Forecasting Elder Care Trends for the 21st Century.

• Position: Brief Article

Medicaid will be gutted before reasonable alternatives can be found by Federal and state governments. American workers will opt for long-term care benefits in lieu of pay raises. More businesswomen moving into leadership positions means a greater shortage of elder-caregivers. One in nine baby boomers will live at least 90 years. Those 85 years old and over will triple in number by 2020. These and other prognostications come from the 21st Century Eldercare Trends report created by SCAN, a managed care plan for seniors that could be the model for solving many of the health care challenges facing the country in the next 50 years.

The SCAN report details 12 major trends in elder care. With the aid of demographic projections and survey analysis, the report conceptualizes the future of elder care in America. For example, the need for caregivers has fostered a trend to telecommuting. The percentage of companies with telecommuting rose steadily during the 1990s and will continue as the population ages.

"Health care maintenance in this country must undergo a dramatic overhaul if we are to care for the 13,000,000 people who will need caregiver assistance by the year 2020," warns Sam L. Ervin, president and chief executive officer of SCAN. "While the White House and Congressional leaders have promised Medicare reform this year, it appears that the future of health care in this country will merely be a subject used to fuel campaign rhetoric leading to the 2000 elections."

The result, he contends, is likely to be a shallow agreement based on partisan politics. "The big picture will be missed unless our leaders in Washington face cold facts and look at where we are heading."

The median age of Americans has been steadily rising since 1970. The Census Bureau projects that the over-65 population will more than double between 2000 and 2050. In 1900, one American in 25 was 65 or over; in 1984, one in nine. The Census Bureau predicts that, by 2050, one in five Americans will be 65 or over, with the proportion of "oldest-old," those 85 and over, growing even more rapidly--tripling in size by 2020.

One of the biggest questions is who will care for the aging population as more and more women, the primary caregivers, move into...