In Coming Decades, Fewer Caregivers

Who will care for me when I’m old? 

by Judith Graham

If you’re a healthy baby boomer looking after your own elderly parents, that question may not have crossed your mind just yet. But it’s going to be a big issue going forward.

The AARP’s Public Policy Institute issued a report on Monday suggesting that potential caregivers will be in much shorter supply starting in 2026 — just 13 years from now — when the first boomers begin to turn 80. According to the report, there will be a shortage of both unpaid caregivers – typically, family or close friends – as well as paid caregivers, like home care aides and personal care attendants.

The data highlighted in the AARP study is startling. In 2010, there were 7.2 individuals of prime caregiving age — 45 to 64 years old — for every person age 80 or older. By 2030, the “caregiver support ratio” (the proportion of people in prime caregiving years to those age 80 or above) will drop to 4.1, then plunge to 2.9, by 2050, according to AARP’s projections.

About 14 percent of potential caregivers found themselves actually providing care to someone age 80 or older in 2009, according to the AARP. Another 14 percent helped someone younger than 80. The larger the pool, the more likely it is that someone will be able to step forward and assume what often are challenging responsibilities.

In 2010, more than half of adults age 80 and older had a severe disability, and 30 percent needed help with bathing, using the toilet, dressing, cooking, eating, paying bills or other routine activities. Whether similar trends will apply in the decades ahead is an open question.

(If you want raw numbers, here they are: The population of baby boomers stood at 78 million in 2010, and it is expected to decline to 60 million in 2030 and 20 million in 2050 as members die off. The aging of this generation will swell the ranks of those age 80 and older from 11 million in 2010 to 20 million in 2030, then to 34 million in 2050. People in the 45 to 64 age group numbered 82 million in 2010; that will essentially stay flat at 83 million in 2030 and rise to 99 million by 2050, according to figures supplied by AARP upon request.)

“What these numbers tell us is that relying on family and friends to provide long-term care may be unrealistic in the future,” said Lynn Feinberg, a senior strategic policy adviser at AARP. “We need to be thinking about new approaches to financing and delivering long-term services and supports, particularly home

The explanation for what AARP calls an impending “care gap” lies with well-documented trends, including longer life spans, smaller families, more divorces among those age 50 and older, more people who never had children, and rising rates of disability associated with the obesity epidemic.

“The number of ‘frail older people,’ those age 65 and over with any disability, is projected to increase from 11 million in 2010 to 18 million in 2030,” the report notes. “The percentage of frail older people who are childless is projected to rise from 14 to 18 percent during this period, and the percentage of frail older people who have only one or two adult children is projected to increase from 38 to 49 percent.”

There are limitations to the AARP study. For instance, it doesn’t say how many people are entering older age living alone, without family or friends nearby. The numbers here paint a big picture of a big problem, but details that might flesh out who is particularly vulnerable are lacking. Asked what solutions AARP recommends, Ms. Feinberg discussed a need for “better supports for family caregivers” but didn’t endorse specific suggestions.

That said, the points raised in the report are an important contribution to a discussion now under way as the national Commission on Long-Term Care prepares to issue a report outlining policy recommendations in September.