Category: Elder Care

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Declining Elders: You Should Probably Start Writing This Down…

To die of old age is a death rare, extraordinary, and singular…a privilege rarely seen.

– Montaigne, Of Age, 1575

Getting old isn’t for sissies.

– The PracticalDad’s grandmother (circa 1990)

You should probably start writing this down…

– BH, The PracticalDad’s wife (circa Autumn, 2014)

American Elderhood is terra incognita.  Our parents are living longer and yet the tide of financial assets to support them in their elderhood is ebbing, as is our own.  The structure of the family is imperceptibly changing as a result and it is up to us in the moment to figure out how to manage.  The model that we’ve known for the past three generations, retiring at a relatively early age and spending our later years with a degree of material comfort, is ending.  And it’s not just happening in the United States.  The general unrest in France is wholly rooted in the question of retirement funding and the unrest in Chile is partially rooted in anger at the status of retirement and pension funding.

Not only has the lifespan increased, but the causes and nature of death for Americans have changed as well.  At the turn of the 20th century, 120 years ago, the American lifespan was approximately 50 years and it has since risen to almost 80 years, with a few years differential by gender.  In that same span, the causes of death have shifted as well.  Back then, the top three causes of death for our elders were pneumonia/influenza, tuberculosis and GI infections whereas today, they have been supplanted by heart disease and cancer.  This doesn’t touch upon accidental death more than a century ago and the statistical rise of Alzheimer’s today; their elders died young enough that Alzheimer’s wasn’t a consideration whereas our elders won’t get offed when the family buggy is whacked by a train at an unmarked crossing.

Death was a quicker process back then and consequently, far less expensive.  Eldercare is challenging with a varied set of demands that range from assistance in ordering and managing medications to getting a declining Elder to appointments, and even attending the appointment with her.  Factor in the degradation of mental and/or emotional status that might accompany the decline and it can be highly problematic for both Elder and adult child.  My own parents were a microcosm of this disparity.  My father succumbed to a relatively short four-month course of cancer while my mother passed after a several year affliction with Alzheimer’s.  And it was early in that latter illness that BH made her suggestion:  You should probably write this down…

The suggestion was god-sent although it wound up being a far different thing at the end than at the outset.  It wasn’t a consideration for my father’s illness as his disease course was relatively fast and straightforward and he was in full possession of his faculties up to the moment of his death.  But contending with a lengthy and convoluted process like Alzheimer’s involved not just medical, but logistical and legal issues that made it the singularly most important tool in the endeavor, serving as a resource and stay against the confusion that arises out of contending with a stressful, prolonged and complex situation.  My exercise in this lasted for more than two and a half years and in the end comprised 63 typed, single-space pages with entries that only ended upon the day of her death.  But having done it and finally reflected upon it, there are some points that can be taken from the document and the process.

First, understand precisely what it is…and what it isn’t.  I referred to my notes as a journal at the outset and that, in retrospect, was a poor descriptor.  Journaling is now a practice in which someone engages to record their feelings and/or thoughts and is recommended for self-help and exploration.  Keeping notes for the process of Eldercare is wholly for informational purposes and you should expect that you will likely share at least a portion of the document with a sibling or spouse.  Full disclosure:  managing a parent with Alzheimer’s tinged with paranoid dementia led to instances of personal distress that are best left unrecorded for others.  To put it in terms of professional journalism, you are writing to cover the essential questions:  who, what, when, where, why and how.  If you are compelled to actually maintain a journal for reasons of self-care, keep it completely separate from the log notes and never mingle the two.

