06/23/2026
I know many people do not subscribe The Atlantic so I posted most of the article.
Elder Care Navigation is something I have provided nationwide to my clients for the last 25 years. This service includes setting up your home for safe Aging In Place, with assistance if and when needed, to include a private home health aide or live-in, physical therapy, RN nursing visits, etc.
If you or your loved needs to move to an Assisted Living or a Skilled Nursing facility with Memory Care, then I can help you find the most exceptional facilities in your City or State. Please reach out if your need my guidance.
I highly recommend that each person purchase a Long Term Care insurance policy before turning 50 years old. You will need it someday.
From the article:
"As far as growing old goes, the Dutch have it pretty good. The Netherlands offers arguably the world’s most generous long-term-care insurance, covering professional nursing or home care for all residents who can demonstrate need. The country spends a whopping 4.1 percent of its GDP on formal elder-care services, 94 percent of which is publicly funded. (The United States, by comparison, spends 1.3 percent, 71 percent of it publicly funded.) “No other country spends more per capita on publicly financed formal care,” a 2023 working paper published by the National Bureau of Economic Research concluded.
And yet, nearly half of elderly Dutch residents who need assistance with the basic functions of daily life—dressing, bathing, grocery shopping, paying bills—still partly or even entirely rely on informal care from family and friends. Herein lies a lesson for Americans: Chances are, your elder care will not be outsourced, at least not entirely.
It is no secret that in the United States, the accessibility and quality of long-term care leave a lot to be desired. But many Americans go through life carrying two big misconceptions about aging. One is that, in the postindustrial world, a ton of elder care is hired out to professionals. The other is that, with sufficient savings and adequate public services, it is possible to avoid relying on kin for help.
These notions are, quite simply, more myth than reality.
In my own conversations with family and friends, I find that many of them presume that relying on one’s grown children in old age is a thing of the past. But the truth is that, across the developed world, the majority of elder care is still done informally—usually by spouses or children, sometimes by other relatives or friends—and it is probably not possible for matters to be any other way.
More than 80 percent of Americans over 65 in need of care depend on kin; about two-thirds rely solely on informal care. And the share of American elder care done on an unpaid basis is, if anything, growing over time.
For context, things don’t look all that different in our peer countries, including those that spend far more on elder care: In an analysis of 10 high-income nations with varying levels of public investment in long-term care, the Netherlands emerged as the only one in which less than half of the elderly population relied on kin. This suggests that if the United States were to suddenly and massively scale up its formal care services—a possibility that, in the current political climate, seems unlikely—Americans would still most likely rely on a significant amount of informal care.
Even when families can find and afford formal care, many older people are deeply resistant to the idea of moving into a nursing facility or having a stranger come into their home to help them, Emily Kenway, a social-policy doctoral researcher at the University of Edinburgh and the author of Who Cares: The Hidden Crisis of Caregiving, and How We Solve It, told me.
Aging can be psychologically and emotionally difficult. Accepting that you need a home health aide means coming to terms with your own vulnerability, which is easier said than done, particularly for those who have been non-disabled their entire lives. And when you are struggling with a cognitive impairment, as many elderly people do, changing homes or having strangers care for you can be genuinely frightening. (In some cases, Kenway noted, racial biases can add to the discomfort—a difficult reality, but one that family members cannot simply hand-wave away, given that the majority of nursing and home-care workers are people of color.)
Of course, many spouses, daughters, sons, nieces, and nephews want to care for their aging loved ones. But considering recent demographic, economic, and social trends, the need to seriously reckon with the load-bearing role that kin play in elder care has become freshly urgent.
For one, a growing number of Americans don’t have children or spouses. This is partly why the proportion of older adults with daily care needs that will go unmet is expected to grow by more than 30 percent by 2050. At the same time, even people with spouses and children can’t assume that those family members will be willing or able to care for them, especially if they’re in the workforce. Many employers don’t make it easy to combine work and care.
..None of this is to say that there is no point in publicly funding formal care—only that such care is not enough. Formal care is “necessary but insufficient,” Kenway said: vital, but only one half of the “duet” required to meet elderly people’s needs. In fact, it’s perhaps best to think of formal and informal elder care as complements rather than as substitutes for each other. Even if an elderly person is receiving formal care at home or in a nursing home, someone has to coordinate those services, whether applying for programs and figuring out how to pay for them, scheduling appointments, or corresponding with government agencies, insurance providers, and care workers. “The family caregiver is like the boss of a team,” Kenway told me.
..But ultimately, it will fall to individuals to put the kin network they’ll eventually require in place—a task that may get only harder the more that people resort to tech-enabled life hacks in the present. A defining feature of modern existence is the ease with which able-bodied adults can survive without turning to family and friends, or encountering another human at all. But that style of living has a time limit. For most of us, truly preparing for old age will mean getting much more comfortable with asking for help and offering it to those around us, regardless of whether we’re bound by blood or law. It will require thinking strategically and long in advance about where we live—and whom we live near. It will mean resisting the temptations of digital convenience and instead opting for human interaction. More than anything, it will mean accepting that we still need one another in a world that makes it all too alluring to act like we don’t."
Many assume that if they can afford paid help in older age, they won’t need to rely on kin. They’re wrong.
