How to Mitigate the Looming Senior Care Crisis如何缓解迫近的老年护理危机

丽贝卡·洛夫/文　李方超/译

Long-term and senior care in the United States is in crisis. We have over 56.4 million people over 65. There are few， if any， good insurance-covered， affordable or scalable options to meet the needs of this aging population—in everything from housing to services to care. How we care for older people is a community issue—or it should be.

美國老年长期护理陷入危机。目前美国65岁以上的老年人超过5640万。老年人口需求涵盖住房、服务、陪护等方方面面，然而美国满足老龄化群体需求的有保险覆盖、可负担或可升级的好方案如若有，也是寥寥无几。我们如何照护老年人乃社区之关切，是社区理应之责。

Our current approach of casting aside1 older adults isnt sustainable for them， their caregivers or society. We must shift our cultural view of aging to ensure that our senior citizens are welcomed and integrated into the fabric of2 community life， not shut away3， out of sight.

我们目前对老年人置之不理，这种做法无论对老年人、他们的看护人亦或是社会来说都是不可持续的。我们必须转变在文化上对衰老的看法，确保老年人受到欢迎，被社区生活所容纳，而不是把他们隔离起来，清出视野。

Unlike other countries， seniors in the U.S. live “lonely lives separ-ated from their children and lifelong friends.” We are on the fast track to a crisis that will impact senior citizens， younger generations and our countrys long-term economic health.

美国与其他国家不同，我们的老年人“独自茕茕，与子女和终身好友异地而居” 。我们正在迅速奔赴一场危机，它将对老年人、年轻人以及我们国家经济的长远健康发展产生影响。

The sandwich generation， those raising a family while caring for their elderly parents， may face severe economic problems. If these young families support their parents， how will they save for college， buy a new car and shop for back-to-school clothes and supplies？

“夹心一代”既要抚养子女，又要照顾年迈的父母，可能因此面临严重的经济困难。这些年轻家庭若要赡养父母，他们将如何攒钱供孩子上大学、购买新车以及为孩子在返校前购买新衣服和置办用品？

By 2030， 1 in 5 Americans is projected to be 65 years old and over. As the number of senior citizens in the U.S. continues its dramatic upswing， the systems weakest elements—healthcare， social services and housing—could stretch4 societys resources to the point of collapse， especially if we ignore the incremental5 needs of older adults until they are unable to care for themselves.

到2030年，美国65岁及以上人口预计占1/5。随着美国老年人口数量继续大幅增加，美国体制当中的最脆弱部分（医疗、社会服务和住房）可能会把整个社会资源消耗到近乎崩溃的地步，特别是我们如果一直对老年人不断递增的需求视而不见，直到他们无法自理。

There are several challenges that an aging population presents for individuals involved with their care， as well as for policymakers. An aging population is accompanied by an increasing need for healthcare， long-term care and social services， even as some in Congress are calling for cuts to Medicare6 and Social Security7.

人口老龄化给老年人护理涉及的个人和政策制定者带来了一些挑战。即便一些国会议员呼吁削减老年医保和社会保障开支，但是人口老龄化带来的医疗、长期护理和社会服务需求只增不减。

These issues wont be solved in the near term. But there is one challenge that we can meet head-on8 and begin resolving today： the lack of affordable or preferable9 housing options for seniors. Depending on your income and health needs， housing options today may include a 55+ retirement community， an assisted living facility10， a nursing home or staying with family.

這些问题短期内无法解决。但是，缺少可供老年人选择的廉价或较合适住房，这个问题我们今天能够直面并着手解决。目前根据个人收入和健康需要不同，有55+退休社区、安养照护机构、养老院、居家养老几种居住选择。

And depending on the region you live in， 55+ retirement companies can cost upwards of11 $5，000–$10，000 a month， which for many senior citizens is not affordable.

依据个人所在地不同，55+退休社区每月费用至少5，000—10，000美元，许多老年人负担不起。

Meanwhile， the staffing short- ages faced by nursing homes and assisted living facilities continue to impact the industry at rates severe enough to be labeled a crisis. The Bureau of Labor Statistics reports the sector has lost nearly 229，000 caregivers （or more than 14% of its workforce） since February 2020， the worst job loss among all healthcare sectors. The lack of available staff has forced more than 60% of nursing homes nationwide to limit new patient admissions. Over 500 nursing homes closed during the pandemic， frequently attributed to the challenge of recruiting workers. Among these closures， more than 40% were distinguished facilities with four or five-star ratings.

与此同时，养老院和安养照护机构面临的缺工问题将继续影响行业发展，情况严重到足以被视为一场危机。美国劳工统计局称，该行业自2020年2月以来已经流失近22.9万名护理人员（占该行业劳动力的14%以上），为所有医疗行业离职之最。全美60%以上养老院因人手不足，迫不得已限制收容新患者。疫情期间，500多家养老院多因招工难而歇业。在这些歇业的养老院当中，超过40%为4星级或5星级知名养老机构。

I believe a viable solution is to create and support intergenerational communities. However， it will require the support of business leaders and policymakers.

我认为，打造并支持跨代社区是一个可行的解决方案。然而，这需要企业领袖和政策制定者的支持。

A public-private partnership could build intergenerational communities.

