The Washington Post article about aging in place was, uh, provocative. It provoked me, anyway. The concept of aging in place has been oversold, says Professor Stephen Golant, author of a new book called less provocatively Aging in the Right Place. The Post encapsulation included a few gems from his book, noting that seniors who prefer to age in place have 'residential inertia' -- and paraphrasing their thinking as 'I’d rather rot in my own home.' The premise that the concept was oversold to the public, however, makes a nice headline, almost sounding like a marketing campaign -- but that simply is not what has happened in the recent past. What else was going on?
Government enablers and incentives emerged to keep seniors out of nursing homes. Aging in place is not only a concept, it was a government strategy and policy for low income elderly, government agencies viewed it as cheaper than Medicaid-reimbursed nursing homes. So over the past twenty years funding programs like PACE and Medicaid Long Term Services and Support specifically focused on keeping people out of nursing homes and thus in their homes (or variants). To make this ‘aging in place’ a reality, nursing home building moratoriums appeared from time to time – and sometimes lasted for a very long time – as in Florida. Pretty soon a waiver system sprang up to use nursing home Medicaid funds for the equivalent of nursing home care – at (some sort of) home. And the Money Follows the Person program had a similar result. By 2000, due to this migration of money, many nursing homes closed.
Some aging in place hype came from notable names. Who could forget Henry Cisneros’ 87-year-old mother staying isolated in her cavernous house, her friends gone and the neighborhood in decline. But she wanted to age there, and he was thus inspired to write a book about independent living and hit the talk circuit. Sadly, she only lived another 3 years, dying at 90, never recovering from a fracture from a fall. Would her time have been safer, more pleasant, and possibly lengthened into another decade in an assisted living community with meals, care and watchful eyes of staff? Yes. Did she stay (rot?) in her home because aging in place was oversold as a concept or was she just stubborn? By the time aging in place becomes the nightmare that it is for many, seniors are in their mid-80s and beyond – the move to senior housing more of an imperative than a choice.
Then there was that other law of economic unintended consequences. The economic downturn of 2008 forced many middle class seniors to remain longer in their homes. There was nothing oversold or conceptual about a fragile economy that kept many in the past decade from selling their homes and moving somewhere. Maybe they are the young-old, moving into a 55+ community like the renown Florida cluster known as The Villages, for example, which may turn out to be the equivalent of Aging in Yet Another Place before Yet Another Move. It is intriguing to note that the 80+ population in that setting barely represents 7% of the 107,000 residents. Perhaps those of more advanced age move out. Perhaps they need the full services of pricier senior housing communities that are affordable only if prospective residents sell large assets like homes. Given today’s lengthening life expectancies, these moves must be sequenced to help the money last as long as an individual needs it. That may be the underpinning of so-called 'residential inertia.'