Infrastructure for Our Elderly

As I took the bus home yesterday, I observed a concerning yet awesome event. An elderly women, who clearly had difficulty even walking without assistance, was being helped by a complete stranger up the steps of the bus and into a seat. When she got off the bus, another woman helped her down and then walked with her to her final destination a block away, acting as a stabilizer as she had a quite unsteady gait and would have likely fell trying to get there on her own. I was proud that I didn't even have the chance to offer my assistance. That people jumped up so ready to help. However, the clinician in me asks: why does this woman A) not have a walker or other assistive device, and B) why is this woman out on her own without assistance.

It is concerning that the woman did not have an assistive device, it could be due to any number of problems from her refusing to use it because of vanity to receiving inadequate medical care, to not having enough money to pay the 20% co-pay, to recent change in functional status. The real concern however is the safety of our elderly and the lack of infrastructure, even in elder friendly cities such as San Francisco where there is ample public transit, defined sidewalks and many willing and able citizens to help a stranger cross the street.

As our population ages over the next 20 years, how are we going to cope with the onslaught? How is society going to provide the necessary services in order to prevent large swaths of the elderly public from being institutionalized? When elderly lose their ability to drive or to walk to the supermarket, who will help them? Meels on wheels or variations thereof are not everywhere and even where they are, it only solves part of the problem. Personal assistive services are generally only available to the very poor who are eligible for Medicaid and the very affluent who can afford to pay exorbitant rates for personal care upwards of $250,000/year.

It seems to me that the current setup is going to require family to take the largest burden, whether through payments for long term care or through assisting aging relatives with ADLs and IADLs. While we can expect family to assist in taking care of their family relatives to some extent, we cannot expect that this will become their full time job in most cases. Beyond most families not having the financial capability to do this, by doing so they will also be pulling themselves out of the real economy, further aggravating problems with paying for Social Security as well as endangering the economy as a whole. While the current financial crisis may be the only thing on the political radar at the momment, the graying of our society has the potential to be a true economic and thus national security threat as it begins to effect the economy over the next 10-20 years.

So the question is, considering where our society is now, and the lack of political opportunity at the momment to forward an agenda examining how to care for and create an infrastructure for our aging population, what are the next steps towards moving forward with an agenda for this enormous problem?

What ideas do you have for improving the infrastructure for taking care of our aging population? What barriers exist? How do we pay for the investment in our elderly? How can we help our elderly to age in place instead of being institutionalized? These are all questions that need to be answered before moving forward with an agenda into the political realm. As emerging scholars, we will become the experts in these fields over the next few years. Thus, we should start thinking of answers now so that when an opportunity does occur for political change in these areas, we are ready!

I encourage all of you in your disparate fields to think about how our society is about to change, and in our love for the study and care of the elderly, how we can assist, whether on an individual level, a city/county level, a state level, or on the national level, as things will only change if our voices are heard loud and clear throughout the country!