiener made this convincing observation: "I fear for the nursing home resident visited once a year on a trip. Family is the most important part of ensuring quality care."