My high school buddies and I recently got together and reminisced about old times. “Can you believe we’re 60?” we howled. “That used to seem really old!” Many of us are still caring for parents who have crossed the 90-year-old threshold. As we joked about our aging bodies — the creaky knees and achy joints — we mused about another topic, too. Who will care for us as we grow old? Will our adult children with their busy lives assume the role of caregiver? And will the childless among us rely on nieces, nephews, friends or neighbors to step in?
When it comes to the growing demand for caregiving, the numbers just don’t add up. The United States, like many industrialized countries, is looking down the barrel of a looming care gap. As my fellow Baby Boomers move headlong into old age — we are now retiring at a rate of about 10,000 per day — there may not be enough caregivers to go around. The potential pool of family caregivers, whose stories I tell in my book, My Parent’s Keeper, will not sustain the growing demand for care. An estimated 117 million Americans will need assistance of some kind by 2020, yet the number of unpaid caregivers is expected to reach only 45 million. The caregiver support ratio, the number of potential family caregivers relative to the number of older Americans, is projected to decline sharply by mid-century.
Where have all the caregivers gone? Declining birth rates, far-flung families, a rising number of women in the workforce, and the projected increase in Alzheimer’s disease and dementia are contributing to this supply/demand conundrum. The responsibility for a growing population of seniors will be borne by fewer family members. Now more than ever, this diminishing army of caregivers needs to prepare for what lies ahead.
These trends are already being felt in the marketplace, where employers are losing an estimated $33 billion per year due to employees’ caregiving responsibilities. The Wall Street Journal recently noted that family caregivers, “long the backbone of the nation’s long-term care system, provide an estimated $500 billion worth of free care annually — three times Medicaid’s professional long-term care spending, and help keep people out of costly institutions… But the supply of caregivers is shrinking just as the nation needs them most.”
This demographic wave is also being accelerated by cultural trends, beginning with what MIT Age Lab director Joe Coughlin calls the “three D’s” — divorce, distance and debt. The divorce rate for adults 50 and over has doubled: Not only are aging adults less likely to have a spouse to take care of them, but their adult children may have to choose which parent to care for as they age. The number of “frail” older adults without children is expected to double by 2040. Already, more than one in five adults over the age of 65 is a “solo senior” — someone aging without a spouse or an adult child. Even those seniors with adult children will find that this generation of adults is less likely to move back home — and that distance between kids and loved ones can be debilitating: “When adult children leave their rural homes,” the New York Times recently reported, “a key component of elder care goes missing.” Meanwhile, even the Millennials who can come back are being saddled with historic heaps of debt — over $30,000 for an average college grad — which may restrict their ability to pay for, or take time off for, caregiving.
Who will take care of us when we age?
So what will we do when there are fewer relatives to take care of us? Many will seek to hire paid caregivers, who will be increasingly in demand as the population ages. Only about three in 10 older adults who require daily assistance hire paid caregivers now. But that percentage may increase since there won’t be enough family members to go around. The U.S. Bureau of Labor Statistics estimates that nursing assistants and home health aides are among the top 10 occupations with the greatest projected job growth in the U.S. These unsung heroes, who are disproportionately women of color, work for low wages and are often economically powerless. They are people like Roseline, a home health aide who tenderly cared for my father with dementia during the last years of his life and always greeted him with a hug and a smile. Roseline tended to my father’s needs with skill and compassion. She performed an important job that our society does not sufficiently value.
How can we support people like Roseline, part of a vital care workforce, who often live below the poverty line, dependent upon public assistance to support their families? Fortunately, there are industry leaders and innovators who are taking a stand and pushing for change. In 2010, Ai-jen Poo, executive director of the National Domestic Workers Alliance (NDWA), helped lead the creation of the Domestic Workers Bill of Rights in New York, the first in the U.S. to guarantee domestic workers basic labor protections, which has been signed into law in a growing number of states. Just last month, Seattle passed a version of the law, which guarantees a minimum wage and modest breaks.
If wages for paid caregivers do increase, as they should, how will the average family afford care? Most families are digging deep into their pockets already. Public policy may offer some respite — including the Family and Medical Leave (FAMILY) Act, which offers up to 12 weeks of paid leave for family caregivers in a handful of states. But even if the U.S. were to adopt this more broadly, there would still be plenty of uncertainty on the horizon. Will Medicare, which faces an ominous threat of insolvency, take on the burgeoning costs of long-term care? Will Medicare even be around when millennials start turning 65? And what about the professional caregiving workforce? Will people like Roseline leave their jobs altogether and find higher-paying work elsewhere? As the Times reported last year, paid caregiver jobs are “so unappealing that it is hard to keep workers in them: four in 10 leave the occupation entirely within a year. Many prefer the fast-food business.”
Is technology the answer?
One answer to the looming care crisis may be the promise of technology. Most people will want to age independently, staying close to the things they know and love. Family caregivers will increasingly have all sorts of technology options at their disposal. Remote activity monitoring through in-home sensors can alert them to worrisome changes in their loved ones’ daily routines. Robots can now lift people into and out of bed, dispense pills, even fold towels and follow recipes. That might help. But the vital importance of human connection, in my opinion, will never be replaced by technology.
So who will provide that connection if there aren’t enough caregivers to go around? We will need to think differently about how we view caregiving, relying less on the traditional models and shifting toward a broader patchwork of support from family members and friends. Still — unpaid caregivers cannot do it all. That’s why we have an obligation to find ways to support our professional caregiving workforce. One example of that spirit in action: Back in 2015, the NDWA — along with for-profit partners like my employer, Care.com — introduced the “Fair Care Pledge,” a national effort advocating for fair pay, paid time off and clear job responsibilities for professional caregivers. Paid caregivers should not have to seek better job protection and wages by flipping burgers rather than caring for our elders.
After all, most of us will someday be caregivers or need care ourselves.
This article originally appeared on Forbes.com.
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