Bridging the Gap: The Urgent Need to Reform America’s Older Adult Care System

In the older years of life, every individual deserves the dignity of care and support. Yet, in the United States, a silent crisis is unfolding. A significant portion of aging adults face their daily struggles alone, without the necessary care and assistance. This issue, deeply rooted in the systemic reliance on family for Older Adult Care, leaves those without family or sufficient wealth particularly vulnerable.

The Stark Reality of Unmet Needs

Imagine a day in the life of an older adult struggling with basic tasks like dressing or preparing meals. Now, picture that person reaching out for help, only to find no one there. This is the reality for 8.3 million people, or 42 percent of adults who have difficulty with these tasks and did not receive any help in 2020. This alarming statistic from a policy note by the Schwartz Center for Economic Policy Analysis is like a canary in a coal mine, signaling a deeper, more pervasive issue in the U.S. Older Adult Care system.

The consequences of unmet care needs are profoundly serious and far-reaching. Older adults lacking essential support are more prone to accidents, such as falls that can lead to hip fractures, a common and severe injury among older adults that often leads to long-term disability and increased dependency. Without help for daily tasks, these individuals might struggle with medication management, leading to preventable hospitalizations due to incorrect dosages or missed treatments.

They also face more negative health outcomes, including a higher incidence of chronic conditions worsening due to neglect or improper care. Increased disability levels are another significant concern, as older adults might find their mobility and independence rapidly diminishing when they don’t receive the necessary assistance, turning once-manageable tasks into insurmountable challenges. This lack of support not only diminishes their quality of life but also places a heavier burden on healthcare systems.

The Dependency Dilemma

America’s Older Adult Care system is heavily dependent on unpaid family caregivers. This model, while rooted in familial responsibility, overlooks the changing dynamics of modern society. With declining marriage and fertility rates, and higher divorce rates, the future looks bleak for aging individuals without a family support system. The policy note highlights that “there are 7.2 million adults over the age of 55 who have no spouse and no living offspring,” underscoring the growing segment of the population at risk of neglect. It’s like expecting a garden to thrive without a gardener to tend to it.

Wealth: Not a Guarantee for Care

Contrary to what many might assume, having wealth does not necessarily guarantee care. The research reveals a counter-intuitive result: significant shares of people across all wealth quartiles do not receive the care they need. It’s like owning a car but not having access to a mechanic. “Only 23 percent of adults aged 55 and older who have difficulty with one or more ADLs or IADLs received some care from a paid professional,” the policy note states. This finding indicates that the issue transcends economic boundaries, affecting individuals across the wealth spectrum.

A Call for Systemic Reform

The current state of affairs calls for urgent systemic reform. Expanding Community Medicaid is proposed as a viable solution. This program provides financial subsidies for care services in homes or communities, yet its accessibility varies significantly across states. The policy note argues for expanding access and raising enrollment caps, especially in states with long waiting lists or low-income and asset-eligibility caps. It’s akin to opening more lanes on a congested highway to allow more traffic to flow.

The Path Forward

As America grapples with this growing crisis, it’s clear that a multifaceted approach is needed. Expanding Community Medicaid is just the start. The nation must also invest in innovative care solutions, support caregiver networks, and foster a culture that values and supports its aging population. It’s like repairing a bridge while also building new ones to ensure everyone can cross safely.

In the words of Forden and Ghilarducci, “Expanding access to benefits like Community Medicaid will help Americans across the wealth spectrum get help without having to rely on unpaid family caregiving or pay for high-cost professional care.” It’s a poignant reminder that in the pursuit of a more caring society, no one should be left behind.

As policymakers, stakeholders, and communities ponder the future of Older Adult Care in America, the time for action is now. By bridging the gap in care, we can ensure that the later years are marked by dignity, support, and compassion, not neglect and struggle. It’s about building a society that holds every life as precious, supporting each other from the first steps to the last.


In the U.S., a crisis in Older Adult Care leaves millions of aging adults without necessary support, leading to serious health consequences and increased dependency. Despite the common belief, wealth doesn’t guarantee care, with many across all economic levels struggling to receive needed assistance. The system’s heavy reliance on unpaid family caregivers fails those without close family ties, a situation exacerbated by changing societal dynamics. Urgent systemic reform is needed, with expanding Community Medicaid proposed as a key solution to provide financial aid for care services. A multifaceted approach is essential, including innovative care solutions and support networks, to ensure a dignified, supported, and compassionate environment for all aging individuals.


Forden, J., & Ghilarducci, T. (2023). U.S. Caregiving System Leaves Significant Unmet Needs Among Aging Adults. Schwartz Center for Economic Policy Analysis at The New School for Social Research. Retrieved December 22, 2023, from


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  • Comment (2)
  • It is important to note that the Older Americans Act provides for home and community based services to seniors. These services are provided through Area Agencies on Aging and their partner organizations. There are 611 AAAs covering all 50 states. Not mentioning this network of services leads the reader to believe that there is not already a formal and integrated local network nationwide of service provision to our most vulnerable seniors.

    • Thank you so much for your input, Ann Marie! This is a very helpful clarification for our readers. We in no way intended to minimize the very important work of AAAs and greatly appreciate the feedback.

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