Tag: long term care

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The following is an excerpt from Your Best Path Forward by Brad Breeding, founder of MyLifeSite and a recent guest on Varsity’s Roundtable Talk podcast. Brad has spent more than 15 years helping older adults and their families navigate senior living decisions with greater confidence and clarity. Check out his full conversation with Derek Dunham on Roundtable Talk.

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In 1950, there were just over 12 million people age 65 and over in the United States, representing around 8% of the total U.S. population. Fast-forward 60 years to the time of the 2010 census, and there were approximately 40 million people age 65-plus, representing about 13% of the total U.S. population.

At that point, as baby boomers began turning 65 at the rate of 10,000 per day, the growth of this age cohort accelerated rapidly, expanding by another 40% over the next decade alone to reach 56 million, or roughly 16% of the U.S. population. The pace of growth in the 65-plus population between 2010 and 2020 averaged about four times the annual growth rate seen over the previous six decades.

This trend is unlikely to slow down anytime soon. By 2040, the 65-plus population is projected to reach 80 million, making up nearly 22% of the total U.S. population. To put this further into perspective, it is expected that within the next 10 years, for the first time in the United States, the number of people age 65 and over will surpass the number of people under the age of 18.

Not only do older adults make up a much larger share of the population today, but they are also living significantly longer. In 1950, a 65-year-old could expect to live about 11 more years, on average. Today, most 65-year-olds can expect to live roughly another 18 years—an increase of about 60%. And of course, many will live well beyond this average, but often not without chronic health conditions requiring some form of long-term care.

This rapid growth in the older adult population, combined with their longer average lifespans, has far-reaching societal implications, placing additional strain on our healthcare systems and federal programs such as Medicare, Medicaid, and Social Security, while simultaneously reshaping the labor force and economy. It also brings significant societal challenges, particularly in the availability of paid and family caregivers to support our aging population.

AARP prepared a study in 2013 analyzing the caregiver support ratio in the U.S., which measures the number of potential family caregivers age 45 to 64 for each person age 80 or greater. At the time of the report, there were more than seven potential family caregivers for every person in the high-risk age group of 80-plus. However, the report projected that by 2030, the ratio will decline sharply to 4 to 1, and it is expected to fall to less than 3 to 1 by 2050—a time when nearly all baby boomers will be in the high-risk years of late life. If this projection holds, it will represent a nearly 60% decline in the availability of family caregivers over those 37 years.

Adding further concern to the decline in both paid and family caregiver support is the fact that the number of “solo agers”—people who are growing older without support from a spouse/partner or adult children—is simultaneously increasing in the United States. Since the caregiver support ratio referenced previously only accounts for potential caregivers age 45 to 60, it does not include most spouses and significant others, who are often the first to bear caregiving responsibilities. Yet, the number of individuals age 80-plus who are solo agers is rapidly increasing. According to the Joint Center for Housing Studies of Harvard University, there were around 4.5 million people age 80 or over living alone in 2018. By the year 2028, this number is projected to jump to nearly 7 million and then to just over 10 million by 2038.

These statistics raise an important question for our society. Where and how will older adults live and thrive? For far too long, our society has taken a mostly reactive approach to addressing the lifestyle and healthcare needs that we may face in the later years of life. All too often, individuals and families wait until a significant health event occurs before evaluating their options, shifting into crisis management mode without the resources, flexibility in schedule, physical ability, or emotional capacity to handle such a task. Yet, the above statistics make it startlingly clear that it’s more important than ever before to plan for your future, especially for those living alone or without available family caregivers.

Making a plan

While the rate of aging differs from person to person, financial planners and other professional advisors often segment retirement planning into distinct phases. Recognizing that the entire concept of retirement is being redefined, with more people choosing to work beyond the traditional retirement age of 65, planners generally view the early years of retirement as a transitional phase, often lasting about five years after someone retires from their career. This period is marked by the need to reevaluate spending habits, adjust income strategies, and settle into a new daily routine. For many, it’s also a time of rediscovery—figuring out what brings purpose, structure, and fulfillment now that work no longer defines their schedule or identity.

For a person in average to good health, the mid-retirement phase is commonly thought of as the period beginning around the early to mid-70s and lasting until the early 80s, or as long as the person remains able-bodied and high-functioning. Many individuals in this phase can live an independent and active lifestyle today, but this is likely to change as they age.

The late phase of retirement begins when a person’s health has declined to the point of requiring daily living support with little chance of restoration. Statistics from the American Association for Long-Term Care Insurance reveal that nearly 70% of all long-term care insurance claims begin after age 80. At this stage, the goal is that all the planning done during mid-retirement helps to make the transition as smooth and supportive as possible, ensuring a higher quality of life despite the potential for increasing care needs.

If you are approaching or in the mid-retirement phase, now is the time to plan for your later retirement years, while you are still active and able. Delaying important decisions about tomorrow’s needs may leave you and your loved ones facing difficult and often costly situations in the future.

