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Time Magazine
5 hours ago
- Time Magazine
Why So Many Seniors Can't Afford Long-Term Care
Aisha Adkins' mother Rosetta was adamant that she wanted to age at home. So when Rosetta's dementia started worsening at age 59, Aisha started looking around for options. She quickly found that round-the-clock at-home care was extremely costly, and that her mother didn't qualify for government assistance. Stuck in the middle, Aisha, who was 29 at the time, ended up quitting her job to take of her mother care of her herself. At first, Rosetta just needed help preparing meals and reminders to take her medication. But as her care needs deepened, Aisha had to learn how to bathe and dress and feed her mother. She and her father hired a home health aide for a few hours a week when they could, but most of the care fell to the two of them until her mother finally qualified for Medicaid through a complicated process called spousal impoverishment protection, which allowed her father to keep some assets. 'We faced so many challenges; it was really a struggle,' says Adkins. She ended up caring for her mother for ten years on both a full-time and part-time basis, until her mother passed away in 2023. Many middle-income seniors are unable to afford care As the U.S. population ages, many families are facing the same challenges. Long-term care, which is assistance with the activities of daily living either in a person's home or in a facility, is expensive. Most people pay for it either out of their savings, or by spending down those savings until they qualify for Medicaid, which covers long-term care for indigent seniors. (Medicare does not cover senior housing or long-term care.) But there's a large group of people who are stuck in-between: they are 'too rich' to qualify for the Medicaid benefits that enable them to hire at-home help or put loved ones in a nursing home, but they do not have enough money to pay for the in-home, all-hours care their loved one needs. It then falls to family members to make up the difference. Around two-thirds of caregiving hours for older adults in the U.S. are provided by informal and unpaid caregivers. On one end of the spectrum, there are many expensive communities for seniors with deep pockets who want to start out in apartments and continue on to assisted living or more extensive care. On the other end, there are nursing home spots available for people who qualify for Medicaid, the government payor of last resort, which is strictly for low-income seniors or people who have spent down their savings. Read More: How Health Insurance Monopolies Affect Your Care But 'there aren't a lot of middle-income options on the market, so inevitably people rely on family care and out-of-pocket home care until they end up qualifying for Medicaid,' says David Grabowski, a health care policy professor at Harvard Medical School and one of the authors of a 2019 study about middle-income seniors. His research predicts that as the U.S. ages, many seniors will have insufficient resources for housing and health care needs. People like Rosetta Adkins are often referred to as the 'missing middle' or 'forgotten middle'—the seniors who aren't wealthy but who also aren't poor. There just aren't a lot of options for these seniors in the middle who need care. One 2021 study estimated that a nursing home in the U.S., on average, costs $100,740 per year for a semi-private room, and that home care for six hours a day, five days a week costs $42,120 a year. The costs have only gone up since then. By 2033, researchers at the University of Chicago estimate, there will be 16 million middle-income seniors who can't afford to pay for the health, personal care, and housing services they need. They will have to rely on family members—or on themselves—until they can qualify for Medicaid. There may be even more people in this situation going forward, after the giant cuts to Medicaid in the Trump economic plan recently approved by Congress go into effect. Home and community-based care for low-income seniors is considered an optional program in Medicaid, so states can cut it when their budgets are thin. That may mean that in some states, it will take even longer for people like Rosetta Adkins to qualify for care through Medicaid, putting even more pressure on family members to help out. 'When a state's Medicaid budget is constrained, which is absolutely going to happen because of this bill, there will be limits on some of these home-based services,' says Allison Orris, a senior fellow at the Center on Budget and Policy Priorities, a national research and policy institute. A lack of options puts stress on family members Family members already face intense pressure to provide care for their ailing loved one while still maintaining their careers and taking care of children. One recent report by researchers at Columbia University's Mailman School of Public Health found that nearly half of U.S. states are on the brink of an unpaid family caregiving emergency. That means that in many states, unpaid family caregivers are contributing hundreds of billions of dollars of unpaid labor. The report found that dementia care—like the kind sought by the Adkins family—is driving a lot of the labor. 