Second, decide if it’s even necessary and if so, whether it’s even the appropriate time to start the log notes.  It might not even be necessary, as in the case of my father.  But if you do deem it necessary to begin keeping log notes, there isn’t necessarily any hard and fast rule about when to begin.  It doesn’t just tick over automatically, such as the arrival of the first AARP magazine at age 50 or Medicare at age 65.  There should be a defining instance that drives the start of the process, and for the logkeeper, it will indeed be a process.  In my mother’s situation, it was a spate of mutually frustrating incidents for both my mother and I that led to my wife’s suggestion.  This was confirmed in conversation with my sister, who was also noting separate incidents.  Every entry that I made noted the date, except for the first entry which referenced an entire two month period followed by a synopsis of events.

Third, understand that this is something that perhaps shouldn’t be shared with the Elder.  Pride is a driving factor for many people and is especially so for an elderly parent who has raised you and saw you into your own adulthood.  It can be physically dangerous for them as they are unwilling to accept that their debility can pose significant risk, particularly in regards to the driver’s license.  Hell, I can attest to this in my own debility as my toddler grand-daughter will sometimes yell “Pop!  Cane!” if she sees that I don’t have it when we venture out somewhere.  Sweetpea, I love you to death, but please…do I have to?

The point is that while it is an invaluable tool for you, consider what their response would be were they to know.  I have met adult children who openly carry a notebook for the appointments and the elder is fully accepting.  In my mother’s case, her knowledge that I was taking prolific notes would have disastrously exploded in my face.

Fourth, establish ground rules on making entries.  What prompts an entry and what are your rules on maintaining it?  Mine had weeks between some entries just because there was nothing materially new to write.  If one daily phone call is just like another ad infinitum, what’s the point?  At other times, she simply refused to speak with me; there were a few instances when I made notes that I had at least attempted contact just for informational purposes.  But if there was a new thread of conversation, concern, allegation or news, then it was worthy of an entry.  Likewise, any interaction with another individual – doctor/nurse, lawyer, social worker – led to an entry just to help keep straight the growing cast of characters as well as their input.

The other two comments here are the need to stay current and disciplined in the process to minimize the confusion.  There were instances when I had to refer back to texts with wife and sibling to jog the memory, but that was the exception to the rule.  I also kept a small notebook in the glove compartment in the event that I needed to take a few notes after leaving her.  Finally, consider the depth of information that you are planning to retain.  I rarely wrote anything pertaining to exact medical findings – blood pressures, etc. – because that’s the purpose of the medical record.  If there was a material change in the physical or mental status and especially if it lead to some new circumstances, then I’d make the entry.  But I never saw the point of writing every last piece of data.

Fifth, expect to share this information with family.  When there are siblings involved, communication is critical to keep a bad situation from getting worse.  One of today’s boons is the technology that allows almost instant communication; texts were a lifeline with both my sibling and wife and there were occasions when we literally blew up the text feed.  But texts aren’t a great way to fully capture the gist of an extended conversation with the elder or a doctor/lawyer.  It wasn’t uncommon to follow a brief text with a lengthier email, followed by the log entry and towards the end, I simply did the log entry and then cut and pasted it into the necessary email.

It’s only been in the past two weeks that I’ve come to realize this:  Google Docs could have made my life much easier.  There are potentially thorny questions, such as who has administrative access and what are the family repercussions of limiting access; but with one sibling who was in lockstep agreement on where we were headed with our mother, it would have made life a bit easier.

Sixth, make certain that the information is backed up or printed.

If you’re a Philadelphia Eagle fan, you’re familiar with Coach Doug Pederson’s philosophy of the Next Man Up.  In the worst case scenario of your death, the document should serve as a reliable guide to what has occurred so far with your elder, making your successor’s work at least that much easier.

The last entry in my own log notes simply covers the final hours prior to Mom’s early morning demise.  There were separate notes for the logistical and legal activities that arose after the fact but it just seemed appropriate to keep them apart so they have no part of the log.  The binder then went into the bookcase and it wasn’t until many months later that I was able to read any part of it without anxiety or nausea.  There are a few entries from the month prior to her death that still affect me deeply.  But I have pulled it occasionally to read just to remind myself of certain things, and to see what can be taken from it for when my own family might be responsible for me.

