Older Americans are finding the health care system awaiting them in their later years to be expensive or inadequate to their needs. And a lot more of them are on the way.
Projections indicate the U.S. population – as with most other countries – is getting increasingly older, with the number of Americans aged 65 years and up expected to rise from 58 million in 2022 to 82 million by 2050, according to the Census Bureau.
The trend has given greater attention to the need for addressing the health care and long-term care support needs of this growing age group. Critics have contended the current health system for aging Americans can often feel fragmented and inequitable and put a substantial financial burden on both patients and their loved ones.
Such were the main findings of a new report released this week by the John A. Hartford Foundation, a not-for-profit healthcare policy philanthropic organization, in partnership with the Harris Poll and research firm Age Wave.
The analysis, based on nationwide survey results of more than 5,000 adult Americans – roughly half of whom were ages 65 years or older – found that while the average lifespan of Americans has increased over the decades, their healthy life expectancy, or the number of years they can expect to live without disability, is much shorter. On average, adults in the U.S. spend the last 12 years of their lives in poor health, according to the report, with healthy life expectancy estimated at 65.7 years among women and 63.2 years among men.
The report found the cost of care was a major barrier, with the average person over age 65 with Medicare coverage spending more than $6,600 out of pocket for health services, medications, and supplemental insurance each year, with those in poorer health spending an average of 20% of their income on health care services.
Long-term care, which Medicare does not cover, costs an average of $104,000 annually for care in a facility and $69,000 for care services conducted at home. Overall, the report found the average couple in the U.S. will spend up to $472,000 throughout their retirement in out-of-pocket health care and long-term care expenses.
Yet such costs have not equated to better health outcomes. The report found that 79% of older Americans surveyed reported having at least one chronic health condition, with one-fifth having three or more conditions and nearly two-thirds saying they had difficulty walking or climbing stairs.
Terry Fulmer, president of the John A. Hartford Foundation, says the problem with care for older Americans is indicative of a health system that has focused more on providing care that saves lives rather than care that promotes wellness and a better quality of life.
Fulmer spoke with U.S. News about some of the major care challenges older Americans face and ways in which to transform the current system to one that can become more receptive to their needs.
The interview below has been edited for length and clarity.
What was the biggest takeaway from the report’s findings?
There’s a major disconnect between the kind of care older Americans want and the kind of care they receive. We’ve got a lot of older people in this country and we spend millions of dollars every year on health care, and what we need to do is make sure we begin to shape health care into what’s wanted and needed for older adults.
What’s been the biggest obstacle to providing better health and long-term care to older adults?
Right now, we have very little coordination of care for older adults. If you have an older person in your life, you know they go to the cardiologist, and then their oncologist, and then the renal specialist – that disconnection is confusing, it’s complicated, and it makes billing complicated. You need to get to a place where things are really clear and where we can focus more on care for function and well-being instead of disease by disease.
Another problem is ageism. We love to save older people, but we don’t like to take care of them in this country. When there is a new therapy, it makes the headlines. But when it comes to providing care, people’s eyes glaze over. In this country, a lot of people think Medicare is going to pay for their long-term care, and that’s wrong. It doesn’t. And that’s where they get into this situation where all of a sudden they understand that they’re going to have to spend down (their assets), and I think that is a beginning to thinking about what the complexity is.
Adding long-term care (coverage) to Medicare is supported by all parties, whether they’re Republican, Democrat, or independent. And that’s a place where we could be heading – adding long-term care to Medicare.
What changes does the country’s health system need to improve care for older Americans?
Our public health system in this country has been financially gutted over the past 30 years. When I was young, you had public health nurses who visited older people in their homes. So, I think getting ourselves back to prevention in public health as opposed to acute and critical care is going to be a lifesaver.
We need to support our frontline workforce of community health workers, for example. Our frontline workforce is predominantly made up of minimum-wage individuals who maybe have two or three jobs – that’s a problem. We need to support this workforce and pay them a living wage.
Is the U.S. prepared to meet the growing care needs of older Americans?
I do believe we are ready to pivot. I think we can be ready to meet the needs of older Americans. We’re helping people to think about what matters to them, and that’s the basis for “age-friendly” care – care that focuses on what matters to the patient, their mood and memory, their medication based on what matters, and their mobility. If you get those four things right, then you’re going to fundamentally get the next 20 things right.
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