I'm talking about the baby boom, the one that happened back in the 1940s.

我說的是 20 世紀 40 年代的嬰兒潮。

Baby boomers. There's an estimated 69 million of them in the U.S., making up 21 percent of the U.S.

嬰兒潮一代。據估計，美國有 6900 萬嬰兒潮一代，佔全美人口的 21%。

population and holding more than half of the nation's wealth.

人口，擁有全國一半以上的財富。

They're soon going to be hitting their long-term care years in a major way.

他們很快就會迎來長期護理的重要時期。

I think this space is completely underprepared for the number of older adults that are going to need long-term care and end-of-life care.

我認為，對於需要長期護理和臨終關懷的老年人數量來說，這個領域完全沒有做好準備。

As baby boomers move toward retirement homes, nursing facilities and hospice care, they're flooding into an already struggling industry, plagued by labor shortages, climbing costs and chronic government underfunding.

隨著嬰兒潮一代向養老院、護理機構和臨終關懷機構遷移，他們正湧入這個本已陷入困境的行業，該行業受到勞動力短缺、成本攀升和政府長期資金不足的困擾。

Since 2020, the U.S.

自 2020 年以來，美國

has lost more than 62,000 nursing home beds and saw 774 nursing homes close their doors.

養老院床位減少了 62,000 多張，774 家養老院關門歇業。

Currently, the U.S.

目前，美國

has more than 14,000 nursing homes and long-term care facilities to provide for almost 5 million Americans.

擁有超過 14,000 家養老院和長期護理設施，為近 500 萬美國人提供服務。

We've historically relied heavily on families.

我們歷來非常依賴家庭。

There's not going to be the number of family members that we've had in the past.

我們的家庭成員不會像過去那樣多了。

We came to the decision that it was time for hospice.

我們決定是時候採取臨終關懷了。

It wasn't a surprise, but it was a very difficult, emotional decision because when you think of hospice, you typically think of death.

這並不意外，但這是一個非常艱難、充滿感情的決定，因為當你想到臨終關懷時，你通常會想到死亡。

Now, Wall Street is looking at the aging cohort as a money-making opportunity, with both public companies and private equity dollars flooding into the space.

現在，華爾街將老齡化群體視為賺錢的機會，上市公司和私募股權投資資金紛紛湧入這一領域。

Roughly around 25.5 percent of all Medicare beneficiaries that received hospice care receive them from a publicly traded or a private equity-owned hospice.

在所有接受安寧療護的醫療保險受益人中，大約有 25.5% 接受的是上市公司或私人股本所有的安寧療護。

Between 2015 and 2022, 47 private equity firms bought 124 U.S.

2015 年至 2022 年間，47 傢俬募股權公司收購了 124 家美國公司。

hospices. The market is growing significantly.

臨終關懷機構。該市場正在大幅增長。

Do we have transparency in who owns the building and how they're spending our dollars?

大樓的所有者是誰，他們如何使用我們的資金，這些都透明嗎？

So who is positioned to make money off this massive block of aging baby boomers?

那麼，誰能從龐大的嬰兒潮一代老齡人口中賺錢呢？

And what does it mean for senior citizens and their families?

這對老年人及其家庭意味著什麼？

The U.S.

美國

senior care space is siloed into two categories.

老年護理領域分為兩類。

Long-term care includes services like nursing homes, assisted living and home-based care, valued at $577 billion. Then there's end-of-life care that includes shorter-term services like hospice and palliative care, estimated to be worth $14.5 billion in 2025 and growing.

長期護理包括養老院、輔助生活和家庭護理等服務，價值 5,770 億美元。臨終關懷包括臨終關懷和姑息治療等短期服務，預計 2025 年價值將達到 145 億美元，而且還在不斷增長。

We believe it is going to grow at 8.7 percent for the next seven years to reach around $26 billion by 2032.

我們相信，在未來 7 年內，這一數字將以 8.7% 的速度增長，到 2032 年將達到約 260 億美元。

And there's a reason it's seen all this growth, because senior care in the U.S.

它的增長是有原因的，因為美國的老年護理服務。

is pricey. Between 2009 and 2024, the cost of medical care services in the U.S.

價格昂貴。從 2009 年到 2024 年，美國醫療保健服務的成本將從 1.5 億美元增加到 2.5 億美元。

climbed 54.5 percent.

攀升了 54.5%。

In 2023, the median annual cost for a private nursing home room was over $116,000.

2023 年，私人養老院病房的年費用中位數超過 116,000 美元。

For in-home care, the median annual cost was $75,000.

居家護理的年費用中位數為 75,000 美元。

Now, families can and do fill those care need gaps, but a large portion of the funding for both long-term care and end-of-life care comes from Medicaid and Medicare.

