Unfinished Business: 2014 and Beyond

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

With the start of a new year it seems an appropriate time to look back, and look forward. Here, in no particular order, are four eldercare and healthy aging issues that should play a more central role in our national dialogue in 2014.

  • A realistic program for long term care

    It's stunning when you think about it: The federal government spends enormous sums of money managing chronic illnesses (even those that are largely untreatable) in older adults, but Medicare pays virtually none of the costs of in-home, assisted living, or long term (nursing home) care. We're not suggesting that current Medicare dollars aren't well-spent-not at all-but in the long run even a modest increase in federal investment in proactive eldercare and assistance with activities of daily living could pay huge dividends, both financially and with respect to older adults' quality of life.
  • Improving our public transportation infrastructure

    Environmental issues aside, access to reliable public transportation is crucial for healthy aging. In our area (Nassau County, NY), using public transportation involves navigating a maze of unreliable, inefficient bus lines; if you happen to live in an underserved area it can take more than an hour to go a few miles. In our former locale (Gettysburg, PA) things were worse: Public transportation simply did not exist. The US is decades behind other western nations in maintaining and upgrading our public transportation infrastructure. It will take decades to correct the problem, but it's time to begin.
  • Redefining retirement

    Two issues here-timing and engagement. Most people understand that the old "retire in your 60s" model is obsolete; people live longer, healthier lives now, and many of us can-and should-continue working longer. To facilitate this generational shift we need to connect older adults with activities that match their skills and interests…..mentorship, for example, or providing elder- or child care. New online "time bartering" websites which allow you to trade your time and skill for the time and skill of another person could be an ideal means of jump-starting such a movement.
  • The Affordable Care Act

    Quickly replacing Social Security as the "third rail" of politics, the Affordable Care Act is (to say the least) a work in progress. It's a workable concept, but it's not currently working. When our neighbors-lifelong, staunch Democrats-spent part of New Year's Eve telling us how their daughter recently lost her job because her employer couldn't afford the additional health insurance costs, it became clear that something is awry.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, which is available at, or may be purchased directly from HarperCollins Publishers.

Our latest book is entitled How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement, published by Ten Speed Press, a division of Random House.