The golden years will lose thier luster, unless baby boomers support sweeping changes in the long-term care industry

I’ve seen the future – and you don’t want to.

Actually, you’ve seen the future, too, if you’ve tried finding, managing or paying for the care of an ailing, aging parent. If you were like me, you carefully, exhaustively searched for the best affordable facility.

Let’s say you found one that was clean and safe, that was close enough for regular visits. There were three hot meals a day, activities and outings listed on the bulletin board, a sympathetic administrator.

It’s a good place. But admit it: Like me, every time you visit, you can’t wait to leave. You are thankful that you don’t have to live there. This will never happen to me, you vow under your breath on your way back to the car. I’ll never end up in a place like this.


There are about 78 million baby boomers in the United States. By 2030, 58 million of us, then ages 66-84, still will be alive. Where do you think many of us will be living?

Like you, I imagine a vigorous, stimulating old age (if I allow myself to imagine old age at all). Maybe I will live right here, in the house I helped design and build when my children were young, or maybe a smaller place closer to town, or perhaps a little apartment just off the Piazza del Campo in Siena. That’s the future I see, the one I am planning for.

And yet, the statistics are against me, against us. The longer we baby boomers live, the more chance we have of falling prey to something that will erode ability to live the future we imagine. If AARP statistics are correct, only about a quarter of us will be living unassisted in our old age. The rest of us will be in continuing-care retirement facilities and assisted-living residences and adult foster care homes or, if we are not as fortunate, in nursing homes or memory care facilities. You know, those places our parents now live in, the ones we visit, the ones we can’t wait to leave. This is what’s in store for us unless we – the much-vaunted generation that sought to revolutionize just about everything – revolutionize elder care.

I have spent a lot of time in elder-care facilities: the reception areas that look like economy motel lobbies; the greenish fluorescent lights; the cold beige walls sparsely decorated with Wal-Mart art; the wipe-able, vinyl-upholstered furniture; the scent of room freshener layered over Lysol. I toured more than a dozen places before I chose one for my mother, the homiest one I could find (although it certainly didn’t look like anyone’s home).

Then, some years later, as research for a book, I took an entry-level caregiving job in an Alzheimer’s facility and worked there for more than four months. Alzheimer’s facilities are, of course, on the extreme end of the elder-care spectrum. Still, what I learned there can be broadly applied.

“Maplewood,” as I renamed the place in order to protect the privacy of the residents, was state of the art with a spacious indoor atrium, pleasant sky-lighted common areas, prettily landscaped patios and attractive private rooms. This was a far cry from the numbingly sterile, hospital-like atmosphere of many places I had seen, not just Alzheimer’s facilities but nursing homes and assisted-living complexes.

Would I want to live at Maplewood? Would you? Absolutely not. The physical space was pleasing, but the life within it is not. (I am not talking disease here.) The food is bland, at best. You eat what is served, when it is served. You are free to make almost no independent decisions, from what time to wake up to when to take a shower to when to go to bed. (Believe me, even people with Alzheimer’s want to feel that some decision, however small, is theirs.) A considerable body of research suggests that when people lose their ability to control things, they become unhappy, hopeless and depressed. I sure would be.

Then there are the activities. Happily, Maplewood had activities. When I worked there, Maplewood employed an energetic, caring activity director – which is not always, or often, the case in elder-care facilities. But she assumed she knew what the residents wanted. She did not, for example, bring together an advisory group of healthy elders to ask what activities people of that generation might enjoy. In 20 years, would you like a staff of Gen-Xers and Millennials planning your outings? Deciding what music to play and what movies to show? I think not.

Finally, and most important, the reason you or I wouldn’t want to live at Maplewood – or thousands of other elder-care facilities in America – is that the place is seriously understaffed and the staff seriously overworked. Most days I cared single-handedly for a dozen people in various stages of disability, waking them, showering them, brushing teeth, dressing, toileting, feeding, hefting them in and out of wheelchairs, getting them to and from activities. I did laundry, wiped counters, vacuumed carpets, emptied garbage and filled out paperwork. In between, I struggled to find the time to talk with the people I cared for, help clear confusion and calm fears, to give hugs. I did this for minimum wage. I did this after two days of training.

This does not have to be our future. We can – and should – start now to make things better: increase staffing, improve food, soften the institutional atmosphere, rethink activities, create opportunities for meaningful involvement on the part of residents. Advocating for change, facility by facility, can be as simple as contacting your state’s long-term care regulators.

That’s a start. But the problem is not that any one facility is gloomy or understaffed or poorly run. The problem is systemic. The problem is that elder care is a booming, $30 billion-plus, for-profit industry dominated by chains that are, themselves, being bought up by private investment groups. The problem is, a lot of money is to be made, and much of it is being made by slashing operating costs.

According to a recent article in a New York Times series on nursing homes, six of the nation’s 10 largest nursing home chains have been purchased by investment groups in the past few years. The facilities run by investment-owned large chains were, according to the newspaper’s examination of thousands of records, 41 percent more profitable than the average facility.

That’s good news for the investors but can be bad news for those who live in or work at those facilities. To maximize profits, facilities are cutting staff and squeezing food, supply and activity budgets. The result: Fewer caregivers with less training (and few, if any benefits) – a high-turnover, stressed-out work force caring for our parents.

And soon, ourselves.

This is the systemic problem we face now as we navigate the choppy waters of elder care for our parents. It will be the same system – only with choppier waters – when it’s our turn unless we can exert the mighty influence of our generation by embracing health care reform on the national level. It is time. It is past time.

We also can be pioneers. The generation that helped conceive and build many alternative institutions – from free health clinics to listener-sponsored radio to alternative schools (that’s us) – can now, today, apply our energy to building alternative options for our later years. Elder communities, intergenerational planned communities, co-housing, home-sharing and other innovative ideas await our attention.

From Santa Fe, N.M., to St. Petersburg, Fla., there is already a fledgling movement to create non-institutional living options for the elderly. In Davis, Calif., 12 old friends, average age 80, are pioneering a new kind of commune. In Abington, Va., a 76-year-old former nun is spearheading a community of elders. A communal housing development for the elderly will soon be opening in Boulder, Colo.

To rework a saying from back in the day: We need to become part of the solution before we become part of the problem.

Lauren Kessler is the author of five works of narrative nonfiction, including “Dancing With Rose: Finding Life in the Land of Alzheimer’s.”

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