And for the record, when the grand-daughter reminds me to take the cane, I take the cane.

 

 

 

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As Eldercare Comes Home

When not overshadowed by President Trump’s perfect Ukraine phone call, the national conversation in this Presidential election cycle pertains to higher education funding and healthcare.  But the issue that is approaching steadily from behind is how we’re going to manage our rapidly growing population of senior citizens.

Youngest and I sat before the television screen, watching and commenting upon the potential candidates during the fourth Democratic debate on October 15.  It was the usual back-and-forth and the only recurrent question between us was why in the hell is Beto O’Rourke still here?  But out of nowhere, Senator Amy Klobuchar of Minnesota caught my attention with her comments that apart from the two principal issues, who was paying attention to other pertinent topics, such as the rapid growth of the aged population in the United States – what she referred to as The Silver Surge.  Perhaps it’s that Minnesota has a significantly larger and growing elder population; next year, Minnesota’s 65-and-above age cohort will exceed the 17-and-younger cohort for the first time in their history and by 2030, more than 20% of Minnesotans will be senior citizens.  They aren’t as far along as Maine, thank you Jesus, but they are well on their way.

Klobuchar is right.  The almost complete absence of political conversation means that any meaningful programs moving forward will not pertain to the elderly; we will have to manage via programs cobbled together at the state and local levels.  The reality is that the onus will devolve down to the granular level of the family unit.  I purposefully stated that the issue is approaching from behind because the adult children in a society with a declining middle class are looking forward generationally, attending to the needs of their own families and children.  Kids are very squeaky wheels requiring investment in time and money and their parents will hear very little from their own elders about their conditions until there is a significant health event which knocks the axle off the elder truck.  It’s generally a two-way silence; the adult children are simply trying to keep things afloat and the elders say little out of pride, fear or shame.

So once again, it’s up to the family to work this out.  Our society has become so complex that inattention can have potentially catastrophic results personally, medically and financially.  The obvious question then is where do we even start?

The good news is that old age doesn’t just happen overnight, like – *POOF* – Mom’s suddenly old.  Aging is a continuum and while there’s always a downward trend, the slope is typically longer and shallower until there’s one or more medical events that sharpen the decline before culminating in death.  Perhaps the first question to answer then is where are your elders on the continuum?  Are they poster elders for Senior Olympics or are they already doddering around on gimpy legs with a laundry list of daily medications required for simple survival?  Even then, how is their condition mentally versus physically?  The body itself might be in decent shape for elderhood but Alzheimer’s, while severely affecting mental capacity, is a physical malady.

The question of location on the continuum is important.  Once you have a sense of that location, you can begin to consider some of the aspects that must be covered as they move forward along it and with that, a sense of the time and criticality with which these aspects must occur be addressed.

What are some of these aspects?

The Conversations.  American Elderhood can be aptly described as terra incognita for our society.  We’ve been obsessed with youth and uncomfortable with the concept and practice of dying.  Medical advances have pushed the envelope of lifespan so that the fastest growing demographics are our elders; and remember that there is not just one age cohort for the elderly.  But that increase hasn’t been correspondingly matched by either assets to financially support the longer lifespan or an increase in individual mental and physical capacity to support it either.  There have to be multiple conversations with them to help plan so that their waning days are as comfortable and meaningful as possible.  Given the complexity and emotional discomfort that can accompany such discussions for both elders and adult children, it’s entirely likely that these won’t be completed quickly.  The time to start having the conversations is sooner than later.

The Overwatch.  Is it possible to develop meaningful, yet discrete and respectful, tabs on how our elders are doing?  It’s been difficult to even find a term for this situation; surveillance is laden with negative connotations and is disrespectful to them, not to mention potentially counter-productive.  The difference between a declining elder and a kid is that a kid with an offended sense of pride can’t blind you by tearing up your HIPAA forms.

