As Global Aging Shapes Our Future, New Models Are Required
Paul Irving, chairman at the Milken Institute’s Center for the Future of Aging, did not mince words when he said “global aging, along with climate change, may be the great challenge of this century.” Despite our jaded response to such claims, this is one deserving of serious contemplation and immediate response. Why? Because Mr. Irving is correct and he has the data to support it. In addition to lower birthrates, advancements in science, technology, and sanitation have driven the average life expectancy on a perpetual incline over the past century. As new demographics bring forth added pressure on budgets and social structures, innovative paradigm shifts to institutions, safety nets, and social contracts are required.
While increased longevity of life brings forth an abundance of opportunities to individuals and societies at large, it also significantly impacts government budgets, workforces, and healthcare systems. At present, the United Nations has confirmed “virtually every country in the world is experiencing growth in the number and proportion of older persons in their population.” Currently there are over 900 million people in the world age 60 years or older. By midcentury, that figure is expected to reach 2 billion according to the World Health Organization. Total Medicare spending in the U.S. reached $618.7 billion in 2014. While 86 percent of older persons cited Social Security as a major source of income, total spending here reached $888 billion in 2015. Together, Medicare, Medicaid and Social Security account for nearly half of the federal budget. This, coupled with our national debt of nearly 20 trillion dollars points to the simple conclusion that as things stand we’re having a difficult time paying for senior citizens, if that population more than doubles as expected, financial crises lie ahead.
Family, Community, and ALFs
This growing population has effects beyond that of economics and finance. Population aging has also begun to reshape our homes, churches, and communities. In their first issue of 2017, the pulitzer prize winning Christian Science Monitor, released an article on global aging entitled “Where Seniors Count”. In it they interviewed a family in Baghdad currently caring for their 85 year old matriarch. The daughter, Hanaa, spends nearly half her salary on her mother’s medical care. War and sanctions have prohibited them from sending her to decent doctors in Iraq or abroad so the act of caretake falls to Hanaa, Jafar, and their 7 year old son, Fadl. Historically this arrangement has been common place in many middle east and Asian countries, both of whom stress cultural and/or religious importance of caring for aging parents. In the wake of our new globalized economy, this custom has begun to fade.
As the shifting landscape of markets and workforces moves ever further from rural to metropolitan, the youth in many nations are forced to follow. As the young move to cities in search of jobs and opportunities, a shortage of caregivers for aging parents has resulted in a growing demand for assisted living facilities or ALFs. These facilities are even breaking ground in places like China and Qatar where once they were a cultural anomaly. This surge in ALFs is born out of necessity in caring for seniors physical well being, as well as their psychological. As Stanford Professor Laura Carstensen wrote, “feeling socially connected to others is critical to physical and mental health.”
Next comes the issue of staffing these facilities or in house caregivers. In 2014, the New York Times reported that the U.S. would need a subsequent 1.3 million paid caregivers to meet the demand over the next decade. Soon to become the largest occupation in the nation, surpassing even retail, the industry needs revamping. Caregiver positions are often low-paying, demanding, and offering little in the way of benefits. Unsurprisingly, experts are skeptical as to whether the needed positions will be filled.
Socio-economics also plays a key role in who can and will be able to afford this type of care. The national median rate for a one-bedroom unit in an ALF is $3,500 a month or $42,000 a year. This, coupled with the fact that over 25 million Americans aged 60 or over are economically insecure and living on less than $30,000 a year makes ALFs unrealistic for many senior citizens. The task of caring for those without families or private facilities falls heavy on government budgets. However, that burden is nothing compared to the psychological and psychical effects that befalls the 15 percent of seniors who live in poverty and the 34 percent of those who report income under $15,000 according the U.S. Department of Health and Human Services.
At this crucial juncture, solutions must be found to both reduce costs on seniors and taxpayers while increasing education and wages for caregivers. It would appear the opposite approach may be heading our way. As President-Elect Donald Trump and a republican Congress lead by Paul Ryan look to repeal and replace the Affordable Care Act, many fear cuts to Medicare and Medicaid, both of whom, as the Times reported, are financially responsible for 75 percent of services provided by home care agencies. We could analyze the efficacy of their replacement plan if such a plan was made public, or existed at all. At present we can only speculate based on Trump’s vague previous positions and his cabinet appointees such as Tom Price. The threat of privatization looms ominously on the horizon.
A Dangerous Gamble
Privatization of Medicare is a system wherein senior citizens receive a voucher from the federal government where they then take to private insurers for health care coverage. A conservative argument in support is that doing so would drive much needed competition within the insurance market and force prices to lower, benefiting seniors, the national budget, and the economy. Liberals, and perhaps history, would argue that insurance companies simply do not want older customers, do not accept pre-existing conditions, offer only plans at incredible mark ups, and perhaps most importantly, Medicare is cheaper. As our society gets older and more people, institutions, and facilities are needed to care for them, it is an important moment for social policy reform — one the Trump presidency looks unlikely to succeed in.
Photo by Ari Seth Cohen
Look to Technology
One way to help lower government and private spending is to tackle the crippling costs of healthcare. The private sector, along with technology, is doing it’s part. Increasing the amount and efficiency of care while decreasing costs comes in the form of medical tech like Denmark’s Patient Briefcase and IBM’s Watson Health.
