Alone and unable to care for themselves: This is the plight of millions of older Americans

By Paul Brandus

There are nearly 20 million people age 55 and older who have difficulty with one or more basic daily activities, study says

It's an epidemic that's hiding in plain sight: Everyday tasks like getting dressed, using the toilet and preparing meals are beyond the capability of millions of older Americans who lack access to eldercare. That's according to a study by the Schwartz Center for Policy Analysis at the New School for Social Research.

The study's authors, Jessica Forden and Teresa Ghilarducci, estimate that there are nearly 20 million U.S. adults age 55 and older who have difficulty with one or more basic daily activities. Those include shopping for essentials, properly using medical devices and taking medications.

Of those people, Forden tells MarketWatch, "[fewer] than 60% are actually getting care. That leaves over 40% who need care but aren't getting it. So there's this huge need that is not being met by the way that our current system is set up."

Why aren't those 40% - about 8.3 million people, the study estimates -getting the help they need?

"Our current system is very individualistic," Forden says. "It relies on family care and whether people have spouses or adult children, in particular, who are near them, who can help them, who can provide that care."

On that point, the SCEPA study shows that children, grandchildren and spouses are far more likely to be the ones providing care than professional caregivers. But lifestyle trends - including the rising number of so-called gray divorces among older couples, and children or grandchildren who might not live nearby - can limit who is available to care for those who need help.

"Adults without spouses and offspring are most vulnerable to experiencing unmet care needs due to heavy reliance on family caregivers in the U.S.," the SCEPA study notes. "There are 7.2 million adults over the age of 55 who have no spouse and no living offspring. Another 12.6 million adults do not have partners, but do have offspring who live more than 10 miles away, which reduces their likelihood of receiving care from them."

But even when older people do have family members nearby who can help, there is an added dynamic - and, Forden adds, it's not a good one. That's because those caregivers - most commonly a spouse or child - often must make huge economic sacrifices to extend that help, which threatens their own financial security down the road.

"What we find is that adults who are providing daily eldercare, they end up leaving the labor force or sort of reducing their hours of work to provide that care," Forden says. "This impacts your ability to participate in the labor force. And that, especially when we think about how retirement security is secured throughout a lifetime for an individual, it's very dependent on Social Security credits and being able to save in a 401(k). This obviously impacts your ability to build your own long-term financial security."

This means that a child who makes sacrifices to help a parent in need is "much more likely to be below the poverty line or to rely on public programs themselves when they're older," she says.

There are some policy prescriptions that could help here, though they wouldn't come cheap. In most states, single people cannot have assets worth more than $2,000, not counting the value of their home, in order to qualify for long-term Medicaid benefits. Raising this means-testing limit would enable more of people to get assistance.

SCEPA's research also underscores a somewhat common finding: While there are programs in place to assist lower-income individuals who need assistance, and wealthier individuals have greater resources to pay for assistance, those in between - the middle class - can be at greater risk of falling through the cracks. They might earn too much to qualify for means-tested programs but not enough to afford private care.

The SCEPA report, which is based on 2016 data, notes that "the average cost of assisted facility living ranged from $3,628 to $6,844 a month, depending on the accommodations, while hourly rates of home-based care were $20 to $20.50 an hour." Such daunting figures, which have certainly gone up since 2016, help explain why so many spouses, children and grandchildren pitch in - despite the long-term economic self-sacrifice Forden mentions.

There is a policy prescription for this as well. Forden suggests expanding Community Medicaid programs, which are Medicaid benefits received not in a facility like a nursing home but in one's home.

Right now, Community Medicaid "is inaccessible to a lot of people," Forden says. "One, because the system is kind of complicated, but two, also because of the variation in eligibility caps. Secondarily, you usually have to be 65 or older - but people are probably experiencing difficulties before age 65, but are not being covered by that."

-Paul Brandus

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12-09-23 0741ET

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