Opinion | Who Will Take Care of Our Aging Population? – MedPage Today

We are in the midst of a “crisis of compassion” or “compassion exhaustion.” As our nation lurches from one short-term response to the next, from surge to surge, we are concerned about the long-term implications of the COVID-19 pandemic on our elderly care system.

The U.S. population 65 years and older will nearly double over the coming decades. People 85 years and older are already the country’s fastest growing age group. Who will take care of them — us — 10 years from now?

COVID-19 is hollowing out our workforce and drying up the pipeline of caregivers, nurses, doctors, and everyone else within our health and social care systems. “Compassion exhaustion” is threatening the safety and proper care of people needing long-term services and supports (LTSS).

The challenges confronting LTSS were known long before the pandemic. Estimates from years ago warned of a national shortage of 151,000 caregivers by 2030 and a 355,000 caregiver shortfall by 2040. The pandemic has super-charged these shortfalls.

As many as 94% of nursing homes and 81% of assisted living communities nationwide have reported pandemic-induced staff shortages. Meanwhile, doctors are leaving medicine at a rate four times higher than pre-pandemic. Two of every three nurses are currently considering leaving the profession.

Too often the solutions presented narrowly focus on increased compensation. Yet, the burgeoning labor shortage belies a more complex picture where shifting personal priorities, feelings of lacking respect, powerlessness, dysphoria, burnout, “moral distress,” and despair drive many to turn elsewhere.

A recent survey of public health professionals underscores the pandemic’s overwhelming burden: 53% reported symptoms of at least one mental health condition in the past 2 weeks including depression, anxiety, PTSD, and suicidal ideation.

We observe a larger context for why frontline workers are suffering: divisiveness, hostility, and anger that pervades the public sphere. Civility, respect, and empathy have seemingly evaporated. When an outburst is directed at a healthcare worker at the end of a 14-hour shift, that could be the final nudge for them to walk away.

Rugged individualism has long been part of the American ethos. But the balance between the individual and the community is currently broken. Robert Putnam, PhD, and Shaylyn Romney Garrett diagnosed this as a weakening of our social fabric. During the COVID-19 pandemic, the breakdown of the “We vs. I” that Putnam and Romney Garrett elucidate has taken on new intensity. Individualism is overpowering and crowding out our collective consciousness.

We face a post-pandemic world where there are not enough personal care workers, nurses, pharmacy techs, or even EMTs to provide the services that are fundamental to life. Now is the time to strengthen our aging care system to better support direct caregivers who will support us and our dignity as we age.

The Build Back Better legislation under debate in Congress attempts to do just that with $150 billion in new funding for aging care. This investment in Medicaid-funded home and community-based services (HCBS) would expand access to care and strengthen the direct care workforce. Medicaid is the largest payer of all LTSS. Yet, it is only one — albeit significant — part of the wider system. Further, it could take time before many of the intended effects are fully realized. Our aging care system needs help today.

To make comprehensive policy change as is needed with aging care, we must find a way to express our individualism within a more collective lens. We must examine how to engage our society much more meaningfully in the provision of care and support. For example, by establishing adult learning programs that invite people to pursue new careers in in-demand fields like caregiving. Through the enhanced training offered by these programs, caregivers would be afforded greater compensation, autonomy, and agency within their work.

The creation of a caregiving national service program (Caregiving Corps) could take this a step further. Such a program would help to reframe caregiving so that our society views it as a highly respected career that is fundamental to our way of life.

We must also more seriously investigate, finance, and regulate the use of technological advancements such as robotics to provide certain aspects of care. This would free up caregivers to focus on the more personal, complex interactions that provide a level of human connectedness that is essential to our wellbeing throughout life but especially in advanced age.

It is time to expect our leaders to lead us — to adopt platforms with a cooperative lens and govern for the common good. Build Back Better is a step toward that goal. But our aging care system needs more support and it needs it now.

The cost of paralysis is far too great. Together is the only way out of this crisis.

The views expressed here are solely those of the authors and not of any organization or institution.

Keren Brown Wilson, PhD, is CEO of the Jessie F Richardson Foundation, and CEO of AGE+, a 501(C)3 that empowers communities to address the challenges of aging. She is also a board member of Concepts in Community Living, a senior housing provider operating in Oregon and Washington. Walter Dawson, DPhil, is an assistant professor at the Oregon Health & Science University School of Medicine, faculty at Portland State University’s Institute on Aging, and a Senior Atlantic Fellow for Equity in Brain Health with the Global Brain Health Institute at the University of California San Francisco and Trinity College Dublin.

Disclosures

Walter Dawson reports consulting fees from AARP, Commonwealth Fund, and Oregon Health Care Association, and grant funding from the Atlantic Institute, Oregon Health Authority, Global Brain Health Institute, and Alzheimer’s Association.

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