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What does it cost to age with dignity?
It’s an urgent question as the youngest baby boomers approach 65 and their adult children prepare to take on their care.
I’m one of those adult children – visiting my dad, with advanced dementia, every week in the memory care facility where he has lived for a year, costing $8,500 a month out of pocket. I also live with my mom, who just got a knee replacement and deals with a chronic autoimmune illness.
Like many women of her generation, she had little paid work after my brother and I were born in the early 80s. Women aged 65 and older are roughly 80% more likely to live in poverty than men are, in large part because of the caretaking they provided. My dad, raised in a family that constantly went broke and declared bankruptcy, became a bankruptcy lawyer himself and broke his promises with my mom of equal parenting. Workaholism was his emotional safety blanket after an erratic childhood in which he had to answer the door to debt collectors and lie that his parents weren’t home as they hid in a back room of their Denver bungalow. It’s unlikely my parents’ savings will run out, but savings born of trauma (plus some white male privilege) shouldn’t be a prerequisite for having the care you need in your twilight years.
Unsurprisingly, cultural messages about ageing and savings in the US are riddled with rugged individualism. Our parents should buy long-term care insurance; in reality, only 3-4% of those over 50 have it (my parents don’t). Our parents should save for retirement; the truth is that 46% of Americans have no retirement savings at all, and those who do have an average of $955, a far cry from estimates that say most of us will need $1.5m to retire comfortably. This is not a color-blind consideration: white families accumulate more wealth over time than Black or Hispanic families; in their 70s, the average white family had more than four times the wealth of the average Black family.
Even if you did attempt to build wealth, our current elder care system, if one can even call it that, pushes you into a Sophie’s choice in your so-called golden years. The “forgotten middle”, as researchers have begun calling them, have an annual income and accumulated savings that are too high to qualify for Medicaid, but too low to afford the care they need as they age. These elders are often forced to spend down their savings so they can be destitute enough to qualify for Medicaid.
If our parents didn’t buy long-term care insurance or save for retirement, they are cast as irresponsible. They’ve made their bed in a dingy, overcrowded skilled nursing facility, as it were, and now they have to lie in it. If they saved just enough to buy a little home – perhaps their one special symbol of the American dream – they have to sell it now in order to get care, leaving their children nothing in the end (or maybe a big pile of debt).
In other words, the gap between what should happen in some theoretical economic climate and what is happening in the real one is, preposterously, being blamed on our parents regardless of their demographic or educational background.
The biggest American generation is now largely past retirement age, and shame, in addition to being immoral, is inadequate. Boomers haven’t saved enough, and most didn’t even have the chance in the first place. Now how about we cut the bootstrap rhetoric and get real about how to invest in collective solutions that give our elders the last years they deserve, create good, humane jobs for professional caregivers, and let family caregivers avoid such dramatic stress and debt?
I’ve got a few ideas, having survived a gauntlet of elder care crises in the last few years myself:
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Day programs. Day programs for elders, like those for kids, are a fantastic community resource. Publicly funded transportation can take elders to a center designed with their joy and capacity in mind. My dad went to one such program and it was a balm; he sang karaoke, he saw the on-staff nurse when needed, and I was able to get some work done without him joining my Zoom calls. What’s more, according to recent estimates, the median day program costs $100 a day v about $200 for assisted living and more than $200 for in-home care. Day programs, vastly underfunded in most states, are a great way to keep elders ageing in place, prevent loneliness, and make sure family caregivers don’t burn out or have to quit their jobs.
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Worker-owned home healthcare. There’s a care workforce shortage for good reason; too many of these jobs aren’t good jobs. One small but growing part of the home healthcare market consists of worker-owned cooperatives, where professional caregivers are the leaders of their own organizations – setting hourly rates, vacation and sick leave policies, and training approaches. These organizations are shown to have far better worker retention than traditional care companies and, of course, it’s a boon to family caregivers to know that the person taking care of their loved one feels empowered and will stick around.
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Public long-term care insurance. Washington is the first state in the country to create public long-term care for its full-time workers, WACares. By contributing a small amount (0.58%) from wages to the fund, Washingtonians earn a long-term care benefit (up to $36,500) for when they need it. This could be a test case for other states that want to be humane places for people to age.
It’s time to acknowledge that collective solutions – not shame and blame, piled on top of longstanding inequities – are the key to get us through a tender time in our family’s lives. How we handle elder care in the next 20 years is going to shape the future of this country in innumerable ways; our economic and ethical future hangs in the balance.
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Courtney E Martin has a weekly newsletter called Examined Family. Her most recent book is Learning in Public: Lessons for a Racially Divided America From My Daughter’s School
