There will be fewer people to care for the aged, and tax-supported nursing home costs will bust budgets.
Lynn and Steve Halverson saved taxpayers about $175 yesterday -- the cost of a nursing home room -- and they'll do it again today as they start their third year of caring for Lynn's 80-year-old mother in their Apple Valley home.
"It's what you do -- you take care of family," said Steve Halverson, who was laid off as a Schwan's manager the same month that an increasingly frail Joan Anderson moved to their house from Eau Claire, Wis.
"We get by, but some days it's not easy," he said. "It's about caring -- loving, I guess you'd say.''
Across Minnesota about 650,000 caregivers -- one in five adults -- are deeply involved with the joys and frustrations of helping aging relatives. Many help with chores, arrange doctor visits, shop for groceries or simply check in by phone every day. But for others, the care is far more intense and intimate -- feeding, bathing, dressing, monitoring chronic diseases and answering a million repeated questions.
The need for that sort of help -- whether from paid staff or families -- is about to explode. About 680,000 Minnesotans are 65 and older now. That number will soar to 950,000 in a decade, then to 1.3 million by 2030, when baby boomers start turning 85.
It's an amazing success story in longevity, but it's tempered by a worrying problem: There are far fewer young people behind them to provide care -- or finance it -- as this "silver tsunami" gains force. One measure, the age dependency ratio, shows that compared to people of working age, the proportion of seniors will almost double over the next 20 years -- from 21 per 100 workers to 39.
That will be offset slightly by a drop in the ratio of children to working-age people -- but caring for children is cheaper than caring for the frail aged.
Demands on families likely will grow as the aging tsunami breaks on the shores of worker shortages in long-term care -- shortages driven both by fewer younger workers to give care, and unattractively low pay rates in geriatric care, from health aides to physicians.
It's a worrisome picture to people like state demographer Tom Gillaspy and state economist Tom Stinson, who for several years have talked about the challenge to any group that will listen. They note, for example, that the cost of taxpayer-funded long-term care for elderly Minnesotans will quintuple in the next three decades, to $5 billion, placing immense pressure on the state budget.
The combination of troubling economics and aging demographics means Minnesota is moving to a "new normal," Stinson said, with rising pressure on families and government in an era of tighter finances.
For more than a decade, the state's Department of Human Services has been working to persuade governments and families to prepare as baby boomers move into old age.
"We still have a little time, but not that much time," said Loren Colman, the department's assistant commissioner for continuing care, which has produced analyses and recommendations in reports called Project 2010 and Project 2030.
Its proposals include helping communities create better services and infrastructure for seniors -- respite care, coaching, home-delivered meals, chore services and the like -- encouraging people to plan and save for their own old age and keeping caregivers engaged.
"We have to help them avoid burnout," Colman said. "Government simply cannot replace with tax dollars the 90 percent of care that families now provide."
How big is the challenge? The national Family Caregiver Alliance estimates that family-provided care for the elderly is worth $7.1 billion a year in Minnesota -- eight times the federal and state taxes spent annually on nursing homes.
Love and exasperation
Like the Halversons, many families find care-giving is a blessing and a bane, a mixture of joy and exasperation -- and sometimes desperation.
"We haven't had a vacation since Mom came here," said Lynn Halverson, 60, a former teacher. "You think you know what you're getting into when you start this journey, but you don't. You plan, then you deal with whatever happens.''
Her mother, who has Parkinson's disease and some memory loss, now uses a wheelchair outfitted with a wireless doorbell so she can summon help.
"Some days it's a joy," Lynn Halverson said, "and some days it's a struggle to keep your sanity."
Recently, it's been a struggle. Her mother was awake nights, demanding attention and watching old TV movies at top volume, then sleeping days and refusing to take her pills.
"One or two weeks and that will pass," said Halverson, who recently ended "boot camp" workouts at her health club because of lack of sleep. "The quieter and slightly gentler Mom will come back."
Lynn's mother always ruled the family with a well-honed tongue. It sent everyone scurrying for cover "except for me. I'm the one who spoke up,'' she said. "That's why Mom is here."
Without family caregivers like the Halversons, the web of care for older people would collapse. But the pressures take a toll, and families often find themselves grinding deeper into care-giving than they ever imagined.
Each Wednesday and Friday, Steve and Lynn get a four-hour respite for lunch together at McDonald's and a movie or a few errands. That's when Marie Schueller, 71, comes to call. Schueller is a "friendly visitor" from DARTS, a Dakota County social service agency. She assembles jigsaw puzzles with Anderson, watches TV with her or just sits as she sleeps.
"A saint, a gift from God," is the way Lynn Halverson describes her.
When is it time?
At DARTS, social worker Lynn Cibuzar trains caregivers in navigating the tricky shoals of parent care. She helps them figure out what the older person really needs, what caregivers realistically can do themselves and what other resources might help. She also helps them decide when it's time for assisted living or a nursing home.
"The state is really interested in saving money, so they regard someone moving into a nursing home as a failure," Cibuzar said. "But sometimes, that's absolutely the right thing. Many caregivers hang on too long out of love, or guilt for not fixing the unfixable fact of aging."
Most caregivers are women -- though many men are joining the ranks -- and most are 45 or older. But not all.
Jenelle Donnay, 28, moved in with her 68-year-old dad in Brooklyn Park last year after her stepmother died of ALS and it became clear how much his Alzheimer's had advanced.
"It's much more common to find families moving in together -- partly because of the economy, but also because the need for care seems that great," said Jody McCardle, who heads the Como Park Living at Home/Block Nurse program.
One of 45 such programs in Minnesota, the nonprofit helps keep about 150 elders in their homes with a range of professional and volunteer services.
The need for help
Care-giving can be "almost overwhelming," said Joe Gaugler, a researcher at the University of Minnesota. To stay in the game, caregivers need the skills to cope with difficult situations, such as combative patients or interfering siblings, and to find essential services.
With a $1.2 million federal grant, Gaugler is studying 100 people who care for relatives who have dementia. He thinks his mix of education, support groups and counseling on demand will result in healthier caregivers who make better decisions with less stress.
That might delay nursing home placement by 18 months -- potentially an $80,000 savings to the older person and taxpayers who pick up the tab when the savings run out.
At their home in Apple Valley, the Halversons joke about the future as Steve continues to seek full-time work and Lynn bears the brunt of care-giving.
"I told Steve we'll know it's time for Mom to go to the nursing home -- at my funeral," she said. "Seriously, how will we know? Mom was in a good nursing home for rehab after hip surgery three years ago, and it was awful. I know nursing homes can be good, but we'll try to keep Mom with us. Even when she keeps me up all night, I know she's safe."
Warren Wolfe • 612-673-7253