2050 and the Caregiver Dilemma

Published in the Woonsocket Call on April 22, 2018

The year 2030 marks an important demographic turning point in U.S. history according to the U.S. Census Bureau’s 2017 National Population Projections, released last month. By 2030, older people are projected to outnumber children. In the next twenty years, when these aging baby boomers enter their 80s, who will provide informal caregiving to them.

Almost three years earlier, in a July 2015 report, “Valuing the Invaluable: 2015 Update Undeniable Progress, but Big Gaps Remain,” the AARP Public Policy Institute warned that fewer family members will be around to assist older people with caregiving needs.

According to AARP’s 25-page report, coauthored by Susan C. Reinhard, Lynn Friss Feinberg, Rita Choula, and Ari Houser, the ratio of potential family caregivers to the growing number of older people has already begun a steep decline. In 2010, there were 7.2 potential family caregivers for every person age 80 and older. By 2030, that ratio will fall sharply to 4 to 1, and is projected to drop further to 3 to 1 in 2050.

Family caregivers assisting relatives or close friends afflicted with chronic, disabling, or serious illness, to carry out daily activities (such as bathing or dressing, preparing meals, administering medications, driving to doctor visits, and paying bills), are key to keeping these individuals in their homes and out of costly nursing facilities. What is the impact on care of aging baby boomers when family caregivers no longer provide assistance in daily activities?

“In 2013, about 40 million family caregivers in the United States provided an estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013, up from an estimated $450 billion in 2009,” notes AARP’s caregiver report. What will be the impact on the nation’s health care system without family caregivers providing informal care?

The Census Bureau’s 2017 National Population Projections, again puts the spot light on the decreasing caregiver ratio over the next decades identified by the AARP Policy Institute, one that must be planned for and addressed by Congress, federal and state policy makers.

Who Will Take Care of Aging Baby Boomers?

With the expansion in the size of the older population, 1 in every 5 United States residents will be retirement age. Who will provide informal caregiving in our nation with a larger adult population and less children to serve as caregivers?

“The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in U.S. history,” said Jonathan Vespa, a demographer with the U.S. Census Bureau. “By 2035, there will be 78.0 million people 65 years and older compared to 76.4 million under the age of 18.”

The 2030s are projected to be a transformative decade for the U.S. population, says the 2017 statistical projections – the population is expected to grow at a slower pace, age considerably and become more racially and ethnically diverse. The nation’s median age is expected to grow from age 38 today to age 43 by 2060.

The Census Bureau also observed that that as the population ages, the ratio of older adults to working-age adults, also known as the old-age dependency ratio, is projected to rise. By 2020, there will be about three-and-a-half working-age adults for every retirement-age person. By 2060, that ratio will fall to just two-and-a-half working-age adults for every retirement-age person.

Real Challenges Face Congress as the Nation Ages

Jean Accius, Ph.D., AARP Policy Institute’s Vice President, Independent Living, Long-Term Services and Supports, says, “The recent Census report highlights the sense of urgency to develop innovative solutions that will support our growing older adult population at a time when there will likely be fewer family caregivers available to help. The challenges that face us are real, but they are not insurmountable. In fact, this is an opportunity if we begin now to lay the foundation for a better system of family support for the future. The enactment of the RAISE (Recognize, Assist, Include, Support and Engage) Family Caregivers Act, which would create a strategy for supporting family caregivers, is a great path forward.”

Max Richtman, President and CEO of the Washington, DC-based National Committee to Preserve Social Security and Medicare, gives his take on the Census Bureau’s 2017 statistical projections, too.

“Despite how cataclysmic this may sound, the rising number of older people due to the aging of baby boomers is no surprise and has been predicted for many years. This is why the Social Security system was changed in 1983 to prepare for this eventuality. Under current law, full benefits will continue to be paid through 2034 and we are confident that Congress will make the necessary changes, such as raising the wage cap, to ensure that full benefits continue to be made well into the future,” says Richtman.

Richtman calls informal caregiving “a critical part of a care plan” that enhances an older person’s well-being. “While there currently are programs such as the Medicaid Waiver that will pay family members who provide caregiving support more can be done to incentivize caregiving so that loss of personal income and Social Security work credits are not barriers to enlisting the help of younger individuals to provide informal support services,” he says.

