‘Silver Tsunami’ arrives, creating large population of vulnerable older adults

By Dennis Archambault

For an increasing number of older adults, the financial struggle to stay healthy, housed, and fed is becoming a silent, invisible crisis. Health care costs/debt are a major contributor to financial insecurity among all adults, but for older people it’s that much worse.

Despite having access to Medicare – hospital coverage – older adults need to acquire additional coverage, such as a Medigap plan – or don’t qualify for Medicaid and don’t have access to an employer or union-based pension program. The result could be high, unaffordable deductibles and co-pays. A recent survey conducted by  The Commonwealth Fund reveals some alarming, negative indicators that the situation is worsening.

• About one in five adults aged 65 and older with Medicare were underinsured, meaning their out-of-pocket expenses are high relative to their income. People with low incomes, below 200 percent of the federal poverty level (FPL), had the highest rates of underinsurance, with no significant differences between people in Medicare Advantage and traditional Medicare, after accounting for differences in income.
• More than one in five adults aged 65 and older with Medicare reported that they struggled to afford their premiums. For those with incomes under twice FPL, two of five reported struggling to afford premiums.
• Cost-related problems accessing dental care were reported by more than a quarter of older Medicare enrollees. A similar share of those in Medicare Advantage plans as those in traditional Medicare reported delaying or skipping dental care because of the cost. Similar shares of older adults with either type of Medicare coverage reported skipping prescriptions, recommended treatments, or needed specialty care because of the cost.
• About one in six older adults with Medicare reported problems with medical bills and debt, including more than one in five of those with incomes below 200 percent of FPL.

Financial insecurity, often caused by early unplanned retirement and complicated by health care debt, has resulted in more seniors defaulting on their mortgages and being evicted from their homes. A 2017 study of homelessness in three large American cities concluded that the number of people over 65 who are homeless will triple in the next 10 years.

Increased food insecurity among older adults is a related problem. In past 10 years, food insecurity increased significantly from 5.5% to 12.4% among older adults; this increase was more pronounced among lower-income older adults, according to a report by the American Geriatric Society. Food insecurity is associated with lower overall diet quality among older adults, supporting the need for clinical efforts to identify those at risk of food insecurity and public health efforts to alleviate food insecurity and promote healthy eating behaviors among older adults.

For years, demographers have warned that the “silver tsunami” will hit our culture hard and that we needed to prepare for it. The wave has crashed and we’re beginning to see the unfortunate consequences of it.

Dennis Archambault is vice president of Public Affairs for Authority Health.