By Lani Luciano
Aging-in-place is a broad term for arrangements that allow seniors to remain at home rather than relocate as frailty or disability increases their need for help with daily activities.
Services and products that support a senior’s independence include everything from home-delivered meals for people who can no longer cook, to home health care for older people with chronic health conditions, to scooters for those who can’t get around easily.
Also important are community-based programs that give seniors the chance to socialize, become engaged in activities and sometimes help each other out – for instance with transportation to doctors’ appointments. In some cases, long-term care services are incorporated in retirement housing complexes, letting older people stay longer in these settings even as their health declines.
Unsurprisingly, most older adults – 86 percent according to the AARP – prefer to live on their own rather than move to a nursing home as their personal needs increase. Besides the comfort of familiar surroundings, being at home gives seniors a greater sense of control.
Governments, too, have a stake in keeping dependent people out of nursing homes, since the cost of institutional care weighs heavily on public coffers. (70 percent of nursing home residents rely on Medicaid, accounting for 40 percent of all Medicaid spending).
One recent sign that delaying the path to a nursing home or avoiding it altogether is a priority for states: Minnesota’s new law requiring that applicants to assisted living be offered “transitional counseling” on cheaper home-care alternatives. (See this story by Minnesota Public Radio.)
Though a popular idea, aging in place isn’t always easy to achieve. Finding adequate services and/or enough money – public or private – to pay for them is a major barrier. The prolonged economic downturn has squeezed both individual wealth and the ability of governments to subsidize care for the needy.
Middle class seniors aren’t immune from this pressure: Even a few hours of help at home every day can strain their budgets. According to a 2011 survey from the MetLife Mature Market Institute, the average cost for a homemaker is $19 an hour, while home health aides go for $21.
In mid-2010, The New York Times highlighted cuts to home care services being made by financial strapped states. This trend is ongoing and it’s one that you’ll want to watch. For a recent analysis of how all 50 states are responding, check out a report from the AARP Public Policy Institute, “Weathering The Storm: The Impact of the Great Recession on Long Term Services and Supports.”
The Affordable Care Act could provide some financial relief, if it remains in force, by supplying extra funding for innovative state Medicaid programs that help older people live at home and stay out of nursing homes. See this February 2011 press release from the U.S. Department of Health and Human Services for more details.
The National Academy for State Health Policy reviewed new state options for funding home and community based services under Health Policy in this report. Families USA summarized these provisions in a fact sheet. And Health Affairs examined at the issue in a March 2011 article, “How the Affordable Care Act Can Help Move States Toward a High-Performing System of Long-Term Services and Supports.”
Another development you’ll want to track is the growing use of technology to monitor the safety, health and well-being of home-bound elders. This can include everything from small electronic devices that record an older person’s vital signs and allow the data to be transmitted to a doctor’s office to homes outfitted with sensors that record an older person’s daily activities.
See this CNN story for examples of how monitors are being used in the homes of older people. Also, look at this brochure from IntelliHome Systems for an example of the kind of services being marketed to older adults and their families. Privacy is clearly a concern for some seniors, who don’t want their every movement being tracked.
On the social front, the Internet is a godsend for growing numbers of older people who live alone but who can now interact with friends, family or strangers online via email, Skype, Facebook or chat rooms.
In a demonstration project in New York City, some home-bound seniors have begun participating in activities at senior centers via their computers, with the help of webcams and broadband Internet services. See the story “Virtual Senior Center Enhances the Lives of Home Bound Seniors.”
For more on the possibilities, check out the Center for Aging Services Technology, the Aging Technology Alliance and the Home Care Technology Association of America.
Because the topic of aging-in-place is so broad, it can be somewhat unwieldy to cover. Your challenge will be to find timely stories that illustrate what’s going on in your communities and reflect broader national developments as well.
Questions of interest:
Which cities and states lead or lag in advancing aging-in-place programs?
What models for aging-in-place are emerging or have emerged across the country?
So-called “villages” – seniors in a community who join together, purchase some services cooperatively, and agree on self-help – are a relatively recent example. This village movement began in Boston with Beacon Hill Village, founded in 2001. Check the Village to Village network for more examples.
Another example are “naturally occurring retirement communities.” For more information about this model, which originated in New York City, see the NORC website.
Which agencies in your community are engaged in helping seniors age-in-place and what services do they provide? What are eligibility requirements?
Make sure to check with your state or local Area Agency on Aging. You can find a directory of these programs here.
What are the costs of aging-in-place programs, products and services available in your community and who pays for them – insurance, government, individuals?
This vast market includes paid caregivers or home health aides, home-modification contractors, medical products like walkers or wheelchairs, financial products like reverse mortgages and long term care insurance, specialized services such as geriatric care management, professionals now marketing themselves as “certified aging in place specialists” and much, much more.
Are government programs threatened by funding cuts? Are seniors being put on waiting list for services or being told they can no longer receive services they once had? If so, what are the consequences?
What is the future outlook for government spending as the baby boomers age and look to these kinds of programs? Is it realistic to expect that this enormous population will be able to remain home indefinitely? What if they can’t?
Are private companies that market aging-in-place services to seniors delivering what they promise?
What are drawbacks or limitations or shortcoming of the programs, products and services being marketed to seniors?
What implication do various policy proposals have for the aging-in-place concept? For example: block-granting of Medicaid funds – a popular idea for deficit-reduction – may mean more money to keep needy seniors at home or it may mean less.
Are community-based aging-in-place models that depend on volunteers sustainable over the long haul? Do they reach enough seniors to really make a difference?
Sources:
- National Aging in Place Council
- Aging in Place Initiative
- Village to Village Network
- NORCs: An Aging in Place Initiative
- Center for Technology and Aging
- Center for Aging Services Technology
- National Association of Area Agencies on Aging
- “Aging in Place: A State Survey of Liveability Policies and Practices,” December 2011, by AARP.
- “The Maturing of America: Getting Communities on Track for an Aging Population,” published by the National Association of Area Agencies on Aging and several other partners in June 2011.
Lani Luciano has covered health care issues for consumer and business publications for more than 30 years.