Adds Richtman, the Medicare and Medicaid benefits which reimburse for the home-based services and skilled nursing care “will be unduly strained ”as the diagnosed cases of Alzheimer’s disease skyrockets with the growing boomer population. He calls on Congress to “immediately provide adequate research funding to the National Institutes of Health to accelerate finding a cure in order to save these programs and lower the burdens on family caregivers and the healthcare system. “

Finally, AARP Rhode Island State Director Kathleen Connell, says “Our aging population represents challenges on many, many fronts, including healthcare, housing, Social Security, Medicare and, of course, caregiving. It would be nice to think everything would take care of itself if there were more younger people than older people. But that misses the point entirely. The needs of older Americans are a challenge to all Americans, if for no other reason than most of us end up with multiple late in life needs. And too many reach that point without savings to cover those needs.”

“It’s worth noting, by the way, that many of the solutions will come from people 50 and older — many of whom will work longer in their lives to improve the lives of older Americans. We need to stop looking through the lens of ‘old people’ being the problem and instead encourage and empower older Americans to take greater control over their lives as they help others,” says Connell.

“Congress needs to focus on common sense solutions to assure families that Social Security and Medicare are protected. The healthcare industry needs to face the medical challenges. And at the state and local level, we must focus on home and community-based health services,” adds Connell.

For details about the Census Bureau’s 2017 statistical projections, co to http://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html.

For more information about AARP’s July 2015 caregiver report, go to http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf.

Reply Reply All Forward

New Report Says Alzheimer’s Disease Is Now Major Public Health Issue

Published in the Woonsocket Call on March 25, 2018

For the second consecutive year, total payments to care for individuals with Alzheimer’s or other dementias will surpass $277 billion, which includes an increase of nearly $20 billion from last year, according to data reported in the Alzheimer’s Association 2018 Alzheimer’s Disease Facts and Figures report recently released last Tuesday.

According to the Alzheimer’s Association, the annual report, first released in 2007, is a compilation of state and national specific statistics and information detailing the impact of Alzheimer’s disease and related dementias on individuals, families, state and federal government and the nation’s health care system.

“This year’s report illuminates the growing cost and impact of Alzheimer’s on the nation’s health care system, and also points to the growing financial, physical and emotional toll on families facing this disease,” said Keith Fargo, Ph.D., director of scientific programs and outreach for the Alzheimer’s Association, in a statement. “Soaring prevalence, rising mortality rates and lack of an effective treatment all lead to enormous costs to society. Alzheimer’s is a burden that’s only going to get worse. We must continue to attack Alzheimer’s through a multidimensional approach that advances research while also improving support for people with the disease and their caregivers,” he said.

Adds Fargo, “Discoveries in science mean fewer people are dying at an early age from heart disease, cancer and other diseases,” said Fargo. “Similar scientific breakthroughs are needed for Alzheimer’s disease, and will only be achieved by making it a national health care priority and increasing funding for research that can one day lead to early detection, better treatments and ultimately a cure.”

2018 Alzheimer’s Facts and Figures

New findings from the 88-page report on March 20, 2017 reveal the growing burden on 16.3 million caregivers providing 18.4 billion hours of care valued at over $ 232 billion to 5.7 million people with the devastating mental disorder. By 2050, the report projects that the number of persons with Alzheimer’s and other dementias will rise to nearly 14 million, with the total cost of care skyrocketing to more than $1.1 trillion.

Between 2000 and 2015 deaths from health disease nationwide decreased by 11 percent but deaths from Alzheimer’s disease have increased by 123 percent, says the new data in the report, noting that one out of three seniors dies with Alzheimer’s or another dementia. It even kills more than breast cancer and prostate cancer combined. In Rhode Island in 2015, the number of deaths from Alzheimer’s disease was 453, making the devastating brain disorder the 5th leading cause of death in the state.

In 2017, 53,000 Rhode Island caregivers provided an estimated 61 million hours of unpaid physical and emotional care and financial support – a contribution to the nation valued at $768 million dollars. The difficulties associated with providing this level of care are estimated to have resulted in $45 million in additional healthcare costs for Alzheimer’s and other dementia caregivers in 2017.

State Updates Battle Plan Against Alzheimer’s Disease

“The Alzheimer’s Association’s most recent report about Alzheimer’s Disease in Rhode Island illustrates the need to take swift action in updating our State Plan to ensure Rhode Island is prepared to provide the necessary resources to families, caregivers and patients who are struggling with the disease,” says Lt. Governor McKee,

McKee adds that the updated State Plan will be a blueprint for how Rhode Island will continue to address the growing Alzheimer’s crisis. “It will create the infrastructure necessary to build programs and services for the growing number of Rhode Islanders with the disease. The updated Plan will also outline steps the state must take to improve services for people with Alzheimer’s and their families. After the update is complete, my Alzheimer’s Executive Board will seek legislative and regulatory changes to carry out the recommendations of the Plan and ensure that it is more than just a document,” he says.

