AARP Trends: Longer Life Does Not Mean More Disability

According to Census 2000, the 1990s were the first time in the history of the Census that the population aged 65 years and older did not grow faster than the total population

Jan. 17, 2003 - Contrary to popular belief, longer life has not meant higher rates of disability and use of nursing home services, according to a new report by AARP's Public Policy Institute. The original assumption that increased longevity would necessarily be accompanied by higher rates of disability and usage of institutional long-term services was clearly wrong.

The Public Policy Institute report, Before the Boom: Trends in Long-Term Supportive Services for Older Americans with Disabilities, is a comprehensive compilation of national level data examining demographic, socioeconomic, market and policy trends that have had impact on the direction of long-term supportive services over the past couple of decades. Additionally, it examines how these national trends are likely to affect demand for such services between now and 2030 when the oldest Boomers turn 85.

"State and federal policymakers should seize the rare opportunity afforded by positive demographic, socioeconomic, and health trends to make essential changes in the nation's long term care programs," said John Rother, AARP Policy and Strategy Director.

"Current favorable trends present a window of opportunity for the public and private sectors to work together to create a new vision for long-term supportive services in this country," he added.

"The report, while being good news for many, also points out that if the issues of the growing and aging population's future long term care needs, are not addressed today, the choices will be limited to the wealthy and highly educated. Access to choices for the population at large will be restricted to those who can afford alternatives to nursing homes such as assisted living or home and community based services. Any changes must extend the benefits of improved health and increased choice to those who have been left out thus far," said Rother.

Differences in the size and social characteristics of different age cohorts are changing the demand for supportive services in old age. According to Census 2000, the 1990s were the first time in the history of the Census that the population aged 65 years and older did not grow faster than the total population. Yet, the older population will grow significantly over the next two decades. Most of the growth will be among those 65 to 74 years of age, and they are at relatively low risk for needing long-term supportive services.

The aging of the Boomers has sometimes been viewed as likely to overload the long-term care service system, but it is not until the 2020s when the oldest Boomers start to turn 75 that demand for long-term supportive services is likely to increase substantially. Even then, past experience with projections indicates that the demand for services may not be as great as some fear.

In 1990, the Senate Aging Committee predicted that 2.1 million older persons would be in nursing homes by 2005, based on the best data then available. Newly analyzed 1999 data show that this predicted level will be pushed back to 2017 if the 1999 rate continues. And, if recent rates of decline in utilization continue, the nursing home population will not reach 2.1 million until 2034.

Current trends indicate overall that there will be no age-driven tidal wave of demand for long-term supportive services for at least two decades even if utilization trends stay constant at recent rates. "Of course, these trends are playing out differently across the states," said John Rother. "Florida, for example, has already experienced a demographic wave that illustrates the need for timely changes in state programs."

In the 1970s, high rates of disability, widowhood, childlessness combined with low rates of wealth accumulation created demand for publicly subsidized long-term supportive services. The resulting creation of long-term care facilities outpaced the growth of the older population. Many factors that drove rapid growth in nursing home utilization reversed course by the mid-1980s. With lower rates of disability and more financial and family resources, the older population is already demanding more service options, spurring dramatic growth in home health care and assisted living. As a result, nursing home utilization rates have declined steadily since the late 1970s. The trends that have brought about these declines are likely to continue for at least the next two to three decades.

The report concludes that the next 20 years offer a rare opportunity to make needed changes in the nation's system for delivering and financing long-term supportive services-before Boomers enter the age of high risk in large numbers. Building on socioeconomic improvements and medical/technological developments, policymakers now must lay the foundation for a new generation of services that will enhance consumer choice and quality of life for all those who face disability in their later years.