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A Crisis Of Care: As America Gets Older, Who Will Pick Up The Slack?

Caregiver Warren Manchess helps Paul Gregoline with his shoes and socks, in Noblesville, Ind. (Darron Cummings/AP)
Caregiver Warren Manchess helps Paul Gregoline with his shoes and socks, in Noblesville, Ind. (Darron Cummings/AP)

The older population of the U.S. is skyrocketing, with the number of seniors expected to approximately double in the next few decades – while the population over 85 nearly triples.

The aging of the baby boomer generation means millions of job openings for elder care workers, as well as geriatricians, geriatric nurses and other healthcare workers, and soaring health expenses.

“We’re absolutely unprepared,” says Elizabeth Eckstrom, Chief of Geriatrics at Oregon Health & Science University in Portland and author of “The Gift of Caring: Saving Our Parents From the Perils of Modern Healthcare.”

In the past, Eckstrom says, the U.S. and other countries have relied on families to care for elders.

“And that is just shrinking and shrinking… probably worse here than other places in the world, but happening everywhere,” she says.

Have you had trouble finding a caregiver? Or struggled to care for a parent on your own? Tell us your story in the comments. 

Interview Highlights

On why the U.S. is so unprepared to deal with higher demand for elder care

“When I travel around the world, I notice that other places still have a family infrastructure that allows for some elder care. But here in the U.S., it’s very fragmented and almost gone. So instead we rely on paid caregivers, and there just aren’t enough of them. And one of the things is that it requires a fair bit of training and yet the pay is extremely low. People walk into those jobs and just realize that they’re incredibly hard, and it’s really hard to retain people in that field.”

On whether federal programs like Medicare and Medicaid could fill the need gaps for seniors

“Medicare right now does not pay for any of these services. Medicare is kind of strictly hospitals, physician practices. They will pay for in-home skilled nursing services if somebody needs that after a hospitalization or something. But any of the long-term support and services that older adults need is not covered by Medicare at all. That could certainly change. It would be wonderful if it did. Medicaid does pick up a fair bit of this work, but unfortunately you have to be pretty poor to qualify for Medicaid. So a lot of elders just don’t qualify for it. … Somehow we need to kind of pick up that gap for people who are above the cutoff for Medicaid. There needs to be some ability to have financial support for caregiving, which is very expensive.”

On how the debate over immigration relates to the elder care worker shortage 

“I think that as the immigration rates go down, as people are more afraid to be in the workforce here if they are in our country undocumented, it will become harder and harder to find caregivers for older adults. And we don’t have an answer to that question right now. There’s no other workforce that’s taking it over. Young Americans are not stepping into roles to kind of fill in some of those gaps, so it’s making the crisis even more acute at this point in time.”

On why younger Americans aren’t interested in jobs caring for older Americans

“We have a culture of youth here. There’s just so little respect for older adults. There’s so little understanding of how valuable and meaningful relationships can be with older adults. We don’t foster intergenerational relationships very strongly right now. All of those things have kind of happened gradually, but are really coming to a peak right now. So that young people don’t really have much access to older adults, and that’s something that we really need to change.”

On models in other countries for elder care

“I think some of the countries that have put in place social services for this are places like Sweden, where if you’re older, you have a disability, you need care, they have in-home workers that can go see you as often as every two hours. They’re not there 24/7, but they can stop by every two hours, and that is all paid for under country health insurance so that you do not have any out-of-pocket expenses … I don’t know that anyone has the perfect answer yet. I think we have need for lots more research into what really works and then how to pay for it because that’s one of the biggest glitches right now.”

On whether there are public health implications for inexperienced families caring for their aging loved ones

“I think people are trying their hardest most of the time. One of the things that we highlighted in our book “The Gift of Caring,” was that even my co-author Marcy Houle – who is very savvy, you know, a really smart woman – she felt so many times that she just didn’t know the right answer. She’s highly educated and just [found herself] in these conundrums where she didn’t know what to do. And you know, that was after she had basically sacrificed her own career during that period of her life. She was trying to raise kids. And I think a lot of us are in that boat where we’re trying to do elder care without the skills we need. It’s really not even fair to have those expectations of our family members and yet we do.”

Francesca Paris produced and edited this interview for broadcast and adapted it for the web with Tinku Ray

This article was originally published on

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