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Thursday, November 5, 2009

Baby Boomers & The 2010s

The Aging Bubble About To Burst

For nearly 17 years I have been warning those of the Baby Boomer generation born between 1939-1953 to prepare for the future. It was a very difficult thing to do considering that this generation of "youth" had been in denial about aging to the point of attempting to "turn back time" with pills, liposuction and Viagra, all to no avail.

The majority of all Baby Boomers are now in the 60s, while the oldest Baby Boomers have turned 70 years old in 2009 and the last of this generation will turn 60 years old by the year 2013.

What is most amazing about this generation is the fact that with all the denial of aging that has been a part of the Boomer "consciousness" that the passage of time itself continues to show that along with the denial of aging has come the lack of any preparation for the realities of aging which is now upon the Boomer generation.

Many Boomers have been fighting aging, and the knowledge of it with a passion. One would have witnessed this with the emergence in the late 1990s and 2000s with the rise of the anti-aging industry and pharmaceutical drugs that swarmed into the public consciousness via 24-hour a day commercials/infomercials hawking everything from Viagra, Botox, pills for nearly every malady known to humanity along with the potions and lotions to hide the effects of the passage of natural time.

From injecting toxic strains of bacillus into one's face to unwrinkle skin to having multiple plastic surgeries and liposuction to improve physical appearance, the generation of the Baby Boomers have been on a very expensive quest over the last 17 years in their efforts to turn back the hands of time.

And we all know that Time cannot be "turned" back.

What has emerged as the world enters the second decade of the 21st century is a large generation wholly unprepared for the future, and for their own care as senior citizens.

Attending to the use of drugs while avoiding becoming naturally healthier has led to increasing rises in obesity, heart disease and type II diabetes, among other maladies that will swarm the health care system of the 2010s and 2020s with elderly Baby Boomers wholly unprepared for retirement.

An "aging bubble" has been quietly taking shape since the end of the 20th century. I say "quietly" because from the time that Boomer generation became the establishment in 1993 to the time this generation leaves the reins of power as the establishment in 2010 there has nary been a public call from amongst Baby Boomers to prepare for old age.

The very word "senior citizen" is not used by Boomers, who have long admired their own youth from a far and up close without looking down the road to make preparations for becoming senior citizens themselves.

Much of this can be attributed to the positions of the outer generational planets, especially those of Neptune, and Pluto, that, during the era the Boomers were born into (1939-1953) shows a generation obsessed with ego reflection, drugs and youth.

Troubles Ahead

Most of the problems ahead that the Baby Boomers and society faces is that this "aging bubble" comes at a time when the world will be dealing with the after-effects of the global economic crisis that will linger into the decade of the 2010s.

Coming just prior to the time that Baby Boomers as a generation will retire, the healthcare demands and costs of this generation easily outstrips all budget concerns and frightens the few politicians who had seen this disaster int he making build year after year with little to no attention to making preparations.

Looking ahead to the next decade, we can see that by the year 2010, during the start of the Cardinal Crisis transits that begin in mid-summer of that year, that from this time onwards into the decade of the 2010s, there are signs everywhere that the Baby Boomer generation is in serious trouble based on not providing for their own care as the new elderly, simply because of denial of aging, which happens to all generations.

The troubles ahead is a long list, but here are some highlights of what to expect:

Shortage of Doctors

There is a severe shortage of physicians worldwide, as many doctors are also Baby Boomers who are aging. It is estimated that the United States will need as many as 125,000 new doctors by the year 2025.

Figures show that there are only 700,000 active doctors in the U.S. in 2009-2010, but by 2025 the population of people who are over the age of 65 will have increased by an astounding 75% - from 37 million people in 2010 to 64 million by the year 2025!

From my calculations of astrological transits over this period of time, this is confirmed, and means that the number of doctors will fall dramatically at the same time that demand for doctors will increase.

This is a disaster that has been building for some time, and comes as a direct result of a generation that has been in complete denial about aging and the facts of life.

The problem comes from the Baby Boomers themselves, which is amazing, considering that this generation will be the most hard pressed to find adequate medical professionals to support them in old age.