現在，家庭可以也確實填補了這些護理需求缺口，但長期護理和臨終關懷的大部分資金都來自醫療補助計劃和醫療保險計劃。

Medicare being federal health insurance for people 65 and older.

醫療保險是為 65 歲及以上老年人提供的聯邦醫療保險。

Medicaid being state and federal health coverage for people with limited income.

醫療補助是州和聯邦為收入有限的人提供的醫療保險。

Medicaid makes up 44 percent of all long-term care spending in the U.S.

醫療補助佔美國所有長期護理支出的 44%。

Medicare covers around 20 percent.

醫療保險覆蓋率約為 20%。

In 2023, 90 percent of U.S.

到 2023 年，90% 的美國人都將在美國生活。

hospice patients were Medicare beneficiaries.

安寧療護病人是醫療保險受益人。

That means seniors and their families are often at the mercy of Medicare and Medicaid policies, which don't favor at-home health care. Medicaid is not a super generous payer, and it often pushes individuals into nursing homes before they would like to go there, basically.

這意味著老年人和他們的家庭常常受到醫療保險和醫療補助政策的擺佈，而這些政策並不支持居家保健。醫療補助並不是一個超級慷慨的支付方，基本上，它經常會在個人願意去養老院之前就把他們推進養老院。

It underfunds care in the home, in the community, where older adults and their family typically want care to be delivered. And more people aging into the space means more Medicaid and Medicare policies and more money, a lot more money. And that's catching the attention of companies and investors with deep pockets.

它為家庭和社區護理提供的資金不足，而老年人和他們的家人通常希望在家庭和社區提供護理。越來越多的人步入老年，意味著更多的醫療補助（Medicaid）和醫療保險（Medicare）政策以及更多的資金，大量的資金。這引起了財大氣粗的公司和投資者的注意。

Private and public entities have been investing in the senior care space for a while now.

私營和公共實體投資老年護理領域已有一段時間。

This is nothing new. Big health care players like Vitus, a subsidiary of ChemMed, has been buying up smaller regional hospices and long-term care operations for years.

這並不是什麼新鮮事。像 ChemMed 的子公司 Vitus 這樣的大型醫療保健企業，多年來一直在收購較小的地區性臨終關懷機構和長期護理機構。

Insurance companies, REITs and real estate companies are also investing in nursing homes and hospice agencies. All these companies and structures make for a pretty crowded space, especially when it comes to long-term care.

保險公司、房地產投資信託基金和房地產公司也在投資養老院和臨終關懷機構。所有這些公司和機構構成了一個相當擁擠的空間，尤其是在長期護理方面。

This is highly segregated or highly fragmented market.

這是一個高度隔離或高度分散的市場。

The top 10 competitors in this space may not account for more than 10 percent of market share.

該領域排名前 10 位的競爭對手所佔市場份額可能不超過 10%。

What is new is this, the influx of private equity deals in the senior care space since 2020, with a significant uptick happening in the hospice space, a trend that's been picking up steam since the 2010s.

令人耳目一新的是，自 2020 年以來，大量私募股權交易湧入養老護理領域，其中安寧療護領域的交易顯著增加，而這一趨勢自 2010 年代以來一直在加快發展。

Hospice was started as a grassroots nonprofit movement where the majority of care, you know, a couple of decades back, was provided by strictly nonprofits.

安寧療護是一項非營利性的基層運動，在幾十年前，大多數護理都是由嚴格意義上的非營利組織提供的。

And in this current landscape now, the majority of hospice providers are for profit.

而在目前的情況下，大多數安寧療護機構都是以盈利為目的。

Between 2011 and 2019, there were 409 private equity transactions involving hospice agencies, 58 percent of those transactions involved buying a nonprofit hospice.

2011 年至 2019 年期間，共有 409 宗私募股權交易涉及臨終關懷機構，其中 58% 的交易涉及購買非營利性臨終關懷機構。

Now, 75 percent of hospice agencies in the U.S.

現在，美國 75% 的安寧療護機構都在使用該技術。

are run on a for-profit model of some kind.

都是以某種營利模式運行的。

Historically, we've had low interest rates.

從歷史上看，我們的利率一直很低。

So that means that money is cheap to borrow.

這意味著借錢很便宜。

Hospice is interesting because you don't need a lot of capital to start one.

臨終關懷很有意思，因為開辦臨終關懷不需要很多資金。

You don't need a traditional brick and mortar setting to provide hospice care.

提供安寧療護並不需要傳統的實體機構。

The care can be provided in a person's home, a nursing home, assisted living facility.

護理可以在個人家中、療養院或輔助生活設施中提供。

And so the margins can be very high.

