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Stranded by geography: today’s caregiver support ratios and the 80+ population

Now is the winter of discontent. Neighborhoods disappear under the weight of snow piling up and billions of dollars are adding up in lost business (think car dealers and restaurants). But what of mitigating the isolation and providing care for the elderly, especially for those seniors aged 80+, living in communities overwhelmed by bad weather? Is the likelihood of having family to help related to geography? That topic was addressed by state in the August, 2013, AARP INSIGHT report, The Aging of the Baby Boom and the Growing Care Gap, introducing the term and an infographic for the caregiver support ratio (CSR) – "the number of potential family caregivers aged 45-64 for each person aged 80+." The report prediction: given future population changes, CSR would decline from its 2010 level of 7 potential caregivers for each person aged 80+ (7:1) down to a ratio of 4:1 in 2030 and 3:1 in 2050. Today, those low ratios have been reached around the US – in both locations that are warm…and snow-covered.

The 80+ are concentrated in Florida counties – but seniors are also stranded elsewhere.  What counties have the highest concentrations of the 80+ and also the lowest CSR, the available population of people aged 45-64 to help care for them?  Call that population what it is – stranded -- without enough available people in the age ranges that can provide care (family or any other type). This dubious honor goes to Palm Beach County, Florida, with 103,120 individuals aged 80+ but a CSR of 3.4 -- below AARP’s prediction for the year 2030. Sarasota County is a leader of sorts, where one-third of residents are 65+ and more than 39,000 people are aged 80+, but with a poor CSR of 2.8.

Seniors may strand themselves in retirement destinations. The leading counties for stranding the 80+ may be those where working age adult family members cannot -- or will not -- find year-round employment, even as these counties are popular retiree havens. For example, Marion County, FL (with 22,000 aged 80+) is home to the The Villages, an entire city (Ocala) built up around retirees,  wtih poor CSR of 4.1.  In Barnstable County on Cape Cod in Massachusetts – there are more than 16,000 individuals age 80+ and a bleak CSR of 4.3.  In terms of sheer numbers of 80+, however, Ocean County, NJ leads with 39,365 people aged 80+ and a CSR of 3.8. Allegheny County, PA has the second largest population of 80+ with 71,162 -- but they are not as stranded; the CSR is 4.9.

Are family caregiver demographics the only destiny? Statistics do not tell the full story, of course, about whether the 80+ population is really 'stranded.' In the absence of local family care providers today, there are many alternatives, some of them good, some not so good. For example, Palm Beach County has 89 home health agencies, 3 senior centers, and many in-home care providers. But sometimes those are also problems. In fact, due to issues of in-home care elder abuse and theft, the county is contemplating tougher regulation around in-home care. And finally, family caregivers can be found on the list of most prevalent sources of elder financial abuse.

See ATTACHED PDF: Caregiver Support Ratios in US Counties through 2013

PDF icon Stranded Care Ratio Counties348 KB
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These stats are key to understanding the magnitude of need. Planning and caregiving policies which fill the void, coupled with housing & community design which enable are keys to the solutions. Thank you Laurie.

Esther Greenhouse, M.S., CAPS, CGP

Environmental Gerontologist

As a Home Care owner, it has become very obvious that the shortage of quality caregivers has been happening for some time now. We recruit almost daily to keep our pipeline flowing with quality people as it takes 10 interviewees to get 1 acceptable hire. We are really thinking of unconventional ways to attract quality candidates as the standard ads, etc are no longer enough to get enough interest to get a candidate in our door for a face-to-face interview.

Terry Madden

Owner at Assisting Hands Home Care

Hi Laurie,
Great stuff - thanks for sharing. Considering the distinction between use of technology for Baby Boomers vs. those 80+, do you know of similar statistics for the percentage of Baby Boomers per county across the US?

Just curious....


Have posted on my facebook page (www.facebook.com/ThePPAL) and numerous linked in groups.  Would add an appreciation for the unique challenges of the PHYSICAL demands of care that often demand 1:1 care:  we need innovative design of mobility/transfer devices that promote self-care and mobility.  Hoping that DME/HME manufacturers are paying attention - This is a case where "need" equals "demand" -


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