"We're not producing enough primary-care physicians," President Barack Obama said at one forum on health care. "The costs of medical education are so high that people feel that they've got to specialize."

  • Over the last 5 years, a declining number of US medical school graduates have been choosing careers in internal medicine and family medicine - the two fields that are the source of applicants for geriatric fellowship programs

  • Physicians in internal medicine, family medicine - and geriatrics - earn significantly less and have less predictable work schedules than those in other medical and surgical specialties, especially disciplines such as dermatology, plastic surgery, otolaryngology, radiation oncology, and emergency medicine

  • A career focused on caring for older adults can be particularly financially unattractive for physicians who carry increasingly large medical school loan debts

  • Over 86% of medical school graduates carry educational debt and the median debt burden for graduates of medical institutions is over $100,000

  • The median salary for a geriatrician in private practice in 2005 was $162,977 - significantly lower than that of most other medical and surgical specialties

  • In many parts of the U.S., Medicare payment rates for physicians are lower than commercial insurance rates

  • Medicare reimbursement rates for mental health services are discounted even further than rates for geriatric medical services

  • Medicare reimbursement is the major source of income for most geriatricians and, as a result, community-based geriatricians have lower incomes than most other physician specialists.

  • Doctors who are trained in general internal medicine are the the physicians who are on the front line of primary care. However, because of pressure from Boomer administrators and the artificially -raised costs of healthcare to meet the demands of corporations many doctors have been swarming into entire ranges of sub-specialties of internalized medicine, like cardiology and oncology - and have left primary care to fewer and fewer physicians who are low paid.
It is estimated that newly trained physicians owe more than $140,000+ in student loans by the time they graduate. Moreover, the two decades of pressure from Baby Boomer administrators to "specialize" in medical areas has squeezed out training for primary care physicians, the very medical professionals who will be needed in droves to service millions of aging Baby Boomer elderly.

Senator Max Baucus, a Democrat from the state of Montana complained that Medicare payments were directed
against primary-care doctors. These are the very physicians required to care for older people who have chronic conditions like congestive heart failure, diabetes and Alzheimer's disease. "Primary-care physicians are grossly underpaid compared with many specialists," Baucus said.

Nowhere is this problem observed more than in the field that the Baby Boomer generation will increasing depend, and one that this generation itself has caused a severe shortage in - Geriatric medicine.

Geriatric Medicine

When I give counseling advice to clients interested in the medical field, I always point them to primary care and Geriatric medicine, for these are the growth areas in healthcare for the next 40-50 years.

What is amazing about the coming shortages of doctors, is that it is already here; especially in the very medical sector that deals with the primary care of the elderly.

Some facts:

  • According to a recent JAGS editorial, 30 percent of the most frail Medicare beneficiaries will need to be cared for by a geriatrician and because of the frailty, one geriatrician can care for a patient panel of 700.

  • Primary care internists and family physicians would manage the healthier and better functioning 70% of older adults

  • There are only 7,345 certified geriatricians practicing in the US -- a 5.4 percent decrease from the year 2000 and roughly half the number currently needed

  • That said, currently about 1.1 million 65 and older Americans would benefit from the care of a geriatrician - a shortfall of 8,421 geriatricians.

  • There are far fewer geriatric psychiatrists. Currently there are 1,596 - one for every 11,372 older Americans. That ratio is projected to decrease by 2030 to one geriatric psychiatrist for every 20,195 Americans 75 and older.

  • In 2007, 91 residents who graduated from U.S. medical schools (USMDs) entered geriatric medicine fellowship programs (slightly more than 0.5% of all medical students in that graduating class), down from 167 in 2003. In 2007, 24 USMDs entered geriatric psychiatry fellowship programs (less than 0.2% of all medical students in that graduating class), down from 30 in 2003.
Shortage of Care Facilities

There are severe shortages in nursing home, or assisted-living, facilities across the country. There are also shortages in home health care companies and staff to provide even independent services to the elderly.

In addition, the current training capacity for geriatrics faculty cannot even sustain the current level of faculty over the next 10 years. To correct the current and future deficit, substantial increases in both geriatrics fellowship positions and mid-career training positions will be necessary.

