"As a society, we're totally unprepared for the aging of America," said James Firman, president of the National Council on Aging. "We have our head buried in the sand. The whole health-care system is out of whack in every way."
Some good news, too, some glimmers of hope, emerged from the annual joint meeting of the American Society on Aging and the National Council on Aging, which drew 4,000 people who work in aging services.
Culture-changing technology is just a few years away - doctors, nurses and boomers will be a touch screen from frail elders, thanks to new interactive computers, monitors, cameras and sensors.
New technologies, presenters said, could provide enough information and assistance to delay the onset of falls or diseases, and in some cases prevent them, improving the lives of elders and caregivers.
Plenty of new ideas for where and how seniors will live at the ends of their lives were discussed. One trend getting attention is "cohousing," where either seniors or people of all ages come together "in community," looking after one another (www.cohousing.org).
A radical, smaller-scale reinvention of the nursing home - the Green House - is expanding fast, experts reported, with 33 in operation by the end of 2007, including one for gays and lesbians, and another with a kosher menu, both in the Boston area. None is yet planned in the Philadelphia area.
And research is revealing ways to improve the lives of elders. For instance, those who engaged in the arts in a serious way have better brain function and health than those who didn't, said Susan Perlstein, director of the National Center for Creative Aging.
Also getting attention are the power and benefits of "civic engagement" - looking at aging Americans as an asset, with great contributions to make, rather than as a burden.
Philadelphia's former Mayor W. Wilson Goode Sr., for instance, has reinvented himself, launching a program, Amachi, to mentor the children of prison inmates. Goode, 69, winner of the $100,000 Purpose Prize for his work, was a scheduled speaker at one session.
One full day of the meeting was devoted to family caregiving. Estimates of the number of family caregivers today range from 17 million to 44 million, depending on one's definition.
That number will only grow as the boomers and their parents age. The prognosis isn't good. "Family caregiving is going to mean the disruption of people's lives," said Emily Friedman, a health-policy analyst in Chicago who spoke at the convention.
She noted that 20 percent of women caregivers under 65 have no health insurance, 46 percent of caregivers have a chronic condition themselves, and 50 percent of family caregivers live in households with less than $50,000 annual income.
She and others noted an ugly catch-22 for women. They tend to be poorer and in greater need of money in later life, so they are less able to leave the workplace in their 50s and 60s. But they must do so to become caregivers.
"When women become caregivers, they are 2.5 times more likely to end up living in poverty," said Cindy Hounsell, executive director of the Women's Institute for a Secure Retirement.
And don't count on family physicians to keep track of all the specialists and medications a frail elder will need.
"Doctors just aren't keeping track, that's a fact," said Gregg Warshaw, a physician and director of the Office of Geriatric and Family Medicine, University of Cincinnati. "Individuals with three or four chronic illnesses have 8 to 14 physicians taking care of them. The complexity for caregivers is a tremendous challenge."
Home health aides are and will continue to be in short supply - increasingly older. All too often the only people poorer than elders receiving care are home health aides providing it for low wages.
Most people at this conference would like to see social insurance, much like Social Security, to cover long-term care. All Americans would pay in beginning at a young age, and those who need help in later life would take out. But experts here said this is still not even being discussed in Washington.
"Policy makers know the need is there, but nobody's willing to pay," said Friedman. She called this a "time bomb."
Currently, the only real help for Americans with long-term care - whether they are getting it at home, or in institutions like nursing homes - is from their own wallets or from Medicaid when they are indigent, having spent all their own money.
One third of Medicaid long-term dollars now pay for poor people to receive some support at home, rather than in nursing homes, said Rosalie Kane, a University of Minnesota professor and long-term-care expert, underscoring the shift toward helping the frailest elderly remain in their own homes.
And several states, including Pennsylvania, are studying public-private partnerships, in which people allowed to keep more of their assets.
"We've got Congress cutting billions in Medicare and Medicaid," said Diane Menio, with CARIE, the coaltion to affirm the rights of the infirm elderly, in Philadelphia. "This whole infastrcutre is really broken."
John Rother, the head of policy and strategy for AARP, was hopeful about health care in general, if not specifically about long-term care.
Last November's elections "liberated health care," putting it back on top of the domestic agenda. This year, he said, "is shaping up to be the most significant for health care since 1965," the year Medicare was formed. He was hopeful that states, if not the federal government, would begin to provide care to the nation's 45 million uninsured.
"What we do about health care is the challenge of our nation," he said. "We don't tackle that, nothing else matters."
Contact staff writer Michael Vitez at 215-854-5639 or firstname.lastname@example.org.