She had just been moved from the Alzheimer’s unit to skilled nursing, the Care Center, they called it. She’d fallen in her private room and it became clear she needed more supervision and medical care. The new building fell under a different set of rules and regulations and as my brother and I transitioned our mother into the new venue with all those new rules, there were some bumps along the way. We called a meeting with the department heads and were graciously accommodated; after all the salient issues were put on the table and discussed to everyone’s satisfaction, the administrator said to us, “Your mother is lucky; you are an unusual family.” Being the modest sorts we are, my brother and I asked what he meant by that.
“Most people here have no one. Their families take the steps to get them here, get them financed with long-term care insurance, family money, or Medicaid, then they’re off. They rarely visit, they don’t check in for care meetings; most of the time we make all the decisions about our residents without family input. They’re on their own.”
And while this is tragic and truly sad, consider it was being said of a bona fide medical facility designed for the aging sick. Extrapolate that to those elderly who do not even have family to take those steps. To a place like a shelter for the homeless, where the elderly are now flocking – or being abandoned – in ever-increasing numbers.
It was always understood that as the behemoth baby boomer generation and war veterans, with their myriad of health and emotional problems, aged, the number of homeless in need would increase exponentially. It has. A report at McClatchyDC.com cited numbers that are, in fact, somewhat staggering:
A 2010 study by the Homeless Research Institute, an arm of the National Alliance to End Homelessness, projected that the number of elderly people who are homeless would increase by 33 percent, from 44,172 in 2010 to 58,772 by 2020, and would double to 95,000 by 2050.
“It seems like there are two main things going on,” said Nan Roman, president and chief executive of the alliance in Washington, D.C.
“One is that there’s a group of people who are homeless who are becoming older. They were younger homeless people, so the population is aging that way. The other thing is that our whole population is aging. Even though older people are less likely to be homeless than other people because they have more of a safety net, because there are more and more older people in general, we are going to have more and more elderly people vulnerable to homelessness.”
Beyond the statistics, there is also the issue of changing cultural norms. In the “olden days,” families typically kept their elderly at hone with them; Grandma and Grandpa lived in the spare bedroom, their needs met by their adult children and grandchildren, and as they reached the end of their lives, were allowed to die at home in the warmth and solace of loved ones. Contemporary norms and economical realities, however, have shifted that paradigm. Now, typically, most adult members of a household work and cannot be home to care for an elderly parent in need. Sometimes the limitations of family finances cannot afford a home large enough to accommodate an elderly relative. There is also the issue of the increasing numbers of mentally ill – Alzheimer’s in particular – which throws another wrench into the works. The 2012 Alzheimer’s Disease Facts and Figures report states that the number of seniors with Alzheimer’s is expected to increase by 30 percent by 2050. This population requires a level of care and interaction that most families would not have the skill set to properly manage even if they did have room in their home.
There is also the case of elderly poor who do not have adult children – or whose adult children are not involved with their care (as mentioned at my mother’s facility); that contingent can too often end up on the street with little or no money, nowhere to go, and often mental and emotional problems that exacerbate their neediness and inability to fend for themselves. These people, by and large, are either abandoned at shelters or simply find their way there.
Sandy Swank, director of housing and homeless services for the Inter-Faith Ministry of Wichita, Kansas, sees a lot – too much – of this population, with numbers increasing:
“I’ve been working at Inter-Faith since October 1990,” she said. “In the beginning, we’d have an occasional elderly person come in, but if they came in, they came in with someone else. They always had someone to look after them. In the last 10 years, we have seen more elderly people, and each year it seems like the number increases.”
Swank remembers another woman left at the shelter. She arrived in a hospital gown with no shoes. There was snow on the ground. The front left wheel of her wheelchair was off.
“I was just outraged,” Swank said. [Source]
While there are a growing number of faith-based and other organizations stepping up to meet the need as the numbers of needy increase, the question remains: where will all the elderly poor go; who will care for them, and who, more crassly perhaps, will pay for their care? A hot and much-debated issue in Congress is the funding parameters of Medicaid, Medicare and Social Security, a discussion driven by the clear realization that the cost of caring for this growing population could potentially outstrip funds available. USNews reported on some of the points at issue, as defined by the September 2012 National Research Council report, Aging and the Macroeconomy: Long-Term Implications of an Older Population:
According to the report, the ratio of adults aged 65 and over compared with people aged 20 to 64 will increase by 80 percent in the coming decades. This is partly because the average life expectancy has risen from 47 years in 1900 to 78 years today, and is projected to be 84.5 years by the year 2050.
Another reason for the growing rates of older Americans: Declining birth rates as couples choose to have smaller families. This not only means a smaller proportion of the population will be under 65, it also means there will be fewer workers contributing taxes to support seniors, who are less productive and consume more, the report said.
