Editor's note: This article is part of a year-long project about aging well, planning for the changes aging brings and shaping how society thinks about aging.
If 90 percent of adults over 65 want to remain in their homes as long as possible, as a 2011 AARP study suggests, why do so many wind up in retirement communities, assisted living facilities and nursing homes?
This was the key question at the National Aging In Place Council's (NAIPC) annual meeting held this week in Washington, D.C.
Meeting the needs of millions of individuals with different incomes, a range of health conditions and diverse living situations is a complex puzzle with no one-size-fits-all solution. But as NAIPC pointed out in the white paper
prepared for the meeting, finding innovative ways to keep older adults in their homes longer would provide huge social and financial benefits to individuals and society as a whole.
(MORE: SPECIAL REPORT: Transforming Life as We Age)
Speakers at the meeting presented a variety of experimental models to address what is expected to be a growing need — projections show there will be 89 million Americans over 65 by the year 2030, including 20 million who will be older than 85.
The three models featured below were presented as options either for boomers who want to stay in their homes as long as possible or for those over 80 (possibly the parents of boomers) who also want to stay in their homes, but have greater health and home care needs.
The Technology Model
Teel saw a need for greater support for his patients to help them live at home. “My patients were telling me, ‘Don't you ever think of putting me in a nursing home,’” he said. "But there were not very many options for these very fragile but very proud people.“
He realized that some of his elderly patients could avoid moving to an assisted living facility or nursing home if they had a combination of digital tools to keep tabs on their health and a network of family, volunteers and paid caregivers to help with other needs — from buying groceries to driving them to the dentist to weeding the garden.
With the right support, at Full Circle America, Teel says he can reduce the number of daily hours someone needs for personal care and supervision from 24 to just two, with an additional 22 hours of monitoring via webcam and volunteers.
Full Circle America provides patients with a kit including a web camera, blood pressure cuff and stethoscope to monitor their health. The rest of their healthcare and living needs are coordinated by a combination of paid staff, family and volunteers. According to its website, the program (of technology and paid caregiving) costs $100 to $400 per month depending on the level of monitoring needed, plus a start-up expense of $500 for the equipment. The telemedicine service costs an additional $200 more per month.
The expenses can be daunting for someone on a fixed income, but compared to the $5,000 to $10,000 monthly cost of an assisted living facility or nursing home where the person might not want to be, it’s a bargain, Teel says.
Teel wants to expand his program to other communities, working with local family physicians and possibly the Area Agencies on Aging
. "The demograogics demand a very bold plan … who's going to step up and do this?" he asks.
So far, Teel says he has not been able to find investors who will buy into the range of services needed to make his model work. They don’t want to hear, for instance, that we’ll arrange dialysis for someone’s cat, Teel says, adding that those types of services areimportant to clients and critical to the mission of keeping someone in his or her home as long as possible.
The Village Model
While programs like Full Circle America can help the fragile elderly live in their homes longer, boomers want to stay in their own residences longer, too. They may not have critical health needs, but some find they need adjustments to their homes and lifestyle as they age.
(MORE: What It Takes to Age in Place)
Washington, D.C.’s Capitol Hill Village
(CHV), another cutting-edge, lifestyle model presented at the NAIPC meeting, is a nonprofit, membership-based program founded in 2006 by people who wanted to continue living in their city homes but needed more support. The program, part of the Village-to-Village Movement
, helps members who live on or near Capitol Hill maintain their homes, secure transportation and find in-home care. CHV also sponsors classes and social activities for its members.
There's an annual fee of $530 for individuals ($800 per household) to tap into the services provided by the village, with financial assistance programs for those who qualify. The village currently serves more than 265 individual and household members.
CHV was one of the first villages in Washington, D.C., which now has 14 similar programs and 40 in the D.C. metropolitan area. For a closer look at why members like the village concept, watch AARP's profile of CHV.
The Purpose-Driven Model
Mark Dunham, external affairs counsel for Generations of Hope, presented a third innovative, lifestyle model for aging in place. Generations of Hope is an affordable-housing concept in which residents, roughly 60 and older, are offered subsidized housing to live in a community that needs their help.
(MORE: Volunteers After 50: AARP Experience Corps Tutors)
The original Generations of Hope, Hope Meadows in Rantoul, Ill., pairs families raising foster children with older residents who volunteer at least six hours per week doing such things as babysitting, tutoring, gardening or serving as a crossing guard.
Dunham says his model has been replicated to serve veterans returning with traumatic brain injury in New Orleans and families with autistic children in other parts of the country. In each case, he says three generations live in the same community — one that's created to address a specific social need using older residents as volunteers.
The strength of this model is that the families with children (or in the case of the veterans, young adults) who have special needs get extra support, while the older residents who choose to live in the community benefit from a greater sense of purpose and connection. "It's figuring out what's in our hearts and translating it to workable models," Dunham said. Generations of Hope is expanding, with two projects being developed in Washington, D.C. and more across the country.