Why is that? And could long-term care go from being a sleeper issue to one that boosts a candidate out of the 2020 pack?
Demographic trends have prodded and pulled America’s long-term-care problem into a long-term-care crisis. A driving factor is the increasing risk of reaching a point in our lives when we can no longer perform some of the essential activities of daily life, from getting dressed to using the toilet. Approximately half of the American population will need some form of long-term care, and an estimated 15 percent will face related medical bills exceeding $250,000.
Paradoxically, this is partly due to advances in medicine. Since the 1940s, for example, antibiotics have dramatically reduced the number of Americans dying of pneumonia, which was once a leading cause of death among older Americans. But advances like those mean more people are living long enough to contract debilitating chronic conditions like Alzheimer’s.
On the flip side are broad public-health trends such as obesity and the spread of sedentary lifestyles. These have led to an epidemic of chronic diseases like diabetes that, while not necessarily fatal, leave more and more people struggling with disabling conditions for decades.
Then there’s the looming impact of Baby Boomers hitting retirement, so massive that it’s often referred to in the terminology of natural disasters, like “the gray tsunami.” A chart of the ratio of middle-aged adults (potential caregivers) to people over 80 (the people most likely to need care) is like the steep downhill of a roller coaster, starting at 7 to 1 in 2010 and plummeting to 4 to 1 by 2030. In addition, average family size has shrunk significantly since the 1970s. With smaller families now the norm, the strain on individual caregivers within families has increased enormously. The imbalance will become even more acute if America cuts back on the flow of immigrants, who make up a large portion of professional caregivers.
This was easy to see coming, by the way. As far back as 1971, Congress held hearings on the impending crisis in long-term care, and throughout the 1980s and ’90s, think tanks and blue-ribbon commissions issued a stream of reports on what to do about it, predicting catastrophic consequences by the 2020s if the problem went unaddressed. But it did go unaddressed, perhaps because, like climate change, it was both unpleasant to contemplate and seemingly far off in the future. Meanwhile, other countries with aging populations, including Japan, Canada, and most European nations, took action, offering a range of substantial benefits to family care providers, from directly compensating their work to subsidizing professional home care. But in the United States, public attention to long-term care faded even as the problem grew more acute.
Sandra Levitsky has a theory about why long-term care has not yet gained traction as a political issue. A sociologist at the University of Michigan, she’s the author of Caring for Our Own: Why There Is No Political Demand for New American Social Welfare Rights, a book she researched in part by schlepping between adult day-care centers, nursing homes, and a hospital in Los Angeles, interviewing caregivers and scribbling notes at the back of support-group meetings.