qotd: Single payer and the pending boomer caregiving crisis

January 11, 2016
Long-term care must become a more prominent part of the single-payer campaign
By Henry Moss, PhD

We are facing a perfect storm. AARP's Public Policy Institute points out
that as boomers age into their 80s, there will be a sharp drop in
available family caregivers due to the "birth dearth" following the
postwar baby boom. At the same time, longevity is increasing due to
effective treatments of heart disease, lung disease, diabetes, cancer,
and other conditions. A longer life, however, will likely mean more
years with severe disability for boomers due to the secondary effects of
increased obesity, including high blood pressure, high cholesterol, and
inflammation due to metabolic disorders.

These secondary effects include damage to brain blood vessels and a
likely increase in the incidence of dementia, including Alzheimer's
disease. We already know that the prevalence of dementia will grow due
to the sheer size of the boomer cohort. In addition, however, it now
appears that a recent steady decline in the incidence of cognitive
impairment and dementia have ended and are starting to reverse. Dementia
is by far the most care-intensive of conditions. More years with
dementia (and other disabling conditions fed by the effects of obesity,
including mobility disorders) will mean more need for 24/7 care in the
face of declining numbers of family caregivers.

Hence the perfect storm. Hence the "2030 crisis". 2030 is when boomers
start becoming the "oldest old" in large numbers.
The boomer generation is defined by a dramatic rise in home ownership.
This trend, coupled with real and perceived problems in nursing homes,
means that home care has become, by far, the preferred approach to
long-term care. With declining numbers of family caregivers, an army of
personal care aides, well-trained and better-paid, will be needed to
address the coming crisis. Medicare or another universal plan will need
to cover the cost.

PNHP and the single-payer bills circulating in Congress fail to place
enough emphasis on long-term care and severely underestimate the costs
associated with an aging population and declining numbers of
caregivers. There is no way to separate long-term care and health
care. Living at home alone with dementia, frailty syndrome, or a
mobility disorder are an invitation to falls and other safety-related
events, a major source of healthcare costs for older adults. Shortages
of physicians, nurses, psychiatrists, and social workers with
specialties in geriatrics and mental health will create serious concerns
for elderly patients both in and out of nursing homes. Medication
management will be severely compromised. The health of stressed family
caregivers will also suffer.

Over the course of its history, Medicare has added mental health
services, prescription drug benefits, and hospice care. Long-term care
is the next frontier and boomers and their future caregivers represent a
massive potential constituency. It must become a prominent part of the
single-payer campaign.


(Henry Moss is a retired baby boomer doing independent academic and
public policy research and writing. He has a PhD in philosophy and has
written on cognitive science and the history and philosophy of
technological progress. His public policy interests include health
care, housing and urban development, technological progress, and
theories of social democracy.)

The 2030 Caregiving Crisis; A Heavy Burden for Boomer Children, by Henry
Moss (250 pages)
For paperback, eBook or free PDF download:
http://www.2030caregivingcrisis.com

***


Comment by Don McCanne

Most single payer advocates certainly support inclusion of coverage for
long-term care in a national health program. Inevitably there is concern
about the magnitude of the problem, including defining the conditions
requiring long-term care, and the costs that care will entail.

In his book, "The 2030 Caregiving Crisis," Henry Moss discusses the
pending crisis when a disproportionately large number of baby boomers
will require long-term care at a time when there will be a
disproportionate decline in available family caregivers. Addressing this
problem now will provide a policy platform which will ease the problems
of long-term care once the surge in baby boomers diminishes through
attrition.

His book is well researched and well referenced, plus he provides his
own constructive thoughts as to addressing this problem. Hopefully it
will be a helpful resource as PNHP members clarify and organize our
concepts on the financing of long-term care, as a part of our mission to
achieve health care justice for all.