The Age Boom is Coming: Implications for Our Aging Society

Kate Wilber, PhDDavis School of Gerontology, USC

California Association of Area Agencies Board Meeting and Retreat

September 24, 2008

Boomer Aging: What is Over the Horizon?

How will the baby boomers age?

How will the Baby Boomers Age?

Topics/Themes

Demographics of an aging society will drive change Longevity Diversity

Characteristics of the Baby BoomersCharacteristics of the Environment 2008+

Health care delivery is costly, ignores chronic care and is a nightmare to navigate

Work, retirement and manpower issues Threats Trends and Innovations

Pop Quiz

1. In the year 2025—Will the age of the US population be older, younger, or basically the same as Sweden in 2000?

2. What years were the Baby Boomers born?

3. How many baby boomers are there currently living in the US?

4. What is the age at which current workers say they plan to retire?

5. Peter Drucker and David Walker, (Comptroller General of the United States) agree that the most dominant trend we face is?

Peter Drucker’s Insights on Why Aging Matters (Conference Board Review Nov/Dec 2000)

Single dominant factor for all countries will be population changes.

The biggest and fastest growing population group determines the mindset and the mood.

Who are the Baby Boomers?

“Generation” born between 1946 and 1964

Currently the oldest are 62; the youngest are 44

About 80 million people

Who are the Baby Boomers?

Latino10%

A/PI 4%Other 7%

Black 12%

White 67%

White 67%

Black 12%

Latino10%

A/PI 4%

Other 7%

8372

61

811

18

6 10 12

3 5 8

0%

20%

40%

60%

80%

100%

2000 2030 2050

Asian

African-American

Latino

White

US 65+ Population is Becoming More Culturally Diverse

Baby Boomer Characteristics:Education

Some College

30%

College Grad17%

Grad Degree10%

< HS15%

HS Grad28%

< HS

HS Grad

Some College

College Grad

Grad Degree

Are Baby Boomers Better Educated than their parents?

76%85%

19%27%

0%10%20%30%40%50%60%70%80%90%

100%

age 65+ age 44-62

High school grad

College Grad

Baby Boomer Characteristics Sociodemographic Indicators

Two-thirds are married 18% separated or divorced More likely to be childless (almost 20%) or to have small

families (fertility rate= 1.9) compares to 10%; 3.4 earlier generation)

12% live alone 4% are “linguistically isolated” 75% are employed

Income 8.5% below poverty 21% within 200% of poverty

Costs: Comparing “early boomers” with current elders 65+Older American 2008: Key Indicators of Well being. Federal Interagency Forum on Aging Related Statistics

12 5

7 13

18 16

32 34

13 13

19 20

0102030405060708090

100

55-64 65+

Other

Food

Housing

transport

Healthcare

Ins/pension

Baby Boomer Facts From AARP:• Boomers are staying in the workforce longer than the previous

generation—only 11% want to stop working completely• Only 6% plan to down size to smaller homes in the next 5

years• 82% use the internet for email, instant messaging,

downloading music or movies, financial transactions and online gaming

• One-quarter are empty nesters, 37% currently live with children in their home

• 9% are “wealthy” (have income of $150,000/yr). 

Sources of Income: Four Legged Stool

29 28

9012 18

1

15 15

4

3437

1

0%10%20%30%40%50%60%70%80%90%

100%

65+ 1967 65+ 2005 Baby B's2000

Other

Social Security

Assets

pensions

earnings

20% of Baby Boomers Live with a Disability Sensory

2.5% Physical

7% Mental Health

4% Personal care limitations

2% Mobility limitations

7%

Disability that affects work 13%

More than 1disability 10%

Disability and Placement are not one way streets: Getting worse/getting better

Current Housing 78% Home owners

12% own “free and clear”2/3rds live in single family homes (67%)6% live in Mobile homes5% in attached homes

17% Renters 5% live in “group quarters”

Housing Problems

Without complete plumbing (.61%)

Income kitchen (.5%) No phone (2%) No heating fuel (.7%) No vehicle (6%) Homeless

Up to 30% are 50+

Who are California's Baby Boomers? (from US Census)

