Caregiver and client Projectionsput the average annual assisted living and medical expenses cost in10 years at $62,000, meaning that a majority of the middle-incomeseniors then will not be able to afford an assisted livingfacility. (Photo: Shutterstock)

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In 10 years, more than half of middle-income Americans age 75 orolder will not be able to afford to pay for yearly assisted livingrent or medical expenses, according to a studypublished Wednesday in Health Affairs.

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The researchers used demographic and income data to projectestimates of a portion of the senior population, those who will be75 or older in 2029, with a focus on those in the middle-incomerange — currently $25,001 to $74,298 per year for those ages 75 to84.

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And it doesn't look good for that group because of the risingcosts of housing and health care. The researchers estimated thatthe number of middle-income elders in the U.S. will nearly double,growing from 7.9 million to 14.4 million by 2029. They will make upthe biggest share of seniors, at 43 percent.

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By 2029, more than half of the middle-income seniors will haveannual financial resources of $60,000 or less, even if the equityin their homes is included. Projections put the average annualassisted living and medical expenses cost in 10 years at $62,000,meaning that a majority of the middle-income seniors then will notbe able to afford an assisted living facility.

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Middle-income seniors are a group that Beth Burnham Mace, one ofthe study's authors, said has been often overlooked whenpolicymakers and legislators think about housing and care for agingAmericans.

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“The low-income cohort has been taken care of by tax subsidies,while the high-income cohort is largely self-sufficient. But themiddle-income seniors have been ignored,” said Mace, who is chiefeconomist at the National Investment Center for Seniors Housing andCare, a nonprofit research group.

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The study's authors said they are probably underestimating theextent of the looming problem. They projected out-of-pocket medicalcosts of only $5,000 a year for seniors.

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Deborah Carr, chairwoman of the department of sociology atBoston University who studies aging, noted that Americans “are ableto live longer today than they have in the past because of medicaltechnology.” The downside, said Carr, who was not affiliated withthe study, is “if they're living for years with dementia ormobility issues, then they have to pay longer for medical care forthe additional years they live.”

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Indeed, the researchers projected that 60 percent ofthe middle-income seniors will have mobility limitations, while20 percent will be considered “high needs,” meaning theyhave three or more chronic conditions and one or more limitationsin activities of daily living, such as bathing or dressing. Eightpercent will have some form of cognitive impairment.

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Seniors living with mobility limitations, chronic conditions orcognitive impairment are more likely to need care and support suchas that offered by an assisted living facility.

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But that's not a reality for many.

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In her written responseto the Health Affairs study, Jennifer Molinsky, a senior researchassociate at the Joint Center for Housing Studies at HarvardUniversity, addressed the needs of seniors who decide to stay athome as they age instead of going to an assisted living facility.She said these older Americans face a different set ofchallenges.

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“One of the challenges is that most people don't live incities,” Molinsky said in an interview. “And most houses in theseareas are single-family detached homes. The infrastructure is notset up for safe walking, so you have to drive. People often give updriving as they age. So these locations can be difficult to provideservices to people.”

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Molinsky said other issues to consider are making homes moreaccessible by adding ramps for wheelchairs or wall handles in theshower and the cost of these changes.

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The other dire warning of the study: While spouses andmiddle-age daughters have historically provided the bulk of eldercare, that is a less likely option in the future because ofchanging marriage patterns, lower birth rates and the increasingnumber of adult children who live far from their parents. Someseniors will need to seek paid care.

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The study suggests that policymakers could expand Medicarebenefits to include access to a wider range of supportive services,or create a new benefit, “Medicare Part E,” that funds long-termcare. However, other attempts to set up such a program have runinto resistance among lawmakers because of cost.

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While Medicaid is the primary payer of long-term nursing homecare, right now the program is available only to low-incomeseniors. Seniors may become eligible if they impoverish themselves.However, lawmakers could also broaden the Medicaid incomeeligibility requirements or expand options to include home-basedcare for those with higher-end incomes.

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Some seniors are already turning to creative solutions toaddress their growing need for affordable housing.

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Carr said one innovative option she has seen is the Village to Village Network, acommunity program that allows seniors to stay in their homes buthave access to general support services, such as home repairs,transportation, health care and even social activities.

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Co-housing, where seniors share a residence, like in the classicTV show, “Golden Girls,” is another solution, Carr said.

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Mace said she hopes the study will spark more conversationbetween public and private sectors for creative ideas to addressthe issue of housing the growing number of Americans who will turn75 or older in the next decade.

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Her advice to both those seniors and their children is to openlydiscuss the issue.

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“It is a good idea to sit down and talk about what your plan maybe,” said Mace. “Talk about what the financial assets are and thehousing options. It's a worthy topic to talk about, though it canbe hard, because it helps to avoid putting both children andparents in difficult situations in the future.”

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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