Risking Old Age in America: The Coming Elder Care Crisis

Solutions for the coming elder care crisis
  • 4.0 (4)
  • Society & Culture
  • Updated Semimonthly

In just five years, the oldest of the 65 million baby boomers in the United States will begin reaching their late 80s, the age at which people are more likely to need care. At the same time, most younger baby boomers have already left the workforce, many without enough money to pay for retirement, much less their future care needs. In this podcast, I talk with experts in the fields of aging and elder care about what this will mean for the nation and how we can prepare, both collectively and individually.  More on Harry Margolis: https://margolisbloom.com/harry-s-margolis/ Harry’s Substack: https://okayboomer.substack.com/  

  1. 5d ago

    Nicole Jorwic on Caregiving’s Funding Crisis

    Harry interviews Nicole Jorwic, Chief Program Officer at Caring Across Generations, about the challenges facing unpaid family caregivers and the paid direct care workforce. Jorwic explains that unpaid caregivers contribute about $1.1 trillion annually, while the largely female, heavily immigrant direct care workforce faces low wages, limited benefits, and unstable jobs—creating a system where care is both underpaid and unaffordable. She argues Medicaid funds over 70% of direct care wages and warns that the nearly trillion-dollar Medicaid cuts in the One Big Beautiful Bill Act, including work requirements, will increase red tape, strain state systems, reduce provider rates, and worsen waiting lists and caregiver burden. The conversation covers strengthening wages and career pipelines, adding a home care benefit to Medicare (“Medicare at Home”), making Medicaid home- and community-based services mandatory, and exploring payroll-tax models like WA Cares. Jorwic urges families—especially baby boomers—to start planning conversations and highlights CareConversations.com.   Topics 02:00 Who Provides Care 02:43 Caregiver Challenges 04:44 Medicaid Funding Squeeze 06:03 Congress Cuts Fallout 08:45 Work Requirements Red Tape 13:30 Strengthening Care Jobs 15:33 Supporting Family Caregivers 18:29 Paying Family Caregivers 20:15 Credits and Tax Relief 22:07 Future Workforce Crunch 24:15 Fixing the Cost Paradox 26:25 Three Leg Policy Plan 28:37 Public Support and Hope 31:00 Top Policy Priority 32:36 Start Care Conversations

    Nicole Jorwic on Caregiving’s Funding Crisis

  2. Aug 19

    Robert Espinoza on The CareWorks Project & the Caregiving Economy

    Harry interviews Robert Espinoza, founder of the CareWorks Project, about improving long-term care quality and delivery. Espinoza describes his 16-year career in the sector and argues the U.S. long-term care system was designed as an extension of hospitals, despite most care now occurring at home and people wanting person-centered, dignified support. They discuss affordability, citing annual median costs ranging from about $75,000 for home personal care to $170,000 for a private nursing home room, and an estimated $563 billion spent on long-term services and supports in 2023, alongside major unpaid and opportunity costs, including over $1 trillion in unpaid family caregiving. Espinoza warns of worsening workforce shortages, with high turnover and over nine million openings needed, and advocates for a federal social insurance program, stronger state experimentation, and more proactive immigration policy. He outlines CareWorks services in advising, program design, narrative change, and leadership support.   Topics 00:35 Robert’s Care Journey 03:09 Why Care Feels Institutional 04:54 Affordability and Hidden Costs 08:51 Unpaid Caregiving Economy 10:53 Crisis Becoming Catastrophe 12:43 Workforce Shortage Reality 14:04 Social Insurance Solutions 16:52 States vs Federal Action 18:42 Vesting and Social Contract 23:07 What CareWorks Project Does 25:34 Policy Ask Immigration Reform 27:56 Advice for Families 30:06 Closing Thanks