More than 10 million live in CA 51% female 64% married; 14% never married;18%

divorced/separated 12% live alone; half (49%) live with

spouse+others 18% report a disability 7.5% in poverty and 9.5% near poverty (<200%)

California’s Diversity Current diversity

CA Latinos=30%; US=13% CA Asian-American=12%; US=4% 95% of CA’s 65+ speaks English

Baby-boomers: not the stereotype 40% African American, Latino, or Asian 30% foreign born

Future diversity (2020) Latinos 65+ will increase 3Xs Non-Hispanic Caucasian will increase 50%

Diversity among California Communities

Demographics of an Aging Society

Population aging is driven by: Reduced Mortality/Increase longevity Decreased fertility

Changing fundamental age distribution in the US

65+ population will double the first 25 years of this century (35 million to 70 million)

4.07 4.31 4.355.45

6.848.15

9.239.80

11.3012.50 12.79

13.35

16.49

20.00

0

5

10

15

20

25

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030

Trend in % of 65+ Individuals in US from 1900 to 2030

Population of Sweden 2006

Men Women

Los Angeles County- 1990 East Los Angeles Beverly Hills

Men Women

Dependency Ratio

(# people under age 18) + (# people over 65)

# people ages 18-65

Calculates # of people depending on money, goods, & services provided by workforce divided by # of workers

79.98

73.1871.12

67.76

59.7

64.41

81.6378.71

64.97

61.8163.33

60.91

68.17

78.7479.91

40

50

60

70

80

90

100

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2050

Trend in Dependency Ratio in US from 1900 to 2030

0

10

20

30

40

50

60

70

under 18 40.4 37.9 37.2 34.9 30.6 31.0 35.7 34.2 28.2 25.7 26.0 24.5 24.1 24.1 24.4

18-64 55.6 57.7 58.4 59.6 62.6 60.8 55.1 55.9 60.8 61.8 61.2 62.2 59.5 56.0 55.6

65+ 4.1 4.3 4.4 5.5 6.8 8.2 9.2 9.8 11.3 12.5 12.8 13.4 16.5 20.0 20.0

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2050

Trend in % of Distribution for Dependents and Non-Dependents in US from 1900 to 2050

“Baby Bloomers” now in their prime are:(US Census Bureau News, 3/9/06)

Healthier ~ disability rates declining

Better educated

Higher income

More diverse

Living Longer

Longevity/Life Expectancy

Competing models2% reduction in mortality/year (Japan)Rates similar to past (.6% annually)

ImplicationsSocial Security Administration projects

someone born in 2030 life expectancy=84Given the 2% assumption life expectancy for

someone born in 2030=104

Diversity (US Census Projections) http://www.census.gov/Press-Release/www/releases/archives/population/012496.html

2030—All baby boomers will be 65+ 20% of the population will be 65+

2039—The working population will be more than 50% minority

2042—Minorities=The Majority 2050—The 85+ will triple to 19 million 2050—The working population will be more than

30% Latino

Diversity with the cohorts:What has shaped your life? Identify 2-3 world events that defined your

life? What music do you associate with your

childhood and adolescence? What television shaped you as a child?

Different Experiences of different Cohorts in the Baby Boom Generation

Variation Among Boomers

Early Boomers (1948-1955) Civil Rights Vietnam War Assignations (JFK, RFK, MLK)

Late Boomers (1956-1964) Watergate Stagflation

Shared Cold War

Problems on the Horizon Changing health and wellness

Obesity Toxins Pandemic Dementing Illnesses

Crises in Entitlements Problems that go unaddressed in Medicare and Social

Security Generational Equity Issues

Lack of investment in younger generations that will economically support Baby Boomers

(education, health care, opportunities)

Obesity

One-third of the US population and one-third of baby boomers

Causes 300,000 deaths annually Rivals cancer and heart disease as leading causes of

death 13.2 million older Americans will have

Alzheimer's disease (AD) by 2050 (Evans 2003, Archives of Neurology)

Currently 4.5 million

Projected Rates of AD

Year Age 65-74 Age 75-84 Age 85+ Total 2000 0.3 2.3 1.8 4.5 2010 0.3 2.4 2.4 5.1 2020 0.3 2.6 2.8 5.7 2030 0.5 3.8 3.5 7.7 2040 0.4 5.0 5.6 11.0 2050 0.4 4.8 8.0 13.2