公私联手打造跨代社区。

These communities can help resolve the social care crisis older adults face while boosting the supply of affordable housing for students and young families and ensuring reliable and high-quality preschool education for working parents.

跨代社区有助于解决老年人面临的社会养老危机，同时为学生和年轻家庭提供更多可担负得起的住房以及保障工薪阶层父母为子女提供可靠、高质量的学前教育。

One of the best examples is a housing project on the waterfront in Aarhus， Denmarks second-biggest city. Pioneering an innovative intergenerational living concept， the House of Generations is a 300-unit mix of retirement and nursing homes， family homes， youth flats and apartments for disabled people. Retirement and nursing homes make up the majority of housing and also come with the necessary additional care. Indiv- iduals or couples living in retirement homes receive daily visits from a care worker， while those in the nursing home units receive more substantial medical support.

丹麦第二大城市奥胡斯的临水住房项目“世代家园”是跨代社区的一个典范。它是一家拥有300套单元房的混合型社区，包含养老和看护房、家庭住宅、青年公寓及残疾人公寓，是跨代同居创新型理念的开拓者。养老和看护房构成了该社区的主体户型，同时配有必要的额外护理。住养老房的个人或夫妇每日会有护理人员上门，而住看护房的人可以接受更多的实质性医疗帮助。

Rather than shutting older adults away， this solution integrates them into the community， enabling them to decide what care they need or want. Not only do people know each other， but they are actively involved in helping each other live better lives. So， older residents may babysit for families with young children， while students volunteer to help bring those with mobility issues to concerts or other activities free to residents.

这个解决方案把老年人融入社区，赋予他们护理需求的自决权，而没有把他们隔离开来。人们彼此熟络，积极互助，让每个人都生活得更舒心。因此，老年人可以给有孩子的家庭照看小孩，学生则提供志愿服务，帮忙把行动不便的老年人带去音乐厅，或是参加社区居民的其他免费活动。

The “business” benefit is that the burden of being the primary caregivers for their elderly parents is lifted for the sandwich generation. Caregiving costs can decline because community members look out for each other， and child care is resolved because the elderly help look after kids.

这项“业务”的收益是卸掉了夹心一代作为自己年迈父母主要看护者的重担。社区成员守望相助，老人护理成本就可以降下来；老人还可以照管小孩，小孩看护问题迎刃而解。

Business leaders can reach out to local community development organ-izations to rally12 support for the project or form their own nonprofit to work directly with an affordable housing developer. In the former， the community development would take the lead， issue a call for proposals， hire the developer and put together funding. In the latter， the nonprofit would take the lead. A third option is for the nonprofit to partner with the community group.

企業领袖可以接洽当地社区发展机构，为项目争取更多的支持；或是自建公益机构，直接与廉价住房开发商合作。前者要社区发展组织牵头，征集建议书，雇佣房地产开发商并筹集资金。后者需要公益机构牵头。另一个方案是公益机构和社区组织合作。

The concept of an intergenerational community can also extend to the workplace.

跨代社区理念可延伸至工作场所。

Businesses can create a workplace culture that combats ageism and embraces older workers with workplace policies that avoid age-related biases in hiring and promotions and encourage intergenerational collaboration.

企业可以营造抵制年龄歧视和接纳老年员工的职场文化，以职场制度规避员工聘用和晋升中的年龄歧视，鼓励代际协作。

They can embrace flexible work policies， implementing those that allow for13 phased retirement， job-sharing or remote work options to retain Baby Boomers experience and expertise. They can also provide ongoing training and skill development opportunities to update older employees on the latest industry trends and technologies.

企业可以欣然奉行灵活的工作制度，贯彻支持阶段式退休、工作共享或远程办公方案的举措，以保留婴儿潮一代的经验和技术。它们还可以不断提供培训和技能发展机会，让老员工了解最新行业趋势与技术。

Our current system is failing our older citizens from every perspective—costs， emotional and physical well-being and sustainability. We need bold， innovative solutions， such as intergenerational communities， to help solve some of the more pressing challenges individuals and society will face with an aging population. Its not just the older population that benefits. When we fully integrate older citizens into a welcoming community， everyone benefits.

我们现行的制度无论从成本、情感和身体健康，还是可持续性等各方面来看，都有负于我们的老年人。我们需要大胆而富有创新性的方案，诸如跨代社区，以帮助解决个体和社会因人口老龄化而面对的一些紧迫挑战。受益者不只是老年群体。当我们完全把老年人融入到一个愿意接纳他们的社区时，人人都会受益。

（译者为“《英语世界》杯”翻译大赛获奖者；单位：四川民族学院）

1 cast sb/sth aside〈正式〉抛弃；丢弃。  2 the fabric （of sth）〈正式〉（社会、机构等的）结构。  3 shut sb away把某人藏起来；隔离；禁闭。

4 stretch（大量地）使用，消耗。  5 incremental递增的。  6 Medicare（美国的）老年保健医疗制度。  7 Social Security（美国）社会保障制度。  8 head-on正面相撞的。

9 preferable更可取的，更好的。

10 assisted living facility提供輔助看护的养老院。  11 upwards of至少；超过。

12 rally召集；（使）团结。  13 allow for sth考虑到。