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https://washingtonmonthly.com/magazine/july-august-2019/the-strange-political-silence-on-elder-care/?fbclid=IwAR1hi-CM8XyJo5-_E1wzaPLGJxUycd5V-Kiy6SGR5Fn4Fu2Cjrr_D5OeGcI



Interesting article I thought I'd share.

There is no single cause for the long-term care crisis:
- boomer population bubble increases demand for care
- post-boomer low birth rates: not enough paying into the tax coffers to cover each Medicare/Medicaid user
- broken immigration system stalling legal intake of future workers/taxpayers
- cost of medical care is mind-numbing and lacks transparency
- shortage of caregivers (even at a higher wage many young workers don't want to do it and don't have enough training)
- shortage of doctors (est, at 25K to 30K)
- low compensation to medical providers by Medicare & Medicaid disincentivises them to provide care
- cost of care increases over the past decades has outpaced savings by responsible retirees
- increased life span of care consumers
- many citizens saved $0 and many more are ignorant of the issue or in denial
- govt is an inefficient, unaccountable mess that has never run anything well (see VA, Post Office, etc) and won't be any better at managing your LTC
- ad nauseam

I don't think there'll be a single solution either. Taxing people is the same old panacea. I'm a small business owner with employees. Do I want to pay more in employment taxes like is being done in WA? Nope, it's hard enough to make a living in high-tax MN.

Starting in 2015 we cared for 5 people over the age of 83, in various stages of care needs, 2 completely broke, 3 who had modest savings, 2 out of state. During that time we still had 3 sons at home, 1 in HS, 1 in college and 1 working. And our 9-yr old grandson lived (and still lives) with us every other week and we are involved with his care. All while me and DH work full time running a business with employees. If there were no Medicaid, I don't know what would have happened to my ailing, broke and deeply in debt inlaws.

Before they entered facilities we engaged our sons to help drive the inlaws places, check up on them, deliver them groceries, pick them up off the floor in the middle of the night, reprogram their remote literally every other day. My sons learned to be more selfless and practice patience and mercy while getting an eyeful of reality. I'm glad they got to "practice" on them. The multi-generational approach is one part of the solution. But now all but 2 sons are gone and we still have my eldest and his son living with us. My 90-yr old mom lives next door. A loosely knit team of relatives, neighbors and a care service companion help me oversee my 2 aunts ages 97 and 100 as they are determined to age in place at home in FL. Thankfully, my mom and her 2 sisters are physically healthy, 1 has progressed dementia. If either one gets profoundly ill they may outlive their savings. My mom's ok for now but she may also live to 100.

The only solution the govt ever has is to tax people to pay for this care. We the people will need to be responsible and realistic about our own futures and get creative in how we provide the best possible care for our LOs. What that will look like, I'm still working out on a daily basis. At least we're not China where, thanks to the 1-child govt policy, many hundreds of millions of only children will have 2 parents to care for with very little help and few resources.
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Alva
It is even worst than that, because now if someone goes to school for four yrs and not only does he/she have huge debt, but he/she may not get a job in their field. I am fairly young and companies only want to work you about 25 hrs a week. I have talk to servers, which I use to do when I was young, they are working 2 to 3 jobs just to make what I use to make in a week working at one place 4 to 5 days a week. You are right things have change so much I'm not sure where I fit in.

