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Aging in Place Has Come Of Age

February 11, 2015

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.

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. One solution is to bring health care and social services to neighborhoods where a large part of the population has aged in place. These areas, known as Naturally Occurring Retirement Communities, or NORCs, are a logical place for senior programs, which involve the combined efforts of private agencies, housing managers or neighborhood associations, and residents (see About 70 NORCs—more than half in New York State—currently have programs in place.

Other communities use the "village" concept to provide services and support to seniors living in the neighborhood. The idea, which originated in the Beacon Hill neighborhood of Boston, is to create a nonprofit organization that arranges services—including transportation, home repair and social activities—for fee-paying members. About 85 such villages have sprung up around the country, with 120 more in the works. The annual membership fee for a single member runs $430, on average, according to a report by the Rutgers School of Social Work. Most villages offer a discount to members with financial need.

Another way to stay put and get help with home maintenance, errands and other chores is to share your home with someone who will provide those services in exchange for below-market rent. This arrangement offers not only household help and a way to cover the bills but also companionship, and many seniors who go this way feel safer and happier with the companionship.

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