Impact of Changing Demographics

Those at Highest Risk (Low income/Less education): More chronic care services

Increases in LTC need based on age-related chronic illness & disability

High health care inflation

Need for more manpower resources: Families and informal caregivers provide most of the care ~ over $250 billion in 2000

The Retirement Landscape2007 Federal Budget (Concord Coalition)

20.5

13.4

9.63.3

23

21.5

Defense

Soc Sec

Health

IncomeSecOther

Education

Entitlements (Social Security, Medicare, Medicaid) comprise 42% of the Fed Budget

Addressing Ageism and Age Anxiety Young @ Heart Less anxiety

Older age Good health Not poor Knowledge about

aging Regular (at least

weekly) contact with older people

Change Our Thinking: Bill Thomas

“By lionizing youth and using the benchmarks of a healthy adulthood as the gold standard of well-being, contemporary society has created a simple but radical reinterpretation of age and aging.

Old age has been recast as a merciless descent from the apex of youth — a hurling fall and a peculiar form of brokenness that must be resisted with every available means”

(What are old people for?

VanderWick & Burnham, 2004; p. 84)

The Current Context: Threats and Our Aging Society Debt & Deficit (more in a minute)

Money spent servicing debt Current Bailouts: $ Financial crisis Mortgage crisis Globalization

Loss of manufacturing jobs (US produces half of what we consume)

Foreign creditors Commodity inflation

Energy/oil shortage Climate change

The Current Context for Elders

Reduced pensions More defined contributions/fewer defined benefits

Health care costs/inefficiencies/poor outcomes Increasing personal dept

Largest increase in bankruptcy aged 55+ 1/4 of Boomers have no savings or investments

Low level of savings Increasing unemployment Increasing health and wealth disparities

Debt http://www.concordcoalition.org/learn/debt/national-debt

Current Federal Debt is over $9.5 trillion $9,652,942,800,000 (9-20-08) http://www.concordcoalition.org/learn/debt/national-

debt $31,000/person in US

Consumer dept (excluding mortgages) $ 2.5 Trillion ($8,333/person and $18,600/taxpayer)

Bailouts for the financial and mortgage crises—$1 trillion+ secured by assets

Lack of savings, earning options, and safety net to fall back on

Income: Social Security

Replaces about 42% of the final wage earned for a “typical” worker” (full career, average wage)

Social Security provides 3/4ths of income for the bottom 60% of earners at retirement

The US has one of the highest average retirement ages (63) among developed countries College educated remain in the labor force longer We can expect to see Baby Boomers stay in the

workforce longer

Chronic Care Consumers

In 2001, 12 million people in the U.S. used long-term care

• 57% were 65+

• 40% were adults under the age of 65

• 3% were children

18 to 64

40%

< 183%

65+57%

Health Care Costs

$1.9 trillion+ in 2004 (16% of GDP) $6,423 per person

More than 2.5 times the $717 billion in 1990 (13% of GDP)

More than 7 times the $255 billion in 1980 (9.1% of GDP).

Estimated $3.6 trillion by 2014 – 19% of GDP or about $11,045 per person

Problems with Health Care

Outdated acute care delivery system

Medical/social services are fragmented, disjointed, duplicative, & inefficient

Multiple/mutually exclusive funding streams

Incompatible regulatory requirements

Disconnected bureaucratic authority

Lack of integrated information systems

Chronic conditions impair functioning affecting quality of life & create dependencies

LTC is ignored

Health Care Score Card (Commonwealth Fund) 2007, more than 75 million adults—42 percent of

all adults ages 19 to 64—were either uninsured or underinsured, up from 35 percent in 2003.

U.S. now ranks last (19th) on mortality amenable to medical care, 101,000 fewer people would die prematurely if the

U.S. could achieve leading, benchmark country rates. Rates of control of diabetes and high blood

pressure, have improved significantly.

