Further Ruminations on an Aging Population
“Senior Citizen.” The term summons an image. Until you experience it yourself, usually watching your parents age, it seems like a generic term. It isn’t. Someone who’s 65 is a senior. Odds are, they’re still doing their own grocery shopping, getting to doctors appointments. Living independently. By age 75, maybe not so much. By 85, Father Time has caught up.
We Boomers swamped everything when we hit – public schools, colleges, the job market, the housing market. And left carnage in our wake when we moved on.
When we decided rock music was music, popular music overnight went from “How Much is that Doggie in the Window?” and “The Little Nash Rambler Went Beep-Beep-Beep” to “House of the Rising Sun” and “Like a Rolling Stone.” When we decided we didn’t want to be drafted, boom, the draft was gone. We started perpetual inflation in the housing market that won’t abate until we abandon our own houses.
The oldest Boomers now are 76. The youngest are 59. After that come generations of much smaller cohorts. We’ve barely begun to hit the retirement market, and we’ve already swamped it. Worse is yet to come, both the numbers of seniors and the amount of care each senior needs.
Adams County has placed its bet for the future with seniors. It’s the only segment of the population that’s growing, and it’s growing rapidly. Unfortunately, because they don’t bring demand for schools, our planners have treated seniors as a population that doesn’t need infrastructure. Nothing could be further from the truth. Seniors need a huge infrastructure, which “the market” is basically ignoring. Seniors will require massive increases in senior housing, including assisted living, medical care, home health care, therapists, transport, etc. In Adams County, it’s isn’t just that nothing is being done to meet future demand in any of these areas; in a lot of cases it appears that nothing can be done. For example, the supply of home health aides is fully exhausted and, with the lack of affordable housing, there is no chance that anyone will ever relocate here to be a home health aide.
Having spent more than a month in the hospital and rehab world, I understand the challenges of an aging population so much better than I did a month ago. There are people like me, who basically aren’t sick, who crack jokes during therapy, sing the lyrics along with the oldies station, and expect to go home soon. Then there are the stroke victims and the broken hips and the random surgeries. They might or might not be going home but while in require a lot more care. And, seeming from my experience to be a growing problem, the diabetes/obesity cohort with its heart problems, amputations, and worse; many of these people are in and out of hospitals and rehab, sometimes spending a month or more at a time. That’s what you see in a place like Chambersburg Hospital Rehab, with a rigorous three hour daily rehab schedule. I spent three weeks there recently. None of those categories of demand are going to be reduced as the population ages.
Then you get to a rehab facility that’s collocated with a residence facility, and you run into the Alzheimer’s patients, people living in permanent twilight, maybe for years at a time. The support needs for them are off the charts. And the current workforce isn’t adequate for current needs; all you need to do is sit for ½ hour half-dressed at breakfast time waiting for an assist while the Alzheimer’s patient next door shouts “Help!” and “Where is everyone?” and “I want to get out of here” to understand that the workforce is inadequate in either staffing levels or skills or both.
As we age and as more and more of us climb in that boat, there inevitably will be issues. First, where will we live? That house in Amblebrook may look pretty attractive to someone moving from Chantilly, VA, where the same house would be $1.2M. But a few years later, it’s “too much house.” The current stock of seniors housing is already over-subscribed and nothing is being developed.
Where’s the money coming from? It’s not hard to be solvent 5 years out from retirement. How about 20? After a few rounds of home nursing aides not covered by Medicare? Or that Medicare Advantage plan that seemed like such a great deal when you were young and healthy, but now the co-pays are literally consuming your social security check.
Who’s going to take care of us? Where will our aides come from? One thing is for sure, the Gettysburg housing market isn’t going to sustain the home aides needed for a 75+ population. The current aide market is barely sufficient for the current senior population. Nobody is moving to Adams County to work as a health care aide.
Who’s going to vote for schools? Currently, the schools love Amblebrook because it brings in residents who pay taxes but don’t add children to the school system. Seniors now make up 30% of the county’s population, up from 18% a few years ago. Given current trends, it could easily be 40% in a few years. What about when the seniors rise up and say, instead of schools, how about more money for home health aides and Rabbit Transit? Seniors vote and they get what they want.
There’s one source that’s already being tapped out, long before the wave hits. That is, the spouses and adult children of the elderly. If you spend any time in medical care, they’re easy to spot. They do everything from transport to medical appointments to intense, round-the-clock personal care. That’s another life, placed on pause. Another person who’s working hard but not considered to be in the workforce. Another person for Republicans to claim “doesn’t want to work.”
The demographic hit to the workforce when we Boomers retired has been a matter of discussion for decades. The double hit as many of us dragged another person out of the workforce hasn't yet become a matter for discussion. But as more and more people age, the demand goes up and the supply doesn’t increase, the cost of home health aides and assisted living will continue to escalate, leaving more families with no choice but providing the help from family resources. What will that do for our workforce?
Another issue that is more national than local is the whole social security, Medicare/Medicaid funding challenge. Republicans continue to dream up scams to divert more and more funding to private sources (Medicare Advantage) and Democrats continue to insist on no benefits cuts. As the date of “insolvency” arrives, the pressure on the federal budget will grow. The safest bet in Washington is that there will never be benefits cuts in Social Security or Medicare. That is going to put huge pressure on everything else in the federal budget.
In summary, the baby boom will hit the seniors support market as hard as it hit public schools 65 years ago. These markets are already showing signs of strain and do not appear to be very elastic. Because of its growing dependency on seniors, Adams County seems particularly vulnerable to these growing trends. The time to address the problem is now, not in 10 years when it’s a current problem.