'It is repeatedly the family caregiver who shoulders the immense pressures generated by health care shortages and rising dementia cases,' says John McHugh, lead researcher of the study and an adjunct assistant professor of health policy and management at Columbia University's Mailman School of Public Health. Read More: The Surprising Reason Rural Hospitals Are Closing Aisha Adkins, for instance, set aside her career so she could care for her mother. Her life choices for the next decade were determined by what her mother needed: picking a graduate school nearby and then finding a job that would allow her to work remotely. Aisha, who is only 40, is already worried about how she will pay for her own long-term care when she ages because she was out of the workforce so long caring for her mother. This, too, is not uncommon. 'Many times, family members are reducing their own incomes because they're taking time out of the workforce, or they're working less,' says Amber Christ, managing director of health advocacy at Justice in Aging, a nonprofit that advocates on behalf of low-income seniors. 'They're risking their future retirement, which increases the likelihood they'll age into poverty. So it's really a multigenerational impact.' There's a reason there aren't many options for middle-income seniors: companies can't make money providing it. Over the past few decades, many expensive aging facilities have opened as investors put money into options for Baby Boomers who have extensive savings. But those places are out of reach for many seniors. 'The million-dollar model seems to work,' says Grabowski. 'But middle-income models don't seem to thrive.' Though there are options for nursing homes and facilities for seniors on Medicaid, they often provide a relatively low quality of care, with sparse staffing and dilapidated facilities. Options for middle-income seniors are also limited because many people want to age at home, but at-home care is expensive and there are vast staff shortages, especially in rural areas. The industry is plagued by low compensation, unpredictable scheduling, and high turnover. Analysts predict this shortage will only worsen, with an estimated 4.6 million unfilled jobs by 2032. Aisha Adkins says that even when her mother qualified for Medicaid, it was extremely difficult to get aides to consistently come to the house and provide care. Inexperienced caregivers didn't know how to handle her mother's dementia, so Aisha or her father still had to stay in the home even when a caregiver was around. 'It really fell to my father and myself to ensure that she was safe at all times, even sometimes when the caregiver was in the home,' she says. Solutions for middle-income seniors are expensive Adkins says she now advises friends to look into long-term care insurance or think more carefully about putting aside more money for when they age. But even long-term care insurance, which requires people to pay monthly premiums as they age so they can have care when they need it, has proven so inadequate that only about 4% of Americans 50 and older pay for a policy. Though most people spend down their savings to qualify for Medicaid, elder law attorneys can sometimes help people protect their savings from long-term care costs. "It's worth meeting with and listening to an elder law attorney to find out how to protect your resources," says Eric Einhart, president of the National Academy of Elder Law Attorneys. A few states have tried to help people pay for long-term care by establishing state programs. The WA Cares Fund, in Washington State, is a mandatory program that takes a small percentage of the paychecks of working Washingtonians and then allows them to access benefits of up to $36,500 to pay for long-term care services. But that amount of money won't last them very long if they need more than a few months of care. The lack of long-term care planning in the U.S. is a contrast to many other countries. The Netherlands, for instance, has long included long-term care in its universal health care system, and requires that taxpayers contribute a chunk of their income towards insurance premiums. In 2019, Singapore introduced a mandatory long-term care insurance program. Japan has had a mandatory long-term care insurance system since 2000; it requires people 40 and over to contribute. Read More: America's Dental Health Is in Trouble Most experts agree that the U.S. needs some sort of plan to help more seniors pay for long-term care, especially as Baby Boomers age. Otherwise, many people will spend down their savings until they qualify for Medicaid, which is going to get very expensive for the U.S. government. 'We're going to be swamped by just the pure number of individuals in the system who need long-term care going forward,' says Grabowski. 'We're not at a place politically today to talk about this,' he says—because recently so much discussion has been focused on cutting services, rather than adding them—'but in the longer run, it's a discussion we really need to have.' It's something Aisha Adkins knows at her core. Although her mother passed away in 2023, Adkins is gearing up for another struggle. Her father was recently diagnosed with a type of dementia, too. He spent almost all of his savings paying for Rosetta's care. Now, Aisha is starting to look into options for him. She knows, from experience, that they will be limited.
