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Age friendliness -- sounds good, where is it?

Not to be a spoilsport…but 'age-friendly cities' aren’t. US News Money ran an article this week about ‘aging in place’ – what a great idea, but…  Adding the 'but' is a correct assessment -- senior-friendly communities don’t really resonate as two words in the same sentence, although I suppose that is depending on whether you are imagining a young-aged (in either age or demeanor) senior. The AARP-sponsored state-by-state study cited underpins the issues, particularly with transportation. But what really struck me: "Of Americans over age 65, 21 percent do not drive," the report said. "This reduced mobility has a direct and often debilitating effect on older Americans' independence. More than 50 percent of non-drivers over age 65 normally do not leave home most days, partly because of a lack of transportation options." So let’s count that up, shall we? With 40 million aged 65+, 8.4 million of them are non-drivers, 4.2 million not leaving the home most days because of a lack of transportation. What are these people doing in their homes? Who sees them? How age-friendly is that?

Meanwhile, why are so many 'aging in place?'  Because they can’t sell their houses -- and when they do, it is later and later – the average move-in age for assisted living is 86, the average price for assisted living is > $39K per year, according to this 2011 John Hancock study.  A Senior Housing News article this week cited "The greatest policy challenge yet to be fully addressed is the need for some type of affordable assisted living for low-income Americans."  Yes, but – it seems like the price point of assisted living is a barrier for middle and upper income seniors as well – if you are a woman and live to age 85, you have a good chance of living another 6-8 more years. That potentially means a bank account or willing adult child contributor of $312,000, assuming there are no future price increases!  And that price presumes you are not in ‘memory care’ and that you don’t live in high cost East/West coast or in any big city locations.  Given that real estate market reports indicate a median sale price US-wide of $169K in 2011, this would seem to be an early indicator that that the assisted living average move-in age may rise again.

How to meet a serious need based on terminology and cost trends.  From my various related calls and encounters this week: heard the term ‘forever home’ versus aging in place; heard that builders believe that older adults don’t like the term aging; that senior housing complexes are communities, not facilities; that they are marketed in the context of a business, not an industry, that 55-plus housing is making a comeback among 65-year-olds; that home care (of every type) is hot, and that everything that sounds mobile and health-oriented is HOT and avoiding readmission to the hospital is HOT, HOT, HOT – especially where the government is the insurer of record.

Do you see the collision course we are on? The pending gap between the ability to pay and the need for assistance will only grow. This gap offers opportunity for service and tech businesses that can gear price points to low-income tolerance. It will also likely will result in various stop-gap government measures in a state here or a city there. Let's see more of today's senior housing businesses reach out with services and centralized hub-and-spoke offerings in which the sum of many low-cost services offered adds up to real revenue? Seniors will mostly stay in their unmodified, age-hostile homes. In lieu of assisted living, they will need home care. Home care is unlikely to offer enough hours of (reimbursed) care to fully mitigate isolation and risks – both for the low-income home care worker and the care recipient. Hope this isn't a rhetorical question, but why can’t the standard ('age friendly city') practice be a combination of home care services in partnership with nearby senior housing organizations to offer some type of remote camera-enabled monitoring care that also enables checking in the most isolated-in-place? 

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Answering the 'partnership' question you pose likely implies responders' trepidation or uncertainly re: reliable revenue and margins. And the old privacy/cameras dilemma still lurks. Perhaps some private/public grant funds somewhere are poised to support an actual model or demo of how your proposed partnerships could be successfully implemented.

Dave Brooks

Laurie you are right on with your comments regarding home care's ability to provide sufficient/cost effective hours of care to mitigate isolation and to provide quality care coordination. I would challenge the industry to develop more innovative solutions within adult day services. One such provider is The Ivey (www.theivey.com). Isolation without quality care coordination cannot be solved with technology (it can help). Personally I believe we need more providers like The Ivey to address many of the concerns you state above.


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