June 11, 2007 , New York City—As the baby boomers reach the so-called third age, they are healthier and more active than any earlier group of retirees. However, one day they will be joining the already growing population of those over 85, raising economic and health care issues that range from addressing the special needs of the aged to containing the costs of meeting those needs, especially the costs and problems involved in nursing home placement. A new issue brief from The Century Foundation warns that the nation must address the critical issues raised by this trend, or caring for this population will increasingly strain the resources of individuals, their families, and federal, state, and local governments.

In “Facing the Problems of Providing Long-Term Care for the Oldest Old,” Beverly Goldberg, a senior fellow at The Century Foundation, examines the demographic realities facing our nation as the boomers continue to age, the special needs of the oldest old, the costs of the long-term care necessary to meet those needs, and the challenge of developing a large enough cadre of health care workers who are trained in gerontology. Goldberg, an expert in the issues posed by aging and author of Age Works: W hat Corporate America Must Do to Survive the Graying of the Workforce (The Free Press), also suggests actions that can be taken now to avoid a potential crisis.

The brief presents a careful analysis of the scope of the emerging issues. It begins by exploring both the physical problems and the effects of cognitive impairment or dementia on daily living, which often make living independently problematic, and looks at the failure of the health care community to deal with the need for training in gerontology and research into the effects of medication on the aged. It goes on to discuss the personal costs and the public costs (especially through Medicare and Medicaid) of providing decent care, whether in nursing homes or at home, and the role of private insurance in meeting some of those costs. Finally, it examines the issues involved in finding caretakers, especially the shortage of trained medical personnel and home health care aides, and the reasons why such care is not likely to be provided by family.

Goldberg’s recommendations for policies that will improve the care of the elderly while containing costs for government and families include:

• establishing programs to train primary-care doctors, nurse practitioners, and others who provide nursing care in geriatrics;

• ensuring that drug trials include the elderly; that possible interactions between drugs used by the elderly are reported, studied, and information about them made available;

• covering long-term care through a social insurance mechanism like Medicare;

• encouraging the use of, and payments for, alternatives to nursing home placement;

• expanding the available tax credit for family caregivers or passing legislation providing direct cash payments to family members who provide such care;

• creating a civilian health service corps that will train people to provide basic home health care in return for funds for vocational training or community college education after a given term of service is completed;

• providing forgiveness for loans taken out to cover college tuition for nurses who work for a certain mandated time in nursing homes;

• increasing the pool of available home health care workers by increasing the number of visas for low-skilled workers; and encouraging businesses to provide programs aimed at easing the care-giving problem for workers, which would aid in retention, decrease absenteeism, and improve the productivity of workers carrying such burdens.

“Facing the Problems of Providing Long-Term Care for the Oldest Old” can be downloaded from The Century Foundation Web site at www.tcf.org or its health policy site at www.healthpolicywatch.org. For more information about the issue brief or to set up an interview with Beverly Goldberg, please contact Christy Hicks at hicks@tcf.org or (212) 452-7723.