Scientific American
11 hours ago
- Scientific American
The Pandemic Aged Everyone's Brain—Even in Healthy People
The brains of healthy people aged faster during the COVID-19 pandemic than did the brains of people analysed before the pandemic began, a study of almost 1,000 people suggests. The accelerated ageing occurred even in people who didn't become infected. The accelerated ageing, recorded as structural changes seen in brain scans, was most noticeable in older people, male participants and those from disadvantaged backgrounds. But cognitive tests revealed that mental agility declined only in participants who picked up a case of COVID-19, suggesting that faster brain ageing doesn't necessarily translate into impaired thinking and memory. The study 'really underlines how significant the pandemic environment was for mental and neurological health', says Mahdi Moqri, a computational biologist who studies ageing at Harvard Medical School in Boston, Massachusetts. It's unclear whether the pandemic-associated brain ageing is reversible, because the study analysed scans taken at only two time points, adds Moqri. On supporting science journalism If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today. The findings were published today in Nature Communications. Pandemic effect Previous research has offered clues that SARS-CoV-2 infections can worsen neurodegeneration and cognitive decline in older people. But few studies have explored whether the pandemic period — a tumultuous time marked by social isolation, lifestyle disruptions and stress for many — also affected brain ageing, says study co-author Ali-Reza Mohammadi-Nejad, a neuroimaging researcher at the University of Nottingham, UK. To find out, Mohammadi-Nejad and his colleagues analysed brain scans collected from 15,334 healthy adults with an average age of 63 years in the UK Biobank (UKBB) study, a long-term biomedical monitoring scheme. They trained machine-learning models on hundreds of structural features of the participants' brains, which taught the model how the brain looks at various ages. The team could then use these models to predict the age of a person's brain. The difference between that value and a participant's chronological age is the 'brain age gap'. The team then applied the brain-age models to a separate group of 996 healthy UKBB participants who had all had two brain scans at least a couple of years apart. Some of the participants had had one scan before the pandemic and another after the pandemic's onset. Those who'd had both scans before the pandemic were designated the control group. The models estimated each participant's brain age at the time of both scans. Nearly six months more The models predicted that the brains of people who had lived through the pandemic had aged 5.5 months faster on average than had those of people in the control group, irrespective of whether those scanned during the pandemic had ever contracted COVID-19. 'Brain health is shaped not only by illness, but by our everyday environment,' says Mohammadi-Nejad. Pandemic-related brain ageing was most pronounced among older participants and men, who are known to be more susceptible to neurological changes when they are stressed than women are. The brains of those experiencing hardship, such as unemployment, low income and poor health, also aged faster than did those of other participants, suggesting that these lifestyle stressors have a detrimental impact on brain health. Form and function Next, Mohammadi-Nejad and his colleagues assessed participants who had completed cognitive tests both times they were scanned. They found that only those who had a SARS-CoV-2 infection in the interval between the scans showed signs of cognitive decline, such as reduced mental flexibility and processing speed. This suggests that physical brain ageing might not have been severe enough to affect mental acuity during the pandemic. 'Some changes do not trigger symptoms, and some others take many years for any symptom to be manifested,' says Mohammadi-Nejad. Although the findings are 'compelling' evidence that brain ageing accelerated during the pandemic, more work needs to be done to investigate a causal link, says Agustín Ibáñez, a neuroscientist at the Adolfo Ibáñez University in Santiago. He adds that future studies should include data on factors such as mental health, isolation and lifestyle to clarify the mechanisms underlying the brain-ageing effect and how it plays out in people from different backgrounds. The next steps for Mohammadi-Nejad and his colleagues are to unravel some of these mechanisms and explore whether the effects are long-lasting.
