From great silence to loud booming: The changing face of senior care

Mr. Fuller was right on the money when he made that comment, although it’s unlikely he was talking about long-term care. He might as well have been; our future is going to be very different from the landscape we have come to know and anticipate. We have largely been serving The Greatest Generation, who came of age during the Depression and World War II, who are now more than 88 years old.

Those known as the Silent Generation—born between 1925 and 1945—who are now currently 67 to 87 years old, are also our customers. Although more and more Silents will continue to live in our communities as they surpass 80, the Boomers—the oldest of whom are now 66, will also begin to look at what we now call LTC services.

Many Boomers have gotten to know our services because they are the adult children of our residents. And many are or will be faced with managing chronic illness, which can lead to their needing assistance in their late 60s or early 70s. So will the Boomers want to age differently from the Greatest Generation and the Silents?

The answer is yes. And we know something about the ways they will be different. For one thing, owing to both desire and economic necessity, many of them want to continue to work later in life. Older workers are staying on the job and are more vocal about wanting to stay in their homes and communities, offering an opportunity for operators to expand service beyond their own bricks and mortar. And their homes are not always unigenerational.

Sometimes there are multiple generations sharing the home—and members of this household will interact with LTC providers in different ways—sometimes helping an older resident in making the decision to move, sometimes as a member of a care team when a family member is in rehab and sometimes, if our doors are open, using programming that is open to people of all ages.

Once they make the decision to move to an LTC setting, Boomers are so accustomed to being connected—through both active social engagement and technology—that they are likely to demand the ability to stay involved both inside and out. They have strong and diverse preferences for music, food, personal space design and activities and expect these desires to be met, regardless of whether they are unique in the community. They will want to be able to influence life in the community, so resident councils are likely to be strong and demanding. And they will want to stay in touch with their friends and families.

And yes, they will expect to continue to be sexually active and enjoy a cocktail in the evening—two issues that have stirred controversy in long-term living for some time. They will not accept the idea of having to ask permission for these activities and will be outraged at the idea that there is any reason to limit them. Training staff to recognize that enjoyment and engagement with life often includes these activities, and there is no particular reason to limit them among competent elders, will be essential.

How to determine competency and continue to be respectful and person-centered will require sensitive training. In these cases, remembering the preferred view concepts can be very helpful. Many Boomers will not see themselves as old and will have difficulty accepting this challenge to their preferred view. Autonomy, independence, freedom—concepts that were key components of their cultural experience—figure strongly in their view of themselves and are difficult to relinquish.

To help them stay independent and engaged, supporting Boomers as they struggle with multiple chronic conditions, either in an LTC setting or by service provided outside of it, and how these medical challenges interfere with their desires for an active and engaged lifestyle, will be the big opportunity of the future.

Technology will figure heavily in this equation, for Boomers have embraced all things technological and know that it may hold the key for their continued quality of life. Social engagement, especially, can be enhanced by technology and communities will need to be fully wired and ready to accommodate the heavy demands of round-the-clock connectedness. Medically, too, services like remote sensor monitoring of blood sugar levels, heart conditions and more, will figure prominently in making the Boomers’ later life more convenient and healthy.

In short, the 78 million Baby Boomers (a group sometimes lamented as a burden on society, a challenge too great to meet) will offer those of us in long-term living the greatest opportunity for service innovation and improvement that we have ever seen. Creative and person-centered organizations, which can offer engaging and respectful options for aging, will realize growth beyond what has been possible in the past. Those who will succeed will have separated their know-how from their bed count. The future isn’t what it used to be—but it might be even better. 

Judah L. Ronch, PhD, is the Dean of and a professor at the Erickson School, University of Maryland Baltimore County, which offers undergraduate and Master’s degrees in Management of Aging Services as well as online and live Executive Education programs and customized industry training. He can be reached at

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