A Senior Challenge

The Baltimore Sun

We are in so much trouble, boomers.

I know, I can hear the Gen-XYZs saying, "Please, not another baby boomer whining about getting older." Well, bear with me here. Our pain might be your pain one day.

I've just come back from visiting my mom. She lives in a large, Baltimore-area retirement community. She'll turn 95 this fall, but she still steams through the halls behind her walker as if the place were on fire. She calls it "playing golf," and walks the "links" at least three times a day.

But she is struggling with vascular dementia (hardly anybody hits 90 without slipping a cog), which is why we had to move her earlier this year from her "independent living" apartment to assisted living, and very soon after that to the community's nursing home.

It's beautiful, really. Clean. Cheerful. It doesn't smell the way many nursing homes do. She was able to bring along a few pieces of her own furniture. She gets dressed every morning, eats well and takes part in a few of the activities the place organizes for the residents. They make sure she gets her medicine on time, and keep her safe and well-scrubbed.

When she complains about this or that, I tell her, "You're very lucky to have such a beautiful place to live, and a whole staff of people to look after you. It could be lots worse."

She's also very lucky that, when her bill leapt from $1,500 a month in independent living, to $8,000 a month in the nursing home, she was able to pay. For now.

Even with long-term care insurance, she will all-too-quickly burn through her life savings, apply for Medicaid, and become the taxpayers' burden.

You'd like my mom. She's the most upbeat and enthusiastic person I've ever known. A few years back, when my wife and I told her we were planning a trip to Italy to visit my grandfather's birthplace, she said, "Let's go!" So, we took her along. She was 88. She's no complainer. She'd rather do something to make it better.

So when she tells me now that she waits "forever" for an aide to come to help her dress, or put on her hearing aid, or bring her lunch, I pay attention. But I can see the staff is working hard. Most residents on the floor have needs much greater and more urgent than Mom's. I tell her she needs to be patient.

As I walk through the halls on my visits, I can't help but notice the staff is small, with a great deal of work to do and little time to stop and chat with residents like my mom, who is hungry for conversation and has plenty of stories to tell -- the old ones she still remembers.

It is not pleasant work, to my eyes. Residents have accidents, and they have to be cleaned up. Some get agitated. Many are fragile, blind and forget where they are. And they're frightened. They cry out and wait to be comforted. Call bells ding. And ding. And ding.

By comparison, Mom's needs are minor, and easily postponed. While she charges down the hallway with her walker, 10 or 15 other residents -- nearly all of them women -- idle in their wheelchairs near the nurses' station.

They're parked where the staff can more efficiently watch them, give them their pills and take their blood pressure. They doze, some flopped over in their chairs. Sometimes they speak to each other, but more often it's to no one in particular. The TV drones in the corner but nobody seems to be watching.

You think this won't be you, boomers? You figure you'll check out before it comes to this?

Mom thought so, too. She and my step-dad promised they'd go together. But when he died in 2000, she soldiered on. She swore she'd swallow a "purple pill" and depart gracefully before she lost her marbles. She once asked me, only half in jest, if a leap from her fourth-floor apartment would be enough, or should she make friends with someone on the sixth.

When her health and her dementia began to worsen last winter, she sensed she was losing control of her fate. We talked about it. She told me, "You can talk about getting out before things get too unpleasant. But when you're looking at the end, staring it in the face, it's not so easy to give it up."

Which brings me, finally, to my point here: Unless we are hit by a massive coronary, or a bus, most of us boomers, eventually, are going to need long-term care. And, as with everything else we've done since the '50s, our numbers will put enormous demand on the system and its employees. Think your kids will take you in?

My mom's experience -- in one of the best nursing facilities in Maryland -- tells me there are already too few people willing to do the work at a quality and a price we -- or society -- can afford.

Who will look after us, and keep life bearable, when we start checking into the nursing homes?

I can hear at least one answer in the voices of some of the people who care for my mom -- accents, some clearly from the Caribbean, some from South Asia, but others I can't quite place, too.

Immigrants. They work hard, and from what I've been able to see they're caring and gentle with these sometimes difficult old people. Think that's easy? How many of us stay home these days to nurture and diaper and clean up after our own aging parents, much less other people's? Lots of us don't even stay home with our kids.

I know, I know. We do need to get control of our borders. We want people to come here legally, fairly. But have you ever spoken with an immigration lawyer about how difficult we make it, and how long it takes, for people to do the right thing? I have.

Elder-care jobs aren't the only ones we must fill. There are factory owners, construction companies and plenty of other employers who can't get enough help, in a legal way, without ruinous waits. This just has to get fixed.

I say, establish a fair and efficient entry process for anyone willing and able to take jobs we can't fill. Screen them. Give them secure IDs and working papers at the border. Let the free market work its magic, as it did for my immigrant grandparents, and has throughout our long history of immigration. Go further. Give them training, English lessons and a road to citizenship.

Deport illegals who otherwise obey the law and go to work every day? Are you kidding? For our own sakes, let them earn a living wage and pay Social Security taxes. These are the wage taxes that will keep Medicaid funded and keep your Social Security checks from bouncing.

If you have a better idea of who will answer the call bell when you ring it some day, Mom and I would love to hear it.


Senior boom: What the future may hold

America's older population is on the threshold of a boom, with enormous economic, social and health consequences:

Numbers will double. The over 65 population is expected to grow from from 35 million to 72 million, representing nearly 20 percent of the total population by 2030.

Centenarians. The number of Americans 100 and older has grown from about 37,000 in 1990 to over 50,000 in 2000. About 80 percent of centanarians are women.

Healthier lives. People in the United States are living longer and healthier lives than ever before. Average life expectancy at birth rose from 47.3 in 1900 to 76.9 in 2000.

Chronic illness. About 80 percent of seniors have at least one chronic health condition and 50 percent have at least two. Arthritis, hypertension, heart disease, diabetes, and respiratory disorders are some of the leading causes of activity limitations.

Nursing homes. Nursing homes provide the most common institutional setting for older people with over 90 percent of institutionalized elders in the United States living in nursing homes.

Support ratio. The ratio of older people to other age groups is important to society because older people, especially the oldest old, are dependent on family, the government, or both for financial, physical and emotional support. There are currently about five working-age people to support one senior but by 2030 there will fewer than three working-age people for each senior.

Accidents. As a group, the 65-and-over population had the second-highest death rate from motor vehicle accidents in 2000, following those aged 15 to 24. Overall, among older men, death rates related to motor vehicle injuries rose substantially with age.

Depression. Depressive symptoms occur in about 15 percent of older people living in a community and up to 25 percent of those living in nursing homes. Among the risk factors are alcohol use, social isolation, widowhood, cancer and elder abuse.

Disability. About 20 percent of older Americans have a chronic disability, about 7 percent to 8 percent have severe cognitive impairments and about 30 percent experience mobility difficulty. Studies have shown that with every 10 years after reaching the age of 65, the odds of losing mobility double.

Quality of life. Studies show that at age 65 women could expect 9.8 disability-free years on average out of a remaining life expectancy of 18.9 years, and men could expect 7.4 disability-free years out of a remaining life expectancy of 15.1 years.

Health insurance. The proportion of those 65 and over with private health insurance declined from 76.1 percent in 1989 to 63.1 percent in 2000.

Help for seniors. Over 65 percent of older noninstitutionalized people with disabilities depend solely on unpaid help. Almost all nursing home residents need some help with the activities of daily living. Older people with long-term care needs tend to have limited insurance coverage for that purpose, while spending on long-term care can be high.

[Sources: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Aging, the Economics and Statistics Administration, U.S. Census Bureau]

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