Will Healthcare Be Able to Handle the Silver Tsunami in 2030?

HealthLeaders spoke with MedStar Health elder care directors about what the industry must do to prepare for the influx of an aging population.

It's predicted by 2030 that senior citizens will make up 20% of the nation's population. In a 2018 press release for its 2017 National Population Projections, the United States Census Bureau stated that, for the first time ever, there will be more older adults (over the age of 65) than children.

"By 2034, there will be 77 million people 65 years and older compared to 76.5 million under the age of 18," the release said.

With the anticipated influx of older adults just eight years away, there's much to be done to bolster healthcare services to match up with demand.

HealthLeaders spoke with George Hennawi, MD, physician executive director of geriatrics and senior services at MedStar Health, and Lauren Bangerter, PhD, scientific director of health, economics, and aging research at MedStar Health Research Institute about what the healthcare industry needs to do to prepare for the "silver tsunami."

HealthLeaders: How did the pandemic impact older adults?

George Hennawi, MD: It became extremely challenging during COVID, devastatingly challenging, but the learning piece is that we need to invest in a better infrastructure to not only support our nursing facilities but support our older adults aging in place and living in place during or after hospitalization, and during or after illness.

Lauren Bangerter, PhD: COVID disrupted the idea that congregate living for older adults is safe. I think a lot of families assume that if an elder loved one is in a nursing home or some sort of facility that there's a level of safety because there's oversight. COVID disrupted that whole idea and hit home that care in the home is often going to be safe, its often going to be preferred, and that we need to adapt the way that we've been thinking about what that care looks like and invest in the infrastructure so that older adults can age in place. There's quite a bit of infrastructure that is needed for this to happen and there's certainly an appetite and desire for that, not only for the older adults themselves, but for their family members who care for them.

HL: The Centers for Medicare & Medicaid Services have recently strengthened their monitoring of nursing homes through a series of revisions to the Special Focus Facility Program, keeping those facilities accountable for the quality of care they provide. Will adding and improving regulation and accountability measures be enough to take care better care of the elderly?

Hennawi: I think it's a good step, it's well intended, and it's what we need, but I think it's difficult to achieve success with regulations when those folks do not have the proper support. I can ask nursing facilities, for example, to do a COVID test two to three times a week on every employee, patient, and visitor that comes in and out of that facility. But did I support them in recruiting and maintaining their workforce? Did I come up with a better infrastructure for if they got hit with a COVID situation and it became bigger than expected and impacted multiple staff members and multiple patients? Did I support them with the infrastructure to find staff to keep the operation running? Did I improve their reimbursements so they can spend money on preventive measures?

The regulations are extremely needed, the oversight is definitely part of the way to go, but it should come with an understanding of what happens on the ground and investments to make those folks that we're putting under a lot of regulations and holding them accountable successful in the mission they're trying to achieve.

Bangerter: There's a lot to be said for integrating the perspectives of different stakeholders in the development of new policies, and that's something that can't be overstated enough. Talking to the folks who are going to have to implement whatever these polices are, making sure they're involved in conversations from the beginning, can help to build that infrastructure and make sure that's part of those new regulations as well.

HL: Many individuals prefer to age in place in the comfort of their own homes, so do you think it's possible that we'll see a pivot in senior services from skilled nursing facilities to home health?

Bangerter: We may see a few different things. We're likely to see older adults stay in their homes for longer periods of time before making a transition to a facility that provides more intensive care. We're starting to see more opportunities to provide care in the home and more and more opportunities to provide health care in the home at smaller levels.

The other thing that is interesting is that we're seeing in private industry quite a bit of startup companies and new businesses that are aiming to fill this gap and aiming to enable that care to be provided in the home, so that's an interesting space to see some innovation. We certainly are seeing it more, and the COVID-19 pandemic opened new opportunities as far as telehealth and remote care and an openness to that both from the individuals receiving care as well as the providers.

Hennawi: [When the pandemic began], we started with heavy telemedicine, virtual visits. [Digital health] is something that had been talked about forever but it was implemented in a speedy way because of COVID. But then the concept of hospital at home, a theoretical approach to acute care in the home, was implemented in many states during COVID. That model was able to make its way into mainstream services and it's going to continue.

For us, specifically in geriatrics at MedStar Health, we intensified our home health services whether it was sending out providers to care for older adults in the home through our MedStar home care and Med Star primary care services, and now we're thinking of venturing into the [skilled nursing facility] at home model, which is providing the services of post-acute rehab in the home rather than sending folks to a nursing facility.

HL: What needs to be done to prepare for the influx of older adults in the healthcare infrastructure? How can health systems and physicians work with state or federal organizations to prepare for this?

Bangerter: There's a tremendous opportunity to have more emphasis on evidence-based policy, so that requires a bridge between the scientific research community and policy-makers. This is true at the federal level, as well as the state level, and we can draw from both federal and state policies. We're trying to improve that broader federal infrastructure that's going to be needed as well—the innovative, boots-on-the-ground work that happens at the state level. There's different ways to do this, but that's a huge area of opportunity to improve not only the policy development side but to understand policy implementation and whether policies are working the way they're intended to from the perspective of patients and providers.

Hennawi: It's important that we start advocating and educating the public, policy-makers, and the media on what's coming. If you ask Americans what some of their concerns are, in older adults, aging is not a concern for them or it's not ranked high as a concern for the country. We should start thinking about the silver tsunami, a term I've heard, and so we should start thinking about this and making it a big part of our public knowledge, public policy advocacy, etc. That's one piece we need to change.

Out of the folks that I see as a physician, and I see a lot of patients who want to stay at home, I don't have the support structure to keep them there because they can't afford to stay there. The key issue, from my perspective as a physician, is we need to change the paradigm of long-term care.

When we say ''long-term care,'' what we think about is nursing homes, but I think long-term care starts by supporting folks to stay at home when they need that support. Supporting them by having caregivers that are trained, qualified, and well-compensated to take care of them at home in an affordable way. Many people cannot afford caregivers in the home. [We need to] create or support more long-term care insurance that is affordable to everybody, that is easily accessible, that is subsidized for those folks that we care for who don't have much of an income, and that will allow them to tap into this insurance if they need to stay at home.

A big part of the message is changing the paradigm of long-term care from a reactive approach—you end up in a nursing home, we'll support you when you run out of money—to putting the investment up front, create bridges that will support you when you need the support so you can live at home for as long as you need to, in the hands of trained caregivers that will care for you. I think that's the paradigm that we're talking about, and today I believe that paradigm is reactive. I think we need to move to a paradigm that will allow people to invest in this early on and stay at home as long as they desire to.