If you're one of America's 80 million baby boomers, this editorial will tempt you to avert your eyes.
Who wants to think about old age? It's nicer to pretend you'll always be young, or that after a long and healthy life, you'll just suddenly and painlessly expire. With the Grateful Dead blaring from your earbuds.
But it's much more likely that most of you - the lucky ones - will instead get quite old and frail. When that happens, you'll probably need help. And that help will be expensive, especially if you'd prefer not to spend your final days warehoused in a soulless institution overcrowded with too many other boomers.
That's why, whether you like it or not, it's time to think about the prospect of long-term care now. There's also a more immediate reason to focus on this unpleasant subject: Medicaid, the program that pays for long-term care when people can't, is bankrupting New York - and it isn't very good at this problem anyway.
If we act now we can change all this. We can see to it that the boomers spend their final years in comfort and dignity, without impoverishing themselves or imposing a crushing financial burden on their children or their fellow taxpayers.
That rosy future is within reach - and the actions we take now can help more of us avoid nursing homes later. Long-term care doesn't have to mean institutionalization.
It does, however, mean spending. And as with so many other long-term challenges - paying for college, saving for retirement - the numbers are daunting, as was made clear at a recent forum by the Nelson A. Rockefeller Institute, a think tank in Albany. The median annual cost of a home health-care aide in New York State is $48,620, according to Genworth Financial, an insurer selling long-term care policies. An assisted-living facility is $39,000. A private room in a nursing home is $114,793 - and the average length of stay is nearly three years.
Most baby boomers will have trouble saving up this kind of money, and many cannot hope to. Yet the needs won't go away. If anything, a host of signature boomer-generation cultural changes will only exacerbate them.
Divorce, childlessness and our increased tendency to relocate will mean that many boomers won't be able to rely on family. In many cases their children were never born, or will be too distant - physically or emotionally - to be of much help.
The role of women has changed too, so that daughters (and daughters-in-law), still the mainstays of family eldercare, won't be as available for such chores when the boomers reach their dotage. Men seem unlikely to take up very much of this slack.
Our society is aging. But our long-term care dilemma is also a reflection of our own success. People are living longer. Work-related accidents, smoking and other causes of premature death have declined. The result is that more and more seniors will live long enough to need help. By 2050 the number may exceed 20 million, more than double the figure in 2000.
The effect on taxpayers could be profound. About two-thirds of Medicaid is spent on people older than 65 and disabled adults. And Medicaid is expected to more than double as a proportion of gross domestic product, to 6.5 percent, by 2045. At the current rate of growth, Medicaid and Medicare will form a two-headed monster that will gobble up two-thirds of federal revenue by mid-century.
What is to be done? The first step is to acknowledge that this affects all of us. About two-thirds of Americans older than 65 need some help with such basic tasks as cooking, eating or bathing. Even if you escape this need, you may find yourself having to provide care for someone you love.
So the problem is universal. And so is the answer. As things stand, we expect people to pay for this care when the time comes, or if they are too poor, to receive it as a kind of welfare via Medicaid. This costly system is failing us. Some people - perhaps not as many as commonly believed - hand off assets to family in order to qualify. And Medicaid puts way too much emphasis on expensive and unwanted nursing home care.
We need a new approach - one that keeps the elderly at home, makes sure all are cared for, holds down costs, and establishes stable funding for expenses we know are coming.
The way to do this is by moving from welfare to insurance. Long-term care insurance is a standard feature of social policy in Japan and most of Europe, as popular there as Social Security is here - for similar reasons. Everybody pays in, and eventually everyone gets a benefit.
The programs are also affordable, at around 1 percent of gross domestic product. We spend just as much without covering everyone, in large part because the great bulk of Medicaid's long-term care spending goes for pricey nursing home care - precisely the kind most people dread.
Developing such a system, public or private, won't be easy. While everyone needs long-term care insurance, people don't buy it voluntarily, or while young enough so that decades of premiums can cover later expenses. And unless the young buy in, few will find the coverage affordable.
Death and taxes may be inevitable. But long-term care won't happen later unless we start paying for it now hN