America is in the middle of a "demographic revolution." Baby boomers are likely to live longer than their parents and grandparents. And their sheer numbers will challenge aging programs as they get older.
"Baby boomers are going to face a different type of aging," said Fernando Torres-Gil, assistant secretary of the U.S. Department of Health and Human Services in charge of aging policy. "It is an open question as to whether they will be as well-prepared financially, emotionally and politically for a longer life span as their parents and grandparents. They may well face a different environment than 20 or 30 years ago in terms of how government responds to their needs."Torres-Gil will be the featured speaker at an aging conference sponsored by the Utah Gerontological Society Sept. 28 at the Salt Lake Hilton. But he doesn't need a conference to speak out about issues of concern to senior citizens.
Some issues are clear: health and its cost, long-term care, home- and community-based care. Older people are concerned about crimes and violence, housing, transportation, volunteering and being productive, employment and age discrimination, Torres-Gil said. "And older Americans are deeply concerned about their children and grandchildren and what will happen to them as they get older."
The solvency of the Social Security system is a key issue, Torres-Gil said.
No one knows exactly how long Social Security will be around. Originally, it seemed safe until at least 2030. Now there's reluctance to guarantee a date.
While a recently formed advisory council on Social Security and Medicare studies the issue, Torres-Gil believes the system will remain intact "well through the retirement of the majority of baby boomers."
"That brings out another issue. We need to find a way to educate our cohorts and younger groups about the importance of planning for long life - adjusting, saving, taking care of ourselves, developing support systems, etc."
Congress created Medicare to cover substantial portions of the medical bills for older Americans. Medicaid was created to do the same for low-income people. But "both have changed quite a bit in the last 30 years," he said.
Medicare has become the government's single-payer plan for older adults, as well as the "barometer and pacesetter for how the entire industry adjusts to issues. It sets precedents for how we pay, how we measure and assess the effectiveness of various treatments, how we get cost saving."
Medicaid, on the other hand, has become, to a large extent, a program to pay for nursing-home care. And both programs are under tremendous pressure because of their high cost.
"We may have to address their solvency before the end of the century."
Health-care reform is important to the aging population, he said. That includes long-term care, both in facilities and within the community.
"There's a growing consensus that when we talk about long-term care, it's not just home care or nursing-home care, it must be a variety of services that can be a continuum of integrated and seamless services revolving around home and community-based care. We need to allow an individual, regardless of age, to stay at home or in the community."
Doing that may mean providing more meals, attendants, personal care, adult day care, specialized housing, generally "social and supportive services,"
said Torres-Gil. Such services are cheaper than institutional care.