Patient Briefcase is a briefcase size device with a screen, microphone, and one solitary button. The device allows patients to see and speak directly with their doctors and nurses from the convenience of their homes, or ALFs. On those merits alone the device would be a good step forward, what makes it a great step forward is it’s ability to have other medical devices plugged into it — scales, spirometers, blood pressure monitors, etc. This information is then sent to their doctor’s telemedicine workstation for review and testing.
Patient Briefcase is a innovative solution to treating many chronic illnesses such as chronic obstructive pulmonary disease. Older persons diagnosed with chronic conditions and functional limitations make up the second largest high-cost group within the healthcare industry (40%), solutions such as these will prove vital. Harvard’s Kennedy School case study found patients’ who used Patient Briefcase had their hospital stays reduced from 7 days to 24 hours. Co-chairman of the African Union’s High Level Panel on Science, Technology, and Innovation, Professor Calestous Juma, thinks devices such as Patient Briefcase must also be utilized in developing nations with limited medical staff and resources. The Harvard professor knows that “new technologies offer the prospects of designing new health care systems that address the needs of the elderly while lowering costs.”
The Cognitive Era of Computing
As data analytics and artificial intelligence continue to optimize our world, cognitive computing like IBM’s Watson is yet another giant leap for mankind. Watson, a supercomputer that combines artificial intelligence and sophisticated analytical software, is often accredited with launching the cognition era of computing. Thomas Friedman wrote in his latest book, Thank You for Being Late, “By June of 2016, Watson was already being used by fifteen of the world’s leading cancer institutes, had ingested more than twelve million pages of medical articles, three hundred medical journals, two hundred textbook, and tens of millions of patient records, and that number is increasing every day.” This incredible feat of human and technological capabilities means that today, “you can get genetic sequencing of your tumor with a lab test in an hour and the doctor, using Watson, can pinpoint those drugs to which that particular tumor is known to best respond— also in an hour”. Watson is utilized throughout the medical field, from hospital administrators and CIOs to physicians and care managers. Efficiency and cost solutions such as this will restructure an industry in dire need of both.
Work and Volunteerism
In May of last year, the Brookings Institute, a think tank, published a paper in which they offer two solutions to the challenge of aging populations: Gradual retirement plans and championing systems for volunteerism, care, and artistic activities amongst seniors. The guiding principle of both solutions revolves around work which they rightly argue has both monetary and non-monetary benefits to one’s well being. Studies continue to show isolation and loneliness amongst senior citizens to have very real effects on both mind, body, and soul. Interaction amongst younger members of society, most of whom make up the majority of the workforce, is mutually beneficial. Phased in retirement would mean seniors could remain within the workforce, but reduce their hours and commitments. Brookings writes that retiring ageism and encouraged retirement would allow for continuity in tax revenues and reduce expenditure on pensions. Doing so would also benefit businesses and their younger employees who both gain valuable experience, level-headedness, and knowledge. Lastly, late-life work has been proven to give positive health and well-being for older employees. I’m reminded of later seasons of the sitcom Frasier where the father, Martin, a retired policeman, takes up a post as a part-time security guard. In doing so the proud patriarch is given fresh life, a sense of purpose, pride, friendships, and a paycheck. Though this is a fictional telling it’s real world parallels are similar.
For those unable to continue work in paid industries volunteerism and creative activities prove a wonderful outlet in helping both themselves and their communities. Older persons volunteer in communities, sit on advisory boards, and assist in city planning. By doing so they provide much needed transparency as how to businesses and city councils affect members of the senior community. Such volunteerism is also key to economic and cultural development which the Brookings Institute has found to provide nearly 8 billion hours of service — a value of $184 billion dollars. This volunteerism doesn’t necessarily mean spearing trash on the side of highways. The possibilities are endless, as are the rewards. Creative activities include writing, painting, sculpting etc. Brookings is right to suggest that “governments can promote such activities by financing arts and crafts courses in social clubs or community center for older participants.”
Ultimately, the situation at hand requires overhauls in both the private and public sector. Technologies must be introduced to the healthcare system in order to decrease costs while increasing effectiveness, efficiency, and access. Medicare must remain a solid social safety net and also given the ability to negotiate drug prices with pharmaceutical companies which, at present, is illegal. And while high profits and competition creates the best drugs known to western medicine, some sort of cap must be created to limit the overpricing of lifesaving drugs. Affordable housing solutions must also be made available to the thousands of senior citizens who have access to neither a home nor an ALF.
Age is a Work of Art
While each solution requires implementation, or serious debate at the very least, perhaps the simplest and most important reform is our collective, arcane perception of what old age means. Clinging to former opinions and policies of what old age use to mean is doing a massive disservice to our society and older persons within. These new demographics brings untold gifts, the challenges can be mitigated if we act swiftly, creatively, and unanimously. The long road of life stretches out before us all, only now the road has stretched a little further. We must work to repave and reline the road so as to enhance opportunity, creativity, and pride in old age. We’re not getting any younger — the future is for the old.
Written by Tanner Maroney
Source: The English Room