The Siblings.  Do you have siblings and what are their circumstances?  Are they geographically nearby and what is their relationship with both the elders and you?  How are the lines of communication and is there a delineation of responsibility?  Most importantly, are they willing to acknowledge elder wishes even if they might not be in agreement with them?

The Finances.  How aware are you of their finances and are they capable of handling them?  If you have to step in, are measures in place to allow it?

The Documentation.  There is a considerable amount of paperwork involved with the elderly and much pertains to assuring that their rights are protected, particularly as they become less able to care for themselves.  Everybody knows about wills, but do you know where your elders have theirs and is it accessible?  Is there paperwork granting Power of Attorney not just for financial matters but healthcare matters as well?  Do you have the appropriate clearance to speak with the potentially numerous medical providers?

The Allies.  The demands upon you will increase as your elders age and you will likely have to depend upon the assistance of others in the eldercare system.  Have they reached the point of requiring your attendance at appointments and who can get them there?  What if they have a pre-existing relationship with another professional, such as their own lawyer or financial adviser?  Do you have a go-to person for help in navigating a complex medico-legal eldercare system?

The Systems:  Healthcare and Housing.  You’ve likely been spending your time dealing with the kids and haven’t had to seriously consider the complexity, opacity and cost of the healthcare system and elder housing structure.  Getting a crash course in navigating them is frustrating and fraught with peril.  What exactly is the Doughnut Hole – yeah, that’s actually a thing – and why must your elder leave their continuing care retirement community for somewhere further away for skilled care?

The System:  End of Life.  Even if your parent has been clear about everything – communication, paperwork and documentation, final wishes – getting him or her to that point at which final wishes can be honored can be problematic.  Most of us have little experience with death and the confluence of physical and emotional factors can create an immensely stressful situation.  Is there clarity about what the final wishes are?  How do you contend with the potentially large number of specialists who might be called in because of multiple systemic failures?  What are the resources available to you?  What exactly is hospice and when is the best time to get them involved?

What’s the aftermath?

These various aspects itemize neatly, as though each was a Lego block that stacked and nestled neatly together in a self-supporting structure.  But the reality is that each aspect is more like a thread that would be woven among the other threads in a tapestry.  Each can dramatically impact another aspect for better or worse and how one works out can be dependent upon how well another aspect was addressed.

Caring for your elders – parents or grandparents – can be a rewarding and fulfilling experience and there are those who count it as a privilege.  But it can still be problematic and there are moments when you are likely to find yourself pushed and exhausted and at times, bereft.  Understand in those moments that you aren’t alone and if you’re able to look up, there will be moments of amazing grace emanating from circumstances and people that will pull you through.

Much of what that’s written moving forward will not necessarily be an exhaustive What to Expect When You’re Expecting type of guide to everything about aging.  But it will be framed extensively by the experiences of being involved with an aging parent with Dementia, including the missteps and miscues.  All of the aspects mentioned can be drawn directly from personal experience and to the extent possible, these experiences will touched upon so perhaps something of value can come from them.

 

 

 

 

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Is the Multi-Generational Family Under-represented?

In 2018, Pew Research noted that the multi-generational family structure – defined either as co-habitation among two generations older than 25 years of age or grandparents and grandchildren – was making a comeback.  As of 2016, the last year for which data is available, 20% of American families comprised this model and this was the highest level since 1950.  When we think of this type of family, we recall the Walton family from the iconic CBS series The Waltons, which aired more than three decades ago.  When the series aired, the percentage of American multi-generational families was at or near it’s low point.  Since then, it has risen consistently and while there may be other reasons, economic factors play a front-stage center role.

