A couple of months ago, I was sitting n a press conference where Chandler Ralph was talking about big changes at the Uihlein nursing home in Lake Placid. Ralph is CEO of Adirondack health, which operates nursing homes, hospitals and clinics in the northeastern Adirondacks.
“The state does not have a firm public policy on how we’re going to treat the elderly and service the elderly in the future, in my humble opinion,” Ralph said.
It’s an astonishing idea, given that we live in a society being reshaped by the aging of the baby boom generation.
The population of Americans over 65 grew 15% over the last decade alone. The population of young workers, age 18 to 44, grew just .6 percent.
These trends, combined with the troubled economy and the trainwreck national debate over the future of entitlement programs, make it more and more urgent that policy-makers begin to hash our a kind of Marshall Plan for America’s seniors.
We know that the old system of guaranteed-payment entitlement programs probably isn’t affordable. Already, even solidly “blue” Democratic states are squeezing Medicaid reimbursements so hard that nursing homes and hospitals are struggling to survive.
Simple economics dictate that more and more nursing homes will turn away the poorest seniors, who rely solely on Medicaid.
As state and Federal officials move to tackle the astonishing levels of debt we have accrued as a society, boosting those payments will be all but impossible, particularly at a time when more and more seniors are entering the system.
It’s also a simple fact that the marketplace isn’t solving this problem. Many seniors have been hurt badly by the stock market’s gyrations, by the collapse in the value of their homes; and by the decision by private companies to cut or curtail pensions.
And there is simply no way that two-worker families, or traditional groups like churches, can care for the millions of old and very old Americans who will be added to the population over the next couple of decades.
At risk here are the enormous moral gains that we have made a society since the 1940s. Before that time, dire poverty was a normal state of affairs for the elderly. Old people starved or froze to death, or died for lack of basic medical care.
So what’s the answer? I’m guessing that it will take a complex, multi-faceted and non-ideological approach to create the next generation of safety nets for seniors. We will have to raise taxes. We will have to make painful decisions about what kinds of end-of-life care are affordable.
But we should also be far more creative.
One troubling aspect to this is that, so far, leaders at all levels have approached the question of senior care as a zero sum game, asking only what burdens their budgets can bear.
I would suggest that it’s time to turn the conversation around. Let’s ask first what that safety net should look like. What is the most basic network of support programs for seniors that would fulfill the requirements of dignity, respect and care?
What are the services that an ethical society simply must provide?
From that answer, we should work towards finding the most efficient, cost-effective and creative approaches possible.
A first step might be to create an “aging czar” in Washington, someone who can pull together all the thinking and resources from balkanized bureaucracies ranging, from the VA to the Administration on Aging to Housing and Urban Development.
Begin working with the states to foster experiments in creative elder care. Look to churches and NGOs for their best ideas.
The first baby boomers are now hitting 65 and people who look at the fate of nations say demographics is destiny. If we handle this change well, we could emerge with a more logical, affordable and decent safety net for our most vulnerable people.
This challenge could make us a better, more caring nation.
If not, if we shirk the tough decisions or simply turn away and leave more and more people to the Darwinism of aging, I suspect we will wind up with a humanitarian crisis among the very old not seen in the US since the 1930s.