是以，利潤率可能會非常高。

Margins for for-profit agencies generally land around 18 to 22 percent, a major uptick compared to nonprofit agencies. There's a lot of factors drawing private investors into the hospice space, but most experts point to

營利性機構的利潤率一般在 18% 到 22% 左右，與非營利性機構相比有了很大提高。吸引私人投資者進入臨終關懷領域的因素很多，但大多數專家指出

Medicare's fixed payment model as a driver.

醫療保險的固定支付模式是一個驅動因素。

Hospice is paid on a daily rate or a per diem rate based on the level of care provided, regardless of the number services rendered in a given day.

安寧療護根據所提供的護理水準按天或按日支付費用，與一天內提供的服務次數無關。

So for each patient that is enrolled in hospice, for each day, they're reimbursed a fixed amount.

是以，每一位加入安寧療護的病人，每天都能獲得固定金額的報帳。

It doesn't matter how many services that hospice provides to you, they're getting that fixed amount of money.

安寧療護為您提供多少服務並不重要，重要的是他們能拿到那筆固定的錢。

For-profit owners sometimes cut costs to boost margins in a space that is already grossly understaffed.

營利性企業的業主有時會削減成本，以提高人員已經嚴重不足的空間的利潤率。

This isn't just affecting the hospice sector.

這不僅影響到臨終關懷部門。

It's also impacting long-term care operations.

這也對長期護理業務產生了影響。

We have huge staffing shortfalls in all parts of our end-of-life care system, from nursing homes to assisted living to home and community-based settings to hospice.

從養老院到生活輔助設施，從家庭和社區環境到臨終關懷，我們生命末期護理系統的各個環節都存在巨大的人員缺口。

There is still a shortage of skilled laborers.

熟練工人仍然短缺。

We've seen a lot of inadequate symptom management and support due to the untrained caregivers and insufficient expertise. And less staff means less resources for patients and families.

我們看到，由於護理人員未經培訓和專業知識不足，很多症狀管理和支持都不到位。人手減少意味著病人和家屬的資源減少。

When a private equity company acquires a nursing home chain, we see an increase in emergency department visits, an increase in hospitalizations.

當一傢俬募股權公司收購一家連鎖養老院時，我們會發現急診就診人數和住院人數都會增加。

And then there's some really stark evidence on increased mortality when an individual is cared for in a private equity facility.

還有一些非常嚴酷的證據表明，如果一個人在私募股權機構接受護理，死亡率就會增加。

That motivation to cut costs also extends to patients.

這種削減成本的動機也延伸到了病人身上。

For-profit hospice agencies are more likely to accept patients based on their profitability.

營利性安寧療護機構更有可能根據其盈利能力接受病人。

Studies found these types of hospices prioritized people with neurological diagnoses like dementia over cancer patients who pass away in a shorter time span.

研究發現，這些類型的臨終關懷機構會優先照顧痴呆症等神經系統疾病患者，而不是去世時間較短的癌症患者。

The first couple of days of being enrolled in hospice and the last couple of days until you unfortunately die are the most intensive and costly to the hospice, where in the middle, it's the least costly and the most profitable.

加入安寧療護的最初幾天和最後幾天，直到你不幸去世，對安寧療護來說是最緊張和成本最高的時候，而在中間階段，成本最低，利潤最高。

Not every nursing home is equally profitable and not every nursing home resident is equally profitable.

不是每家療養院都能獲得同樣的利潤，也不是每位療養院居民都能獲得同樣的利潤。

For long-term care, the trend is flipped, with for-profit ownership preferring patients with shorter stays to those with long-term needs.

在長期護理方面，趨勢則發生了逆轉，營利性企業更喜歡住院時間較短的病人，而不是有長期需求的病人。

Medicare is a very generous payer for post-acute nursing home care.

聯邦醫療保險對急性期後的療養院護理非常慷慨。

So I'm thinking about an individual that has a stroke or a hip fracture, needs a hospital stay, then followed by some rehabilitation in the nursing home and then hopefully discharged to the community.

是以，我想到的是，一個人如果中風或髖部骨折，需要住院治療，然後在療養院進行一些康復治療，最後希望能出院回到社區。

That individual is very lucrative.

這個人非常有利可圖。

So basically, if you're running a nursing home, you want to maximize those short-stay Medicare patients and minimize those long-stay Medicaid residents.

是以，基本上，如果您正在經營一家療養院，您希望儘可能多地收治短期住院的醫療保險病人，儘量減少長期住院的醫療補助住院病人。

And that's exactly what private equity has done.

這正是私募股權基金所做的。

They've looked to expand the share of Medicare patients who are maybe a $600, $700 daily payment rate versus a

他們希望擴大醫療保險患者的比例，這些患者的日支付率可能為 600 或 700 美元，而不是

Medicaid resident that may be $200 or $250 a day.