The Pew Research definition is solid because it describes a family composition that is objectively quantifiable via census and sampling data.  But what if this is only a partial picture?  What if American families are altering their decisions and actions accordingly to account for the decline of the middle class, but in ways that are not as easily captured via standard data collection techniques?  What if familial generations are making decisions and arrangements that bind themselves more closely together to provide mutual care without co-habitation?  If co-habitation is changing the family structure – the skeleton – are there less overt changes occurring that re-knit the generational sinews in ways that quietly alter American society?  Such examples would include:

  • One generation purposefully relocating closer to another in order to receive or provide support, material or otherwise;
  • One generation providing childcare or other supportive measures;
  • One or more generations refusing to relocate because of the impact upon the other generations.

I note these examples because these are actions that I have witnessed both among members of my extended family as well as friends and neighbors over the past several years.  What I have come to realize in my adulthood is that while I would like to think that I am special –Thank you, Mr. Rogers and Sesame Street – there is actually nothing that special about me.  My actions, apart from that ill-considered goat and tequila incident in college, are generally rational and cogent.  This likewise applies to most people, who reside in a stable neighborhood along society’s Bell Curve.  Expand this observation to the larger population and perhaps there is more going on within the family structure than the definition provided above, material but objectively immeasurable.  What do you do if it can’t be objectively measured?  Should it just be dismissed out of hand?

In my case, I took the family dog for a walk around the immediate neighborhood.

Since 2017, we have lived on a cul de sac within a golf course community.  It’s clearly not representative of larger society and truthfully, we don’t live here for the golf.  In early 2017, we needed to retreat to a house that was more amenable to my own physical condition; specifically, one floor living with minimal use of stairs.  That the previous owner left behind a fully furnished theater room that allowed my sons to hear the Angels sing was just icing on the cake.  Our home is one of 28 units on the cul de sac and every four or six units are clustered together in duplex fashion.  Like most Americans, I don’t know every soul in the immediate neighborhood but after two years of conversations and chats, I have a sense of who lives in most of the units and their living arrangements, at least superficially.

I’m really not a creep.  I just pay attention.

As the dog and I strolled the neighborhood, I noted what I objectively knew for each of the 28 units.

  • Units 1 – 3:  One vacant and being flipped.  Two empty-nesters.
  • Unit 4:  My family, nuclear but providing partial daycare for a grandchild.
  • Units 5 – 8:  A traditional nuclear family.  A single parent household with child and roommate, the unit purchased by the grandparents of the adult daughter, and a unit serving as a vacation getaway for an elderly couple from another state.
  • Units 9 – 13:  Empty-nesters and elderly couples.
  • Units 14 – 15:  True multi-generational household with two adult generations and a grandchild (and a really cool Labrador).  Nuclear family with adults likewise providing daycare for grandchildren.
  • Unit 16:  Single parent with teenagers who returned to be closer to family.
  • Units 17 – 22:  Empty nest or unknown.
  • Unit 23:  True multi-generational household with two adult generations and grandchildren.
  • Units 24 – 28:  Empty nest or unknown.

So of 28 units, two meet the multi-generational definition and an additional four – including my own – have some significant interaction in which one or more generations provide material assistance to another.  This isn’t the least bit objective or statistically relevant but what makes this particular cul de sac in some way not indicative of larger trends within society?

The upshot?  It is possible, although not objectively quantifiable, that the multi-generational interactions are being understated.  The winnowing of the middle class and the opioid epidemic are fostering a greater interdependence among the generations than has been seen in decades.  Newer linkages are likely being formed because circumstances require them and unless or until someone can ascertain a means to measure this extent, these material interactions will be understated because they exist beneath the data gathering radar.

So perhaps the definition noted above is incomplete.  Perhaps it should be expanded from physical co-habitation to this:

  • One adult generation relocating to closer proximity to another, or refusing to relocate away from another, in order to give or receive increased physical or financial support;
  • Providing or receiving some form of physical or financial support (childcare, eldercare) between the adult generations.

