As Baby Boomers Age, the Challenges Facing Senior Care Providers Are Increasing
By Don Drake, Connelly Law Offices, Ltd.
"The baby boomer generation, born between 1946 and 1964, is a significant demographic worldwide, especially in developed nations," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "This generation represents nearly 28% of the American public, and as they age into the senior care system, the challenges facing senior care providers will increase. Between 2011 and 2031, the number of adults aged sixty-five and older is projected to double, leading to increased demand for healthcare services, housing, and other support systems. This demographic shift will require significant infrastructure, technology, and workforce training investments to ensure seniors are cared for with safety and dignity. However, they will also bring behaviors not seen in senior care settings in the past. Let's look at some issues facing senior care providers today and in the future."
Bullying
"The use of the term 'bullying' when referring to aggressive behavior among seniors is a topic that deserves further discussion and attention," stated Attorney Connelly. "Many seniors whom I have spoken with who have experienced aggressive behavior from their peers feel that the term 'bullying' doesn't accurately describe the severity of the situation. It can even be considered disrespectful to the targets of such behavior. The use of the term 'bullying' may downplay the severity of the issue, and in some ways, it may even trivialize the experiences of those who have been affected by it."
Research has indicated that 10-20% of older adults experience some form of senior-to-senior aggression in institutional settings. However, many investigators feel this is a low estimate, and the number of cases may be much higher. In many cases, the underlying pathologies of bullying, such as mental illness, dementia, and delirium, may be to blame. But in other cases, the behavior is driven by personality traits and disorders, which can be much more challenging to treat. The most concerning bully type has an underlying need for power and control over others. These individuals often have lifelong patterns of aggressive behavior and social interaction aimed at accomplishing that goal. They may have a history of criminal activity, drug or alcohol abuse, or even homelessness.
"Unfortunately, trends suggest that this type of personality is becoming more prevalent in senior housing programs and even long-term care facilities, and the problem of bullying behavior is increasing," points out Attorney Connelly. "It is vital that we recognize the severity of the issue and take steps to address it directly. Whether through more stringent regulations, better staff training, or increased awareness among seniors, we must work together to combat bullying behavior and protect the well-being of all seniors."
Substance Abuse
Baby boomers are carrying their substance abuse habits with them as they age, with binge drinking and prescription drug use being particular concerns in this population. The implications are significant for senior care providers since fifty million people over age 65 in the United States and people over seventy are the fastest-growing group in the nation. Despite the relatively common occurrence of substance use issues in baby boomers, healthcare providers often overlook them for various reasons, including the belief that "old people" cannot have drug abuse issues.
"It has been reported that as people grow older, the use of illegal drugs tends to decrease. However, it is concerning that almost one million people aged sixty-five and above are struggling with substance use disorders (SUD)," said Attorney Connelly. "Based on the latest findings from the Treatment Episode Data Set, a reliable source that tracks the number of individuals who seek treatment for addiction or mental health issues, there is a growing concern that substance abuse among older adults continues to rise."
This worrying trend requires more attention and effective interventions to address the unique needs of this vulnerable population. Here are some numbers to support this finding:
Over the past decade, there has been a significant rise in the number of individuals aged fifty-five or older who have sought out addiction treatment. In 2009, there were 109,412 such individuals admitted to treatment programs. In 2020, that number had risen to 167,200, reflecting an increase of 53 percent.
From 2009 to 2020, the proportion of elderly individuals seeking medical treatment increased from five percent to 12 percent of the total patient population.
Alcohol is the substance that older adults 55+ seek treatment for most often, followed by heroin.
As per the latest data released by the CDC, the number of adults aged sixty-five and over who died due to alcohol-related causes in 2020 was 11,616. While the total number of deaths is relatively low, it is concerning that the rates have been increasing in recent years.
Shockingly, the number of older adults dying from alcohol-related causes rose by a whopping 18.2 percent between 2019 and 2020, which is a significant rise and a cause for worry (and may be related to the COVID lockdown).
