Policymakers must plan for the elder population boom

Massachusetts is facing an unprecedented age boom and, unless policymakers reverse course on key issues, older adults who’ve worked hard their whole lives will increasingly struggle to afford necessary community-based supports and services.

The numbers are daunting. A recent study shows the Bay State’s 65-plus population increasing by 46% over the next 20 years.  Roughly two-thirds of that number will require some form of community-based Long-Term Services and Supports (LTSS), such as home care, Meals-on-Wheels or help getting to the doctor.

John O

The good news is that state and federal programs provide a safety net that helps elders secure those services in-home, saving taxpayers from having to pay for more costly nursing homes. The bad news is that the safety net is increasingly unavailable to middle income families.

This challenging trend has been dubbed the “No Care Zone” by Mass Home Care, which represents a statewide network of non-profit agencies that offer community-based supports for older adults and their families. The No Care Zone begins at an annual income $27,014. Elders under that threshold are eligible for an array of home care services, but those who are not are stuck paying out-of-pocket—if they can. Consider that two hours of daily care can easily run $18,000 annually and you’re starting to get an appreciation of the challenges that await many middle class elders.

So access to affordable LTSS is crucial and demand is set to skyrocket. You may be wondering: how does the Commonwealth plan to meet this challenge?  At this point, there seems to be two primary options:

  1. State and local leaders recognize this looming crisis, and that providing proactive supports to help elders stay in the setting of their choice is both cost effective and the right thing to do. Or…
  2. Our leaders do nothing and stay the course of eroding these vital supports, putting the burden of elder care squarely on families and forcing seniors to consider which necessities they can do without.

Sadly, Option B seems to be winning on Beacon Hill, where current and past gubernatorial administrations have made it clear that elders are not a priority.

The Governor’s recent budget proposal was the final straw for me. There was no hint of a socially responsible vision for how the Bay State will prepare for aging Baby Boomers and beyond. Instead, we see elders viewed primarily through the lens of controlling Medicaid costs. Particularly egregious was a proposal to siphon off monies from one of the few programs for elders who don’t meet stringent MassHealth requirements. What is the plan for meeting those needs?

It’s a common misconception that Somerville-Cambridge Elder Services only serves the economically disadvantaged, but this trend on Beacon Hill threatens to make that perception a reality. The crowning irony is that providing proactive supports can postpone—sometimes indefinitely– costly nursing home placements, which often end up being picked up by MassHealth after elders have exhausted their resources. That approach is pennywise and pound foolish, and the coming age boom threatens to make it unsustainable.

The good news is that we can meet this challenge together; by envisioning the future we want for elders, by investing to make that vision a reality, and by insisting that our elected leaders make this a priority. Here are two suggestions to get the conversation started:

Home Care – Expand the eligibility guidelines for the State Home Care program so that frail, older adults whose income does not exceed $35,000 can access help at home. This would provide immediate relief for those facing the most financial pressure in the No Care Zone.

Health Care – Address out of control health care expenses. In terms of out-of-pocket costs, older adults on Medicare pay a higher percentage of their income now than when the program became law in 1965. Today, individuals who worked hard all their lives face impoverishment in retirement because our politicians fail to sufficiently address this issue.

It’s time for a serious discussion about the future. It is within our power to embrace this age boom proactively, recognizing the value of elders and the best practices for providing vital supports. But if we fall short, we’re creating a situation where the next generation of elders is being set up to fail financially.

We’re better than that.  It’s time we develop a real plan for the largest demographic group in the state.

By John O’Neill, Executive Director of Somerville-Cambridge Elder Services