There has always been some degree of supportive interaction between the generations throughout our history.  In my own family, my father and his parents were forced to move in with his grandmother during the Great Depression.  My maternal grandmother lived within two blocks of my aunt and that aunt routinely checked on her as she aged.  My own parents spent more than two decades supplementing my paternal grandmother’s income with a monthly stipend of $100 with which she managed to accrue a stunning quantity of makeup and costume jewelry.  But these common instances are overtaken because of the economic stresses upon the family from the middle class’ decline.

We teach and raise small children with the idea that they are each, in some way, special.  But we realize in our adulthood that we aren’t as special and are more alike to others.  We, as adults, make accommodations to the circumstances and physical surroundings that might be novel because they are new to us, but which aren’t as novel as they might appear because others are having to make them as well.

The next time that you take the dog for a neighborhood stroll, consider what you know and think whether there’s anything that can be extrapolated.  But I wouldn’t necessarily share it with many of the neighbors because they’re liable to think that you’re creepy.

 

 

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The American Family Changes…

…these are serious structural changes to the economy that will necessarily flow into so many other facets of our lives – food and cooking, housing, education, medicine, child-rearing.

      –  PracticalDad, The Great Reversion  June 27, 2013 

The Great Reversion, which kicked into overdrive with the Financial Crisis of 2007, has now run headfirst into the social institution that the Conservative movement exalts:  the American Family.  Change is constant although most is ebb and flow.  But now, multiple separate data-points about the American family support the concept that its structure is changing in response to its long-term financial circumstances.

Let’s be clear.  There is no longer a true monolithic model for the contemporary American family and no one can lay claim to it, despite what the Religious Right likes to think.  But the separate data-points indicate that the great mass of families – religious or not – is looking at their respective long-term circumstances and making rational family-unit level decisions to best situate themselves for what they perceive to be their future.  We all know the mass of economic data-points showing what’s amiss:

These kinds of circumstances have an impact however, and that impact is now reflected in the long-term decisions of the family adults.  How so?

First, America’s Total Fertility Rate – known informally as our replacement fertility rate – declined in 2018 to 1.73, the lowest point since the Oil Crisis/Inflation period of the mid 1970s.  That was a bleak period two generations ago and I recall a conversation with a gentleman who commented that he and his wife were nervous about bringing new life into a world that was, in the moment, intimidating.  Circumstances improved however:  The Berlin Wall had fallen and the Soviet Union collapsed; even with 9/11, we entered a period in which homes were larger than ever and housing prices would only ever go up.  Money was cheap and anybody who could fog a mirror was able to borrow large amounts for increasingly unpopular McMansions.  And with that increase went the Total Fertility Rate.

Until approximately 2007 however, when the wheels came off.  Since then, the TFR has dropped and it’s low point is confirmed by a second fertility statistic, the General Fertility Rate, which measures the rate at which women are currently having children.

US Fertility Rates/courtesy Pew Research

 

 

 

 

 

 

The typical family is looking at it’s prospect and saying Nah Bruh, I think that I’m good for now…  And this is playing out in the second data-point.

Next, more younger couples are only having one child.  This is now the fastest growing cohort of families and has doubled in the four decades from 1976 to 2015, from 11% to 22% and if the article is correct, then it’s not going to slow appreciably in the near future.  It hasn’t necessarily been a financial decision since part of the interplay is the aspect of delayed motherhood from a greater participation in the workforce and the opening of previously closed career pathways for women.  But my suspicion, gut at best, is that people are looking at the cost, excluding higher education, and holding put at one child.

Third, the American family itself is quietly morphing from its historic nuclear family structure to a multi-generational model.  What we consider the traditional nuclear has been rooted for generations in the two-generation unit, parents and biological children together.  It has shifted itself as the racial, cultural and gender lines have blurred so that a modern nuclear family can be parents of two separate races or the same sex, and the children can be adopted instead of related via birth.  Studies have shown that this particular unit structure can be found in records back as far as the 13th century in England but the sociologists’ research of the 20th century has linked the economic development since the Industrial Revolution of the 19th Century, as well as our own domestic economic growth, to the widespread availability of the nuclear family; it was this foundational unit that was able to move to where the opportunities for economic advancement were then available.

