The growing demand for long-term home care is the result of a seismic shift in demographics. Americans are living longer than ever before. People 80 or older represent the nation's fastest-growing age group. Baby boomers are turning age 65 at the rate of roughly 10,000 per day, the Pew Research Center reported in 2010. And by 2030, adults 65 and older will make up 19 percent of the population.
Age is hardly the only factor, though. Most older Americans face special health care challenges, particularly common chronic diseases such as diabetes, high blood pressure, heart failure, and Alzheimer's. About three out of four Americans age 65 or older suffer from more than one chronic condition, according to the Centers for Disease Control and Prevention.
Unfortunately, chronic disease is the single biggest and fastest-growing contributor to health care costs. About half of the nation's collective health care spending provides for the care of just 5 percent of Medicare beneficiaries. Most of this group live with chronic disease.
That's why patients like Sally have become the subject of a seemingly never-ending debate. Should we invest in what's best for patients or in what is most cost-effective for the country?
Right now, health care delivery for elderly Americans remains largely fragmented, inefficient, and expensive. Most older Americans who are at home and in need of long-term care get only unpaid help, mainly from family, friends, and volunteers. That's a problem. About 70 percent of Americans over age 65 are expected eventually to require some kind of long-term care. But some families and friends must shoulder those responsibilities themselves rather than hire and pay professionals.
This predicament will take a particularly heavy toll on elderly Americans who are members of racial and ethnic minority groups. African-American and Hispanic senior citizens have disproportionately small lifetime earnings and on average have less money saved for retirement. Some live in rural settings and are members of families in which financial struggle is common. Despite the Affordable Care Act and rising rates of health insurance coverage, racial and ethnic minorities also remain more likely than other Americans to live without health insurance and the regular health care it provides.
Already, research shows that racial and ethnic minorities over age 65 often lack adequate access to health care and receive lower-quality health care than their white counterparts. Older minority Americans have also, on average, consistently lived in worse health, as measured by disease and disability, than whites the same age.
Beware the looming omens: By the year 2050, minorities are expected to account for 50 percent of the elderly population. The state of their health and health care will increasingly characterize what growing old and ill in the United States will mean.