STDs and STIs
To start, let's clear up the difference between the terms Sexually Transmitted Diseases (STDs) and Sexually Transmitted Infections (STIs). The main difference is that an infection does not always lead to a disease. While many diseases begin with an infection, not all infections become diseases. For example, Human Papillomavirus (HPV) is the most common sexually transmitted infection. Most people with HPV do not develop any symptoms but can still transmit the virus through sexual contact. If the infection doesn't go away on its own, it can lead to genital warts or certain cancers, which then makes it a disease.
"While young adults and teens are still at the highest risk for STIs, it's important to note that infections among adults aged 65 and older more than doubled between 2007 and 2017," said Attorney Connelly.
According to a recent federal report, the number of cases of chlamydia, gonorrhea, and syphilis has increased by 7 percent from 2017 to 2021, reaching a total of 2.5 million cases. Shockingly, syphilis infections have surged by 32 percent in just one year, from 2020 to 2021. It's important to note that the data only reflects reported cases, but the actual number is likely even higher, according to many healthcare professionals, as many cases go undiagnosed.
According to the National Institutes of Health, because of the "increasing incidence and prevalence of STIs and STDs among older adults, it is essential to assess their knowledge of STIs to promote sexual health and reduce sexual risk. Specific groups of sexually active older adults may be at increased risk of STIs and STDs. Those who are divorced or widowed or those living in congregate settings report increased sexual activity, often accompanied by feelings of freedom and openness to sexual experimentation, which may increase their risks of contracting STIs."
Gambling
"As the gambling industry continues to expand and more forms of gambling are being legalized, experts predict that a growing number of seniors will be drawn to this activity," stated Attorney Connelly. "The availability of modern technology has made it easier for seniors to participate in online betting, raising concerns about the potential risks associated with this practice."
Interestingly, many casinos are now recognized as the new "senior centers" offering seniors a place to socialize and enjoy various gambling activities. This trend is expected to persist in the coming years, which raises important questions about how we can support and protect seniors who choose to engage in gambling activities. As such, it is crucial to implement measures that ensure the safety and well-being of seniors who participate in gambling, such as providing accessible information regarding responsible gambling and offering support services to those who may be experiencing gambling-related issues.
Incarceration
It seems boomers are also bringing criminal activity along with them as well. Some of this can be directly attributed to drug use. So, how much criminal activity is this age group involved in? According to the Prison Policy Initiative (PPI):
Older adults are increasingly ensnared in all parts of the criminal legal process: in arrests, pretrial detention, and imprisonment.
In 2000, 3% of all adult arrests involved people aged 55 or older, and by 2021, this older population accounted for 8% of all adult arrests.
During the COVID-19 pandemic, the segment of the jail population aged fifty-five and older expanded by a more significant proportion than any other age group, growing 24% compared to an average increase of 15% across all other age groups.
Older people make up five times as much of the prison population as they did three decades ago.
The PPI also states that "prisons are unhealthy places for anyone of any age, but keeping older adults locked up is particularly dangerous. A robust body of research shows that incarceration itself accelerates aging: people face more chronic and life-threatening illnesses earlier than we would expect outside of prison, and physiological signs of aging occur in people younger than expected."
Not to mention that behaviors that led to incarceration are not treated due to a lack of treatment programs behind bars and staff shortages, and these behaviors tend to become hardened and transfer to the street when the individuals are released.
Homelessness
The aging baby boomer population is raising concerns regarding accessibility to suitable housing. The increasing prevalence of chronic physical and mental health issues among seniors poses a challenge for finding affordable, safe, and secure housing.
"Unfortunately, the baby boomer cohort represents the fastest-growing homeless group in the country," said Attorney Connelly. "Homelessness among older adults is associated with a range of health issues, including mental illnesses, substance abuse disorders, chronic physical illnesses, diabetes, heart disease, STIs, and STDs, as well as mobility issues. Homeless older adults are often admitted to hospitals, where they may be deemed too ill to return to shelters and placed on a list for subsidized housing or sent to rehab. Some end up in long-term care settings."
Aging in Place
As we look ahead to the future of senior care, it is becoming increasingly clear that "Aging in Place" will play a crucial role in helping seniors maintain their independence and quality of life. This approach centers on providing seniors with the necessary support and services to remain in their homes rather than moving to an assisted living facility, subsidized apartment, or long-term care.