Left Out of Health Care Expenditures

Long-Term Care ServicesCustodial care in nursing facilities

Assisted living

ADHC

Personal care

Senior centers

Nutrition centers

Yip, Myrtle, Wilber, & Grazman (1999)

Current Approach to Long-Term Careis Not Working…

Workforce Issues for California: Shortage of caregivers, providers, and professional workers

American medical system is woefully unprepared for the flood of aging baby boomers (IoM, 2008)

In California only one geriatrician for every 4,000 Californians age 65 and older

California faces a shortfall of 30,000 certified nursing assistants to care for the frail elderly

Currently 80% of care is provided informally by friends and family members

Baby boomer brain drain in State including state service

Manageable Models ADPC/One Stops

Accessible and integrated services Uniform assessment core & appropriate information

sharing across silos Integrated information systems Telephone monitoring (peers/buddies)

Consumer direction, Preferences/Aging in choice Aging in community Support Families Culturally Competent

Changing Housing needs

Will we need the current supply of single family homes? Birth dearth ¼ of Baby Boomers want to live in retirement housing Working with developers Visitability and universal design

Role of Co-housing Transportation Integrated Services

Photo by Genaro Molina, 1993

Next Steps

Last Thoughts: Ideas

Diversity Implications Stay close to your participants and non-participants Use focus groups, listening sessions, ways to

introduce innovations What is working? What do they need/want? What would bring people in? Seniors Count (LA): Dental Services, Wellness, exercise

Normalize Services Café Models rather

than senior centers Promote opportunity

Life long learning Encore careers Intergenerational

Work in Schools (Sheri Lansing)

Book clubs, art, culture

Innovations

Fitness and wellness

Intergenerational Programs

Giving back Empowerment Reciprocity

Build on Experience

Caregiver support PTA model Getting involved with leadership

Service banking Build Community Repertoire of Services/Choice Help with Transitions (Hospital, SNF, accessing

services) Marin Model—Project Independence

Building Capacity of Aging Network Services Prevention using EBP

Fall prevention Medication Management Exercise/wellness Disease management/Disease self-management

Rebalancing/Olmstead Expand HCBS Links to housing and transportation MFP IFP (IIS: service tracking, costs and planning)

Change Language/Change Paradigm Problems

“Senior” “Services” “Volunteer” “case management” “nutrition programs”

Independent Living Resource coordinator Service Navigator Peer Counseling; Peer-

to-peer programs Wellness Disease self

management

Normalizing Facility Care: Eden Alternative Model …dedicated to helping others create enlivening

environments and the elimination of the plagues of Loneliness, Helplessness, and Boredom. We are dedicated to helping people grow.

We must teach ourselves to see the environments as habitats for human beings rather than facilities for the frail and elderly

Spontaneity and variety are valued

Eden Values

Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.

The antidote to helplessness—An Elder-centered community creates opportunity to give as well as receive care.

Normalize Services: Greenhouses (from websitehttp://www.ncbcapitalimpact.org/default.aspx?id=148) De-institutionalizes long-term care by eliminating

large nursing facilities and creating habilitative, social settings. Small intentional community for a group of elders and

staff. Alters facility size, interior design, staffing patterns, and

methods of delivering skilled professional services. Elders can receive assistance and support

without the assistance and care becoming the focus of their existence.

The Last Word: Drucker on Change…

Change needs to be build on strategic realities

Instill value, create culture of change as opportunity

Can’t manage change; stay ahead of it

Change strategies: Organized abandonment of yesterday

What contributes/what doesn’t? Maintaining yesterday’s baggage is costly Key questions:

“If we didn’t already do this, would we?” “If we would do this, are we doing it the best way?”

Drucker’s Change Strategies

Organized continuous quality improvement

Exploit success/feed opportunities Novelty is not innovation Motion is not action

Create change through systematic innovation

Test innovative ideas through piloting

Balance change and continuity

More Drucker on Change…

“To try to make the future is highly risky.

It is less risky, however, than not to try to make it.

A goodly proportion of those attempting to

implement change will surely not succeed.

But, predictably no one else will” (page 93).

Drucker (1999). Management Challenges for the 21st Century. New York: Harper Collins Publisher.

We are stardustWe are goldenAnd we've got to get ourselvesBack to the garden

from Woodstock   

by Joni Mitchell

We are stardustWe are goldenAnd we've got to get ourselvesBack to the garden

from Woodstock    by Joni Mitchell