care is crushingly expensive. Boomers aren’t ready.” Wash Post 3.18.23
I've copied this entire article from our online subscription to the Washtington Post, as well as the link below, to make this important info accessible.
Read it and get ready. You never know when you may be called on to help family or friends with long term care needs due to injury, illness or aging. You could be next yourself due to an accident. (art by Kate Allan, aka "The Latest Kate")
It's impossible to plan for every scenario, but get educated now. Get your estate plan in order! If you own anything of value -- bank accounts; cars; collections -- get it documented, organized, and ready to seemlessly be assumed by your designated beneficiaryor trustee. Have these hard conversations today. Prior to need. It will be easier for everyone. Be proactive so no one will be burdened tomorrow. Your future comfort and safety depends on plans you make with your family.
For more of my top tips for caregivers, see this post: http://stuartngbooks.blogspot.com/2023/04/caregiving-top-tips-20-from-4323.html
Here's the Post article: "An
estimated 18 million middle-income baby boomers will not have enough to pay for
care for moderate to severe needs, according to one analysis."
Beth Roper had already sold her husband Doug’s boat
and his pickup truck. Her daughter sends $500 a month or more. But it was
nowhere near enough to pay the $5,950-a-month bill at Doug’s assisted-living
facility. So last year, Roper, 65, abandoned her own plans to retire.
To the public school librarian from Poquoson, Va., it
feels like a betrayal of a social contract. Doug Roper, a longtime high school
history teacher and wrestling coach, has a pension and Social Security. The
Ropers own a home; they have savings. Yet the expense of Doug’s residential
Alzheimer’s care poses a grave threat to their middle-class nest egg. At nearly
$72,000, a year in assisted living for Doug, 67, costs more than her $64,000
“It’s devastating,” she said. “You can’t wrap your
head around it.”
A wave of Americans has been reaching retirement age
largely unprepared for the extraordinary costs of specialized care. These aging
baby boomers — 73 million strong, the oldest of whom turn 77 this year — pose
an unprecedented challenge to the U.S. economy, as individual families shoulder
an increasingly ruinous financial burden with little help from stalemated
policymakers in Washington.
The dilemma is particularly vexing for those in the
economic middle. They can’t afford the high costs of care on their own, yet
their resources are too high for them to qualify for federal safety-net
insurance. An estimated 18 million middle-income boomers will require care for
moderate to severe needs but be unable to pay for it, according to an analysis
of the gap by the Center for Retirement Research at Boston College.
“It’s this really enormous financial bomb sitting out
there that most people are just hoping won’t hit them,” said Marc A. Cohen,
co-director of the LeadingAge LTSS Center at the University of Massachusetts at
Boston. “There’s an incredible amount of confusion and denial.”
It’s no surprise that people put off decisions about
how to get by during the final years and decades of life; it’s unpleasant to
consider, and in the United States, there are few good options. Home care aides
are in short supply. Nursing homes are seen as overly institutional and cater
to the most disabled.
Assisted-living facilities, the fastest-growing
category of elderly care, provide an independent, homelike environment for
seniors who need some help with day-to-day functions. Chandeliers, comfy sofas,
wood paneling and plush carpets are standard in common areas. You can get your
own apartment with your own bathroom. But it starts at $60,000 a year on
average, according to the National Investment Center for Seniors Housing &
Care (NIC) — and costs go up as residents age and need more care. Locked units
for dementia patients, which increasingly are being established within
assisted-living facilities or as stand-alone facilities, run more than $80,000
a year on average.
Long-term care costs represent “the single largest
financial risk” facing seniors and their families, the National Council on
Aging and UMass Boston researchers said in a 2020 report.
“It has to be addressed because ultimately it will be
a societal crisis. These are the schoolteachers and the firefighters, the
working people who take care of all of us, who cannot afford the [senior
housing] that is being built out there right now,” said Beth Mace, chief
economist for NIC.
