Before I launch into what is, to me, a very important post, let me set the context. In May I took over the running of Avail Home Care. We provide in-home long term care for seniors. It’s been eye-opening, to say the least. And it has led me to believe that the things I’m going to share over the coming months CAN and SHOULD impact you. You should start paying attention now, not because of who is saying it (me) but because of what I’m saying. It affects every single American.

We all need to start paddling, because the wave is coming.  

I’m not going to lie, I’ve started to write this post at least 25-30 times by now. Each time I end up so overwhelmed with the number and magnitude of important things to share with the public that I end up stuck; unable to decide WHICH incredibly important thing to discuss first.

So I’ve settled on the 30,000 foot view as my starting point and decided to just START because people need to know this stuff. 

There are roughly 77 Million Baby Boomers in the United States, their ages spanning from 53 – 73 years. 

For some reason, despite the fact that we have known this generation existed and was much larger than Generation X (of which I am one), we did not make any real preparation for the Boomers’ Golden Years.

And by “we,” I mean all of us. Boomers didn’t save enough (up to 45% report having $0 in savings), Medicare doesn’t cover enough, corporations didn’t build enough facilities (or weren’t incentivized to do so). Collectively America has virtually no plan for what to do when… 

…1/4 of AMERICANS… 

…all need supportive geriatric care at the same time. I’ve provided links to several really excellent articles – everything from scientific studies to editorials in Forbes – with some perspectives and statistics. The truth is, right now, there are not enough facilities and not enough caregivers to take care of the Boomers. 


Although many of us say we’d never want to be in a nursing home, we’re going to find out if we really mean that, because the number of nursing homes has been in decline for some time, while the number of folks needing them will go up significantly as the Boomers age. Which means (and you may already be seeing this trend in your area), more care is going to move into the home. If this can be done well, it will be good in many situations. But it has to be done well.

Which leads to the next issue. 

Family (Informal) Caregivers

There was a time when in-home care was carried out by the adult children of aging seniors, but as one article puts it, the three “D”s – divorce, distance, and debt – have changed that. However, even if the breakup of the nuclear family had not taken place in the 1980s and 90s (which it did), there are simply too many Boomers for Generation X to care for, even if we lived close by and had more financial stability ourselves. There are even a cohort of Boomers with no children who do not have access to informal caregivers. (Although we have seen friends living together.) Which means that the time of the “informal caregiver” as the primary source of care for seniors has largely passed.

Which leads to the next issue.

Professional Caregivers

Professional caregivers include Home Health Aides (HHAs) and Certified Nurses Assistants (CNAs). They are trained, certified, and in some states/cases licensed for their positions. They are going to be needed by the millions to support Boomers in their homes. This is something in which I’m deeply embroiled, as it’s the primary purpose of my company, Avail Home Care. 

Unfortunately there are two HUGE PROBLEMS:

HUGE PROBLEM #1 – There is a massive SHORTAGE of professional caregivers in this country. 

Want to know why? 

Because we treat them like dirt. In the U.S. these professional caregivers are paid around $10/hour, on average, to help seniors to bathe, dress, eat, use the toilet, move from place to place, take their medications, and get out into the world safely. They prevent serious falls, accidents, and medication miscues that land seniors in acute care settings (hospitals, rehabs) that can lead to even worse health outcomes through things like secondary infections or simple decline following a traumatic event. In other words, not only do they keep our seniors safe, they reduce their burden on the healthcare system and improve their quality of life. 

But we pay them $10/hr and also treat them poorly because they are often women and people of color, those whom society has always least compensated for their contributions. But to put their compensation into perspective, the average veterinary assistant makes $15/her. 

As Howard Gleckman of the Urban Institute think tank puts it, “In other words, we pay people $5-an-hour more to care for our cats than to care for our mothers.”

Right now there is an estimated 1M nurse (LPN and RN) SHORTAGE in the United States and no one is even measuring the shortage of Home Health Aides (HHA) and Certified Nursing Assistants (CNA) who perform this in-home care, but trust me, I’m hiring, and it’s tough. There’s a shortage.

So what do we do?

We (as a society) are going to have to PAY MORE for people to do this very hard, very under appreciated work. Right now starting salary at the Whole Foods nearest my home is $15/hr. That includes benefits. For a job where you stand around in the air conditioning and show people where to find the imported Manchego.

How long do you think people will continue to want to lift other humans onto and off of toilets and stay calm while humans with late-stage dementia berate them when they are just doing their jobs when opportunities like “Manchego pointer” exist and pay better?

Which leads me to…

HUGE PROBLEM #2 – Regular Insurance and Medicare don’t pay for Long Term Care

That’s right. You heard me. There are only a few sources of funding for long term care:

  • Long Term Care Insurance
  • VA Aid & Attendance
  • Medicaid Home and Community Based Waivers
  • Private Pay – ie – You or your family pays out of pocket. 

I PROMISE that I’m going to write up subsequent posts on these payers for you all to learn more. What’s important right now is for you to see what is NOT on that list.


MEDICARE – Medicare DOES NOT PAY for long term care. Medicare pays for acute stays and home health (wound care, infusion therapy, physical therapy). If there is no acute “episode” going on in someone’s life, Medicare does NOT pay to send someone to a home to help a senior take a shower without falling, or use the toilet if they are partially paralyzed, or feed themselves if their tremors prevent it. I’m not kidding. Medicare does NOT pay for home care. 

Medicare Supplement – There are some Medicare supplements that have better/longer support after acute incidents. Generally there are significant limits on these plans, you’ll have to look at yours carefully or ask your insurer for more information to know exactly what’s covered. Just know that when you think “constant care” do not think Medicare.

Medicare Advantage – Be very careful with these plans, they vary greatly in what they cover and many are HMOs that are pretty restrictive. They say they cover home care aides, but the offerings in that area are still very grey and – FROM WHAT I UNDERSTAND, I AM NO EXPERT – I believe this coverage is focused mostly on the extremely chronically ill (complex cases). This is what was discussed at a recent industry conference, so more research is needed there. It’s changing right now.

PRIVATE MEDICAL INSURERS – You’ll also notice that the list did not say “Blue Cross Blue Shield” or “AETNA” or “Humana.” That’s because medical insurance doesn’t pay for long term care either. Some have a long term care plan or rider that you can purchase separately, but these tend to offer less coverage/lower benefits when compared with Long Term Care Insurance policies from companies like MetLife, Genworth, and John Hancock (who handles the contract for the Federal Long Term Care Insurance Program). 


Learn what you can about coverage and the system.

I personally know what it’s like to try to navigate the health care system – providers, insurers, claims, limitations, exceptions, costs – when my health and life are on the line. It’s a devastating one-two punch.

Instead you can take some time to educate yourself and prepare. Follow this blog. Read articles like the ones below, pay attention. Look at your policies. Ask questions. And plan ahead. That way you can face your future with information and confidence.

Stay tuned. Stay healthy. 


Will the U.S. Face a Shortage of Nursing Homes for Baby Boomers?