“One of the many types of caregivers benefiting from AARP’s caregiving advocacy in Rhode Island are family members who care for those with Alzheimer’s,” said AARP Rhode Island State Director Kathleen Connell. “They are among the army of 10 million wives, husbands, sons and daughters nationwide. The majority are women and according to researchers, especially when it comes to dementia and Alzheimer’s care. Approximately 40 percent of those caregivers say they have no other options or choices, and a third say they provide care 24/7.

“The latest report indicates what we already know,” Connell added. “This will continue to be rising challenge in Rhode Island as our population ages. The disease will place more stress on our Medicaid-funded nursing home capacity, which should make this a concern for taxpayers. There is a strong case for increasing research funding so that someday we may reverse the tide.

“Our Web site, http://www.aarp.org, provides abundant resources for these dedicated caregivers. AARP in states across the nation, including Rhode Island, have worked to pass legislation that provides paid respite for caregivers who have jobs as well as caregiving obligations. We have supported the Alzheimer’s Association here in Rhode Island for many years and, last year, a small team of AARP volunteers participated in the Alzheimer’s Walk. Joined by others, they are gearing up for this year’s walk.”

Increased Research Funding Needed Now

Donna McGowan, Alzheimer’s Association, RI Chapter Executive Director, says that the 2018 Alzheimer’s Disease Facts and Figures report should send a very clear message that Alzheimer’s disease is an issue that policy makers cannot ignore. “This is an urgent public health crisis that must be addressed. Early detection and diagnosis of the disease leads to better planning, avoiding preventable hospitalizations, and over all a better quality of life for the patient and the caregiver,” says McGowan.

McGowan warns that the health care system is not ready to handle the increased cost and number of individuals expected to develop Alzheimer’s disease in the coming years. “With a vigorous National Plan in place to address the Alzheimer’s crisis, and annual budget guidance for Congress, it is essential that the federal government continue its commitment to the fight against Alzheimer’s by increasing funding for Alzheimer’s research,” adds McGowan.

Rhode Island Congressman David Cicilline sees the need for increased funding for direct services for those afflicted with Alzheimer’s disease. He voted for H.R.1625, the omnibus spending bill that increases funding for the National Institute of Health’s Alzheimer’s research by $414 million. And two years ago, Cicilline worked to pass H.R.1559, “The HOPE for Alzheimer’s Act,” which President Obama signed into law to expand Medicare coverage for Alzheimer’s treatment.

If Cicilline succeeds to get the Republican-controlled Congress to have a vote on H.Res.160, his bill to reestablish the House Select Committee on Aging, it will allow House lawmakers to hear expert testimony and make new policy recommendations to improve the delivery of care to those afflicted with Alzheimer’s and to assist caregivers, too.

For details, go to http://www.alz.org/facts.

Pets Can Bring You Health, Happiness

Published in the Woonsocket Call on February 4, 2018

My newly adopted three-month old chocolate lab, Molly, keeps me on my toes. Literally. My daily walks around the block and playing ball in the back yard equal over eight thousand steps calculated by my Fitbit App. Being a pet owner I can certainly vouch for research findings published over the years that indicate that older adults who also are pet owners benefit from the regular exercise and bonds they form with their companion animal.

The Positives of Owning a Pet

According to Dr. William Truesdale, owner of Seekonk, Massachusetts Central Avenue Veterinary Hospital, “having a companion animal can greatly improve your life. Of course you should always choose the right pet based upon your lifestyle and activity levels,” says the veterinarian who has practiced for over 43 years.

“Studies have demonstrated that having a pet in the home can actually lower a child’s likelihood of developing related allergies or asthma. Children exposed early on to animals tend to develop stronger immune systems overall (as published in the Journal of Allergies and Clinical Immunology),” says Truesdale.

“The Centers for Disease Control and Prevention (CDC) have conducted heart related studies on people who have pets. The finding showed that pet owners exhibit decreased blood pressure, cholesterol and triglyceride levels. All of which can ultimately minimize their risk for having a heart attack,” adds Dr. Truesdale, noting that people affected by depression, loneliness or PTSD may find that a companion animal may greatly improve their overall mood.

“As a dog owner myself and knowing so many people who find companionship and just plain fun as a pet owner, I can attest to the many benefits,” said AARP RI State Director Kathleen Connell. “While not for everyone, there is an abundance of evidence supporting this. I have heard so many stories about pets in senior living centers and even service pets that provide furry contact for patients in nursing homes and hospitals I know they can do so much to brighten a day. And when you are on Facebook, you almost expect to see friends’ proud dog and cat pictures.