A 2008 study prepared by Florida's insurance underwriters' of elderly care assisted-living facilities and nursing homes states that:

"Our medical industry cannot handle the onslaught of all these new patients at once. Therefore, nurses will be even in higher demand than they are right now.

Due to the higher demands there will be fewer people that are qualified to work in in-home care situations, or assisted living facilities to help the elderly Generation.

"The long-term care industry will have to change with the changing demands of an escalating senior population. Liability insurance products also will have to change.

"Shorter nursing home stays with most residents requiring more than custodial care will expose operators to more risks that require liability coverage.

"Agents will be expected to increase liability protection to home health care workers and hospice facilities impacted by the expanding population, as well as to the full range of long-term care environments including nursing homes, assisted / independent living, and continuing care retirement communities."

Baby Boomers & Old Age

From the looks of the global transits of the 2010s and 2020s it clearly reveals that the Baby Boomer generation will want to live independently until they can no longer care for themselves. This presents a serious problem because of the shortages of doctors, nurses, assisted-living facilities, and home health care personnel a crisis is surely in the making.

This mounting problem comes from the Baby Boomer generation with little to no funding for expansion of assisted-living facilities, while at the same time cutting these services while encouraging physicians over two decades to avoid primary care and to specialize, which has left the primary care sector gasping for air, and facing severe shortages.

Another 2007-08 study reveals just how serious this problem will become in the 2010s, 2020s and into the 2030s:

"Baby Boomers whose parents may have been satisfied with nursing home care will opt for independent or assisted living until they can no longer care for themselves. The study projects a need for nearly 160,000 new assisted living units, as 60 percent of residents who would have chosen nursing homes can be served in assisted living facilities.

"Demand for independent living facilities also is expected to increase sharply, creating a need for an additional 260,000 units. Skilled home care services funded by Medicare, Medicaid, and other governmental sources are expected to more than double by 2030.

"The wide range of health care options surely will increase professional and general liability risks and create a need for increased liability insurance in an uncertain market.

Perhaps the most daunting challenge facing the industry over the next couple of decades is the expected shortage of professional healthcare workers. This threatens to reduce the quality of care available to meet demand from the rapidly mounting population of senior citizens.

Demand for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) is expected to grow by 30,000 Full Time Equivalents (FTEs) over the next 22 years. Demand for nursing assistants, home health aides, and personal-care attendants is expected to grow by 122,000 FTEs.

However, the study predicts a severe shortage of RNs by 2030. As of June, 2007, 43 percent of licensed RNs were over 50 years old, and 15 percent were over 60 years old. Academic programs are not producing enough nurses to replace those retiring.

The salary differential is growing between nurses employed by hospitals and those serving in long-term care. Long-term care RN salaries in some Florida markets are not considered as generous as hospitals or other settings, which will result in even greater shortages for skilled care, home care, and assisted living.

"Informal care givers will be the key to managing the explosion in demand for aging services. Approximately 40 percent of women and 19 percent of men over 65 in 2005 lived alone.

"As the population ages, the numbers living alone are expected to increase. Without informal family help, it’s more likely they will require support to meet their daily needs.

"The study concluded that dramatic growth is required in home care, much of it to be funded through public programs and Medicare. The problem is that availability of home-care givers, including family and other informal providers, is expected to decline 41 percent by 2030.

"This means that 420,000 more seniors 85 years and older may be without help at home or moved into already burdened nursing homes and assisted living facilities."

The challenges of the future of the Baby Boomer generation as they become the new elderly will require an massive expansion in all phases of health care: from assisted living, to primary care and support needs of a size that is nowhere being prepared for at this time.

It is already too late to make up for the last 25 years that could have solved these problems. Rather, the problems have been kicked further down the road, and now, that road is coming to a dead end.

As with crumbling infrastructures, the traditional nursing care system has fallen apart. Therefore, we can expect the aging bubble to become a crisis of huge proportions in the 2010s and 2020s that will seek to consume resources that are, at this time, are limited, and not available to even meet the existing demands that are now on the horizon.