Freepik assets
A line-up of elderly people slowly fading into a tidal wave.
I recently ran into a friend I hadn’t seen in awhile. Sadly, news about colleagues who’d passed was on our minds. My friend said, “We’re of age and people are peeling away.” Yes, the baby boomers are starting to leave.
I’m a few years older than the baby boomers (those born between 1946 and 1964), who seemed instinctively capable of speaking out, speaking against, organizing, and demonstrating. We were called the silent generation, and our younger role models marched against an unjust war and claimed the right to birth control and civil rights.They were the multi-taskers and caregivers.
Now, boomer caregivers have aged into the care-needy. They’re discussing aches and ailments with doctors, friends and children. They’re searching for assistance and support, but the seniors’ housing economy is displaying less ability to provide compassionate care.
In the 1980s, a new long-term care model emerged to supplement traditional nursing homes. Introduced in the state of Oregon, assisted living facilities spread across the country. Within a decade, the Wisconsin Legislature joined lawmakers in other states in promulgating rules for homelike apartment settings for people who could no longer live independently but did not require skilled nursing. The regulations address licensing, food service, employee training, leisure time activities, and residents’ rights and safety, among other things. Wary of monotonous wards and strict schedules, family decision-makers (the baby boomers) could now choose from facilities that appeared inviting and humane. Their parents, the residents, could lock their doors and choose paint colors for their rooms. They could plan weekends away.
Assisted living facilities were loosely defined as places to house people who needed help with a limited amount of daily activities, like dressing, toileting or medicine taking. They were homes that provided meals, socialization and observation, but they did not promise health care. Besides licensure and varying degrees of oversight by individual states, assisted living facilities have never been regulated by the federal government.
The seniors (the baby boomers’ parents) living in the facilities enjoyed benefits accorded primarily white middle-class workers, who’d held white- or blue-collar jobs. They were financially secure — backed by Social Security, private pensions, and post-World War II economic growth. Real estate developers, property managers, and facility owners profited from the largesse of private pay in a middle market that was neither super wealthy nor dependent on Medicaid reimbursements.
While the idealized goal was compassionate, dignified end-of-life care, a number of families still experienced unacceptable conditions and associated grief. And, today, as care costs and the economic insecurity of older adults are increasing, the demand for assisted living is placing new burdens on our long-term care system.
There are currently approximately 32,200 assisted living communities with nearly 1.2 million licensed beds in the United States. Developers, managers and shareholders control the narrative. In Wisconsin, where over half the locations contain between four and 25 units, there are approximately 4,000 assisted living facilities. Our state administrative code limits assisted living nursing care to a maximum of three hours per week, per resident. Some facilities operate with no in-house nurses, beyond hardworking and undercompensated certified nursing assistants.
Three issues emerge. First is concentration of ownership. Conglomerates, private equity, and real estate investment trusts buy and sell assisted living facilities with volatile regularity. Remote decision-making, operational efficiencies, and a bottom-line orientation place tasks before safety, contentment and relief. Care quality for the “silver tsunami” (the wave of increasingly diverse baby boomer residents who are now advancing into their senior years) has declined.
Just as important is the staffing crisis that is affecting every industry. Currently, immigration complications limit international sources of employees for all long-term care, including assisted living homes.
In addition, we’re experiencing the rapid adoption of AI-assisted devices and new-age care plans for older people affected by memory loss, Alzheimer’s and other dementias. While this phenomenon might offer high-tech relief to the staffing conundrum, it’s time to question how technological advances will be regulated, how data will be monitored, and how information will be protected.
In the recent past, bills were introduced in Congress by members of relevant health, aging and economic committees, but none have advanced.
Of the approximately 1.5 million boomers in Wisconsin in 2020, half will be older than 75 by 2030. Implementing safeguards to prevent a slide into catastrophe will require us to confront organized, well-compensated voices representing the industry. Those who have the responsibility to effect change must limit the concentration of ownership, establish both staffing minimums and pay equity, and challenge new technologies.
Yet, these issues don’t appear in proposed bills or rules before our Legislature. Historically, Wisconsin was the forerunner in progressive politics, from workers’ rights to gay rights to suffrage. Now, as federal regulatory agencies are being dismantled, we should demand that state elected officials update regulations over assisted living. Wisconsin can take the lead for boomer care.
Judy Karofsky is a Madison author and the adult child of a parent who lived in six different assisted living facilities. She is the author of DisElderly Conduct: The Flawed Business of Assisted Living and Hospice, available at local bookstores and online.
