Americans are living longer than ever before, but the country is facing a difficult question: who will care for people as they reach extreme old age?
Advances in medicine, healthier lifestyles, and improved living conditions mean more people are reaching their 90s and even 100s. While this is a remarkable achievement, it also creates new challenges for families, communities, and the healthcare system.
Ruth Gove of Peabody, Massachusetts, is one example.
At 100 years old, she still lives independently, cooks for herself, and does her own laundry. She takes pride in managing her daily life, but simple tasks have become harder.
After giving up driving at age 99, she now depends on her daughter for transportation. Her daughter, however, is 75 and dealing with her own health needs. Grocery trips and appointments must sometimes be postponed because both women face the realities of aging.
Stories like Gove’s are becoming more common. The U.S. Census Bureau projects that the number of Americans aged 100 or older will quadruple over the next three decades.
By 2040, the population over age 65 is expected to reach about 80 million. At the same time, birth rates are declining, leaving fewer younger people available to support an aging society.
Experts warn that the United States is not prepared for this demographic shift. There is no comprehensive national plan to help families navigate long-term care, which often looks different for each person.
Many older adults require assistance with daily activities, medical care, and transportation, yet services are unevenly distributed and often difficult to access.
Cost is one of the biggest barriers. Assisted living facilities can cost around $70,000 a year, while nursing homes may exceed $100,000 annually. Most families cannot afford these expenses without financial help.
Public programs such as Medicare and Medicaid provide some support, but they are already under pressure as demand grows. Medicaid alone covers a large portion of nursing home residents and long-term care costs, which total tens of billions of dollars each year.
Even when services exist, communities are often not designed with older adults in mind. Many neighborhoods lack safe sidewalks, reliable public transportation, or nearby healthcare facilities. For seniors who can no longer drive, simply getting groceries or attending medical appointments can become a major challenge. Isolation becomes another risk, as mobility issues make it harder to stay socially connected.
Families frequently fill the gap, providing unpaid care that can take a heavy emotional and financial toll. Caring for an elderly relative often requires time off work, significant expenses, and constant attention. As people live longer, they are also more likely to develop conditions such as dementia or Alzheimer’s disease, which require specialized support. Early stages of cognitive decline can be distressing for the individual, while later stages place increasing responsibility on family members.
Some seniors fare better if they have a younger spouse or partner who can assist them. Ninety-three-year-old John Stainton, for example, relied on his partner after a fall led to a series of health problems. She now helps manage his medications, drives him to appointments, and assists with daily tasks. However, many older adults do not have someone available to provide that level of care.
In response to rising costs and limited support, multigenerational households are becoming more common in the United States. Families are increasingly living together to share expenses and caregiving responsibilities. While this arrangement can reduce financial strain, it also changes family dynamics and requires adjustments from everyone involved.
Despite growing awareness of the issue, meaningful policy changes have been slow. Political disagreements and competing priorities have delayed reforms to long-term care and support for caregivers. Experts say the country must decide whether to continue relying on families to shoulder the burden or develop a more coordinated system to support aging citizens.
For people like Ruth Gove, the question is not theoretical. Living past 100 has brought independence and pride, but also uncertainty about the future. As she reflects on her long life, she notes that she never planned to live this long.
Her experience highlights a reality many Americans may soon face: longevity is a gift, but without adequate support, it can also become a challenge for individuals, families, and the nation as a whole.
