People prefer to heal and be cared for at home

• A study about helping people achieve their preferred location of care identifies the location as an important indicator of quality end-of-life (EOL) care. The home was the most preferred location for many patient and about half of the asked people preferred to be cared for at home (47%).
• The proportion of people who prefer to be cared for at home versus in a hospice at the end of their life varies between studies. The range for people who prefer to be cared for at home varies between 25% and 87% and the range for people who prefer to be cared for in a hospice ranges between 9% and 30%.
• Most people prefer to be cared for and die at home, but this does not always happen.
• Even though most people die in hospitals in most countries, few want to be cared for in this facility. Informal carers also highly value home care (25%–64%).
•  More than 50% of Australians die in hospitals, yet only one-fifth of patients would prefer to be cared for in a hospital.
• In general, 47% of patients (n-93) prefer home care either in their own home or in a relative's home.

• It is usually cheaper to provide care at home than in a healthcare setting, even for technology support cares.
• Home is the care recipient’s territory and can be considered as a place where they are accustomed to making the decisions and running the show. It allows them a greater sense of autonomy and for the care provider to focus on the care recipient’s goals and wishes or centered care. Also, it is easier to maintain social, community, and family ties from home.
• At home, care recipients may feel more comfortable, be able to better control pain and anxiety, and be "less likely to experience serious complications such as infections or confusions." Care workers can also better determine what factors at home contribute to the recipient's sustained health and recovery, such as nutrition.
• People receiving care in their homes may not consider themselves as "patients" and care in the home is a balance between respecting the care recipient’s autonomy, prioritizing their goals of care, and mitigating risks presented by the environment.
• The elderly can best receive health care at home because the care is less expensive in that environment and it was proved to be crucial for obtaining optimal health outcomes.
• The home environment allows the primary carer to sustain caring.
• Factors that are crucial to well-being are maintaining one's sense of identity, feeling a sense of belonging, and connections. At home, the well-being of the carer can be nurtured the best.
• The important role home plays as a place of well-being and support for informal caring networks when providing end-of-life care is hardly recognized.

• Patients who prefer hospice care are usually 55 years and older, female, single, and have a high socioeconomic status, patients who prefer home care are usually younger, male, have better physical health but poorer mental health.
• The perceived benefits of home care were that family and friends could provide care to the recipient, that the care recipient is in surroundings that are familiar, that the recipient is physically close to those they love, that the recipient is not alone, and that the recipient's family can experience a more “normal life.”
• The care recipients' greatest worries for home care are that their pain might not be managed well, that they might emotionally scar their family or friends, that they do not have access to expert medical care, that their friends and family might not know what to do while they are dying and after death, and that they might not be found for some hours after they have died.
• The perceived benefits of hospice care were that the care recipient's pain would be managed well, that the care recipient would not form a burden for their family and friends, that their family would have a more "normal life", that the recipient would have access to specialized medical care, and that medical personnel would always be available.
• The care recipient's greatest worries with regard to hospice care were that they would be in unfriendly and clinical surroundings, that their friends' and families' last memory of them would be in a hospice facility, that there is no privacy, that they were not ready to die, and that they would be isolated.

The concept of "home" is fluid

• How the home is experienced is fragile and continually changes with age, health, and life events. "Home can be a memory enhancing device helping family caregivers to hold to their memories."
• Even though people prefer to age and be cared for at home, its role and meaning for caregivers has been insufficiently studied.
• An academic study on the meaning of home found that "home is everything" and identified two major themes. The first theme was that home can have different meanings and can be regarded as a safe haven or can look like a hospital and feel like a prison. The second theme is how the impact of a home is perceived, should one relocate or stay at home but redefine the home environment.
• Home is very important to "a caring networks formation and function in end-of-life care."
• Home can be seen as a place where people feel comfortable and that they belong, where they have social connection and where collaborative care is given, where they are connected to nature and non-humans, where they have achievements and triumphs.

• Based on the United States Census Bureau data, the Baby Boomer population accounts for about 74.1 million people.

WILL THE AGING BOOMER POPULATION STRAIN THE EXISTING HEALTHCARE SYSTEM AND HOW?