“When it comes to dogs, they need walking. Anything that gets older people up and out of the house is a good thing, even if it requires carrying a supply of clean-up bags. Bending and stretching is exercise, you know. In addition, there inevitably is increased social interaction as people meet and make new pet-owner on the sidewalks and at dog parks. It’s all good.”

Pet-Friendly Policies Abound in Health Care Settings

Dr. Karl Steinberg, a San Diego-based hospice and nursing home medical director and Chief Medical Officer for Mariner Health Central, has seen the positive impact of pets in patient care settings. For over twenty years the long-term care geriatrician has taken his own dogs with him to nursing homes, assisted living facilities and on house calls to hospice patients almost every day. ”It generates a lot of happiness,” says Steinberg.

Steinberg sees first-hand on a daily basis the joy they bring to the residents, even those with severe dementia. “It slows down the day a little bit, because when you walk past a room and someone shouts, ‘Oh! A dog!’, you can’t just walk on down the hall. You stop and share the unconditional love, and it’s so worth it.,” says the geriatrician and hospice physician

For years, Administrator Hugh Hall has brought Bella, a Labrador Retriever, to visit residents of the West Warwick-based West View Nursing and Rehabilitation. Bella is considered “an important member” of the Rehabilitation staff of the 120 bed skilled nursing facility,” says Hall, noting the 8-year old canine is utilized by therapists to assist and motivate patients in their recovery.

“Residents love the ability to ability to interact and hold or cuddle with Bella and visiting pets,” observes Hall, noting that his dog is the “official greeter” at the facility’s main entrance. “The residents get to pet her and reminisce about their pets of the past and this memory is warm and happy,” he says.

Mike, a 12 -year old Labrador often makes the “rounds” with Geriatrician David A. Smith, MAD, CMD, at facilities in Central Texas. His pet’s impact on residents is very positive and improves the quality of his rapport with residents enabling him to get “better history and better compliance from them” he says.

“In a meta-analysis of non-pharmacologic therapies for behavioral problems in Nursing Home Residents with dementia, pet therapy was one of only a small number of interventions that showed statistical benefit,” says Smith, who is a past president of AMA: The Society for Post-Acute and Long-Term Care Medicine.

Smith warns that there is a downside in owning a pet. Frail adults may trip over a pet. Elders may age out of the ability to care for a pet, placing an additional burden on a caregiver who must care for the pet. Plans need to be in place for the placement of a pet in case of a move to an assisted living facility or if an owner passes away.

Life-Like Pets Can Also Bring Benefits to Older Adults

But, for those who find taking care of a living pet taxing because of deceased mobility or memory loss, Hasbro, Inc., has created a new realistic pet, an animatronic cat with soft fur, soothing purrs, and pleasant meows and a barking dog, especially designed to bring companionship to older adults.

In 2015, the Joy For All Companion Pets brand, featuring the animatronic cat, was Hasbro’s first foray into products designed specifically for older adults. In addition to captivating older adults, Joy For All Companion Pets can help enhance the interaction between caregivers and their loved ones by incorporating lighthearted fun, joy, and laughter into time spent together.

In 2016, Hasbro’s the JOY FOR ALL Companion Pet brand included a lifelike pup that sounds, and feels like a real dog; when the pup’s “owner” speaks, it looks toward him/her and reacts with realistic puppy sounds. That year the Pawtucket-based toy company collaborated with Meals on Wheels America to fight senior isolation and loneliness, which affects one in four seniors across the country. Hasbro donated $100,000 to Meals on Wheels America and provided JOY FOR ALL Companion Pets to local Meals on Wheels programs across the country in order to provide comfort and companionship to the nation’s most vulnerable citizens.

“Aging loved ones and their caregivers have been thrilled with the Companion Pet Cats, and we are inspired by their positive feedback and personal stories,” said Ted Fischer, vice president of business development at Hasbro in a statement announcing the new life-like product. “The Cat delivers a unique way for all generations to connect deeply through interaction and play, but dog lovers continually asked when we planned to add a dog to the line. We are truly excited for the new JOY FOR ALL product – the Companion Pet Pup – to bring even more lighthearted fun and laughter to seniors and their families.”

“We heard from seniors across the country that companionship was important to their happiness. Many live alone, miss having a pet, or are no longer able to care for a pet,” said Fischer. “While it’s not a replacement for a pet, the Joy For All Companion Pet Cat is a life-like alternative that can provide the joy and companionship of owning a real pet, without the often cumbersome responsibilities,” he says.

The Joy For All Companion products are available for purchase on JoyForAll.com.