How to Avoid the Nursing Home
As my aunt hits her mid-eighties, she has no intention of moving from the house she and my uncle bought when he came home from World War II. She's far from alone in this wish, as an AARP poll indicates that nine out of 10 older Americans prefer to stay in their own homes for as long as possible, rather than go to an assisted living or nursing facility -- and really, who could argue? As our nation's demographic shifts upward, we need to develop more effective, affordable and widely accessible programs and services that enable older people to remain safely and comfortably at home.
I read recently about Beacon Hill Village -- which is known as an "intentional aging-in-place" organization helping people in Central Boston spend their later years at home. Local residents determined to stay in familiar surroundings with friends and family nearby created and funded a nonprofit organization that works like a virtual retirement community. Members pay an annual fee ($580 for individuals, $850 for households) for regular services such as food shopping, drivers to take them where they need to go, and a schedule of outings, exercise classes and lectures. Additional services such as home repair and in-home care are also available for an extra fee as needed. Vendors are carefully screened and discounts are negotiated for members.
This is a growing trend, with more than 100 aging-in-place communities established and more in the works. The first ones grew from grass roots efforts spearheaded by residents, and now government and social service agencies are getting involved as well. Peter Notarstefano, director of Home and Community Based Services at the American Association of Homes and Services for the Aging (AAHSA), told me that setting up these organizations can be a lot of work, but those who do so find the rewards well worth the effort.
THE ELEPHANT IN THE ROOM: AFFORDABILITY
Money, for funding an organization as well as paying individual fees, is the biggest barrier to establishing aging-in-place communities, and indeed most of the existing ones are in affluent areas populated by well-educated and well-connected professionals. However, some government and social service agencies are beginning to step up and share funds and expertise. United Jewish Communities, a national nonprofit, has used federal grant money to develop 45 "Naturally Occurring Retirement Communities" (NORCs: http://www.norcs.com/) as demonstration projects in neighborhoods or buildings where many older people live, including those who lack the means to join fee-based ones. These programs can take advantage of existing services like Meals on Wheels, and fitness classes and outings sponsored by local organizations such as senior centers and YMCAs. Then they focus on filling in identified gaps, such as providing affordable housing for those who can no longer physically or financially manage a large house but want to remain in their community... funding physical adjustments such as ramps and handrails to support mobility challenges... and providing supportive services, such as case managers.
These are steps in the right direction but the government is not focusing on solving the core problems that would reduce costs in the long-term. Notarstefano calls the government policy on spending for the elderly "short-sighted," pointing out, for example, that Medicare won't pay for fall-preventing safety measures such as inexpensive grab bars in the bathroom, but will readily pay doctor and hospital bills resulting from a fall. Medicaid picks up most of the bills for nursing home care, which costs on average $77,745 a year, according to AAHSA. Notarstefano's conclusion: Funding and coordinating more services to enable people to stay safely in their own homes is not only kinder and gentler, in the long run, it's more cost-effective.
WHAT TO DO?
Given that there is no effective oversight of medical practices, billing or program mandates, elders are on their own when it comes to seeking non-medical industry services. Whether aging in place is a goal you want to pursue on your own -- or with like-minded members of your community -- there are many resources and organizations to tap into...
AARP (www.aarp.org). This leading nonprofit offers a wealth of resources for aging in place. For example, there's a list of Certified Aging-in-Place Specialists (CAPS), contractors who are specially trained in making home modifications for older people. Click on http://www.aarp.org/families/home_design/ to find CAPS in your area.
The American Association of Homes and Services for the Aging (www.aahsa.org). The 5,700 member organizations of this not-for-profit offer adult day services, home health care, community services, as well as senior housing, assisted living residences, continuing care retirement communities, nursing homes and more.
The Eldercare Locator (www.eldercare.gov). This national service connects older people to resources -- such as local agencies and community-based agencies that serve seniors and their caregivers -- that help them live independently in their own communities. It is administered in part by the National Association of Area Agencies on Aging.
The National Aging In Place Council (http://www.naipc.org). NAIPC draws together experts from all areas of expertise -- including aging, health care, financial services, legal, design and building sectors -- to help make independent living possible. Click on "A Guide to Aging in Place" for a wide range of practical and helpful tips, from promoting independence to understanding your risks.