    Robert Espinoza on The CareWorks Project & the Caregiving Economy

  3. Aug 5

    New York’s Master Plan for Aging with Greg Olsen

    Harry interviews Greg Olsen, longtime director of the New York State Office for Aging, about preparing for a surge in older adults as baby boomers reach 85. Olsen explains the Office for Aging’s role as the community-based, non-medical long-term care system created under the Older Americans Act, providing services such as meals, transportation, personal care, home modifications, benefits help, and case management to help people remain independent and avoid costly institutional care; Governor Hochul has invested $238 million in these services. He describes New York’s Master Plan for Aging as a cross-agency, public-driven process to combat ageism, support healthy aging, and strengthen supports for those needing assistance, citing extensive stakeholder engagement and examples like caregiver supports, food-as-medicine, an office for older workers, expanded NORCs, hospice access efforts, benefits coordination, and fraud prevention. Olsen urges federal policymakers not to cut Medicaid and other supports, and advises families to plan early, understand who pays for care, seek help before crises, and focus on prevention to reduce dementia risk.   Topics 00:52 Meet Greg Olsen 02:00 What the Office Does 03:34 Accessing Services 04:10 Why It Feels Hidden 04:52 Why a Master Plan 05:58 Older Adults Economic Value 06:56 How the MPA Was Built 09:25 Goals and Focus Areas 11:32 Prevention and Culture Shift 13:19 Medicare vs Medicaid Reality 14:23 Costs and What to Change 15:21 Housing and Community Design 18:47 Managing 100 Proposals 20:44 MPA Wins and Examples 24:06 Advice for Other States 27:07 Federal Policy Ask 30:37 Advice for Families 32:18 Closing Thanks

    New York’s Master Plan for Aging with Greg Olsen

  4. Jul 22

    Professor Israel Doron on UN Rights for Elders & Israel’s Long-Term Care System

    Professor Israel (Issi) Doron, a lawyer and gerontology scholar from the University of Haifa and visiting professor at UMass Boston, describes how an AARP Legal Counsel for the Elderly internship in the early 1990s led him into elder law, followed by a PhD in Toronto on elder guardianship and international work promoting a UN human rights convention for older persons. He explains that older persons lack a dedicated UN convention, notes gaps such as limited recognition of age discrimination and ageism, and recounts recent progress from the Open-Ended Working Group to the Human Rights Council’s active drafting process, which he attended in Geneva. Doron compares Israel and the US: Israel has universal healthcare and a social-insurance community long-term care benefit (about 20+ weekly in-home hours for most), relies on family care plus paid workers (including migrants), and uses needs-based institutional coverage with filial responsibility; Israel also has widespread private long-term care insurance. He highlights Israel’s younger median age due to high fertility but high life expectancy and strong family support, says Arab Palestinians receive the same entitlements, and recommends universal healthcare for US policy and proactive legal/financial planning for families.   Topics 00:00 Meet Professor Doron 01:41 From Human Rights to Elder Law 03:33 Why a UN Convention Matters 06:18 Will It Affect the US 08:54 How Elder Care Works in Israel 14:52 Who Provides Home Care 19:11 When Care Needs Increase 25:13 Demographics and Family Support 28:32 Arab Israelis and Elder Care 30:57 Advice for Policymakers and Families 35:06 Closing Thanks

  5. Jul 9

    LogicMark CEO Chia Lin-Simmons on AI-Enabled Medical Alerts

    Chia Lin-Simmons, CEO of LogicMark, describes becoming a “sandwich generation” caregiver after her experience with an embarrassing, imprecise, unattractive medical alert worn by her mother-in-law, motivating her to modernize the category with AI and IoT. Drawing on 30 years in tech (including Harman, Audible, Google, and an AI startup), she explains LogicMark’s shift from reactive fall alerts to more precise multi-sensor detection and predictive, proactive monitoring using longitudinal data, digital twins, and pattern analysis to anticipate risks. Data is shared via caretaker apps that create a “care village” including family, neighbors, and professionals. She highlights product design to reduce stigma, adding features like cameras, GPS/geofencing, and smaller phone-like form factors. The conversation covers caregiver shortages, enterprise integration, non-wearable sound-based devices, and policy priorities: veterans’ health support, Medicare/Medicaid coverage for enabling tech, and immigration to bolster the care workforce, plus advice for boomers to adopt safety tech, declutter, and plan early.   Topics 02:10 The Ramen Alarm Moment 03:51 Beyond Ive Fallen 06:32 Digital Twins Prevention 10:27 Care Village Apps 11:42 Design Seniors Will Wear 15:46 Future Of Aging Tech 21:24 AI Supports Human Care 27:08 Policy And Personal Advice 31:23 Family Stories And Wrap

