January 2023
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.

Our office will be closed on Monday, February 20th in observance of President's Day.

You’ll hear it all the time, that resolution to do more exercise with the new year. People may start out the first week, but then it’s back to old habits of a sedentary life. TV may be more tempting than putting on those walking shoes, if they even have the shoes. And the excuses are rampant: it’s too cold, it’s too hot, I don’t have time, or I just don’t feel like it. What is this doing to our elders’ health?

In short, the sedentary lifestyle is seriously damaging people’s chances for a longer, healthier life. And some say they don’t care, they’ll accept living a shorter life if they don’t really have to get off the couch. But it’s not about how long American elders live, it about how they live and how many chronic health conditions and disabilities they will accept in exchange for not getting up and moving more. Multiple chronic conditions include obesity, diabetes, cancer, high blood pressure and more. Living with those conditions is expensive and requires a lot of medications and doctor visits. No one wants that. But prevention takes motivation.

How Healthy Are Boomers?

According to a research study in JAMA Internal Medicine going back 10 years, we Boomers are not as healthy as we wish we were. Over half of the study participants did not do any regular exercise at all. The National Institute on Aging has clear recommendations for seniors. They say we should all get 150 minutes a week of moderate intensity exercise plus twice a week muscle strengthening work. Why don’t folks do it, when all authorities say we should?

As an active exerciser myself in my 70s, I often wonder why my age-mates spend so much time sitting and so little time moving their bodies. I know one factor: exercise requires effort! We have to put out the energy to get going. We have to do it when we don’t feel like it. We have to do it to prevent dementia, as we know that vigorous exercise protects our brains as well as the rest of our bodies. We need to do it to stave off those unpleasant chronic conditions.

YouTube to the Rescue

How much work is it? Not all that much, in my opinion. There are fairly easy and even fun ways to get exercise. For those with aging parents who have not gotten started with exercise, there are helpful videos to demonstrate what one can do without leaving the house. Find some videos and play them for your aging loved ones. (for yourself too!) The National Institute on Aging created Go4Life, with workouts on YouTube, which is to encourage older adults to exercise. Free, 10 or 15 minute, at home video-guided programs are a great start.

If you want your aging parent to get moving, a desire I hear often at AgingParents.com, where I consult with families, you can show them what to do or do some of it with them. Your support, encouragement and perhaps participation can be very helpful to the reluctant elder. Anything is better than nothing! If you watch a video with your elderly Mom or Dad and offer to do the routine with them, it’s a fine way to connect and help both of you. Disabled parent? Many exercises can be done while sitting in a chair.


  1. Exercise does take effort but not enormous effort. When we do it, we are trading better aging for sitting on the couch and inviting chronic health problems. The effort is well worth it!
  2. It’s more fun to exercise with someone than all alone. If you have a partner, a group, or even a regular video exercise group, that’s helpful for motivation.
  3. Get the right basic clothes and shoes. It’s not expensive to shop at a discount store for essential walking shoes, some loose pants, shirts and hat and jacket.
  4. If you’re not sure what to do to start, check out the Go4Life videos and try a 10 or 15 minute home workout.
  5. My favorite go-to when no other strenuous options are available or appealing— just walk. Brisk is best, falling into the “moderate” category, great for heart health. In bad weather, you can climb stairs, walk in a mall or do any length video with or without equipment, like light dumbells.

Changing your no-exercise habits is not so easy but I don’t hear anyone tell me that they’re sorry they started an exercise habit. It feels great to be more fit. It can lift your mood, help control weight, and be the start on a road to the healthiest kind of aging.