THE GAP BETWEEN LIVING LONGER AND LIVING WELL

For most of the past century, medicine’s big wins were literally life-changing: antibiotics, trauma surgery, cardiac care and neonatal care. The goal was simple: survival. Keeping people alive through sudden, catastrophic events was the plan and the world of medicine triumphed. And because of that, life expectancy rose. Infant mortality fell. Millions continued to live who once would not have. All good. But this resounding success led to a new reality: we built a healthcare system for responsiveness, not for longevity — and not for the aging care infrastructure long life actually requires.

Here are the facts, and they touch nearly every family. By 2030, every single Baby Boomer will be over 65. One in five Americans will be of retirement age. The fastest-growing segment of the population is those over 85 — the group most likely to need help with daily living. The caregiving crunch is not coming. It has already landed, tsunami style. And our healthcare system is neither prepared, nor built for it. 

The System We Built — And the One We Needed

In hospitals and emergency departments, I watched the same pattern repeat. An older patient arrives in the emergency room after a fall, a medication reaction or a moment of confusion at home. The immediate problem is treated expertly. The fracture is stabilized. The infection is addressed. The blood pressure is managed.

Then the patient is discharged — often back into the same fragile situation that brought them in. The hospital does its job. But the system as a whole does not.

Because what that patient actually needs is not another acute intervention. They need coordination. Monitoring. Time. Support at home. Help managing medications, meals, mobility, memory, and loneliness. They need care that follows them, not just treats them. Unfortunately, the healthcare system did not optimize for aging.

Aging Is Not a Medical Problem. It’s a Life Problem.

As an advisor, I see the other side of this failure. Families are often financially sophisticated and legally prepared — yet completely unprepared for the lived reality of aging, which is gradual and easy to underestimate. Oftentimes, people are in denial that their parents are in physical and cognitive decline. 

And even though these otherwise savvy families plan for everything, and plan carefully for death — they rarely plan for the decade before it — and that’s the hardest chapter of life. They are shocked by how fragmented care becomes, how much time caregiving consumes, how emotionally draining it is to watch a parent change and how quickly costs escalate when support is needed.

Unpaid family caregiving in the U.S. now represents an estimated $873 billion a year in economic value — roughly 3% of GDP. More than 53 million Americans now provide unpaid care for a family member, according to AARP. Nearly half of them report emotional strain; one in five reports financial hardship as a result. This is not a small or isolated problem. It affects families across the country.

This burden is not evenly distributed. Women provide the majority of unpaid care in the U.S., and they are far more likely to reduce work hours, step away from careers, or absorb long-term financial consequences as a result. In effect, the gaps in our aging care infrastructure are being quietly filled by women’s time, labor, and foregone opportunity.

The Emotional Cost Is As Real As the Financial One

We tend to discuss aging in terms of cost curves and demographics, but the more destabilizing impact is emotional. Caregiving rearranges families. It strains marriages. It interrupts careers. It reopens old dynamics. It introduces grief long before death arrives. People feel guilt for not doing enough, resentment for doing too much and fear about what their own future may hold.

None of this appears on a medical bill. Yet it is often what breaks families first.

Longevity Without Infrastructure Is Not a Win

We celebrate longer lives — and we should. But longevity without infrastructure is not a gift. It is a strain. We extended life without extending the systems that make long life livable.

We built hospitals, but not homes designed for aging. We built specialists, but not integrators. We built insurance products, but not care pathways. We built cures, but not continuity. Now we are surprised by the consequences.

Longevity Is Also a Budget Problem

The consequences of this mismatch are not only emotional and clinical. They are economic.

As the population ages, healthcare spending does not simply rise — it reshapes the entire system.

The Congressional Budget Office projects that federal spending on major health programs for older adults, including Medicare and Medicaid, will rise from roughly 6.6% of GDP in 2020 to more than 9% by mid-century. That increase is not driven by waste. It is driven by demography — and by the reality that older adults use more care, more often, and with greater complexity.

People over 65 see physicians more frequently than younger adults and are hospitalized at several times the rate. Costs rise sharply with age: average Medicare spending nearly doubles between the early 70s and the late 80s. And that spending reflects not just more illness, but more layers — multiple chronic conditions, polypharmacy, cognitive decline and the growing need for daily support.

In other words, we are not just aging as a society. We are becoming more medically and logistically complex.

Yet the system absorbing that complexity was never designed for it.

It was designed to intervene, not to accompany. To treat, not to support. To bill, not to follow. That gap — between how people age and how care is structured — is now one of the largest and fastest-growing stress points in American healthcare.

What Needs to Change

Care models must follow people over time, not just through isolated episodes. Medicine, mental health, caregiving and family support should operate as a coordinated system rather than as parallel silos. Public policy continues to focus on death and disability rather than on the long, predictable period of decline that now defines later life for millions of Americans. 

Most of all, we need to stop pretending that the system we built for emergencies can quietly transform into one capable of supporting long lives that requires its own care model.

The Real Question

The question is not whether America is aging. It is whether we will continue to treat aging as a series of medical problems — or recognize it as a complex human transition that requires foresight, coordination and care. The caregiving crunch is not coming, it’s here. And without intentional aging care infrastructure — systems designed to follow people through the long arc of later life, not just intervene in moments of crisis — families will continue to carry a burden the healthcare system was never built to hold.