What to do with the old and poor?

Calls for significant policy development to deal with a rapidly aging U.S. population have been steady for over twenty years now.  Like so many other areas of social welfare provision, however, this one remains sorely neglected.

But demographic trends are relentless, and unless we’re prepared to let older people simply “die in place,” something’s got to give.  Two interrelated mega-challenges stand in the way of that “something” happening in any way that we might call good.  One is cost, the other is workforce.  Caring for older people costs a lot (ask any medical insurance provider, or for that matter any family member pitching in to help mom and/or dad keep body and soul together), no matter who’s paying – the person, their family, or the public via government program.  And since somebody’s got to provide the necessary care, workforce – whether unpaid, as in a family context, or low-paid, the condition of most caregivers working in the various facilities and agencies that focus on aging care.

Things aren’t so bad for older people with money – at least if they have the good grace to die before getting too old.  In additional to traditional assisted living and nursing homes, a range of other aging-in-place options, sometimes organized under the umbrella of “Continuous Care Retirement Communities,” are available to those with means.

But what about the poor?  Many, many older people are poor, and the ranks of the old and poor can only be expected to grow as the Boomers continue their steady assault on the calendar.  It’s a “wicked” problem – complex to the point of insolubility, some would say, with every proposed solution harboring another set of problems of its own (inter-generational conflict, for example, over “entitlement” programs).

I’d make the case that substantive gains can yet be made via some version of the “mutual aid societies” of the sort that predated the modern welfare state – voluntary organizations in which people pool resources of time, talent, and treasure to care for one another in a spirit of social solidarity.

Unfortunately, the U.S. has spent the better part of seventy years eroding social solidarity in the interest of monetizing as many aspects of human relationships as possible.  Is it too late to recover what’s been lost?  Can we learn old lessons anew?

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