July 7, 2021

The big demographic changes coming in heath care's next 10 years

Daily Briefing

    As we hit a turning point in the Covid-19 pandemic, it's time to start looking at how the pandemic, alongside other big market forces, will shape health care in the future. Advisory Board's Nick Cericola sits down with Radio Advisory's Rachel Woods to talk about how changing demographics could affect the health care industry in the next 10 years.

    Read a lightly edited excerpt from the interview below and download the episode for the full conversation.

    Rachel Woods: We're talking about the shift of care into the home as being something that younger generations will prefer and how that's tricky because people even our age tend to be sicker than their parents were.

    But this isn't the only example of shifting care into the home. If I go back to those baby boomers, that aging population, there is a big shift to move their care out of the hospital, out of a skilled nursing facility or a nursing home, and into what might not be the adult's home, but might be their adult child's home. What does that mean for younger generations?

    Nick Cericola: This is one of the issue areas that I think is probably worthy of the greatest amount of study. Some of you are probably familiar with the term the sandwich generation, which describes a cohort of individuals who today are mostly in their forties, perhaps their early fifties, that are responsible for caring for aging parents at the same time that they're caring for their children.

    It spans both generation X and a little bit of the millennial generation right now. But I think that there's a real risk as the industry is increasingly bullish on the shift of care to the home setting that we overlook the realities, the needs, and the characteristics of this sandwich generation.

    Woods: But why? Adults have always been sandwiched in between providing care for multiple generations and honestly providing care for themselves. Why is this problem going to be worse 10 years from now than it was say 10 years ago?

    Cericola: The simple answer is that there will be more in this generation. And that's based on two concurrent demographic shifts. One, of course, is the growing population of individuals in their sixties, seventies, and eighties. So there will be more aging adults who will rely on their adult children for care than ever before.

    Also, because we've seen delays in child-rearing over the last couple of decades, there are more individuals in this age bracket

    There are also more children living at home into their twenties and even into their early thirties, which leads to a second big trend, which is the growth in multi-generational housing arrangements. These are interconnected of course, but there are also cultural factors that are bringing us back to a point in time where multi-generational housing is as common as it was in the 1950s, to be honest.

    Woods: Oh, wow. And so what you're saying is that if we're not careful this sandwich generation is going to get stuck bearing the brunt of care, again, for themselves, for their children, and for an aging and sicker baby boomer population?

    Cericola: They already are and I think the issue could get a lot worse. When we actually look at the experience of individuals in the sandwich generation.

    And this is generalizing, but they experience financial difficulties. That's covering out-of-pocket expenses related to the care for their loved ones, long-term care of course being a significant part of that, but also other expenses related to food and travel.

    We also see them take a significant emotional stake in their loved ones. That's an intuitive leap, but the data shows that there are heightened levels of stress and anxiety, relationship sacrifices that often have to be made by members of the sandwich generation.

    And then there's also evidence that they themselves have worse physical health as a result of the responsibilities that they're executing for caring for their loved ones.

    So as we start to see this generation grow and as you start to see more aging adults lean more heavily on their adult parents, who are often doing this quite willingly I should add. It seems very important to me that we better understand the needs and the preferences of members of this informal caregiving generation if we really want to get the shift to home-based care right over time.

    Woods: I have to admit you're talking about this and I'm literally thinking, "I'm screwed," as somebody who's probably going to be in this bucket or whose family members are going to be in this bucket.

    And what you're talking about is a scenario that will basically push caregivers to their limits because they're sandwiched in this difficult spot. So what do we do to actually uplift and support this generation that's going to be bearing the brunt of health care for their families and frankly for the country?

    Cericola: This is exactly why we're having the kind of conversation that we are, because it's a moment of reckoning, and I don't know the answer yet. But I think there are a couple of things that I would encourage leaders to be thinking about, particularly those who are making big bets or investments in the shift to the home health setting.

    One to think about is what does it take to actually support familial caregivers? Through technologies, through training, through professional resources that help them develop their skills, but also make them more competent and using the technologies that we're hoping are going to make the shift to home as successful as we imagine it might be?

    Woods: What's the business case behind that? Because I have this moment of, "There's got to be more than a moral imperative. It has to be more than, 'I don't want to leave this generation out to dry.'" Why from a business perspective would this be a smart investment in the future for today's leaders?

    Cericola: So there's two ways to think about the sandwich generation. One is that they're a cohort of individuals who we really need to care for ourselves, and I think from that, there often is a moral imperative.

    But at the same time, if we think about the sandwich generation as a natural extension of provider supply, as we look ahead 10 years to constraints in our ability to meet long-term care needs, particularly among aging adults in terms of provider capacity, we ought to be thinking about how we can partner more successfully with informal caregivers. That collaboration will extend the ability of skilled nurses and others whom we are going to lean heavily on to provide the care that aging adults are going to need across time.

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