Single payer and the pending boomer caregiving crisis

Long-term care must become a more prominent part of the single-payer campaign

By Henry Moss, PhD
January 11, 2016

We are facing a perfect storm. AARP’s Public Policy Institute points out that as boomers age into their 80s, there will be a sharp drop in available family caregivers due to the “birth dearth” following the postwar baby boom.  At the same time, longevity is increasing due to effective treatments of heart disease, lung disease, diabetes, cancer, and other conditions.  A longer life, however, will likely mean more years with severe disability for boomers due to the secondary effects of increased obesity, including high blood pressure, high cholesterol, and inflammation due to metabolic disorders.

These secondary effects include damage to brain blood vessels and a likely increase in the incidence of dementia, including Alzheimer’s disease.  We already know that the prevalence of dementia will grow due to the sheer size of the boomer cohort.  In addition, however, it now appears that a recent steady decline in the incidence of cognitive impairment and dementia have ended and are starting to reverse. Dementia is by far the most care-intensive of conditions.  More years with dementia (and other disabling conditions fed by the effects of obesity, including mobility disorders) will mean more need for 24/7 care in the face of declining numbers of family caregivers.

Hence the perfect storm.  Hence the “2030 crisis.”  2030 is when boomers start becoming the “oldest old” in large numbers.
The boomer generation is defined by a dramatic rise in home ownership.  This trend, coupled with real and perceived problems in nursing homes, means that home care has become, by far, the preferred approach to long-term care.  With declining numbers of family caregivers, an army of personal care aides, well-trained and better-paid, will be needed to address the coming crisis.  Medicare or another universal plan will need to cover the cost.

PNHP and the single-payer bills circulating in Congress fail to place enough emphasis on long-term care and severely underestimate the costs associated with an aging population and declining numbers of caregivers.  There is no way to separate long-term care and health care.  Living at home alone with dementia, frailty syndrome, or a mobility disorder are an invitation to falls and other safety-related events, a major source of healthcare costs for older adults.  Shortages of physicians, nurses, psychiatrists, and social workers with specialties in geriatrics and mental health will create serious concerns for elderly patients both in and out of nursing homes.  Medication management will be severely compromised.  The health of stressed family caregivers will also suffer.

Over the course of its history, Medicare has added mental health services, prescription drug benefits, and hospice care.  Long-term care is the next frontier and boomers and their future caregivers represent a massive potential constituency.  It must become a prominent part of the single-payer campaign.

(Henry Moss is a retired baby boomer doing independent academic and public policy research and writing. He has a PhD in philosophy and has written on cognitive science and the history and philosophy of technological progress.  His public policy interests include health care, housing and urban development, technological progress, and theories of social democracy.)

The 2030 Caregiving Crisis: A Heavy Burden for Boomer Children, by Henry Moss (250 pages)
For paperback, eBook or free PDF download:



By Don McCanne, M.D.

Most single payer advocates certainly support inclusion of coverage for long-term care in a national health program. Inevitably there is concern about the magnitude of the problem, including defining the conditions requiring long-term care, and the costs that care will entail.

In his book, “The 2030 Caregiving Crisis,” Henry Moss discusses the pending crisis when a disproportionately large number of baby boomers will require long-term care at a time when there will be a disproportionate decline in available family caregivers. Addressing this problem now will provide a policy platform which will ease the problems of long-term care once the surge in baby boomers diminishes through attrition.

His book is well researched and well referenced, plus he provides his own constructive thoughts as to addressing this problem. Hopefully it will be a helpful resource as PNHP members clarify and organize our concepts on the financing of long-term care, as a part of our mission to achieve health care justice for all.