Three-Quarters of Middle-Class Seniors Priced Out of Assisted Living by 2033

In general, middle-income seniors have income and assets that make them less likely to qualify for Medicaid. At the same time, they may not have adequate resources to pay for the rising costs of housing and care options they need.

NORC study done in 2019 and updated in 2022 shows that nearly three-quarters of middle-income seniors in the US will be unable to afford assisted living programs by 2033 without selling their homes. It is the first study of its kind focused on a growing health care crisis.

Data Used in the NORC Study

The researchers examined gender, race, and education and estimated people’s health, cognitive function, and mobility status using the data for these conditions in 2018.

They evaluated financial resources in 2018, starting from actual income and assets. Then grew them based on the historical changes in each category, annuitized across each senior participant’s life expectancy and their spouses.

Data for financial resources included fixed income streams, such as Social Security, and annuitized assets like retirement savings or mutual funds. The study did not assume adult children could provide support. While housing equity is considered, the reality is that some individuals may be reluctant to sell their homes or have a spouse who continues to live there. Also, many seniors may want to keep their homes as a resource to protect against outliving their assets or having a catastrophic medical event.

With 16 million middle-income seniors in 2033 and 11 million over the age of 75, the size of this demographic will double to include the following statistics:

  • Roughly 9.5 million will be unmarried, widowed, or divorced
  • Four in 10 will not have family members living nearby to offer care or support
  • Over age 75, 54% will have three or more chronic health conditions, 56% will have mobility limitations, and 31% will have cognitive impairments
  • Average financial resources of less than $65,000 in income and annuitized assets will not cover health, personal care, and housing services

Even after selling their homes, seniors in 2033 will struggle to pay for assisted living or require additional help from family members. Health limitations will make it hard to live independently. Without government assistance like Medicaid, this creates a significant problem. Clearly, efforts must be made to improve the affordability of long-term care for seniors, particularly for those of lower middle incomes.

What It Means for the Future

Without a long-term care system able to accommodate a more diverse set of older adults and families, only the individuals with the lowest incomes will be provided with care. Others will be reliant on their families.

Combined public and private policymakers should examine healthcare and housing policies to extend funding for in-home care and caregiving support to prevent middle-income seniors from spending down all their assets to transition to nursing homes. And the long-term care industry must offer more affordable senior housing and in-home care options.

An Immediate Solution

Estate planning and elder law services are necessary to prepare for long-term care costs in the future. By starting early, a thorough evaluation of income and assets can provide resources and options over time. Long-term care and Medicaid planning, including using trusts to protect assets from being spent down for care, can prevent your clients from having a financial and medical crisis.




How Seniors Can Take Steps to Deter Depression

It is easy to succumb to the dark clutches of depression at any stage of life. Life is full of surprises and twists, and not all of them have a positive effect on the psyche. However, once a senior is in the grasp of depression, it is often difficult to find release. More than 6.5 million Americans aged 65 and up are affected by depression.

We will explore what depression is, what some causes are of depression in seniors, and some recent scientific research that has given insight on how seniors can take action to deter depression.

What is depression?

Depression is most often characterized by being sad. But depression can be so much more than that. In fact, for many seniors with depression, sadness is not their main symptom. More prominent symptoms may include trouble sleeping, feeling irritable or tired, being confused, or having attention problems. Because of this, depression can sometimes look like Alzheimer’s disease or other health conditions. Some medications can also exacerbate the effects and length of depression.

Depression in seniors is more likely to lead to other health problems, including a heart attack. Likewise, depression can keep a senior from rehabilitating at an optimal pace. Depression can also increase the risk of suicide. The suicide rate for seniors aged 80 to 84 is nearly twice that of the overall population. Fortunately, some preventative measures can be taken to deter or prevent such gloomy depths in our later years.

What Causes Depression in Seniors?

An adverse health event may sometimes be a catalyst for symptoms of depression. Nearly a quarter of seniors who experience a stroke will develop clinical depression. Seniors who have suffered vision loss are at an increased risk of reporting depressive symptoms. When a senior’s body doesn’t let them function like they used to, daily life can be disrupted and the dread of continued health problems can loom in the back of their minds. An elder might be fearful of having to enter a nursing home or otherwise rely on others for care. And of course, reflecting on the end of life can sometimes be tumultuous and frightening.

A widow/widower is also at a higher risk of depression, especially during the first year after the death of their spouse. Bereavement in folks over age 50 more than tripled the probability of depression. Losing a loved one can, understandably, be a devastating event in a senior’s life.

