How to Mitigate the Looming Senior Care Crisis如何緩解迫近的老年護理危機

麗貝卡·洛夫/文　李方超/譯

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.

美國老年長期護理陷入危機。目前美國65歲以上的老年人超過5640萬。老年人口需求涵蓋住房、服務、陪護等方方面面，然而美國滿足老齡化群體需求的有保險覆蓋、可負擔或可升級的好方案如若有，也是寥寥無幾。我們如何照護老年人乃社區之關切，是社區理應之責。

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.

我們目前對老年人置之不理，這種做法無論對老年人、他們的看護人亦或是社會來說都是不可持續的。我們必須轉變在文化上對衰老的看法，確保老年人受到歡迎，被社區生活所容納，而不是把他們隔離起來，清出視野。

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.

美國與其他國家不同，我們的老年人“獨自煢煢，與子女和終身好友異地而居” 。我們正在迅速奔赴一場危機，它將對老年人、年輕人以及我們國家經濟的長遠健康發展產生影響。

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？

“夾心一代”既要撫養子女，又要照顧年邁的父母，可能因此面臨嚴重的經濟困難。這些年輕家庭若要贍養父母，他們將如何攢錢供孩子上大學、購買新車以及為孩子在返校前購買新衣服和置辦用品？

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，美國65歲及以上人口預計占1/5。隨著美國老年人口數量繼續大幅增加，美國體制當中的最脆弱部分（醫療、社會服務和住房）可能會把整個社會資源消耗到近乎崩潰的地步，特別是我們如果一直對老年人不斷遞增的需求視而不見，直到他們無法自理。

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.

人口老齡化給老年人護理涉及的個人和政策制定者帶來了一些挑戰。即便一些國會議員呼吁削減老年醫保和社會保障開支，但是人口老齡化帶來的醫療、長期護理和社會服務需求只增不減。

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.

這些問題短期內無法解決。但是，缺少可供老年人選擇的廉價或較合適住房，這個問題我們今天能夠直面并著手解決。目前根據個人收入和健康需要不同，有55+退休社區、安養照護機構、養老院、居家養老幾種居住選擇。

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.

依據個人所在地不同，55+退休社區每月費用至少5，000—10，000美元，許多老年人負擔不起。

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.

與此同時，養老院和安養照護機構面臨的缺工問題將繼續影響行業發展，情況嚴重到足以被視為一場危機。美國勞工統計局稱，該行業自2020年2月以來已經流失近22.9萬名護理人員（占該行業勞動力的14%以上），為所有醫療行業離職之最。全美60%以上養老院因人手不足，迫不得已限制收容新患者。疫情期間，500多家養老院多因招工難而歇業。在這些歇業的養老院當中，超過40%為4星級或5星級知名養老機構。

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

我認為，打造并支持跨代社區是一個可行的解決方案。然而，這需要企業領袖和政策制定者的支持。

A public-private partnership could build intergenerational communities.

公私聯手打造跨代社區。

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.

跨代社區有助于解決老年人面臨的社會養老危機，同時為學生和年輕家庭提供更多可擔負得起的住房以及保障工薪階層父母為子女提供可靠、高質量的學前教育。

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.

丹麥第二大城市奧胡斯的臨水住房項目“世代家園”是跨代社區的一個典范。它是一家擁有300套單元房的混合型社區，包含養老和看護房、家庭住宅、青年公寓及殘疾人公寓，是跨代同居創新型理念的開拓者。養老和看護房構成了該社區的主體戶型，同時配有必要的額外護理。住養老房的個人或夫婦每日會有護理人員上門，而住看護房的人可以接受更多的實質性醫療幫助。

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.

這個解決方案把老年人融入社區，賦予他們護理需求的自決權，而沒有把他們隔離開來。人們彼此熟絡，積極互助，讓每個人都生活得更舒心。因此，老年人可以給有孩子的家庭照看小孩，學生則提供志愿服務，幫忙把行動不便的老年人帶去音樂廳，或是參加社區居民的其他免費活動。

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.

這項“業務”的收益是卸掉了夾心一代作為自己年邁父母主要看護者的重擔。社區成員守望相助，老人護理成本就可以降下來；老人還可以照管小孩，小孩看護問題迎刃而解。

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.

企業領袖可以接洽當地社區發展機構，為項目爭取更多的支持；或是自建公益機構，直接與廉價住房開發商合作。前者要社區發展組織牽頭，征集建議書，雇傭房地產開發商并籌集資金。后者需要公益機構牽頭。另一個方案是公益機構和社區組織合作。

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

跨代社區理念可延伸至工作場所。

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.

企業可以營造抵制年齡歧視和接納老年員工的職場文化，以職場制度規避員工聘用和晉升中的年齡歧視，鼓勵代際協作。

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.

企業可以欣然奉行靈活的工作制度，貫徹支持階段式退休、工作共享或遠程辦公方案的舉措，以保留嬰兒潮一代的經驗和技術。它們還可以不斷提供培訓和技能發展機會，讓老員工了解最新行業趨勢與技術。

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.

我們現行的制度無論從成本、情感和身體健康，還是可持續性等各方面來看，都有負于我們的老年人。我們需要大膽而富有創新性的方案，諸如跨代社區，以幫助解決個體和社會因人口老齡化而面對的一些緊迫挑戰。受益者不只是老年群體。當我們完全把老年人融入到一個愿意接納他們的社區時，人人都會受益。

（譯者為“《英語世界》杯”翻譯大賽獲獎者；單位：四川民族學院）

1 cast sb/sth aside〈正式〉拋棄；丟棄。? 2 the fabric （of sth）〈正式〉（社會、機構等的）結構。? 3 shut sb away把某人藏起來；隔離；禁閉。

4 stretch（大量地）使用，消耗。? 5 incremental遞增的。? 6 Medicare（美國的）老年保健醫療制度。? 7 Social Security（美國）社會保障制度。? 8 head-on正面相撞的。

9 preferable更可取的，更好的。

10 assisted living facility提供輔助看護的養老院。? 11 upwards of至少；超過。

12 rally召集；（使）團結。? 13 allow for sth考慮到。