It’s sometimes referred to as the “silver tsunami.” Whatever you call it, it means that those of us known as baby boomers—born between 1946 and 1964—are rapidly surpassing the age of sixty-five. According to the U.S. Census Bureau, by the year 2034, the number of people in this country aged sixty-five or older will be greater than that of people under eighteen.
So what happens to all of these older people, especially when they need assistance from other humans because they are experiencing some sort of physical or cognitive decline? Who will provide this assistance, and who will pay for it?
Too often, this ends up being a loved one, such as an adult son or daughter, who has to drop everything and move many miles away to become the main provider of assistance. That person may become dangerously stressed from suddenly taking on the extra responsibility of watching out for someone else’s well-being. They also might not be paid for providing this valuable service, especially if the person needing the assistance doesn’t have the considerable wealth that is required for paid care.
The person providing the assistance may also not want to be paid for helping out a family member, but doing it for free might not be practical. What if the uprooting requires giving up a job? What if assisting someone else is a full-time job by itself? What will the caregiver do for money? How will they find time to work for a living while taking care of someone else? That’s why it’s good to be paid for the hours spent helping someone execute the activities of daily living, even if it’s Mom or Dad.
Also, what about the person on the receiving end of this care? They might be reluctant to seek or accept the help they need because they don’t want to be a so-called burden. Thus, they may needlessly reduce their lives by not straying beyond the comfort and safety of their homes. Or they may begrudgingly resign themselves to relinquishing their homes and other assets to impoverish themselves enough so that Medicaid will pay for them to live in a nursing home.
Almost everyone will find themselves at this painful crossroads sooner or later. But it doesn’t have to be this way. Like so many social inequities, this dismal situation could be solved if we prioritize doing what it takes to truly care for one another. That begins with drastically reevaluating the view that sees people who are older or disabled as burdens just because we need different public infrastructure than most people to make it through the day. There’s no shame in relying on public services—we all do it. Every time someone walks on a public sidewalk or drives on a public street, they are using a free public service that is funded by taxpayer dollars and available for anyone who needs it.
I’ve had a physical disability all my life, and I use a motorized wheelchair. I’m also sixty-nine years old, so I’m both disabled and a baby boomer. I can’t physically do all of the essential daily tasks we all must do, such as getting in and out of bed, getting dressed and undressed, going to the bathroom, and doing household chores. So I rely on help from a crew of people I’ve hired to come into my home and assist me. I call them my pit crew. They’re paid for every hour they assist me via a state program mostly funded by Medicaid. So it doesn’t cost me a cent, except for the taxes I pay.
This is called a Medicaid waiver program, in which a state government asks the federal government for permission (a waiver) to spend some of its Medicaid money in an innovative way. It enables me to stay in my home rather than being forced into a nursing home to receive the help that I can’t live without.
And I am in charge, too, which is very important to me. I get to hire whomever I find to work for me. I determine their schedules, and I can terminate their employment if I’m not satisfied with their work. The program doesn’t require me to use some home health agency contracted by the state. I don’t have to settle for whatever stranger the agency sends to my home. I don’t have to go to bed at 7 p.m. if I don’t want to just because that’s the only time the agency has someone available. My pit crew answers only to me.
I find good pit crew members in the most unlikely places. They might be neighbors, students at a local college or high school, or relatives. So the more freedom I have to decide who assists me and when, the better the odds I’ll find the right person for the job.
But I think our society is too scared to talk about this. The depth of this fear is reflected in the word “tsunami.” A tsunami is a giant, devastating wave that no one welcomes. It is nothing but a destructive force, and the best we can do to protect ourselves from it is to hunker down and hide and hope it doesn’t sweep us away.
We’ve tried to justify ignoring this challenge in large part by dehumanizing people like me by writing us off as hopeless burdens. We are seen as helpless in every way, and therefore unworthy of public services or capable of deciding for ourselves how to best use these services to meet our specific needs. Thus, we now find ourselves in a situation marked by such a dearth of resources that only rich people can afford to pay for the help they need while others have to rely on the goodness of unpaid or underpaid family members.
I believe that everyone deserves to live in a place with public infrastructure that makes the kind of assistance I receive available to anyone who needs it. Programs like the one that serves me should be as plentiful and abundant as streets and sidewalks. No one should feel like a burden because they need the kind of public support I need each day.
These programs should be designed in a way that prioritizes giving us maximum agency, autonomy, and options. This means allowing us to recruit, hire, fire, schedule, and supervise whomever we think is the best person for the job, whether they’re neighbors, friends, or relatives. The only thing the government should do is process their pay.
I realize that not everyone is capable of making their own decisions, such as someone with advanced dementia, for example. But in cases like that, we still need to design programs that prioritize providing maximum agency, autonomy, and options to those who must make their decisions for them.
Those who assist us deserve to be paid well for the important work they do. They also deserve to receive the benefits, such as medical coverage and paid time off, that are associated with having a good job.
We have to start thinking about other sources besides Medicaid to pay for all this. That’s mainly because Medicaid, in its current form, is far too restrictive. In order to be eligible for Medicaid, one must be dirt poor. So if you have to be Medicaid-eligible to receive the in-home assistance you can’t live without, you probably have no choice but to spend most of the money you have paying for private assistance until you have so little left that you are Medicaid-eligible.
And in order to maintain that eligibility, you have to remain dirt poor. That means you can’t work for pay or do anything to build your assets back. I suppose Medicaid could be reformed to make it more open. But that’s the opposite of what the current fools in Congress, who claim to be improving the program by taking billions of dollars away from it, are trying to do. As usual, their goal is to take a giant step backward by getting rid of these programs without replacing them with anything better.
It’s not inevitable that the aging of America must be feared as a dreadful tsunami destined to drown us all. It can and should be welcomed as a golden opportunity to make things better for everyone.