Medical issues, such as brain chemistry and medication side-effects, can also cause depression in seniors. Restricted blood flow may cause blood vessels to harden and cause issues with brain function. Seniors should take their health seriously and have regular visits with medical professionals and care managers. Of course, depression is a medical condition and should be evaluated by qualified medical professionals if an elder is experiencing depressive symptoms. Besides medical intervention, let’s take a look at some other tools that seniors can arm themselves with.

How Seniors Can Take Steps to Deter Depression

Finding a Purpose in Life

Most people want to feel that our existence is worth something – that our presence adds something to the world. As people age, their children grow up and begin their own lives, friends and loved ones pass away, their physical bodies slow down, and many are left seeking out new goals and ways to spend their remaining time.

Depression has been shown to lead to a cognitive decline and may increase the risk for dementia. Establishing a purpose in life has a mitigating effect on depression and cognitive decline. A recent study used many factors – such as age, race, number of living siblings, and whether the participants had a significant other – to compare the rates at which the participants suffered from mental deterioration. The results were encouraging. Finding a purpose in life is shown to prevent, or at least slow, the progression of Alzheimer’s disease and other forms of cognitive degeneration. Since depression is often formed due to an adverse medical diagnosis, like Alzheimer’s disease, having a purpose in life may also curtail the resulting depressive symptoms as well.

These results are not surprising considering the positive effects on mood and drive when one has goals and tasks to accomplish. How can a senior cultivate a purpose in life? Sometimes, this will involve caring for a loved one. Maybe the senior can get more involved with grandchildren, other seniors who need care, or a charity that they are interested in. Helping others can nurture a feeling of purpose in seniors. If the senior knows that someone is counting on them or that others value the senior, this may help deter depression and cognitive decline by igniting a purpose in their life.

Other activities might include regularly scheduled visits to elementary schools to tell stories or read to the children, volunteering at an animal shelter, writing a memoir, mapping out family lineage, or generally finding something new to explore. Finding something or someone in life that brings joy and purpose to a senior is a major step towards their future well-being.

Engaging in Interpersonal-individual Activities

It is no surprise that staying active, enjoying hobbies, and growing friendships have a beneficial effect on mental health. Interestingly, some activities have much more benefit than others. A study on senior health shows that elders that spend time with specific family members or friends enjoy a greater level of protection from late-life depression. Those taking part in solitary or general social group activities did not realize as significant results.

The study, published by The American Journal of Geriatric Psychiatry, explored a small test group of 48 older adults. Those seniors did not have a cognitive impairment but did have major depression. Each person received nine sessions of engage psychotherapy. Engage therapy is one that uses meaningful and rewarding activities at its core.

Seniors engaged in either solitary activities, social group activities (such as church or senior center activities), or interpersonal-individual activities (connecting with a specific friend or family member) experienced an improvement in their depression. Meaning, those that connected with a specific person that they cared about decreased their depressive symptoms.

These results are a reminder for seniors to keep in touch with those that bring them happiness. Encourage seniors to reach out to beloved family members and vice versa. A caregiver for a senior might try and reconnect the senior to loved ones who may have lost touch over the years. Maybe the caregiver can best facilitate the engagement, through aiding with transportation, communication, and scheduling. The study suggests that bonding with others has protective benefits for the minds of seniors. Perhaps the mixer or social event that a senior chooses to attend will not have significant benefits in the long-term, but the potential friendships developed there will.

Staying Physically Active

In a third study, published by the American Journal of Physiology-Cell Physiology, researchers studied the effects of staying physically active on the minds of seniors. There has been a plethora of prior research on the connection of exercise and mental health in young adults, but limited scientific data on the senior population. Specifically, it was unknown whether muscle deterioration, which invariably accompanies aging, would prohibit seniors from achieving analogous results to that of younger study subjects when analyzing the effects of exercise on mental health.

The study analyzed a group of male seniors who followed a specific exercise program for 12 weeks. The patients engaged in high-intensity interval training, in conjunction with strength training sessions. The results were positive. David Allison, the lead author on the study, said “Even individuals who are already metabolically healthy — with good weight, good blood pressure, and blood sugar levels — need to prioritize regular physical activity to maintain or improve upon their mental health. We have shown such benefits are still achievable in old age and further emphasize the importance of maintaining an active lifestyle.”

While not all seniors can engage in high-intensity interval training, many seniors can start somewhere. Encourage a senior to offer dog walking services to a friend who may be ill, or to park at the far end of the parking lot at the grocery store. A senior with more physical abilities might take part in the National Seniors Games. Competitions include bowling, horseshoes, power walking, shuffleboard, softball, and more. While the 2019 games have recently passed, now is the time to start training for next year!