醫療補助居民每天可能需要 200 或 250 美元。

But for the average family, it can be difficult to get a clear picture of who is in charge of their loved one's care during an already stressful and confusing time.

但是，對於普通家庭來說，要在本已充滿壓力和困惑的時刻清楚地瞭解誰負責照顧自己的親人可能會很困難。

When family members are looking for a nursing home for a loved one, they typically start on the federal website, nursinghomecompare. Currently, however, you can't tell whether or not the building is private equity owned.

家庭成員在為親人尋找養老院時，通常會從聯邦網站 nursinghomecompare 開始。但目前，您無法判斷該建築是否為私人所有。

This leads a lot of families to be flying blind when it comes to ownership of nursing homes.

這導致很多家庭在養老院所有權問題上盲目行事。

On top of everything, political headwinds could throw the entire space into flux.

除此以外，政治上的逆風也可能使整個行業陷入動盪。

The National Council on Aging called long-term care the single largest financial risk faced by older adults and their families, with an estimated 80 percent of seniors unable to absorb the financial shock.

全國老齡委員會稱長期護理是老年人及其家庭面臨的最大財務風險，估計有 80% 的老年人無法承受這種財務衝擊。

We're completely sticking our heads in the sand and not really investing in the types of policies that are going to lead to good outcomes.

我們完全把頭埋在沙子裡，沒有真正投資於能夠帶來好結果的政策類型。

And it's not just the macro environment that can be difficult to navigate.

難以駕馭的不僅僅是宏觀環境。

Personal finances can add unforeseen headwinds to end-of-life care planning.

個人財務狀況會給臨終關懷規劃增加不可預見的阻力。

He was the father that was home at five o'clock, that we'd have dinner, we'd have a catch.

他是五點鐘就回家的父親，我們一起吃晚飯，一起抓魚。

He was always present. He was always there.

他始終在場。他總是在那裡。

This is David Frisch.

我是大衛-弗裡施

He's the CEO of Frisch Financial Planning, a financial advisory firm where he worked with his dad for 20 years.

他是 Frisch Financial Planning 的首席執行官，這家金融諮詢公司是他與父親共事 20 年的地方。

Frisch also recently lost his father.

弗裡施最近也失去了父親。

It wasn't a father-son firm.

這不是一家父子公司。

It was a son-father firm.

這是一家子承父業的公司。

But we loved every second of it.

但我們喜歡這每一秒。

Now, as a financial planner, he guides clients through another part of the end-of-life sector that can be confusing.

現在，作為一名理財規劃師，他負責指導客戶瞭解生命終結領域另一個可能令人困惑的部分。

The more planning and the earlier the planning, typically it is just easier for the family.

一般來說，計劃得越多、越早，對家庭來說就越容易。

Then in your 80s, it's really just making sure that everything is buttoned down and finished and clear and precise and that everything is just neatly organized.

到了 80 年代，要做的就是確保所有事情都扣好釦子，完成得清晰準確，一切都井井有條。

And that things that you may have done in your 60s and 70s may or may not need to be tweaked.

您在六七十歲時做的事情可能需要調整，也可能不需要調整。

And while everyone's situation is different, Fidelity recommends retirees set aside $165,000 in after-tax funds to cover health care costs.

雖然每個人的情況不同，但富達建議退休人員預留 16.5 萬美元的稅後資金來支付醫療費用。

Long-term care today tends to be more expensive.

如今的長期護理往往更加昂貴。

Their pricing has changed dramatically from when they introduced it 25 or 30 years ago.

與 25 或 30 年前推出時相比，他們的定價發生了巨大變化。

In the time it takes you to watch this video, you can start preparing your finances by organizing important documents, including bank account information, mortgages or deeds, insurance policies, plus any retirement or Social Security benefits. Even something as simple as keeping a list of all online banking and social media passwords.

在觀看這段視頻的時間內，您就可以開始整理重要文件，包括銀行賬戶資訊、抵押貸款或契約、保險單以及任何退休或社會保障福利，為您的財務做好準備。甚至可以像保存一份所有網上銀行和社交媒體密碼的清單一樣簡單。

Having these discussions early with your loved ones, thinking about your living arrangement, thinking about how you spend money and your level of savings, that's really going to help dictate where you receive care in your older years.

儘早與你的親人討論這些問題，考慮你的生活安排，考慮你如何花錢以及你的儲蓄水準，這將有助於決定你晚年接受護理的地點。

Doing this for 34 years, I don't think I've ever met somebody that was 100 percent prepared.

幹這行已經 34 年了，我想我從未遇到過百分之百做好準備的人。

I think everybody is unprepared.

我認為每個人都沒有做好準備。

It's just a matter of are they a little bit unprepared or are they a lot unprepared?

問題只是他們是有點準備不足，還是準備不足太多？