However, it is essential to note that this approach is only practical if seniors have a suitable living space and the necessary social and financial support. For example, seniors living in homes not equipped with necessary safety features such as grab bars, wheelchair ramps, or other modifications may face significant challenges in aging in place. Additionally, seniors who lack access to a support network of family, friends, or caregivers or an adequate income may struggle to maintain their independence and quality of life.
Additionally, the group not able to age in place include individuals who are homeless or living in shelters, those who have a history of incarceration, those who struggle with drug addiction and have had multiple relapse episodes, those with chronic mental health problems who live in group settings, and those with medical conditions that cannot be adequately addressed at home. They end up in subsidized housing or long-term care settings.
Preparing for the Future
"We must acknowledge and prepare for inevitable changes to provide all occupants a secure and safe environment," said Attorney Connelly. "Specifically, seniors who have a history of addiction or criminal activity often rely on these behaviors to attain their needs, as their past experiences of living on the streets or engaging in street activities to acquire drugs or just to live 'safely' have led to the development of long-term and deeply ingrained coping mechanisms that are not typically observed in the average senior."
Similarly, individuals who have been diagnosed with certain forms of mental health ailments or have endured extended periods of incarceration are impacted by the development of such behavioral patterns. Here are just a few examples of what may be in the future for senior care providers:
Pittsfield, Massachusetts
Police in Pittsfield, Massachusetts have arrested two men they say ran a prostitution ring out of an apartment at a senior living facility. Pittsfield police say 65-year-old Joseph Van Wert and 45-year-old Randy Lambach have been held without bail pending a dangerousness hearing scheduled for Nov. 29. Authorities say Lambach recruited drug addicts from Pittsfield, took photos of them, and posted ads on adult websites. Police say he scheduled and drove them to and from meetings with men, kept most of the proceeds, and paid the women in drugs. Police say Van Wert used his apartment at a senior living facility as a place to conduct prostitution.
Englewood, New Jersey
The tale of an alleged senior prostitution ring at a nursing home in Englewood, New Jersey. A 75-year-old man and 66-year-old woman allegedly used crack cocaine and ran a prostitution ring out of their apartments at the low-income Vincente K. Tibbs Senior Citizen Building.
Chicago, Illinois
A 70-year-old resident of a Chicago Heights home for seniors has been charged with selling crack cocaine to undercover sheriff's police officers, the Cook County Sheriff's Office said in a news release Friday. Eddie Cain, who lives at the Golden Towers Senior Community, was arrested Thursday and charged with two counts of delivery of a controlled substance on public housing property.
A Final Word
"As the population of aging Americans grows, the facilities catering to their needs are beginning to adapt to the changing demands of the more active, engaged, and street-smart seniors," stated Attorney Connelly. "This means that the facilities will have to develop new strategies to recruit and train their staff to cater to the changing needs of the aging population."
The staff will need training in a range of skills, including knowledge of addictions and relapse, the development of behavioral plans, all levels of crisis intervention, ongoing training on ethics and boundaries, and comfort in discussing sexuality and teaching safer sex behaviors. Moreover, some senior living facilities now employ full-time security, and some urban programs have local police working in their facilities to ensure the safety of the residents.
"Many senior living facilities are beginning to take a hard look at how they respond to some of the new behaviors that are beginning to occur," said Attorney Connelly. "In the past, these facilities have been reluctant to prosecute residents for some of the activities we mentioned above, which is understandable when dementia or certain mental illnesses are involved. However, when a competent resident without significant mental illness is involved in dangerous activities or inappropriately acts out threatening peers and staff, they should be referred to law enforcement for the safety of all concerned."
"The new mindset among many senior care facility administrators is that behaviors that are criminal in the community are also criminal in the senior living setting when the perpetrator understands, plans, and carries out these activities," continued Attorney Connelly. "This welcome change will ensure that the facilities cater to the changing needs of the aging population and that the seniors receive the best care possible while ensuring their safety."
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