08/28/2026
THE INFRASTRUCTURE OF AGING
The graphic says, “Let’s connect the dots.” And that’s exactly what I want to do, because I don’t think we can have the conversations we need to have about aging until we start looking at the whole picture.
When we hear the word infrastructure, most of us think about roads, bridges, utilities and the systems we build because we know people are going to need them. But I’ve been thinking about that word differently.
What is the infrastructure required to support a country that’s getting older?
Not just where people will live, but whether they’ll have enough choices. Whether staying home will actually be possible for those who want it. Who will provide the help and care. How people will afford it. And what happens to families when the systems around them don’t have enough capacity.
We tend to talk about those things separately. Senior living is one conversation. Home care is another. Medicare is another. Workforce shortages are another. Family caregiving is another.
But they don’t operate separately. They’re all connected pieces of the infrastructure of aging.
Let’s start with housing.
NIC MAP’s newly released Senior Housing Market Outlook estimates that the United States could need approximately 576,000 additional senior living units by 2030 to maintain roughly today’s level of senior housing availability.
And this isn’t simply a projection about something that might happen years from now. Senior housing occupancy across the country’s 99 largest primary and secondary markets reached 90.1% in the second quarter of 2026, the highest level since 2007. Meanwhile, construction is moving in the opposite direction. Construction starts have fallen approximately 67% since 2021, and fewer than 24,000 units are currently under construction across those same markets.
From the placement side, I see what limited capacity can mean in real life. A community may be a wonderful fit, but the apartment or level of care someone needs isn’t always available when they need it.
So naturally, another part of this conversation is staying home.
AARP’s national research found that 75% of adults age 50 and older want to remain in their current homes as they age. That’s not surprising. Home is familiar. It’s where our lives are.
But wanting to remain at home and having the support necessary to make that possible are two very different things.
One of the biggest misconceptions I encounter is that Medicare will simply pay for ongoing personal care when someone begins needing help with bathing, dressing, meals or the everyday activities that can become harder with age.
Generally, it doesn’t.
Under current Medicare rules, personal or custodial care isn’t covered when that’s the only care someone needs. Home health aide services are covered only under certain conditions when someone is also receiving qualifying skilled home health services.
That’s why the newly proposed Medicare at Home Act caught my attention. Introduced in the House this month, with a companion bill introduced in the Senate, the legislation would create a new Medicare home-care benefit for eligible beneficiaries who need help with everyday activities.
It hasn’t passed. It isn’t a Medicare benefit today, and there are still important questions about eligibility, cost and implementation. But regardless of what ultimately happens with this particular bill, I’m glad we’re having the conversation. It recognizes a gap that families have been navigating for a very long time.
Then we come to something that both senior living and aging at home depend on: people.
We can build beautiful communities, create better benefits and develop incredible technology. But none of those things eliminates the need for people to support people.
PHI, a national research and policy organization focused specifically on the direct-care workforce, estimates that there are currently about 5.4 million direct-care workers in the United States. Between 2024 and 2034, the workforce is projected to add more than 772,000 new jobs. When you also account for positions that will need to be filled as workers leave the field, change occupations or retire, PHI projects approximately 9.7 million direct-care job openings over that decade.
That’s why I think we need to start talking differently about careers in aging, too. We absolutely need caregivers and nurses, but an aging America also needs people in hospitality, culinary, wellness, technology, operations, social services, programming, maintenance, leadership and countless other roles.
There is tremendous need ahead of us, but there is also tremendous opportunity: meaningful careers, new businesses, better technology, new models of housing and care, and entirely new ways of supporting people as they age.
Now let’s connect those dots to the demographics.
This year, the first Baby Boomers are turning 80. The number of Americans age 80 and older is projected to grow by approximately one-third by 2030, adding roughly 5 million people within the next several years. By 2040, that population is expected to nearly double.
Those aren’t hypothetical people who may or may not arrive someday. They’re already here.
And living longer is something worth celebrating. But longevity requires infrastructure. It requires places to live, people to provide support, ways to pay for that support, communities that allow people to remain engaged and independent, and enough choices that aging doesn’t become a series of decisions made simply because nothing else was available.
Now add another dot: the millions of people in the sandwich generation.
They’re working. Many are still supporting children. They’re trying to prepare financially for their own retirement while they’re aging themselves, and at the same time they may be helping a parent, spouse or someone else they love navigate changing needs.
What happens when the community someone wants is full? What happens when staying home requires more help than they can afford? What happens when they can afford the care but there aren’t enough people available to provide it?
And what happens when several of those things happen at the same time?
The need doesn’t disappear. Very often, family fills the gap.
This is why connecting the dots matters.
Senior living capacity, aging at home, Medicare coverage, the caregiving workforce, affordability, demographics and family caregiving aren’t separate problems. They’re connected pieces of our aging infrastructure.
And I don’t believe the answer is choosing between senior living and aging at home. We’re going to need more of both.
We need more housing choices, better support at home, a larger and stronger workforce, new approaches to affordability, technology and innovation that actually improve people’s lives, and more conversations about aging before decisions become urgent.
We have a tendency to put difficult conversations off until the issue is right on top of us. And when it comes to aging, I think that’s exactly why this conversation matters now. The demographics aren’t somewhere off in the distance, and neither are the pressures we’re already seeing in housing, home care and workforce.
That doesn’t mean we should panic. It means we should prepare.
We should plan, build, innovate, invest, educate and advocate. There is tremendous opportunity in the fact that we’re living longer. The question is whether the systems around us will evolve as quickly as the population they need to serve.
The goal shouldn’t simply be helping millions of Americans live longer. It should be making sure we have the infrastructure to help them live those years well.
And to have that conversation, we have to keep connecting the dots.
New Horizons Senior Solutions
Advocacy • Guidance • Solutions
Sources: NIC MAP Senior Housing Market Outlook, Second Edition (August 2026) and Q2 2026 market data; AARP Home & Community Preferences Survey; Medicare.gov current home-health coverage guidance; H.R. 10020 and S. 5270, Medicare at Home Act; and PHI direct-care workforce projections using federal Bureau of Labor Statistics data.
