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Older disabled woman on wheelchair in nursing home.

Long-Term Care Future: Demand to Double While Workforce Shrinks

May is officially “Older Americans Month”, a celebration of seniors and their contributions to our society, but with the U.S. population rapidly aging, it may not be too long before every month is “Older Americans Month.”

“During Older Americans Month, we honor our nation’s seniors and the tremendous impact they have made in helping build a more perfect Union,” reads The White House proclamation on Older Americans Month, 2022. “They are our loved ones, friends, mentors, essential workers, volunteers, and neighbors.”

And there are more and more of these older Americans.

In fact, when Older Americans Month was established in 1963, just 17 million Americans, some 9 percent of the population, had reached their 65th birthday.

As of 2019, 54 million Americans are aged 65 and over, about 16.5 percent of the population, and with the baby boomer generation continuing to age, another 21 million are projected to reach 65 in the next 5 years.

All this weighs heavily on the future of the long-term care industry which is facing a supply-and-demand conundrum: demand for long-term care is projected to double as the U.S. population ages, but supply of long-term care workers continues to contract with pre-existing workforce shortages exacerbated by the COVID-19 pandemic.

Greying Population is a Worldwide Problem

The greying of the population is not unique to the United States but is a worldwide phenomenon.

“Lower fertility and increased longevity have led to the rapid growth of the older population across the world and in the United States,” said the United States Census Bureau in 2016.

The facts on aging are stark, with the percent of population age 65 and older expected to double in the next 35 years:

  • In 2015 there were 617.1 million people (9 percent) age 65 or older among the globe’s 7.3 billion population.
  • By 2030 the older population will grow to 1 billion or 12 percent of total population.
  • By 2050 the older population will reach 1.6 billion or 17 percent of total population.

“This rapid growth of the older population contrasts with an almost flat youth population (under age 20) and moderate increase in the working-age (age 20 to 64) population projected over the same period,” said the U.S. Census Bureau.

The U.S. older population, which mushroomed from 3.1 million in 1900 to 35 million in 2000, is part of the second oldest region in the world with a projected 21.4 percent of the total population age 65 or older by 2050.

“The United States will experience further expansion of the older population for many decades to come, fueled by the baby boomer cohort that began turning 65 years old in 2011,” said the U.S. Census Bureau.  

7 in 10 Seniors Will Need LTC at Some Point

The aging of the U.S. population will trigger greater demands on the long-term care industry with the Department of Health and Human Services estimating that 7 in 10 seniors reaching 65 years old now are expected to need some time of long-term care before the end of their life.

According to LongTermCare.gov:

  • 69 percent of the older population will need an average of 3 years of some type of long-term care services and support

  • 35 percent of the older population will need the services of a nursing facility at some point

  • 13 percent of the older population will need the services of an assisted living facility at some point

  • While one-third of today’s 65-year-olds may never need long-term care support, some 20 percent will need LTC for longer than 5 years

“As the population ages, the need for care and the cost of providing that care will increase significantly,” said a report by the American Action Forum.

The report says that by 2050, the number of people aged 85 or older will triple and the number of people using paid LTC services in any setting will nearly double from 14 million in 2018 to 27 million.

“The amount and complexity of care for each person will likely increase as well because of the increasing number of chronic conditions per individual,” said the report. “The increasing demand will strain the supply of caregivers due to the caregiver demographic relatively shrinking.”

Long-Term Care Facilities Grapple with Workforce Shortages

Even before the COVID-19 pandemic, the numbers were not adding up for long-term care facilities.

The AARP in 2018 published a report that showed:

  • While the age 85 and over population in the U.S. was projected to triple between 2015 and 2050, the population younger than 65 was only projected to increase 12 percent over the same period.

  • Caregiver support (ages 45 to 64, peak caregiver age) was projected to drop from a ratio of 7 people ages 45 to 64 for every person aged 80-plus (peak care needed age) to just 3 to 1 by 2050.

So, the long-term care industry already faced a future workforce shortage based on demographics alone, but then came the pandemic where more than 200,000 COVID-19 deaths have occurred among long-term care residents and staff.

“The disproportionate impact of the COVID-19 pandemic on nursing facility residents and staff has brought increased attention to long-standing workforce issues that can affect care quality and safety, such as staffing shortages and high turnover rates,” said the Kaiser Family Foundation (KFF). “These issues have existed for decades and have been associated with adverse outcomes, including increased mortality rates, hospitalization rates, and emergency department visits.”

As of March 20, 2022, 28 percent of nursing facilities reported at least one staffing shortage, up from 21 percent reported in May 2020.

“The current level of staff shortages coincides with a period when health care providers, including nursing facilities, grappled with the impact of the Omicron variant, a highly transmissible variant that broke case and hospitalization records,” said the KFF.

One study estimated that the LTC industry would need to add 4 million new workers between now and 2050 to maintain the current level of care.

“The instability in the LTC workforce has caused a myriad of problems, including service-access challenges for consumers; lower safety and quality of care and life; higher provider costs due to the need for constant hiring and training of new staff; and higher workloads for nurses and other staff. The result has been inadequate supervision, more accidents, and higher injury rates,” said the American Action Forum.

The Biden Administration has proposed new regulations that would establish a minimum nursing facility staffing requirement within the next year.

“The President believes we must improve the quality of our nursing homes so that seniors, people with disabilities, and others living in nursing homes get the reliable, high-quality care they deserve,” said The White House release.