The long-term-care needs of aging Americans aren’t a central political issue yet, but that will soon change. The public sector finances over 70 percent of long-term-care costs in the United States, and those costs are set to increase dramatically in the coming decades as the over-65, and for that matter the over-80 and over-100, population is set to explode. In the most optimistic scenario, biomedical innovation will help us manage these costs by allowing us to delay the onset of various age-related diseases, which is one reason why President Obama’s brain science initiative is if anything too modest. But if cost growth stays on its current course, it is difficult to imagine that voters will allow the public sector to retrench in this domain. If anything, there will be pressure for the public sector to pick up even more of the tab for meeting long-term-care costs, as smaller family sizes, and the broader fraying of family ties, imply that aging boomers will have a smaller number of adult children to help meet their needs. Meanwhile, many of these adult children have children of their own, and the human capital investments middle-income parents are expected to make in their children are substantial and growing more substantial over time. There is thus good reason to believe that the politics of the next decade will be the politics of the sandwich generation.
Biomedical breakthroughs aren’t the only way we can limit the spending increases associated with rising demand for long-term care. Private sector innovation can also play an important role. In the new issue of Pacific Standard, Lisa Margonelli describes an unglamorous private sector initiative that appears to be making a positive difference in the lives of retirees:
One of the biggest questions facing the nation with regard to aging boomers is: Where are they going to live? The options amount to a tangle of euphemisms and politically correct titles: independent living, nursing homes, aging-in-place, naturally occurring retirement communities (NORCs), retirement village, memory-care units, age-restricted communities. All this complexity disguises a simple fact about money, happiness, and aging: Seniors who can live on their own cost the country relatively little—they even contribute to the economy. But those who move into nursing homes start to run up a significant tab—starting at $52,000 a year. People who are isolated and lonely end up in nursing homes sooner. Hence, finding ways to keep people living on their own, socially engaged, healthy, happy, and out of care isn’t just a personal or family goal—it’s a national priority. Among seniors’ living options, there is one we overlook: mobile homes. Time-tested, inhabited by no fewer than three million seniors already, but notoriously underloved, manufactured-homes can provide organic communities and a lifestyle that is healthy, affordable, and green, and not incidentally, fun.
As Margonelli explains, manufactured housing is the largest source of unsubsidized affordable housing in the U.S. 18 million people live in 7 million manufactured housing units, including one out of every 12 Florida residents. Because manufactured housing is better able to exploit economies of scale, it is dramatically cheaper than site-built homes. And if well-maintained, manufactured homes can prove as durable as site-built alternatives. (This extraordinary cost advantage is further evidence that the traditional construction industry ought to draw more heavily on modular construction.) Given that aging baby boomers face severe income constraints, due to the deterioration of defined benefit pensions, the collapse of the housing bubble, and family breakdown, Margonelli argues that for-profit communities of manufactured homes represent a way that retirees can maintain some modicum of independence while economizing on living expenses. She profiles one such community — the Pismo Dunes Senior Park in central California, which residents call “Pismodise” – to describe how it reduces loneliness, which in turn reduces the risk of death and deterioration:
In a paper published in the Journal of Housing for the Elderly, Tremoulet speculates that mobile-home parks can, for some seniors, do a better job of meeting needs than more-traditional arrangements in apartment buildings or in the suburbs. The design of the community allows seniors to own and modify their homes, have dogs, and putter around with hobbies like gardening in a way they couldn’t in an apartment building. Meanwhile, because parks have boundaries and streets, they function a bit like a gated community, where residents feel safe and have an easier time making friends than in either an apartment or a suburb. Mobile-home parks give residents a lot of control over their desire to be alone or to be social, Tremoulet found.
There are, to be sure, some downsides associated with this model, and Margonelli doesn’t shy away from them. But overall, her story is very encouraging: Pismodise seems to have crafted a promising ad hoc solution to a big, complicated, and expensive problem.