Sift through the California Department of Finance’s latest county and state population forecast and you’ll find a specific 10-year projection that unsettles many experts who work with, or advocate for, older people in Southern California.

Over the next decade, the number of people 85 years old and older living in Los Angeles, Orange, Riverside and San Bernardino counties will jump by more than 72%. That’s a 10-year window when the 85-plus crowd in the four counties is forecast to expand, on average, by nearly 24,000 per year.

By the time it’s done, in 2035, the four-county population is expected to include 565,493 people ages 85 and up, a pool of so-called “super seniors” that will be slightly bigger than the current population (all ages) of Long Beach and West Covina combined.

That’s not a negative, of course. The vast majority of those older people will be quite pleased to be alive. And they figure to provide the community with valuable life experience and wisdom, and maybe a lot of grandparent-level kindness.

But, collectively, they’ll also present challenges. And how we answer those challenges, according to senior advocates, could push Southern California into a full-blown eldercare crisis.

Consider:

About 1 in 3 super seniors will suffer from Alzheimer’s disease or some other form of dementia. There currently aren’t enough memory care centers or medical experts who can help people with Alzheimer’s, and nobody expects dementia-related services and hiring to keep pace with the coming surge in demand.

About half of the people in that 85-and-up cohort will need daily assistance to maintain their health and dignity, either from a skilled nursing home, an assisted living center or regular visits from an in-home caregiver, professional or family.

Today, some lower-priced skilled nursing and assisted-living centers already have waitlists. But the new economic drivers of eldercare – surging demand and fewer government dollars to pay for the help – suggest those waitlists will only grow.

And, critically, a solid 1 in 3 of those super seniors won’t have enough income, or private insurance, to pay for much or any of their long-term care.

Though the poverty rate for seniors in each of the four Southern California counties is only slightly higher than the overall poverty rate for all ages, a different measure of financial hardship – one that tracks whether a household income can or can’t cover “basic needs,” such as food, health care and housing, in a particular community – shows that a lot of local seniors are broke.

A 2023 report from the advocacy group Justice in Aging suggested the “basic needs” poverty rate for seniors living in Los Angeles, Orange, Riverside and San Bernardino counties ran between 28% and 37%.

All of it suggests that eldercare – already a problem for tens of thousands of local households – is about to get tougher.

“We’re not even close to prepared for this,” said Jim McAleer, chief executive of Alzheimer’s Orange County, a nonprofit that helps Alzheimer’s patients and their families.

“Not only is the senior population growing, but the younger people are moving away,” he added, via email.

“We already see way too few physician specialists, in things like neurology and gerontology. And it will get worse.”

First age, then politics

Yet, for all that, the rise of the 85-and-up crowd is only part of why McAleer and other local advocates fear that dignified old age is about to become tougher to achieve.

Current political trends, they argue, could add stress to the region’s already rickety, immigrant-dependent network for eldercare. That stress, they fear, could produce a have vs. have-not world for people in their last stages of life, with wealthier seniors still getting the kind of care we see today and everybody else scrambling.

At risk, according to some, are some traditional pillars of eldercare:

Nursing home and assisted-living beds – already expensive – could become completely out of reach for a huge number of seniors if Medicaid (known as Medi-Cal in California) is slashed at levels projected in the “big, beautiful” domestic spending bill recently approved by the House and now being debated by the Senate.

Likewise, skilled in-home health care – an option used more in Southern California than in any part of the country – also could be priced out of reach as federal funding dries up.

Even lower-skilled aid givers – the small army of immigrants, legal and otherwise, who provide lower-priced, in-home help for thousands of older people in Southern California – could become expensive or impossible to find as immigration enforcement tightens.

The upshot of it all could be grim.

At least some seniors, including some who have never been poor previously, figure to become homeless in the coming years, a trend that’s already well underway. Others might wind up relying on family care, a trend that could derail careers for thousands of middle-age children and in-laws and make it harder for them to save for their own retirements.

If nothing else, the proposed cuts threaten the existence of lower-priced skilled nursing homes, a category of care that is particularly reliant on federal dollars.