Polls show the vast majority of people would prefer
aging in place, in their own home. But median costs for 40 hours a week of
assistance from a care aide in the home, for things like bathing, dressing,
eating and toileting, run over $56,000 a year. A shortage of home care aides,
moreover, was exacerbated by the pandemic.
Seniors are stuck home alone as health
aides flee for higher-paying jobs.
Nursing homes provide the most intensive care for the
most dependent seniors and function like medical facilities, averaging $120,000
a year unless you qualify for Medicaid, the federal insurance program for the
poor and elderly. Medicaid will kick in only once an elderly person’s resources
are drained away.
Nursing homes are viewed as a destination of last
resort. More than 70 percent of older Americans say they are unwilling to live
in one, according to a 2021 poll by the John A. Hartford Foundation, which
advocates and funds research about age-related issues.
Families often rush to shop among these care options
when a health or safety crisis strikes. They take out loans, liquidate real
estate and ask family members to chip in for costs. They turn to public
internet fundraising sites like GoFundMe for help.
But because of the daunting expenses, many simply
allow elderly people with dementia and other infirmities to remain in
precarious conditions at home, possibly alone or cared for by an aging spouse,
extended family, and neighbors or volunteers. Adult children sometimes upend
their own lives to care for an aging relative.
“There are people who are in cruise ships and yachts,
and there are people who can barely afford to have a life preserver,” said Lin
Chojnicki, who toured several assisted-living facilities for her mother near
their homes in Enfield, Conn.
The buildings she saw were inviting and seemed safe,
she said, but they were unaffordable at over $4,000 a week for base rent and
much more for people with dementia. So her mother continues to live alone in
her own home, getting by with daily drop-in visits from family.
Advocates are calling on assisted-living developers to
build more-affordable options.
“It seems like a failure of industry because you’ve
got money on the table and you have people who could afford monthly rents and
the industry is not meeting that need,” said Caroline Pearson, the lead author
of a landmark 2019 demographic study called “The Forgotten Middle,” warning
that millions won’t be able to afford long-term care in old age.
“It is disturbing that the only option is to
completely spend down and impoverish yourself,” said Pearson, who is now
executive director of the Peterson Center on Healthcare.
Assisted living too often fails older,
sicker residents, report says
Growth in assisted-living facilities has been fueled
by real estate investment trusts, which are focused on generating stable,
recession-resistant returns from their properties, say experts. That means
attracting wealthy clients with greater luxury and amenities.
In 2020, according to federal estimates, there were
818,000 people living in assisted-living and residential units for dementia
patients, compared to around 1.2 million in nursing homes. The number of
assisted-living facilities grew 24 percent from 2015 through 2022 in 99 U.S.
metro areas analyzed by NIC, while the number of nursing homes declined 2.8
The assisted-living industry’s major Washington trade
group, the National Center for Assisted Living, said in an emailed statement
that it recognizes affordability is a problem. It said government must have a
role in creating better options.
About 17 percent of people living in assisted-living
facilities in 2020 were supported by Medicaid insurance, compared with around
75 percent in nursing homes, according to federal data. A persistent concern of
the industry is that Medicaid reimbursement does not fully cover the costs of
“Even before the pandemic, the long-term care system
in this country was broken. It’s too expensive for most people, yet it needs
further investment to ensure front-line caregivers receive a competitive wage
and facilities continue to modernize,” said LaShuan Bethea, NCAL’s executive
“You’re combining housing and health care, and most
Americans haven’t thought about or can’t afford to plan for this expense,” she
Advocates for the elderly say a solution would be to
build insurance programs that will pay for all long-term care and spread the
financial burdens over everyone. Germany, Japan and South Korea have
government-sponsored long-term care insurance. Congress authorized a long-term
care insurance program as part of the Affordable Care Act in 2010, but after 19
months of study, the Obama administration dropped it, calling it unworkable.
Washington state this year is launching a long-term
care insurance program, financed by a mandatory employee payroll tax of 0.58
percent, that will provide families $100 a day toward long-term care with a
lifetime cap of $36,500. Proponents are working on building support for similar
programs in California and Michigan.
