Aging Demographics & Long-Term Care – Expert Interview

The last Baby Boomer turns 65 in 2030. That’s also the year when one in five Americans will be over 65, and an estimated nine million will be over the age of 85—a nearly 50 percent increase from 2020.

At the same time, growth rates for adults under 65 are projected to remain relatively flat (Census Bureau 2017). This demographic shift reinforces the need for effective, sustainable, and person-centered long-term services and supports (LTSS).

The Covid-19 pandemic brought renewed attention to the vulnerability of older adults and improved information about how to support that population and its caregivers. Experts hope the momentum can carry over as America’s demographic tide shifts in the coming years. A miniature revolution is already underway, shaping the future of long-term care. To learn more about that future, read on.

Dr. Kathleen Wilber is a professor of gerontology and the Mary Pickford Foundation chair in gerontology at the University of Southern California Leonard Davis School of Gerontology. She earned her MSW, her MPA, and her PhD from USC.

Dr. Wilber focuses on improving health outcomes and quality of life for vulnerable elders, including those with chronic illness, disability, cognitive impairment, and/or economic insecurity by improving the design and delivery of long-term services and supports (LTSS).

Dr. Wilber’s past research projects have evaluated wellness interventions among frail older adults, models of integrated healthcare, and interventions to prevent elder abuse.

“The aging of the population is now on people’s radar,” Dr. Wilber says. “I think there are lots of opportunities that will result from this awareness, but also challenges, so we need to plan.”

America’s demographic shift is largely driven by the aging of what was once the nation’s largest generation, the Baby Boomers. Americans are also living longer than before: despite a recent drop in life expectancy, the average is expected to increase by approximately six years by 2060 (Census Bureau 2020). Future advances in medicine, science, and technology could extend that forecast even further. But when people live longer, they don’t always live healthier.

“We’re working to make sure that people age as healthy as possible,” Dr. Wilber says. “But we know that not everybody can and does. With the aging of the population, we will need not only more long-term services and supports but better, more innovative, person-centered ones.”

America’s demographics haven’t just changed in age, but in culture and composition. The population is increasingly more diverse than it used to be, making monolithic approaches ill-fitting. Instead, person-centered services are needed to focus on the preferences and acceptable practices of aging individuals and their families, including cultures, norms, and values.

“On the provider side, we need to have people who are sensitive and understand culture, and how diversity and inclusion impact all these services,” Dr. Wilber says. “I’ve seen some very good training, on the provider side, to make people aware of cultural preferences and how to listen and assess and be culturally competent. And I think it’s having an impact. But there’s a lot of work to be done to make sure that people on all sides of service are optimized and treated with dignity and respect.”

Technology is transforming the healthcare landscape, a trend from which long-term care is not immune. Wearables, pioneered by devices like FitBit and the Apple Watch, make remote health monitoring easy. Wearable tech has an enormous range of potential benefits in long-term care, from alleviating staff shortages to increasing health literacy.

“The opportunities are limitless,” Dr. Wilber says. “But when it comes to things like digital monitoring, we want to understand how people are using this in their own caregiving and how we can help them. How do we support caregivers and individuals in facility-based or home care and do this in a way that respects the privacy of the older adult and at the same time offers them more freedom?”

As of 2021, fewer than one in four adults age 65 or older had used tech like wearables to monitor their health remotely. The number is growing quickly. However, it doesn’t just come down to tech savviness: people land in different places on the privacy spectrum. A person-centered approach focuses on supporting aging persons and their families no matter what they choose.

Wearable technology is just the beginning. Gadgets powered by AI and robotics bring a glimmer of science fiction, along with applications that include everything from fall prevention to personal companionship and life extension. But long-term care professionals need to balance an optimistic open-mindedness with the practicality of ethics when delivering person-centered long-term care.

“There are medical and scientific breakthroughs and exciting potential for people to be able to age with a longer health span,” Dr. Wilber says. “But we’re not there yet, so we need to continue addressing both the challenges and the opportunities around supporting older adults and caregivers as we aim to help people live longer healthier lives.”

For all the promise that science and technology bring, the future of long-term care is a human one. Government regulation is needed to protect vulnerable older adults and ensure that all have access to high-quality care. Dramatic reductions in staff due to burnout and illness have exacerbated some weaknesses within long-term care facilities; more can be done to address them, including expanding education and training in gerontology. Aging involves individual choices but deserves collective support.

Family and friends already take on many caregiver duties in the US, but their role is likely to increase even further. An overwhelming majority of Americans want to age in place and live relatively independently in their later years; non-professional support is a critical part of helping them achieve that. Many Americans will still need access to a 24-hour care facility, but even in that instance, family and friend caregivers will continue to play an important role.

Today, unpaid caregivers contribute approximately 36 billion hours per year in family care (AARP 2023). That amounts to roughly $600 billion in economic value, more than all out-of-pocket healthcare spending in the US over the same time span. The non-economic value is at least as great. No science, technology, or regulation can replace the human component of those caregivers’ efforts, but they can support them.

“An ideal future would have staff, or technology to support where they don’t have staff, and a whole variety of options, including support for family caregivers,” Dr. Wilber says. “No matter how sophisticated the technology is, and no matter how much nursing and support care is offered in a facility, we need to do a better job of supporting those family caregivers.”