• According to the Department of Health and Human Services, 47 percent of men and 58 percent of women who are retirement age or older will experience a need for long-term care in the future.
• Americans are living longer than ever before, averaging 78.8 years.
• However, the health care system for older Americans which was a mixture of Social Security, Medicare and Medicaid was built for a society that no longer exists. It was designed for a retirement age of 61 for Social Security and for Medicare and Medicaid it was designed for acute medical issues, like heart attacks.
• “Spending on long-term care is expected to more than double from 1.3 percent of GDP to 3 percent by 2050 as demand increases alongside an aging populace.”
• As of now, Medicaid which was once intended to be the safeguard for the poorest of the poor was showing frailty under the weight of new obligations which is a default payer for 61 percent of all nursing-home residents in the U.S. and projected to continue to increase, according to a June 2017 Kaiser Family Foundation report.
• According to the analysis from the Centers for Medicare and Medicaid Services, US Baby Boomers shifted out of private coverage to Medicare.
• This shift of health care providers cause the paying nearly half the nation's health care tab in less than 10 years and is projected to surpass $5.9 trillion in 2027 accounting for 19 percent of gross domestic product, according to a federal report.
• According to a yearly forecast of U.S. health-care expenditures, aging baby boomers will consume a larger share of the nation’s health-care spending in the near future as the number of people covered through Medicare — and spending on the federal insurance program for older and disabled Americans — is expected to grow more rapidly than private insurance or Medicaid.
• “Average annual spending growth in Medicare (7.4 percent) is expected to be higher than that of Medicaid (5.5 percent) and private insurance (4.8 percent) over the next decade, as more baby-boomers hit age 65 years and "use and intensity" of covered services increases.”
• According to 2017 Supplemental Poverty Measure, increasing medical costs in the US pushed 14 percent of those over age 65 to poverty and the poverty rate increased by 5.4 percentage points when medical expenses were subtracted from income.
• According to Kaiser study, adults age 65 and older, including those covered by Medicare, already spend 41 percent or more of their average per capita Social Security income on health care and is projected to rise to 50 percent by 2030.
• “Current conversations surrounding Medicare policy changes have included raising the retirement age or reducing benefits.”

WILL MILLENNIALS BE IMPACTED IN TERMS OF CARING FOR THEIR AGING BOOMER PARENTS AND HOW?

• According to an AARP report, adult children are already contributing $7,000 to $14,000 a year to caring for an aging parent which would likely to increase too.
• According to Joseph Coughlin, founder and director of the Massachusetts Institute of Technology AgeLab, 34.5 million millennial Americans provided unpaid care to a person over 50.
• According to a Work Services study, the average millennial caregiver spends an average of 21.2 hours a week assisting a loved one.
• "As tens of millions of people take on caregiving responsibilities each year, supporting those caring for our aging population has become one of the most pressing financial issues of our lifetime," Lorna Sabbia, head of Retirement and Personal Wealth Solutions for Bank of America Merrill Lynch, tells Coughlin.
• These are due to the fact that many millennials started their careers burdened with extreme student debt, so up until now they've been more inclined to prioritize salary over flexibility when looking for jobs.
• “As for distance, millennials have moved away from their hometowns in greater proportions than prior generations, so logistics have become a bigger caregiving consideration. And finally, a high rate of divorce among baby boomers means millennials often have to manage separate lives for their parents.”
• Additionally, caring for the aging parents was a struggle for working Millennial as the US does not have a national policy offering paid family leave and leave the decision up to employers.
• “Just 15 percent of workers across the country have access to paid family leave through their employers, and roughly 40 percent don’t even have access to job-protected unpaid leave through the federal Family and Medical Leave Act (FMLA).”
• According to a report by the AARP and the National Alliance for Caregiving, nearly 25 percent of the 43 million adult caregivers in the U.S. are millennial between the ages of 18 and 34.
• “Though many millennials face crushing student loan debt, uncertain job prospects and lower wages than previous generations, 86 percent of adults ages 18 to 29 told the Pew Research Center they view it as their responsibility to financially help aging parents. But many are struggling to balance these new duties with their own careers.”