If the US population continues to grow at the rate projected by the US Census Bureau, then 2030 will be a very interesting year for Americans. It is during this decade that the effects of an aging population will be felt, with 1 in every 5 US citizens being of retirement age. Every baby boomer will be in their mid-60s at this point. Most significantly, however, older people will outnumber children for the first time ever.
By the midpoint of the decade, there will be 78 million people in the US who are aged 65 or over, compared with 76.7 million who are under the age of 18. This will mark the first time in US history that the former group outnumbers the latter. This change is just one of many we will witness as the population shifts.
For example, the overall population size is projected to grow by almost 80 million people. There were about 326 million US citizens in 2018, and by 2060, the number will have crossed the 400-million threshold. As the population as a whole grows older and the number of elderly people increases, there will be an increasing strain placed on the healthcare system. By 2020, the projected ratio for working-age people to retirement-age people is 3.5. However, this is expected to drop to just 2.5 by 2060.
Why Do We Have an Ageing Population?
There is a combination of factors that contribute to the aging of the population as a whole. First, there is the most obvious culprit – improvements in healthcare. As we get better at treating illnesses, we will be able to keep people alive for longer. People are less likely to die at a young age, which would skew the average life expectancy. This second effect is important to note.
It is commonly believed that, because the average life expectancy in the middle ages was around 32, most adults wouldn’t live beyond this age. In actual fact, the results are skewed by the much greater infant mortality rate. While people were much more likely to die during their formative years, those who made it to adulthood could still expect to live to an old age.
It is therefore worth remembering that increasing life expectancy is not just about taking care of the health of elderly people; anything that we do to improve health at any age will improve the chances of survival and contribute to a longer life expectancy.
The Problems of an Aging Population
An increase in the size of the population will always put more strain on healthcare services, even if most of that increase is coming from relatively fit and healthy people. The US is contending with a surge in the size of its overall population – which, again, is driven by a variety of factors – that they need to contend with while also addressing the unique problems caused by an aging population.
The strain on social security in the US has been growing for some time. Contrary to some of the most common attacks leveled at the social security system, it currently takes in more money than it pays out. However, that situation will change in 2020, when the population will begin to draw more money from the system than is being paid into it. This transition has been anticipated for quite some time, but the rate at which the now-retired boomers will draw on these funds means that they will be depleted by the end of the 2030s.
Funding Challenges for Nursing
As people grow older, they are likely to require care from the nursing system. However, this system is already under a significant strain thanks to the growing number of patients it has to cater for. Under existing rules, most nursing home residents are forced to spend their entire savings on their healthcare before they will qualify for federal assistance. Patients are already contributing as much as they can to the system – increasing the costs at the point of service only means that patients exhaust their funds sooner and the government has to pay out more.
The only place that additional funding can come from is the taxpayer, and while many in the US would be willing to pay more taxes for better healthcare, far fewer would be willing to shoulder a tax rise that benefits only part of the population. Many are now coming around to the idea that the best solution to this problem is the Medicare for all approach, but time is running out to identify a path forward before a funding crisis forces our hand.
Medicare and Medicaid
There are many misunderstandings about what Medicare actually entails, and what the Medicare for all program is envisioning. For one thing, Medicare doesn’t cover the long-term nursing costs incurred by people who require ongoing care, such as people with dementia, Parkinson’s disease, or other disabilities and degenerative diseases. Patients with these conditions have to pay out of pocket until all of their available funds are depleted.
Eligibility for the Medicare program generally begins at 65. The program acts as a kind of government health insurance policy that older Americans can take advantage of. Medicare covers some of the costs involved in both routine and emergency medical care. However, one thing that Medicare does not cover is the costs of custodial care – that’s care provided by facilities like nursing homes where the patient will live in the facility as well as being treated there.
This is where Medicare’s sister program, Medicaid, comes into the picture. Medicaid provides coverage for Americans when their assets fall below a certain value. Until this time, the patient will be expected to shoulder the costs of their own treatment. Patients who qualify for treatment in a nursing home are generally required to exhaust the majority, if not all, of their assets before Medicaid will become available. The only alternative is an expensive long-term care insurance plan, which isn’t an option for the majority of those who could benefit from one.
The Costs of a Nursing Home
For those who are most in need of their services, nursing homes are notoriously expensive. In fact, the costs of a nursing home are one of the greatest threats to the financial security of retirees, according to a study by the US Department of Health and Human Services. According to current projections, these costs are only going to continue to grow and are expected to do so at an above-inflation rate.
Addressing These Problems
Both the increasing population and the increasing age of that population present significant challenges for the US healthcare system and nursing in particular. However, there is still hope for the future; many of the problems we are facing can be addressed, but the real challenge is establishing the cooperation and coordination required to do so.
Digital healthcare has a significant role to play in addressing these problems. First of all, digital healthcare can help to alleviate the strain on the main healthcare system. We are rapidly approaching a situation whereby patients will be able to use smartphone apps to diagnose basic health conditions. These systems already exist but don’t offer the level of reliability that is needed if they are to be used as a substitute for a doctor.
Digital healthcare is also enabling an increasingly stretched workforce, especially in the nursing sector, to accomplish more with less. Advances in communications technologies mean that doctors can conduct many of their consultations with patients remotely. Of course, some people will always require face-to-face consultations, but by using these technologies like a screen to ensure that doctors only personally handle the cases that they need to, we can massively reduce their workload.
Another vital development of recent years is the rise of the online degree. Remote learning means that students who would previously have been unable to access the education courses required for the careers they want will now be able to do so. These courses are available to nursing students at every stage of their journey, whether they are studying for their registered nursing (RN) degree, or they are looking to do their post masters FNP. Making training and education more accessible will help to address the labor shortage that exists. This, in turn, will also help to alleviate the strain on the system.
While some significant shifts in the makeup of the US population have been expected for some time, there has been surprisingly little preparation done to prepare the healthcare system for multiple potential incoming crises. If we don’t soon take steps to address the shortcomings in the current system and set it up so that it is sustainable in the future, a collapse seems all but inevitable.
The nursing sector will be particularly heavily hit by the impacts of an aging population. Nursing homes around the US are already trying to contend with a serious shortage of both staff and resources. Throwing the weight of a larger and older population on top of this could trigger a full-blown collapse.