One of the more important and complex decisions to consider in this planning process is where to live. The home and environment in which you live during these retirement phases play a significantly larger role in planning than many people realize and will likely impact nearly every aspect of your life and overall well-being.

Purpose of this book

Beyond motivating you or your loved ones to start planning, the primary goal of this book is to provide clear, straightforward information on the various retirement housing options- including aging in place- while also exploring the key considerations, benefits, and potential challenges of each. It is designed as a launching point to begin the research process as you contemplate the best retirement housing choice for yourself or a loved one with the understanding that even where you live today can potentially shape your future. No single choice is right for every person, and the path that is ultimately best will depend on your own unique set of circumstances and preferences.

There are numerous terms and labels used within and outside the senior living industry to describe the various living options. In this book, I will categorize each type of retirement community and clarify much of the terminology. Still, I urge you not to get too caught up in specific labels because a single term may be used in different ways by different people or organizations. By helping you understand how various retirement living options work and what to look for, you can consider how those options align with your desires and objectives without focusing so much on the labels or terminology.

As you learn about the various retirement living choices, keep in mind that paying for care and access to care are separate issues. For instance, owning long-term care insurance or having a substantial level of savings and assets will help pay for care, but it does not address the other aspect of the issue: where and how your eventual care needs will be provided and the impact it could have on your overall health and well-being.

Remember: You cannot possibly plan for every contingency because it is impossible to know exactly what the future holds, but by understanding the options, considering the pros and cons of each, and having advance conversations with loved ones, medical professionals, senior living providers, and other professional advisors, you can minimize and possibly avoid many headaches (and heartaches) in the future.

Recently on Varsity’s podcast, Roundtable Talk, we sat down with Dr. Robyn Stone, a nationally recognized expert in aging policy and long-term care. As Senior Vice President of Research at LeadingAge and Co-Director of the LeadingAge LTSS Center, she has spent decades bridging the gap between policy, research, and real-world solutions to improve aging services.

Derek and Dr. Stone discussed the workforce crisis in long-term care, the challenges of educating consumers about aging services, and the role of technology in supporting caregivers. She also reflects on her decades in the field, offering insights on how change happens—slowly, but steadily. 

The conversation was filled with fresh perspectives. Below are just a few of them. 

YOU’VE SAID THAT SENIOR LIVING IS OFTEN AN “ACCIDENTAL CAREER”—A FIELD PEOPLE DON’T SEEK OUT BUT END UP LOVING. HOW CAN WE CHANGE THAT?

I’m actually an exception because I always knew I wanted to work with older adults. But over the years, I found that most people in aging services fell into these jobs by accident. Once they started, they realized they loved it. 

One of my primary focuses has been shifting this from an accidental profession to one that people intentionally pursue. We’ve made some strides, but we still struggle. If you look at the challenges in recruiting nurses, social workers, and even geriatric specialists, it’s clear that aging services is still undervalued. I think that’s tied to fundamental ageism in this country.

WHAT ARE THE BIGGEST GAPS IN EDUCATING CONSUMERS ABOUT LONG-TERM CARE?

There’s still so much misunderstanding. People don’t grasp what long-term services and supports (LTSS) actually are. It’s about helping people function independently for as long as possible, but it intersects with medical care because these individuals also have chronic conditions, acute episodes, and post-acute needs. 

Housing is also critical—if you don’t have a home that allows for mobility, your quality of life suffers. Most people still think Medicare pays for long-term care, which isn’t true. We’ve spent decades trying to educate people, but the reality is that most don’t think about it until they’re in crisis.

WHAT STRATEGIES DO YOU THINK ARE MOST EFFECTIVE FOR RETAINING WORKERS IN AGING SERVICES?

The best recruitment strategy is retention. If you retain staff, you don’t have to recruit as much. Retention is about creating a healthy workplace culture with both monetary and non-monetary investments. Higher wages matter—we still have 40% of this workforce on some form of public assistance, which is unacceptable. 

But it’s also about training, strong supervisory support, and career pathways. Not every aide wants to become an RN, but they might want to specialize in geriatric care, behavioral health, or medication management. High-performing organizations are figuring out ways to create these pathways, which leads to better retention and lower turnover.

WHAT HAVE YOU LEARNED IN YOUR CAREER THAT YOU WISH YOU COULD TELL YOUR YOUNGER SELF?

Change takes a long time. It’s a journey, not a destination. When I started in the federal government in the early ’70s, I was filled with hopes and dreams about making the world a better place. Over time, I’ve learned that progress is incremental. But you have to keep your eye on the prize. It’s easy to get discouraged in policy and advocacy work, but if you focus on long-term goals and stay committed, real change does happen—even if it takes longer than you’d like.

Want to hear more from Dr. Stone? Check out the full episode of Roundtable Talk for more fresh perspectives. Watch new episodes of Roundtable Talk on the Varsity website and on Apple Podcasts, Spotify, and iHeartRadio.