The U.S. baby boom population is getting older. By 2030, residents born between 1946 and 1964 will make up 20 percent of the population, with 72.1 million Americans ages 65 and older.
As this population grows, so do concerns that the U.S. health system will not be able to meet the health needs of seniors, particularly in regard to demands for long-term care.
But instead of moving seniors to nursing homes or assisted living facilities, some communities are taking another approach to long-term care: aging in place. Under the practice, seniors are able to reach advanced ages while still residing at home, thanks in part to community resources and programs.
Tamara Lycholaj, of Glen Spey, N.Y., receives a home-delivered meal from nutrition worker Al Patalona of the Sullivan County Office for the Aging in 2012. Helping seniors as they age in place often means bringing community services to them.
Photo by John Moore, courtesy Getty Images
According to AARP’s 2011 “Aging in Place: A State Survey of Livability Policies and Practices,” 90 percent of seniors older than 65 want to remain in their homes. To make aging in place work, communities should have mixed-age residents who can assist seniors and neighborhoods where the infrastructure accommodates those with less mobility.
Besides being preferred by seniors, aging in place offers another benefit: savings.
Marty Bell, executive director of the National Aging in Place Council, said that according to council research, care can cost on average $86,000 annually per person in a nursing home, $60,000 for someone in assisted living and $23,000 for someone aging in place at home.
“There are a lot of people who argue aging in place is the solution to the sustainability of Medicare and Medicaid, that if enough people could be taught to age in place, and it’s available to them, that it can really bolster the sustainability and strength of the Medicaid and Medicare program,” Bell said. “So it’s kind of a win-win for the individuals and the society as a whole.”
Medicaid pays, on average, $150 a day for nursing home care but people without Medicaid could be paying as much as $200 or $300, said David Gifford, MD, MPH, senior vice president of quality and regulatory affairs for the American Health Care Association, which advocates on behalf of the needs of the long-term care community.
For aging in place to be successful, it needs to have a network of skilled professionals, family and volunteers whose care can help seniors avoid entering long-term care facilities.
An example of an aging-in-place model is the village concept planned by California State University-Long Beach. Staff and faculty from the university’s College of Health and Human Services are working to create a university-affiliated village in the Long Beach community.
The village will be a network where people can engage senior adults from racially and economically diverse backgrounds in recreational activities and fulfill needs such as rides to doctor’s appointments and social events. The village will provide an opportunity for university student interns to work on programs with seniors in chronic disease management, nutrition and fraud prevention, said Gail Farmer, DrPH, chair of the Department of Health Science and principal investigator on the project.
“It’s really a holistic approach to empowering older adults to remain in their homes with dignity and with some form of independence and also a purpose in life,” Farmer told The Nation’s Health.
The concept has the added benefit of exposing students to older adults, said co-principal investigator Theodora Papachristou, MPH, a lecturer at the university’s Department of Health Science and Department of Sociology. According to a 2008 Institute of Medicine report “Retooling for an Aging America: Building the Health Care Workforce,” there were approximately 7,100 practicing geriatricians in the U.S., a number that will only decline. Additionally, only 1 percent of nurses and pharmacists and 4 percent of social workers specialize in geriatrics, the report states.
To make working with seniors an interdisciplinary experience, Papachristou, Farmer and Barbara White, DrPH, a co-principal investigator and program director of the university’s gerontology master program, intend to include students studying social work, health science and nursing in the project.
Most seniors older than 65 want to remain in their homes as they age, a 2011 AARP survey found.
Photo courtesy Michelle Gibson, iStockphoto
“My first question to them every semester is ‘Who is the oldest person you have a relationship with?’ and most of them will tell me their parents,” Papachristou told The Nation’s Health. “The majority of students don’t have any interaction with older adults. So what does that mean for nurses? That means they need to develop those skills and the comfort level for interacting.”
As universities work to expose more students to geriatrics, there are potential federal and state solutions to address future workforce shortages.
Geriatric workforce training is available via more than 40 Geriatric Education Centers funded by the Health Resources and Services Administration. Among those are the Stanford Geriatric Education Center, based at Stanford University’s School of Medicine, which has provided more than 1,600 trainings in geriatrics with a focus on assisting seniors of different ethnic and racial minorities, their caregivers and family members. Among the center’s goals are to train both health students and existing health care professionals on health disparities in specific minority populations and culturally appropriate care.
The Affordable Care Act also has potential to alleviate the workforce shortage issue, said Lené Levy-Storms, PhD, MPH, chair of APHA’s Aging and Public Health Section and associate professor in the departments of Social Welfare and Medicine-Geriatrics in the schools of public affairs and medicine at the University of California-Los Angeles. The health reform law created or reauthorized existing programs to boost the public health workforce, such as the creation of mid-career training grants and the reboot of the Preventive Medicine and Public Health Training Grants program.
In Maryland, the state legislature in 2013 passed the Veterans Full Employment Act of 2013, which expedites certification or licensing for health occupations if a veteran’s military work meets certain qualifications, said Dan Morhaim, MD, an APHA member and member of the Maryland House of Delegates. The move could boost the numbers of professionals who work with seniors, such as nurses, he said.
Homes must change as well to meet the needs of seniors aging in place. In Virginia, a tax credit is available for as much as $5,000 to retrofit senior homes or create new housing that is accessible to everyone as they age, said Mary Parker, PhD, a member of the Alexandria Commission on Aging and the Alexandria Commission on Persons with Disabilities, where she is the Housing Committee chair. The credit is open to homeowners and construction companies for measures such as widening doors and hallways or lowering cabinet space.
But there is a long way to go before the aging-in-place concept is widespread and the cost to provide services to seniors is still an issue. Overall, Bell said his organization wants to form national-, state- and city-level agendas for what communities need to make aging in place work. Future growth in the movement could benefit from federal government leadership or a national promotional campaign, he said. An aging in place summit, to be held in Washington, D.C., this month during National Aging in Place Week — observed Oct. 15-21 — will tackle such questions.
Gifford said there still is the challenge of how to pay for the services seniors will need, such as transportation, bathing and management of chronic diseases such as diabetes.
“The real question is going to be, how much money are we willing to put into taking care of the seniors who raised us all at some point in our lives and how much are we willing to pay back to them?” Gifford said.
For more information, visit www.ageinplace.org.
- Copyright The Nation’s Health, American Public Health Association