One particular economic issue today pertains to this very concept of labor mobility.  Economists have noted in the past several years that the percentage of Americans willing to move for employment has dropped by half, from the 1980s to today, from 20% to about 10%.  It’s notable that from 2012 to 2017, this number declined from one in eight Americans in 2012 to one in ten in 2017.  Labor mobility matters because it allows for the best match of labor demand and supply so that productivity is maximized at the greatest benefit to labor.  Consider Detroit’s auto industry in the early to mid 20th century.  American automakers were able to turn out autos at such a rate because they were able to obtain a healthy supply of labor, much of it from the Black communities of the American South.  For all of the social issues that were engendered, the pay for black workers in Detroit was still higher than what they were able to earn in the Jim Crow South and significant numbers of Blacks moved northwards to take advantage of it.  But when labor mobility declines, as it has, then there is a mismatch between the demand and supply of labor and each aspect suffers.  Middle had a college classmate who graduated with a degree in video sound editing and his goal was to move to Silicon Valley; but with the cost of housing so wildly out of reach for the average person, this youngster would have joined others living in vehicles as they worked in their chosen field.  The result?  He stayed on the east coast.

If the nuclear family is a two-generation unit, parent(s) and children, what then is the multi-generational model?  The first thought of many Americans is that of The Waltons, the Depression-era family portrayed on the iconic television show of the 1970s.  They were a nuclear family that became a multi-generational family by dint of having the grandparents live under their roof.  But multi-generational is more than that.  According to sociologists at Pew Research, the multi-generational family model is composed of parents and adult children past the age of 25 or grandparents and grandchildren or any other combination of greater than two generations.  Right away, we recognize two circumstances that have come into focus from this definition.  First, the number of young adults that are now living at home because of their student debt load.  As of 2016, approximately one third of adults between 25 and 29 lived with their parents, triple the percentage who did so in the 1970s.  The second situation is the rise in the number of grandparents caring for grandchildren because of the parents’ instability due to economic factors or more tragically, drug addiction.  The raw numbers aren’t nominally huge, but the percentage of grandparent-headed households has increased in less than a decade.

Percent/Nominal Rise in Multigenerational /courtesty Pew Research

When you note the rise in the percentage of multi-generation families since 1970, also consider the arrival of the immigrant family; both Asian and Hispanic families tend to have more than two generations under the same roof, often because of financial reasons.  Despite this, the percentage of multi-generational families has risen across all racial demographics.

But these factors account for what has happened thus far and don’t necessarily reflect the impact of what will come; expect the multi-generational  model to make far greater inroads as we move ahead.  Simply put, there are going to be far more elderly Americans with far less savings to support themselves through their remaining years and the existing social infrastructure for their care is seriously insufficient.

The first thing to understand is that there is no longer a single demographic cohort for the elderly and these cohorts aren’t growing at the same rate; there are seniors, the elderly and the Old AF. The demographic models are such that the number of elderly Americans, 65 and above, will outnumber young Americans by 2035.  However, the number of those between 75 and 84 will increase by 100% while those above 85 will increase by 200% by 2050.  The raw number of the elderly population is going to outpace the number of workers available to support them via government financed social programs.

The second factor to consider is the state of the seniors’ finances.  According to the Transamerica Center for Retirement Studies,  the median savings for people in their 50s and 60s is $117000 and $172000 respectively.  Many in those age cohorts recognize that it isn’t enough and fully expect to continue working past the traditional retirement age of 65 and the percentage that do is now at now at 20%, double the level of 10% in 1985.    Coincidentally, the percentage of older Americans still working was 29% in 1949, about the same time at which the percentage of multi-generational families was as high as it is now.

