At the same time, the traditional family pool of caregivers is drying up. Families have been getting smaller for a long time. More people are living alone, and large numbers of boomers currently providing family care to their loved ones will wind up becoming large numbers of boomers needing care themselves. When that happens, the baby bust generation will be hard-pressed to provide the help that's needed.
The last part of what could be a perfect storm for caregiving is that we are coming off an extended period when people have not moved into nursing homes. Instead, aided by those large numbers of boomer caregivers, they have stayed in their homes.
AARP wove these trends together in a recent report that provides projections of future caregiver shortages that at best can be described as serious and challenging: "The departure of the boomers from the peak caregiving years will mean that the population aged 45 to 64 is projected to increase by only 1 percent between 2010 and 2030," the report states. "During the same period, the 80-plus population is projected to increase by a whopping 79 percent."
"In just 13 years, as the baby boomers age into their 80s, the decline in the caregiver support ratio will shift from a slow decline to a free fall," the report continues, adding that between 2030 and 2050, the shortage will become more acute before population trends balance again.
AARP also notes that caregiving has become more difficult than in the past because many health care services have shifted into the home from institutional settings. Family members often must care for wounds, give injections and perform other medical tasks "with little training of professional support," AARP says.
If the statistical projections are correct, families with frail older members needing care will either need to forego help, hire more professional caregivers (assuming they are available at any price) or place their loved one in an institution. At the end of the line, Medicaid is obligated under current law to provide long-term care for those who are financially unable to afford private care.
As previously noted, institutionalized care for frail seniors has been declining, and AARP says it fell by 37 percent from 1984 to 2004. "Medicaid costs for institutional care would have been an estimated $24 billion higher in 2004 had utilization rates remained unchanged after 1984," AARP says. "By 2010, the number of older people who received Medicaid assistance for nursing home services had declined by 26 percent from its peak in 1995."
The nation's bill for Medicaid is already projected to rise substantially due to the expansion of health insurance under Obamacare. Imagine what a caregiving crisis would do.
AARP says most caregivers are people ages 45 to 64, and most people needing care are age 80 and older. The caregiver support ratio reflects the relative sizes of these groups. The ratio peaked at 7.2 in 2010 – meaning there were 7.2 people ages 45 to 64 for each person age 80 and older. In 2010, there were many baby boomers in the caregiving group and a relatively small number of people age 80 and older.
Over the next 40 years, however, the sizes of these groups will move in opposite directions. AARP projects that the support ratio will drop to only 4.1 in 2030 and then plummet further to 2.9 by the year 2050.
AARP also looked at trends within individual states. Here are the states with the best and worst projected caregiver support ratios in 2030:
District of Columbia: 6.4
Georgia, New York and Texas: 4.8
California, Louisiana, Massachusetts and Washington: 4.4
Florida and Hawaii: 2.9
New Mexico: 3.2
Maine, Nevada, Vermont and West Virginia: 3.4
Delaware and Montana: 3.5
Here are the states with the best and worst projected caregiver support ratios in 2050:
District of Columbia: 4.0
New York: 3.5
Louisiana and Utah: 3.4
Illinois, Michigan, Mississippi, Ohio and Pennsylvania: 3.3
Alabama, Arkansas, Indiana, Massachusetts and Tennessee: 3.2
Florida and Iowa: 2.3
New Mexico: 2.5
California, Colorado, Kansas, Minnesota and North Carolina: 2.7