It also means that as some adults choose to not have children, or are unable to have children, their senior years will not have the advantage of adult children to help support or care for them. Add that element to the fact that far too many seniors – between one-fifth and one-third – have not saved enough money for their aging years, and it’s not difficult to see that more and more of the elderly will have no choice but to depend on federal programs, which are staggering under the weight:
Medicare, Medicaid and Social Security are on “unsustainable paths,” according to the report, posing significant economic risks.
“Together, the cost of the three programs currently amounts to roughly 40 percent of all federal spending and 10 percent of the nation’s gross domestic product,” the authors of the report stated in a news release. “Because of overall longer life expectancy and lower birth rates, these programs will have more beneficiaries with relatively fewer workers contributing to support them in the coming decades. Combined with soaring health care costs, population aging will drive up public health care expenditures and demand an ever-larger fraction of national resources.” [Source]
If eligibility requirements change, and as the cost of medical care rises (which is already unfathomable, as I can attest by managing my mother’s bills!), it’s likely the number of aging who cannot meet federal requirements, or who are too mentally incapacitated to do the paperwork with no one to assist getting through the often difficult and arcane process of applying for federal aid, will fall through the cracks. Where they’ll end up? Many will end up in shelters like the Inter-Faith Inn.
It is not an insurmountable problem, however; hope lies at the end of the tunnel. The Homeless Research Institute made a list of recommendations that address the specific needs of the aging homeless:
• Increase the supply of subsidized, affordable housing for seniors.
• Create sufficient permanent supportive housing to end chronic homelessness.
• Conduct research to better understand the specific needs of elderly people who are homeless. [Source]
And even before the elderly become homeless, the National Research Council made some suggestions in their report that are preemptive:
One option would be to push the retirement age beyond the currently accepted age of 65 years. And given the example of other nations, this would be unlikely to steal jobs from younger people, as some fear.
Another strategy would be for workers to increase their savings while damping down their spending so they’d have more resources when they do retire. This would require an improvement in “financial literacy,” meaning teaching and helping people to make better financial decisions earlier in life.
A third potential avenue would involve consuming less while still paying taxes so the federal government could set aside more money for federal assistance programs to help support people as they age. [Source]
Ultimately, we’re going to have to make a cultural shift that emphasizes a few cold-water facts too easy to ignore in our youth-obsessed society. WE’RE ALL GOING TO GET OLD. At least, those of us lucky enough to not die young. And because we’re all going to get old, this issue should be salient for everyone; not just those who already are old, caring for the elderly, or working in a home for the aged. EVERYONE. Even you, young 20-something, 30-, 40-, 50-something person whistling past the graveyard of your inevitable aging process, currently and inexorably in full swing.
1. We need to start early to teach our kids about savings, building reserves; setting themselves up financially for their later years. Even lower-income families can imbue their impressionable youth with a sense of “saving for a rainy day,” taking a bit of what they have to spend on video games and iPhones to sock away in a savings account.
2. Preventive health care measures – eating right, exercise, and healthy lifestyle choices – too often ignored by the young, do catch up to make the elderly years far more fraught with illness and infirmity than they need to be. I cannot tell you how many older people I speak to who tell me how much they wish they “hadn’t smoked,” “ate better,” “took better care of myself,” “didn’t stress out so much.” Pay attention, younger ones. They’re living proof that ignoring health issues – physical and mental – can come back to haunt you.
3. Imbue in younger family members with an abiding respect for older people. The media and entertainment does us no favors in this department, eschewing images of vibrant, healthy, insightful elderly to, instead, continuously bombard with the latest, hottest, prettiest, most bodacious, ripped, ready and roarin’ young people, and while that’s all well and good, the sheer invisibility of “older people” – or at least older people who are not being parodied as idiotic simpletons – is shameful. A culture that does not respect, revere, and show compassion for its elderly is one that can also look away or abandon those elderly in need in places like homeless shelters. Every child born on this earth should be made to understand that they, too, will be old some day, and caring for their grandparents, later their aging parents, is a loving and essential part of the human contract. Or at least it should be. Make sure they understand that.
4. Before Mom and Dad get too old and sick, work with them to get their finances in order, or at least known to you. If they are eligible for federal aid, get the ball rolling before they need it so when the time comes, they aren’t left alone at your house while you’re out at work, or, worse, end up stuck in a shelter somewhere because no one in the family can afford the $6000-$10,000 a month to keep them in a nursing home. Plan ahead.
There are many more ideas, plenty of resources to explore online. Think about it as you go about your young life and have other things to focus on. The idea is to help before help is needed. At some point before an elderly person is on the streets, they had someone in their lives, be it family, friends, neighbors; someone. Those “someones” need to pay attention and offer what’s needed to get that person set up for what’s next. That will go a long way toward keeping them off the streets. That seems a worthy goal and one, if we all do our part in our own circles of family and friends, should not be too difficult to achieve.
Because we’re all going to be old someday. If we’re lucky.