“Eliminating key Medi-Cal funding will result in staffing shortages, reduced admissions and facility closures,” said Corey Engel, a spokesman for the California Association of Health Facilities, a trade group that represents skilled nursing homes.

“Given that Medi-Cal is a primary payer for long-term care services, especially for low-income seniors, such cuts would put a financial strain on some facilities.”

But beyond the extremes, and even beyond the money, experts and advocates say an eldercare crisis could push tens of thousands of Southern California seniors – and their families – to a financial and emotional ledge.

“Advocacy groups have been yelling for years about this, (but) it’s fallen mostly on deaf ears,” McAleer said. “It’s going to cost lives and dollars. People with no insurance will be forced into the most expensive forms of public health care.

“Or they will die.”

Economics of eldercare

Not everything that might wind up in the spending bill is bad for seniors, or would accelerate an eldercare crisis.

In fact, supporters argue that one proposal still on the table – reducing or eliminating taxes on Social Security – could boost monthly incomes for about half of the people who currently get a Social Security check. For beneficiaries who have income beyond Social Security, the reductions could be worth a few hundred dollars a month.

Critics counter by saying it’s bad economics.

For one thing, wiping out taxes on Social Security would push up by a year – from 2033 to 2032 – the date when an unadjusted Social Security program’s trust fund is expected to run dry. For another, critics note that the people who most need financial help – seniors who rely exclusively on Social Security – would see no gain because they’re already too poor to pay federal taxes.

But other economic issues linked to the spending bill, as it pertains to eldercare and proposed cuts to federal health spending, might not touch seniors at all.

Medi-Cal is a critical component of one of the biggest sectors of Southern California’s economy: health care. An estimated 1.25 million residents of the four counties work in some area of health care, and more than 110,000 work in nursing homes or assisted living centers, according to an April report from economists at the UC Berkeley Labor Center.

In a separate report, Labor Center experts project that Medicaid cuts approved in the House version of the spending bill could result in up to 217,000 lost jobs in California as soon as next year. They add that economic output in the state could fall by as much as $37 billion and tax revenue could fall by up to $1.7 billion.

“Medi-Cal is critical to hospitals, clinics, nursing homes, and other health care providers; their suppliers,” wrote Labor Center economist Laurel Lucia. The program, she added, also boosts “local businesses where health care workers spend their income.”

But while economists track numbers that show the rise and fall of seniors or health workers around the state, Elizabeth Ramirez, a 58-year-old Ontario homemaker who takes care of her 90-year-old mother-in-law, focuses on just one number that matters a lot to her and her family: $14.

That’s the hourly wage she’s paid as an in-home caregiver, money she gets from a Medi-Cal-funded program known as In-Home Supportive Services. She’s one of 40,626 people in San Bernardino County who are paid to help care for someone in a home, and one of nearly 450,000 in the four-county region who hold jobs connected to in-home health services.

It’s unclear how much Medi-Cal money, or if any of those jobs, will go away. Final terms of the spending bill haven’t been reached.

Still, Ramirez, who described herself as “politically conservative and socially on the fence,” is watching closely.

“If Medi-Cal stops paying, or cuts back, I’ll keep doing this. I mean, we don’t have any choice,” she said.

“It just means we’ll be a little poorer, too.”

Ramirez, who emphasized that she’s not “in the caretaking business,” said her pay is an important bonus but less than half what she made in her previous job, as a school librarian in Utah. Economists note that pay for in-home care services tends to be a win for taxpayers because it helps keep people out of tax-funded nursing homes, which in Southern California cost upward of $130,000 a year for each patient.

Ramirez likes it because of what it means for her family. Her college-age children don’t have to work to support the household. And her husband, who works in a supermarket, doesn’t have to pull as many overtime shifts as he might otherwise.

She said it lets her focus on her routine, which has become centered on doctor visits and prescriptions, making meals, cleaning and helping a woman she described as “my second mom” take a bath.

“She needs a little help, but she’s cool, too,” Ramirez said of her mother-in-law, whom she declined to name.

“It’s a privilege to care for her, not a problem,” she said.

“Except,” she added, laughing, “for the times when it is a problem.”