Aging boomers will jam ERs—why it’s about to get worse | Opinion

There was that word again on The Pitt: “boarding.” Expect to hear it a lot over the next decade, not just on TV, but in real life as patients are increasingly stuck in the ER when they should have been moved “upstairs” in the hospital. That’s because, increasingly, baby boomers will remain in those beds due to a lack of skilled nursing and assisted living facilities where they can continue care outside the hospital.

Boarding is the official term for a lack of facilities at that next level of care, up or down, and patients are forced to remain at an inappropriate level for hours…or days. This ripple effect will get much worse throughout the health care system. It is a demographic reality.

The number of people over 85 will increase by more than a third over the next decade and keep increasing to nearly double around mid-century. And since people over 85 need the most health care, they will jam hospital beds and then need skilled nursing or assisted living facilities when it is time to leave the hospital. Without enough beds for continuing care outside the hospital, the jam-up ripples back to that ER hallway.

The country has seen the impact of this demographic bubble before. A few years after the 18-year-long baby boom began in 1946 the education system was in crisis—way too many kids for the available schools. Those of us who are seniors today lived it back then. In 1953 there were 44 kids in my first grade class at Bethesda Elementary, and a lack of new desks forced Valerie, my wife, to sit on the classroom floor and write on chairs when she was in second grade. Mass construction of schools and a willingness to accept the necessary tax and budget increases got the education boom under control.

Seven decades later we’re headed for a similar jump in facilities demand, but this time with health care. And this time it doesn’t just impact kids. It will touch everyone needing hospital care.

The numbers are simple and big. Today there are 6.6 million people over 85. By 2035 there will be 9 million people and if we just ripple the baby boom through the society with no increase in longevity there will be 12 million by 2050. That’s over 5 million more people who will need the medical facilities and care of late life.

The Alzheimer’s and dementia numbers are equally daunting. There will be, literally, millions more people with Alzheimer’s and other dementias by mid-century.

At current ratios of licensed skilled nursing and assisted living units to population, seniors will require 300,000 more beds by the end of this decade and a million in 15 years. Adding the beds to fix the “boarding” risk will take a half trillion dollars over the next decade with another trillion needed through 2050. Staffing is still more.

Institutions will need 200,000 more licensed caregiving professionals in five years and a half million by mid-century. These include registered nurses, licensed practical nurses, and certified nursing assistants. They will add $9-10 billion in annual health care costs by 2030 and $18-20 billion each year by 2035. The number reaches around $45 billion in additional annual salary costs by 2050.

More than 60 percent of seniors use skilled nursing or licensed assisted living at some point after they turn 65, but 80 percent live out most of their lives at home. They are cared for by a combination of family, professionals, and what are euphemistically called “informal” caregivers—often lightly trained helpers who are often foreign born and frequently undocumented. Government immigration policies are reducing this informal caregiver group at exactly the demographic tipping point.

Families and institutions are all in competition for caregivers today, and that competition will increase along with the 85-plus population. This will drive up the staffing costs for institutions and force more family members to quit or cut back jobs to care for family members, and that will hurt family finances. It will also hurt national productivity, with an inevitable drag on the economy as millions of productive workers become family caregivers.

You can already hear the excuses. Politicians will try to shuffle off the challenge of finding a caregiver for Dad as a “family problem” that’s not of government concern. They will blame the lack of facilities and personnel on “fiscal constraints.” They will avoid tying national economic performance and immigration policy to caregiving.

But the one thing they will not be able to avoid is “boarding.”

Boarding is simple, inevitable, and real. It is supply and demand in an emergency. It could leave you, your spouse, or your child in that ER hallway because when we boomers have nowhere to go, you will have nowhere to go.

Try to explain that if your kid’s lying on the gurney.

Tom Wolzien is a retired Wall Street research analyst and network television news executive, who currently serves on the nonprofit boards of directors of CaringKind, the New York Alzheimer’s support organization, and Kendal on Hudson, a continuing care retirement community in Sleepy Hollow, NY. He was born in 1947, the second year of the baby boom. He can be reached at wolzien@wolzien.com. More information at wolzien.com/background.

The views expressed in this article are the writer’s own.