I don't think politicians care about the elderly nor do they care about the families that had to quit working to care for those family members and how it impacts the economy as a whole.
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I don't see any politicians caring EVER anymore about anyone who cannot vote, let alone about anyone without money to donate. Things have changed so radically and now, at 77, I sound like my parents back in the day when I was saying (about them) "This is just what happens when you get old". I am there.
Things were so different when I became an RN. First of all I became an LVN first, or LPN as they called it in Illinois. My training was absolutely FREE other than cost of my uniform and books. I trained at some of the most wonderful hospitals in the country, Cook Country, University of Illinois. Got a decent well-paid job in a hospital, and slowly over the course of the next 20 years worked my way up to RN by taking classes for pre-reqs one at a time when I could what with two kids, and then "challenged" through a program put out by New York State University through Albany, taking four tests to prove I had the knowledge of an RN, then four days Clinical to prove I could care for patients in various areas of medicine with very little room for any error. I graduated from all that with about a 2,000 investment (my schooling being through SF Community College. These programs do not exist anymore. There is now a requirement for a BS AND your RN. Most cannot afford the money or graduate deeply in debt. We are seeing people now you are close to Social Security with College Loan debts that will never be forgiven by SS time or by bankruptcy. I cannot honestly imagine where we are headed but at 77 I will not likely be here to see it. And as to who will care for our elders? My brother is 85 and had to this year enter assisted living. He saved close to a million dollars working as, of all things, a WAITER. And he certainly did benefit from the escalation of real estate in value. I doubt anyone could get there that way today. Always a careful saver, to be certain, not only no TV but no answer machine, no cell phone, and a coupon clipper. But he will be able to afford his care until he dies in all likelihood, and I don't see our young folk getting there getting out of a four year degree with awful debt to start with. Just can't imagine where it will all go.
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The doctor shortages that have plagued Canada are a direct result of our Universities, in their wisdom, limiting class sizes a generation ago.
And many of the relatively unskilled tasks that people used to learn on the job now require a certificate or even a degree - I've grumbled before that soon we will need to go to college to learn to clean toilets and I am not far wrong, at least if you work anywhere in a health care setting. I keep hearing about labour shortages but what I'm seeing are many who would work but are not considered qualified. While I'm all for education I think it's overkill to expect people to choose a career that pays little more than minimum wage and force them to pay for an education for the privilege. Not to mention the ridiculous practice of never allowing new workers full time hours so that they need to juggle 2 or 3 jobs, is it any wonder there is no job loyalty and schedulers are pulling their hair out trying to fill shifts?
And then we turn around and hand many of the entry level jobs in healthcare to volunteers, people who have no training whatsoever.
Bah, I'm getting down off my soapbox now.
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I agree, Tacy - that's a particular hobby horse for me, too.

I was struck by the calibre of family caregiver the article opened with. Shamelessly making assumptions, here, but we have a lady who turns to Proust for light relief from her daily grind and I don't care, I'm going to jump to conclusions from that. She is persevering, she is educated, she is dedicated, she is even humorous about her situation. And she would like there to be much wider availability of the kind of versatile, high quality care it is costing her (and her husband, bless him) her middle years to provide for her parents, out of love.

And *who* is up to that job? And *what* would it cost to have a lady with these skills and abilities and personal aptitudes trained, cloned and distributed to all dementia care and continuing care facilities?

It isn't even just about money! A government, perhaps with an election on the horizon, not that I'm thinking of any particular example of course, may decide "to h3ll with fiscal responsibility! - let's chuck a few billion at it." Great. So there's the money. Now, where's the highly skilled vocational workforce you should've started training twenty years ago?

Well, one way or another there will be a reckoning. If you need care, and there isn't any, you will have to go without; and what happens as a consequence of that may eventually just be something we will be forced to accept for want of any alternatives.
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I think one of the scarier parts is the fact that there may not be enough people to provide care in the future. For instance, my son decided to go into PT rather than xrays. All potential heath care workers need to take an Anatomy and Physiology 1 & 2 class. He had to do 120 hours of job shadowing but th A & P 2 class has only 1 slot in each of fall and winter semesters, no spring/summer. The class is waitlisted for 2 years due to high demand. So, with the workforce retiring, how do we expect to have workers when colleges are not offering classes needed for degrees to keep up with demand? Yet, there are a dozen yoga classes offered a semester, general ed requurements are a joke.

About the student loan debt, I really think something needs to be done about training for the healthcare workforce in the future. Let's face it, no one is going to become rich becoming a CNA but from what I saw with aides, they definately need more training. If someone is going to make minimum wage, they wont be able to afford being saddled with the debt. The only two solutions I can come up with is free tuition for an associates or expand the CNA program to high school level allowing a workforce training program.

It really doesnt matter how many facilites we have to home the aging if there are not people to staff them.
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Houseplant, what a great excuse for not dusting!
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Barb, thanks for posting about this article.   I skimmed it article with the definite intention to read it more thoroughly later.  I'm still in shock over the 2 mass shootings in the last 2 days.   

I wouldn't disagree that elder care issues will reach a crisis level, and I doubt that anything will happen during the rest of this current administration, for reasons that I think are obvious.     Political attention is diverted to squabbling, name calling, and focus on issues that seem to be intended to increase divisiveness.  

Unfortunately, I'm afraid that crisis at the level of a potential nuclear disaster will have to be reached before anything is done.    Elders don't have the lobbying or purchasing power, or political clout, to effect that much, even with AARP's support.   And it's hard to even get cooperation between the two political chambers, let alone get a bill passed.