The paucity of savings is further complicated by the global experiment with artificially low interest rates. Our national monetary policy for longer than a decade has been to push interest rates to the lower ranges to both encourage consumption – I have to hold back a laugh when I consider the prevailing credit card rates – and assist in managing the interest costs of our national debt.  This is good for the federal government and companies, who have persistently taken on large amounts of debt for the purpose of buying back their stock.  But it is horrendous for middle-aged and elderly savers who, at one time, depended upon the interest income from their lifetime of accumulated savings to fund their nest egg.  As rates have been consistently low for more than a decade, those in or approaching their senior years have been forced to shift their investment focus to riskier investments in the hope of obtaining a higher return.  This is a sea-change from the traditional approach of shifting to safer and more stable portfolios as retirement is reached.  If you are 56 and have $172000 in savings, you are going to run a greater risk of losing it before you hit your final years.

The last factor is that the infrastructure for elder care is simply inadequate for the numbers of older Americans coming down the pike.  Elderly Americans are covered for many, if not all, medical expenses via the Medicare program; most importantly for very elderly Americans, this can include some, but not all, aspects of nursing home residency.  Corollary expense, such as hands-on care for assistance in Activities of Daily Living (ADL) is not covered and is left to the individual or family to pay.  In addition, there is a cap for the per diem fee that Medicare will pay nursing homes for Medicare patients so there is limited profitability for nursing homes in the Medicare program.  The upshot?  There might be a specific number of nursing beds available in a locality but there is only a subset of those that are available to elderly citizens whose primary coverage is via Medicare simply because of insufficient revenue; this isn’t referring to the rates of return on the business but actually even maintaining any profitability at all.

The other aspect to the infrastructure question is simply one of labor.  The dispersion of the American elderly demographic isn’t uniform and some areas are more hard hit than others.  Maine is now what the World Bank classifies as a super-aged entity, noted by a fifth of the population being older than 65 years of age; this is the first state to reach this milestone and by 2030 – 11 years from now – more than half of the states in the country will cross that threshold.  If there are an insufficient number of nursing home beds available for the most infirm, then the next best step is to do everything possible to keep them in their own homes.  It is less expensive and theoretically possible to make this work – except that there are vicinities in which there isn’t enough available trained labor to support that goal of in-home services.  Maine is the first state to face the situation and service providers are simply declining to take on new clients because they just do not have the people to provide the services; the families who are in the area are then forced into situations, often intense, for which they have no minimal resources and training.

Let’s connect the dots.

  • The elder generations will grow significantly and disproportionately, relative to younger generations.
  • These generations lack the assets to support the care that is likely to be required in their much later years as debility and deteriorating medical conditions require greater spending.
  • The infrastructure, both physical and labor, for elder care is insufficient at present in many locations for this growth.
  • The present political conservative political sentiment will preclude significantly increased spending on elder care programs and much of the burden will continue to be shifted back to the family unit as has already happened with retirement, cost of higher education and health care costs. Even if there is a massive shift towards greater social spending, the conversation among the Democratic candidates relates to healthcare and higher education benefits with little mention of Eldercare.

There are simply too many soon-to-be elders and they don’t have the money.  Any correction of the hollowing out of the American Middle Class will likely take decades which means that even the younger generations aren’t going to have the resources and they in turn will have to rely in some measure on their own adult children when they reach their own elder years.  This is the upshot of living through the Great Reversion since our forebears often had to stand for some measure of responsibility for their own parents and grandparents and this is how it’s going to be moving forward.

Raising children can be difficult and teens even more so.  But our grandparents could get through those years with a sigh of relief at the lifting of responsibility because their own parents had the assets to largely support themselves in their dotage.  Many of us are only going to have a few years of respite before we are forced to re-assume that responsibility for our own elders as they navigate their final years.

Understand that your own children are watching you and you’ll want to set a decent example for them when they are, in turn, responsible for you.