WebMD
5 days ago
- WebMD
Weight Loss Drugs Work – but Only if You Do These 3 Things
July 18, 2025 – You know them by names like Ozempic and Wegovy, and for what they can do – help people lose weight. But if you're among the roughly 1 in 8 Americans who've tried GLP-1 drugs – including newer options like Zepbound and Mounjaro, which target more than one hormone – you could be at risk of nutrient deficiency, muscle loss, and even bone loss, unless you make diet and exercise part of the picture. "Although GLP-1 medications are a major breakthrough in obesity management, lifestyle factors still matter," said JoAnn E. Manson, MD, a professor of medicine at Harvard Medical School. "Outcomes of patients on these medications are much better with attention to adequate protein intake, healthy diet, good hydration, and regular muscle-strengthening exercises to mitigate the loss of lean body mass." Manson is a co-author of new guidelines to help, published in JAMA Internal Medicine, one set for doctors and another for patients. "These represent what we believe are the first systematic tools to implement lifestyle interventions alongside GLP-1 medications," said Farhad Mehrtash, MPH, a co-author of the guidelines and a graduate of the Harvard T.H. Chan School of Public Health. Here's a three-pronged approach to make the most of modern weight loss medications. 1. Maintain Your Muscle With any weight loss, including that with GLP-1s, you don't get to pick where you lose it. "Loss of muscle and lean body mass is common on these medications, on average about 25%," said Manson. Over time, that can lead to bone loss too, especially in older adults or those with sedentary lifestyles. Eat plenty of protein, the guidelines say. Aim for 1 to 1.5 grams per kilogram (or about half a gram per pound) of body weight each day – or 20 to 30 grams per meal. That's slightly higher than the standard 15 to 30 grams per meal recommended for all adults. Exercise is also critical. Start with an evaluation of where you are now, and slowly work up to 150 minutes of cardio (like walking) and two to three 30-minute strength sessions each week, the CDC's recommended activity level. Don't just rely on your doctor to guide you. "Most doctors won't have the time to thoroughly go through your exercise history, current lifestyle, and any hurdles to beginning exercise," said Samuel Klein, MD, a professor of medicine and nutritional science at Washington University in St. Louis. "Work with a trainer or someone who is an expert in how to exercise." Insurance might cover personal training (if a doctor prescribes it as part of a medically necessary treatment plan), but a better bet: Ask your health care provider if it offers a formal weight management program – many qualify for reimbursement. 2. Sidestep Side Effects The right eating strategy can help offset potential digestive side effects, such as constipation, nausea, and heartburn. "I recommend smaller, more frequent meals, decreasing fat and salt intake, and chewing slowly so that you reduce the amount of bulk leaving your stomach," said Klein. That helps your gut better manage the slower-than-usual movement of food into your intestines caused by GLP-1s. Staying hydrated helps keep things moving, too – and dehydration is a risk of these medications, which suppress thirst along with appetite. The guidelines encourage eight to 12 glasses of water a day, along with soups and water-rich fruits and vegetables like cucumbers and watermelon. Keep dehydrating drinks with things like alcohol and caffeine to a minimum. 3. Keep These Habits – Even Post-Meds These medications are intended for long-term use, said Jody Dushay, MD, a co-author of the guidelines and assistant professor of medicine at Harvard Medical School. "That said, once people reach a weight loss plateau at the highest tolerated dose, then you move to the weight maintenance phase of treatment." That could mean "lowering the dose, staying on the same dose but extending the number of days between injections, or, least commonly, a trial off medication," Dushay said. In general, keeping weight off is notoriously difficult, but research suggests that the key to success comes down to one thing: consistency. "Weight regain is highly individualized and depends on many factors," said Dushay. Chief among them is an "ongoing engagement in a healthy lifestyle."