Look at the issues now  - what gets the attention of either party?   We have to change that, but I doubt it'll happen until after the 2020 election, and attention for elder issues will be a big toss-up even then if there's still friction between the two branches of battling elected "officials".
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It is going to be difficult with congressmen who don't value life. Most likely this will be taken care of by reduced care for the elderly, passing laws to allow assisted suicide, etc. You won't count for much if you can't vote. It's all about getting the votes - illegal or not!
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Thank you so much for sharing this article! (Barb, you write that your parents are in their late 60s...you are much younger than I'd thought!)

It really lays out all of the issues. Besides all the expectation that women today have to "have it all," work = children, there is also the often unacknowledged expectation that they will be the unpaid caregivers for the elderly. The elderly are living longer, thanks to medical science. But not only do the elderly often live with a greatly decreased quality of life, so do their unpaid caregivers, who usually aren't young themselves.

What would happen if women just started refusing to do this unpaid caregiving? I don't know. The outcry for "free college for all!" or "forgive all student loans!" would mean increased taxes. But so would more money for eldercare. So who would win? Neither?
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I hope boomers are better prepared financially than some of the situations I read about on Aging Care. If people are supposedly $400.00 away from a financial disaster, I doubt they have saved much for retirement.
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I had to meet with my attorney at end of July. We talked about this a bit. She made an interesting point in that yes,it is certainly a boomer tsunami, but when that wave is over you have a bunch of hulking real estate which lies empty.
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Barb, thanks for the article. When watching the 2020 debates last week, only one candidate said anything about "seniors".... sorry, I can't remember which candidate it was, I know it wasn't one of the more well known faces.

A few years ago, I was having a discussion about Medicare with someone who wasn't even on the radar of becoming 65. She was so surprised to learn that even though I had put tons of money into Medicare via payroll deductions, that I was still paying for Medicare when I reached 65 and years thereafter with deductions taken from my Social Security payments.

And that doesn't cover everything, I also need to pay for supplemental insurance of $275 a month.

Makes me scratch my head about Medicare for all.

Anyhoo, here in the Washington DC burbs, 55+ communities, Independent Living facilities, Assisted Living facilities, and Memory Care facilities are popping up all over the place. There must be a dozen in my neck of the woods.

Now I just hope that all these new facilities can find qualified people to staff them, or enough to train.

I know for me, it was $ticker $hock when my parents needed more of a village to help them. Good grief the cost was overwhelming. My parents were the children of the Great Depression, they knew how to be frugal and live below their means. They were ready for the rainy days. So I am now holding my retirement funds hostage for when my time comes. The bucket list is now a thimble list.

You'd think those in Congress who are collecting social security/Medicare would chime in on this subject.

My sig other are in our early 70's and we are still working, it gives us a reason to not wearing pj's all day long. My boss, who is in his 80's, he and I laugh saying we will know when it is time to quit is when we need to call Urber to get us to work :)
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I think you are absolutely right about more Boomers...to be change. I've been dealing with parents and spouse issues for 4 years now. I'm a Boomer and I keep telling people I know that our country hasn't a clue about what's rolling down the tracks. There were never be enough assisted living nor nursing home facilities to handle the massive number of people who, in the not that distant future, will be in need.

The nation is in a reactive mode and it barely can respond and solve issues about the elderly. I'll say again, this country has no clue what's rolling down the tracks. After all I've been through so far and all that I've learned, the current system will collapse on itself. It's not sustainable.

All said, I think two things will happen in the future. People will not meet the life expectancy currently projected by Social Security. (Siblings and I are supposed to live to 85 yrs. Cost of living and lack of health care will be starkly different, so I just think we will turn to dust somewhat earlier than projected. At some point SS will have to adjust those figures down. Again, it's just not sustainable. The other thing that will likely re-develop in the future is multi-generational families to care as a group for both the very young and very old. As with old age, not enough day care, preschool options. That used to be the way it was and it's the only model that's ever worked.

A final thought: this zipped across my computer screen a couple weeks ago, without any author named: YOU COME FROM DUST, YOU WILL RETURN TO DUST. THAT'S WHY I DON'T DUST. IT MAY BE SOMEONE I KNOW.
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Personally, I do not think eldercare is going to be an issue for another 8 years or so. It seems Washington is more reactive than proactive about upcoming crisis. I really think they need to start doing their jobs rather than hanging out on cable news and using Twitter all day, ugh.

If I really think about it, most people in my age range that I know have not went through any type of caregiving experiences. My own parents are in their late 60s and neither liked being retired so both went back to work at flexible jobs. Long term care is not even on the radar yet. I think its that way for most people. Relatively speaking, caregivers are still a small but growing percentage of the population.

It is going to take more Boomers to need care in order for there to be change.
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