Absent any comprehensive insurance, interviews show,
family members are left with the burdens of high costs.
One danger is the escalating care fees — as medical
need grows — that create a trap for people who think they can afford assisted
living over the long haul, said Sherri Lewis, an HIV activist and former pop
singer in Los Angeles who placed her mother in a high-end assisted-living
facility in Beverly Hills. Lewis’s mother, 93, had a long-term care insurance policy
that paid $4,000 a month for life, plus another $3,000 a month in Social
Security and other spousal benefits. That covered her mother’s care until her
needs grew and the monthly bill rose to $10,000. The facility asked her mother
to leave last year and she’s now in a nursing home, Lewis said.
Lewis turned to internet fundraising in a bid for
financial help from her network of friends. She said she was considering giving
up her mother’s long-term care insurance policy in a desperate bid to qualify
“Now we’re really in this horrible money pit,” she
said. “I’m burned out. I’m at the end of my rope.”
Another Los Angeles resident, Marsha Stevenson, a
graphic designer who works from home, lives with and cares for her mother in an
apartment. Stevenson got married in June 2020 and still has been unable to move
in with her husband. She has taken a pass on career promotions because of the
demands of caregiving.
“In the time I’ve been more consistently caregiving in
the last 3 years, I’ve gained 20 pounds and have more cardiovascular issues,”
said Stevenson, 53, in an email. “Even aside from the pandemic, I no longer can
easily get out to see friends or attend events and am often too tired even if I
In Topeka, Kan., Hugh Fitzpatrick, a 70-year-old
retired musician with Alzheimer’s, spent the last two years living in his son
Bryan Fitzpatrick’s basement, burning through the remnants of $88,000 he
received in proceeds from the sale of his house in Houston. Much of the money
was spent on a $175-a-day adult day care program. Once the house money was
gone, that enabled Fitzpatrick to qualify for Kansas Medicaid, said his
brother, Chuck Fitzpatrick.
He moved into a “memory care” unit, as the
dementia-care facilities are called, that costs $5,440 a month, Chuck
Fitzpatrick said. Medicaid will contribute $4,415 monthly toward the cost and
Hugh’s Social Security payment of $1,025 will be applied.
How much Beth Roper’s financial woes will grow depends
on unknowns, including how long her husband, Doug, survives and what happens to
her own health over the next two decades. In addition to postponing retirement,
she abandoned plans to pay for her daughter Kathryn’s wedding.
Doug Roper, who was a history teacher and wrestling
coach at Tabb High School in York County, Va., began showing signs of
forgetfulness that seemed to accelerate in 2018, the same year he retired, Beth
Roper said. By 2022, he could no longer drive and it became clear he needed
“He got to the point where he was confusing the key
fob with the garage door opener trying to unlock the car with the garage door
opener,” Beth said. He began ripping up his own clothes. She realized she could
no longer trust him on his daily walks, after he started trying to open the
doors of random cars around the neighborhood.
Beth scrambled over the summer to find ways to care
for Doug. She started to apply for adult day care openings, but the application
process was taking too long. Home-care agencies seemed too costly and would
still leave her with the heavy burden of caring for Doug overnight. She never
seriously considered nursing homes, she said, because Doug was fairly healthy
except for his cognitive decline.
She found a suitable room in assisted living for
$3,500 a month, but after just four days there the facility management told her
he was a wandering risk and needed to be placed in a costlier, locked memory
care unit, Beth said. Even there, he recently fell and suffered cuts and
bruises on his head and face. Now Beth worries about when she can retire and
what, if anything, will be left for her own long-term care.
You can’t plan for the future. Not to be morbid, but
we don’t know how long Doug will live,” she said.
She’s baffled there is no safety net for families in
her situation. The Ropers saved for college, they paid off their house, they
tithed at church, and they paid thousands of dollars in taxes for more than 70
years of combined work.
“We did everything our country asked us to do,” she