> This is slightly aside, but the concerns over fertility rates in the first world really seem REALLY misplaced to me.

Since the early days of humanity, we've relied on children taking care of us in our old age. I haven't seen a solution for that.

Nursing homes are not a solution. I listened to some grim statistics from my state recently. In many nursing homes, the ratio of staff to patients is 6:1. It takes 6 full time employees to take care of 1 patient. Now I'll grant that these numbers were outliers, because the population was challenging - many/most of these patients had dementia, etc. And they were handling rural areas - you'd get better scaling in the city. Still, I'm sure in a major metropolitan area it's at least 2:1.

And that doesn't account for the poor existence in those places (abuse by employees, abuse by fellow residents - you're screwed if you don't have family members advocating for you).

And that's for patients who get to go. Many elderly will have chronic conditions which are bad enough that you can't live alone, but generally not bad enough for Medicare or health insurance to pay for assisted living. Examples are things like mobility issues - only long term health care insurance covers this, and it's way too expensive. I don't own such a policy and likely won't ever be able to afford it.