Results tagged “aging in place” from Caring For Our Parents

It is an article of faith among many in the elder and disability advocacy communities that aging in place is always the best alternative for someone who needs personal care. I don't believe it, and I recently heard an important panel discussion that confirmed that view.

The panel, sponsored by Washington Grantmakers, was especially interesting because the participants were all supporters of community caregiving. But they agreed that, without a strong infrastructure of family, community, and public support, it is not always possible for people to live at home. Indeed, it can often be lonely and even dangerous.

University of Florida professor Stephen Golant, who has written extensively on housing and care alternatives for seniors, reported that his research finds six major challenges to the frail elderly living at home. They include affordability, physical deficiencies of homes, lack of social supports, neighborhood changes, difficulties accessing community assistance (especially in both inner cities and cul de sac suburbs) and vulnerabilities of old age including greater risks of accidents, poorly trained family and paid caregivers, and even abuse.

Golant concluded that those most at risk staying at home are low-income, very frail, poorly educated women who are 85 or older and either living alone or with a frail spouse. This seems obvious, but these are the very people who have the fewest alternatives. For most, high-quality assisted living or even independent living are far beyond their financial means. Golant says those at most risk are not the very poor but the nearly one-third of seniors he calls "tweeners," who do not qualify for public programs but can't afford to private pay for housing with supportive services. 

Golant suggests that addressing these issues requires "changing the aging in place dialogue." Doing this will require society and families to recognize that living at home is not always the answer, and that focusing on group care may make more sense. This can mean thinking about senior villages and other naturally occuring retirement communities where care can be better coordinated and delivered much more efficiently. 

Charles Smith of the Montgomery County (MD) department of aging and disability services said that it is increasingly difficult for government to deliver the services necessary to support people aging at home. Budgets are being slashed and physical distances make it tougher to provide assistance, especially in the suburbs. Smith said that in sprawling Montgomery County, it costs five times at much to deliver a meal to a suburban house as it does to buy it. Transportation services, the single most common need for those at home, face the same difficult combination of smaller budgets and greater distances.

"We are creating expectations that you should age in place,"  Smith says, but government doesn't have the resources necessary to meet those expectations. 

Rev. Joseph Williams, executive director of Emmaus Services for the Aging, a private non-profit in the District of Columbia, added that grassroots community support is essential for people to age at home. "It can't all happpen in the department of aging," he said.   

None of this means those of us caring for our parents should not do all we can to help them stay at home, if it is appropriate. It does mean that just saying the words won't make it happen. Rather, it will require communities and families to work together to back up the sentiment with real resources, including both time and money. It is a fantasy to believe that assistance will come entirely from government, which will be increasingly strapped for funds in coming years. It will also require us all to recognize that some of our parents will be far better off in a congregant care setting.        

In an important new study, Lynne P. Snyder and Christopher Baker show the importance of energy assistance for elders living at home. The paper, Affordable Home Energy and Health: Making the Connections, was published by AARP. It is another example of why it is not enough for states to provide Medicaid waiver programs to help people receive long-term care at home. Without additional supports, such as energy assistance, the dream of aging in place can easily become a nightmare.

The problem is that rising energy costs put low-income seniors at serious physical risk. About 900 older adults suffer either heat-related or cold-related deaths each year. But those killed directly by extreme weather are only a fraction of those who die as a result of their inability to manage very high or very low temperatrues.

Seniors are at greater risk for death from respiratory or cardiovascular disease in the high heat of summer and from heart disease in the cold of winter. Not surprisingly, those with access to central heat and air conditioning are far less likely to die than those who do not.

Snyder and Baker report that 80 percent of housholds receiving federal energy assistance through the program known as LIHEAP have at least one member who suffers from a disease that puts them at risk of extreme temperature.

This study is yet another example of why states must do a far better job of managing all the needs of low-income elders who require long-term services. These people need more than a Medicaid-paid home health aide. They need an accessible home, transportation, good nutrition, companionship, and, as this study shows, assistance with energy bills. Without a full package of assistance--and without the ability to find and access that help--aging in place is doomed to fail, despite our wishes.

Some of this help, such as transportation and companionship, can be provided by neighbors helping one another. But other services very likely will have to come from government. And unfortunately, Medicaid dollars can normally not be used for supports such as energy assistance. The Snyder-Baker paper is more evidence of why policymakers must think outside of their narrow silos if they are going to do their part to keep frail elders safe at home.     

The Stanford University Center on Longevity has just released a trove of information on the health, living arrangements, and demographics of an aging America. The study, "New Realities of an Older America" tells the story of an independent, remarkably healthy population, but one that will present unique challenges as it lives well into its 80s and, eventually, reaches frail old age.

For example, authors Adele Hayutin, Miranda Dietz, and Lillian Mitchell paint of picture of serniors increasingly living alone and in the suburbs--housing patterns that will make caregiving especially difficult.These seniors want to age in place, but providing assistance to a population that may become trapped in their own subdivisions will be a huge challenge. Caregivers battling traffic. Elders no longer able to drive to the doctor or the grocery store, or to even visit with friends. These are not pleasant images.

Yet, the current population of elders has made their opinion clear. In 2005, even among those with functional limitations, 85 percent lived at home or with a relative. Just 10 percent lived in skilled nursing facilities and only five percent lived in assisted living facilities. Even among all those 85 or older, three-quarters lived in traditional housing. 

The great challenge will be finding new ways to deliver care to this population--a challenge that will be compounded by the growing prevalence of dementia among those 85 or older. While this study finds that disability rates among the elderly are falling (a conclusion that is disputed by other research), it also estimates that the population with dementia will more than double, to nearly 11.4 million, by mid-century. 

There is lots more to chew over in this paper. Take a look at it.

Today, The Washington Post and Kaiser Health News jointly published an article I wrote on aging in place villages--an important element in the effort to help seniors remain in their communities. 

There are close to 50 villages now operating around the country, and at least 600 communities interested enough to send representatives to workshops held over the past year by the non-profit community development group NCB Capital Impact.

Villages come in many shapes and sizes, but there are three basic models. One, pioneered by the Community Without Walls in Princeton, N.J. is an all-volunteer group, with modest dues (just $30 for a couple). Beacon Hill Village in Boston relies on a professional staff, provides concierge services to link members with vendors (for services from home health aides to plumbers), and charges substantial dues. The third model, created by the Maryland non-profit Partners In Care, is based on the concept of time-banking. In this design, members  receive credits for their volunteer time which they, in turn, can exchange for the help of other volunteers. 

Different models may work in different communities. But the key to the success of the village movement will come from their bottom-up, community-based nature: Local people pulling together to help one another as they age. It is a powerful concept with a promising future--both for elders and for adult children caring for our parents.