Wikipedia tells it like it is, not like it was. For a brief period in the history of the definition of Aging in Place, the term was really a continuing care concept. CCRC messaging has tried to link the definition more closely with the ability to remain on a campus of independent, assisted living and skilled nursing – but I don’t think consumers view the CCRC portfolio as aging in place. In 2011, AARP issued its 2011 state-by-state report on age friendliness for remaining at home. The CDC too has been refining definitions to keep up with the times, acknowledging the National Aging in Place Council and universal design principles. Today, aging in place is almost completely disassociated from continuing care retirement communities and the senior housing industry. In fact, as a recent Senior Housing News article observed, it is a movement encompassing active aging, livable communities, universal design principles, villages, NORCs, etc. that threatens the very structure of the senior housing.
Not your grandmother’s ALF – or hell no, we won’t go? In 2009, Howard Gleckman’s The Death of Nursing Homes observed that the introduction of the assisted living industry resulted in 1000 fewer US nursing homes over the period of a decade, ultimately housing only the poorest and/or sickest. More recently, Gleckman surfaced again – noting that Assisted Living was beginning to look a lot more like the nursing home – with frail residents needing numerous services, including skilled nurses, physical and occupational therapy and (a very conservative) 42% having some degree of dementia. According to the study cited in Senior Housing News, Independent Living move-ins are now averaging in the mid-80’s and assisted living resident average ages are now 89-90. Construction of new units in 2011 was slow, according to ALFA. So what’s it mean if the residential population is older and frailer and occupancy is still down?
Eventually boomers will reshape this market into home care. So the creative destruction of markets continues – AL shrank the nursing home market, aging in place will shrink the IL and AL markets. And home care is booming (two of the top ten fastest growing job categories) while the senior housing industry appears to be snoozing right through the boom. Healthcare providers are still stuck on hospitals, waiting for reimbursements to kick in before they switch to remote delivery of tele-alternatives in the home. But let’s imagine a few years forward, long past arguments about Medicare, Medicaid, healthcare laws, and other distractions from today. How can an aged 80+ boomer of twenty years from now get just the life they want?
Labor alone will not suffice. Given life expectancy, there will be a mismatch between need and available paid labor force. An industry plagued with low wages and high turnover, in a market that will not tolerate huge wage hikes, with resources (labor) that will not match the population’s expectations? Several types of organizations will no doubt recognize this and seize the opportunity presented or be marginalized by those who do – and what they’ll do is not a secret. Home care will include remote monitoring and video visits; senior housing organizations will expand into ‘virtual assisted living’ services for those who refuse to move; virtual villages/NORCs will have fully integrated home, home health, and tele-monitoring services. This week in Washington, ASA, 2012 What’s Next Business Summit and the National Forum on the Future of Aging sessions will be filled with folks talking about today, tomorrow, and the future decades – your comments welcome.