    LogicMark CEO Chia Lin-Simmons on AI-Enabled Medical Alerts

  6. Jun 24

    Right Place, Right Time: Ryan Frederick, Founder and CEO of Here

    Harry interviews Ryan Frederick, founder and CEO of Here and author of ‘Right Place, Right Time,’ about how where you live influences quality of life, health, longevity, finances, and social connection—especially in the second half of life. Frederick explains his path from Silicon Valley to senior housing and writing the book during the pandemic, concluding that people lack a framework to evaluate “place.” He defines place through four quadrants—environment, health, community, and finances—and stresses that people choose “micro places” that shape daily life. He describes “place planning” as an intentional process that may or may not involve moving, emphasizing agency in how you engage your home and community and encouraging experimentation before major changes like relocating or moving abroad. The conversation addresses aging in place, senior living options, zoning barriers to downsizing within one’s community, and policy ideas such as increasing accessible housing supply and reducing tax frictions that discourage older adults from moving.   More on Ryan: https://www.ryanfrederick.life/ Ryan’s book ‘Right Place, Right Time’: https://a.co/d/0hXfYGXs   Topics 00:44 Ryan Frederick Origin Story 02:57 Writing Right Place Right Time 05:50 Four Quadrants of Place 08:11 Micro Places and Connection 09:30 What Is Place Planning 11:26 Intentionality and Agency 15:02 Aging Health and Longevity 19:01 Rethinking Aging in Place 21:09 Senior Living Options 22:31 Zoning and Housing Supply 24:13 Moving Abroad and Life Chapters 29:00 Policy Fixes for Better Housing 32:29 Advice to Boomers Plan Ahead 34:32 Closing Thoughts

    Right Place, Right Time: Ryan Frederick, Founder and CEO of Here

  7. Jun 10

    Inside PACE with Anthony Zizza

    Anthony Zizza, a geriatrician and chief medical officer at Element Care PACE, describes his career from Beth Israel Deaconess and Harvard to Landmark Health, a mobile interdisciplinary house-calls group serving the top 5% of complex Medicare Advantage patients, and why PACE was a natural next step. He explains PACE (Program of All-Inclusive Care for the Elderly) as a Medicare/Medicaid model for adults 55+ who are nursing-home eligible but can live safely in the community with support, offering an integrated package including primary care, transportation, therapies, social work, adult day health, home services, palliative and urgent care, and even long-term care when needed, with examples like providing an air conditioner to prevent COPD exacerbations. The conversation covers eligibility (service area, ADL dependence, dual eligibility, asset limits and look-back), Medicare-only/private pay options, limited geographic availability and heavy regulation, overlap and for-profit expansion, and policy recommendations to expand access earlier and simplify enrollment.   Topics 02:06 Landmark Health House Calls 03:58 Why Landmark Ended 05:20 PACE Explained Basics 06:42 PACE Services and Team 08:04 Outside the Box Care 09:34 Costs and Long Term Care 12:35 Eligibility and Enrollment 16:43 Coverage Areas and Red Tape 18:56 For Profit Growth Debate 20:08 Element Care Mission Stories 23:24 Finding a Local PACE 28:26 Policy and Family Advice 30:43 Criticisms and Risk Adjustment 34:47 Closing Thoughts

    Inside PACE with Anthony Zizza

  8. May 27

    Retirement, Inequality, and Social Connection with Daniel Horowitz

    Harry talks with historian Daniel Horowitz, author of “On Retirement: How Aging Is Transforming American Lives.” He discusses his wide-ranging prior work and his move with his historian wife to a continuing care retirement community near their daughter. He describes major changes in aging and retirement since midcentury: longer lifespan and healthspan, key policy supports (Social Security, Medicare, Medicaid), and a shift from defined-benefit to defined-contribution retirement risk. He outlines expanding housing and care arrangements (NORCs, supplemented NORCs, 55+ communities) alongside problems like nursing-home conditions and under-studied elderly homelessness, emphasizing how race, class, gender, and geography shape wealth, access, and even a nine-year longevity gap by income. He explains “successful aging” and critiques its optimism amid inequality, pandemics, and climate threats, stressing luck and fall risks. His personal advice centers on sustaining social connections, not comparing oneself to the past, protecting public programs, and skepticism toward costly longevity clinics and promises of living to 120.   Get Daniel’s book: https://a.co/d/07sy46s8   Topics 00:00 Meet Dan Horowitz 01:02 Books and Background 02:08 Moving to a CCRC 03:32 Retirement Then and Now 05:50 Housing Options and Risks 06:50 Inequality in Aging 10:18 Successful Aging Debate 13:36 Renewal Retirement 16:07 Isolation and Community Design 18:38 Personal Keys to Aging Well 22:02 Policy Advice for Boomers 23:19 Longevity Hype and 120 26:18 Public Health Over Biohacks

    Retirement, Inequality, and Social Connection with Daniel Horowitz
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Ratings & Reviews

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About

In just five years, the oldest of the 65 million baby boomers in the United States will begin reaching their late 80s, the age at which people are more likely to need care. At the same time, most younger baby boomers have already left the workforce, many without enough money to pay for retirement, much less their future care needs. In this podcast, I talk with experts in the fields of aging and elder care about what this will mean for the nation and how we can prepare, both collectively and individually.  More on Harry Margolis: https://margolisbloom.com/harry-s-margolis/ Harry’s Substack: https://okayboomer.substack.com/  

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