A recent study published by the International Journal of Behavioral Nutrition and Physical Activity found yoga to improve strength, balance, flexibility, and mental well-being. While there are a plethora of yoga variations, many seniors of all abilities have taken up chair yoga. This type of yoga has been modified so that certain yoga poses can be done while seated, making yoga more accessible for those with mobility issues. Yoga has been scientifically associated with decreasing stress hormones, alleviating anxiety, and possibly reducing inflammation. An improvement in heart health is also a benefit. It has been illustrated that test patients over age 40 who had practiced yoga for five years had lower blood pressure and pulse rate than those that didn’t practice yoga.

Resolving Regrets

When a senior looks back on their life, what regrets do they have? How are these thoughts impacting their current emotional well-being? Having past situations where one would have preferred to act differently, or otherwise, have a different outcome to the situation, is completely normal. However, living in these pangs of guilt or remorse can be detrimental to an elder’s health. In a study of 213 lower-income older adults, regrets about career, education, and marriage were common. However, more intense regrets originated from finances, family conflict, and the problems of their children. The study found that having regrets was a significant predictor of depression in seniors.

How can a senior work towards revolving regret? Maybe the senior can obtain closure by writing a letter to someone involved in the remorseful situation. The senior may find peace by explaining that they are sorry and wished things would have worked out differently. If a senior has lost contact with a family member, it might be possible to rekindle that relationship in a healthy way.

A journal may help a senior deal with past regrets by highlighting things that the senior is thriving at in the present and how their life is interesting and full. Contemplating current feelings and events can be a reminder to live in the present. Alternatively, the senior can make a list of things that they learned about from that regretful situation and how they have used the experience to learn and grow. Realizing that everyone makes mistakes, but it is how you respond to those mistakes and alter future decisions, is what is important.

The senior may benefit from therapy with a qualified professional, to see how their regret is impacting their life and work towards resolving those feelings. The therapist may help them answer questions like “How are past regrets effecting your actions and current relationships?”, “Have you changed for the better due to that regretful situation?”, or “Is there anything you can do now that will improve the situation or your feelings about the situation?”

Try the Mediterranean Diet

A recent study that was presented to and discussed by the American Psychiatric Association indicates that adherence to a Mediterranean diet may reduce the risk of late-life depression. The Mediterranean diet plan has been touted in America since the 1960s and has been linked to improved physical health and associated with longer life. Heart health is a big benefit of the Mediterranean diet. However, the research on the mental health benefits of the plan is fairly new.

Researchers in Greece conducted a study on participants in day-care centers for seniors. Of the participants, 64% reported medium adherence to the diet, and 34% displayed a high adherence to the diet. Although cause and effect could not be unequivocally proved, the research team ascertained that a diet low in poultry and alcohol and high in vegetables decreased the probability of developing symptoms of depression in those seniors. The authors of the study concluded, “Adherence to a Mediterranean diet may protect against the development of depressive symptoms in older age.”

What is the Mediterranean diet? It consists of fruits and vegetables, legumes, fish, whole grains, beans, herbs, nuts, and of course, olive oil. Moderate amounts of dairy and eggs are allowed. Red meat, salt, butter, and sweets are a rare allowance. And an occasional glass of red wine can be enjoyed. We’ve all hear the adage, “You are what you eat.”  The Mediterranean diet may have not only physical health benefits but mental health benefits as well. If the Mediterranean diet isn’t right for the senior, then make sure whatever diet they follow is a nourishing one, in line with their healthy lifestyle.

In Summary

Everyone wants to be happy. No reasonable person desires to succumb to sadness and depression, especially at a time when one should be celebrating their life and enjoying the years they have left. While seeking professional medical advice would be a recommended first step should a senior start experiencing signs of depression, there are some things that a senior can do to deter depression possibly. This includes finding a purpose in life, connecting with specific friends or family members who bring them joy, staying physically active, and resolving their regrets. The Mediterranean diet might even do the trick! Mental and physical health are intertwined, and helping our beloved seniors stay happy and healthy benefits us all.







Beware of Senior Scams!

There are many, many good people in the world.  Some strangers would give you the shirt off their back, folks who volunteer their time to help others in need, and those who hold the door open for you as you are entering a store.  Especially in our tumultuous times, it is important to be kind and generous to our fellow neighbors.  However, with the good must come the bad.  There are scammers out there who prey on various populations, usually ones who are more vulnerable.  Beware of senior scams!

