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Over the next two decades, 78 million Americans will grow old.  That's the largest number ever in the US. 

At present, there are around 16,000 nursing homes with 1.7 million beds and about a 15 percent vacancy rate. (See: CDC – Resources on Nursing Home Care). 

Clearly, unless the nation undertook a massive building program, there will be many, many more old people than the number of available LTC beds.  

So what are we going to do with all the geezers like me? 

Are LTC beds the only place to put us?  Are there other alternatives that are more cost-efficient?  Given issues of quality  — either perceived or actual —  in many LTCs, do we really even want to keep traditional nursing homes as an option?  What might old people really want?   What are younger people willing to support financially?  What role might pharmaceutical products have in managing age-related issues? What would be the best way for people to age out into death?  

What role does culture play in this discussion?  How do other nations address this issue?

As we think about answers to those questions, there is another level of analysis that looks at the ethics of old age. For example, do you think that everyone has the right to use all the Medicare services they want – regardless of the decisions made about their health when they were younger? In other words, should all old people share an equal right to Federally supported healthcare even if they did not share the same level of responsibility in their earlier choices regarding food, exercise, drugs, and alcohol? 

A second question to consider is whether or not the Government should have any voice in restricting one's personal choices about dying.  Should everyone have the right to die when they want to, regardless of the situation or reasons?  Who and how should an end-of-life decision be made when the person is not in possession of their full faculties?