What are some senior scams to be aware of?

The ne’er-do well must somehow get in contact with you in order to scam you.  This would usually be via telephone or the internet, but it can also be in-person contact.

  1. Watch out for fake Facebook friends.

The Better Business Bureau reported that a government grant scam is prevalent on Facebook.[1]  The scammer makes a fake Facebook profile that looks like it belongs to a friend of yours.  The “friend” sends a message to you stating that the “friend” received a government grant of some sort.  Of course, to receive the government grant, you must make an initial investment or pay an application fee.


  • Don’t believe every Facebook profile is real, even ones that look like they belong to a real-life friend.
  • All legitimate federal grants are listed on
  • Government agencies will not communicate with you via social media.
  1. Watch out for scam emails, fake pop-ups, and fake bank transfers.

Some scammers will send out an email stating that you have a virus or other malware on your computer.  In one instance[2], the victim was contacted by a company called Premium Tech Support to clean up his computer.  The victim was quoted a price of $599, which he paid.  The company subsequently told him they accidentally deposited almost $80,000 into the victim’s bank account and asked for the money back.  The victim transferred the funds back to the company, only to realize that the initial transfer of funds from the company into the victim’s bank account was phony.

In another instance[3], the senior had a pop-up window appear on their computer that informed them they had a virus.  The pop-up asked for the senior to contact customer support to fix the issue.  Once the senior called customer support, a representative took control over the victim’s computer to remove the non-existent virus.  Paying to remove the non-existent virus was one part of the scam, but then the scammer also had access to sensitive information.


  • Do some research to ensure you are working with a reputable business.
  • If you think there has been a banking error of some sort, contact the bank to determine the real facts.
  • Don’t give a third-party access to your computer unless you know for sure it is customer support from a company that you contacted.
  1. Watch out for home repair scams

Home repair scams can come in many forms.  The first thing a scammer can do is quote you one cheaper price for work and then demand much more after it is finished.  Another way the scammer can operate is to do repairs that you never requested or agreed to.  Or, the scammer can impersonate a building inspector and demand immediate repairs.  Some scammers will up their fear game by telling you that they will put a lien on your home if you don’t agree to what they offer.


  • If a stranger comes to your home seeking to do repairs, tell them you want to get other estimates. This will give you time to see if the company is whom they say they are. Legitimate companies shouldn’t have a problem with you getting other estimates.
  • If you aren’t interested in the product or service, then don’t feel bad saying no. It is your choice!
  • If you tell the scammer “no,” then they will oftentimes try to throw in a last-minute “deal.” Please, don’t fall for it!
  1. Watch out for romance scams

Seniors are vulnerable to loneliness, especially in light of COVID-19 restrictions.  Since you may not be able to go to the places you would normally go to meet people, you may turn to the internet to find companionship.  And there are many legitimate websites to find love!  However, some scammers will create fake dating profiles and try to lure you into a relationship.  Then, the scammer can ask for money, sensitive banking information, or gift cards.

In one instance[4], the scammer talked the senior into doing an illegal act.  The senior went to China to meet her paramour, whom she had met online.  He was mysteriously unavailable to meet when she arrived, but some of his “friends” asked her to take a backpack full of the paramour’s clothing back to Australia.  The backpack contained drugs, unbeknownst to the senior.  After taking the backpack through airport security, she was arrested and sentenced to death.


  • Don’t rush into any relationship.
  • If the person cannot be available to video chat, they may not be who they say they are.
  • Do an internet search of the individual’s name and profile pictures.
  • If an in-person meeting occurs, do so in a public place.
  • Definitely don’t send any money to someone unless you are confident it isn’t a scam.

Why don’t seniors report being scammed?

Unfortunately, many senior scams go unreported.  Between 2 and 3 million seniors get scammed every year.[5]  However, on average, only 1 in 44 cases is reported.[6]  But why?  One reason is that many seniors are embarrassed that they were scammed.  They think that others will think them unfit and may even “put them in a home.”  Another reason financial exploitation isn’t reported is the perpetrator is a family member, and the senior doesn’t want to see them get in trouble.

Where can you go for help?

If you or a loved one thinks they have been the victim of a scam, there are ways to get help.  You can call your local police department or call 1-800-677-1116 to reach the Eldercare Locator. This government-sponsored national resource line helps folks find contact information for Adult Protective Services in their area. Here are some more resources to keep handy:

FBI’s Internet Crime Complaint Center

Federal Trade Commission

National Institute of Justice

National Adult Protective Services Association