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The nirvana of aging in place and other age-related reality disconnects

It seems as though there is a seasonal cluster to everything -- conferences (spring and fall), concerts (fall through spring), and... communication about surveys and studies. During the fall of studies announcements, we've seen some interesting and sometimes ironic juxtapositions:

Working. Turns out we're healthier if we keep working, we're not deficient as employees, and we're not so bad at learning new technology.  Take a look at Health Benefits of Working in Retirement, combine with the 'idea' that they are really able to hold their own in the workplace today's NY Times 'Idea' from 2009, in the Myth of the Deficient Older Employee. Meanwhile, older workers don't necessarily want to retire. But then read Buddy Can You Spare A Job.

Caregiving, aging, available income. Caregivers of those over age 50 are themselves older, those they care for are older (> age 75) -- and the largest percentage are caring for their mothers.  See this detail in the sub-report from Caregiving in the U.S. 2009 and combine that with an AARP poll on trends toward multi-generational housing. With that in mind, think about how those age 65 today, according to the CDC in 2009, can expect an average life expectancy of 84. Now juxtapose that with the fact that seniors are living longer on less money, and beyond age 75, are likely to have a disability. 

Aging in place -- the hype is what we want. The housing dream, as told in the MetLife 55+ Housing study in September, is that the vast majority of those 55+ want to remain in their own homes -- aging in place. No matter that our houses may endanger us as we acquire a disability, may impoverish us with housing costs that eat up our declining income, and may suck the life and health out of aging caregivers. Given that there are 5.2 million with Alzheimer's and 3 million senior housing units, the math tells you that people with dementia are living on their own or with caregivers. Specious remarks, studies, and hype mark much of the talk about 'aging in place', but the "Aging in Place is best for those with Alzheimer's" comment from a nurse in the AARP-Microsoft study finally sent me over the aging in place edge:

Putting it altogether -- there's an elephant in the room.  The facts are there. You can see it clearly if you look. Today, what is so cheerfully described as aging in place, with enough money in retirement or the ability to keep working, living in a one's own home, with the myriad of services that are needed -- THIS IS A MYTH. To make it a reality, we need some very new ideas to be fleshed out more carefully and new ways of lowering costs, redirecting innovation energy and funding of new initiatives, and I'm not talking about healthcare. What if we:

  • Break down the fiefdoms in aging services. For example, what if AAHSA, ALFA, ASA, and NCOA all merged?* Maybe then we'd see some creative housing ideas that lowered costs for prospective residents. Maybe innovation initiatives would produce more effective services for the populations they should help -- if they were together as one consortium? I dunno, perhaps they could pool all of their dues and event costs, hold fewer and larger events and use the leftover money to fund innovation in senior services. Why does this have to be a pilot program here, a good idea there, presented at next year's meeting instead of promoted and widely deployed?
  • Examine and promote shared housing, clever transportation. For seniors not supported by caregivers, why does co-housing today seem at the fringe of possibilities? What about housemate matching services for women who seem to make up a large percentage of those aging alone or with their children?  NORCs and 'intentional communities' for independent living sound good for younger and perhaps wealthier seniors -- but it's what's behind the door of the resident when they navigate around their own home and acquire any of the disabilities of aging -- who's watching, who will know? How can people in suburban or rural areas function without some creative ideas about transportation that enable them to get out of the very place in which they are aging?
  • Remarket and rethink current senior housing formats. Today's senior housing (IL, ALF, and SNF) remind me of the newspaper industry -- lots of hand-wringing about decline and how to change the marketing mix and use social media to fill empty units, but not a lot of reinventing of the fundamentals.  Or maybe they're reinventing the fundamentals and we're just not hearing about it. And why is it good that ALFs are regulated on a state-by-state basis, but if you're in a nursing home, ratios, inspections, and environment are governed by federal rules? What's behind the decline of nursing home beds and the increase in average age of ALF resident? Is this good? Or is this a signal that nursing homes have been burdened by so much regulatory baggage and bad press that they may become, as Howard Gleckman notes, as rare as Republicans in Massachusetts.
  • Accelerate adoption of technologies that augment safety in the home and outside.  At the last large event I attended, it was interesting to hear a comment that if you added all technologies together that support aging services, perhaps 5% of the target population is aware of them. I believe it from the complaining I hear about the difficulty of selling, the barriers to adoption, the lack of interest by aging services organizations (even with exceptions duly noted). But here's a crazy idea: what if all the big gun vendors in the technology industry got together and said that smart use of technology could assist folks as they tried to age in place? What if they had one choral voice from the senior housing and aging services industry explaining what was needed -- and then vendors delivered it?

Let's spend some more time and energy in 2010 to dispel the hype about aging in place for seniors today and replace it with realistic, financially feasible, and well-understood strategies that make it possible. Surely, as Liz Boehm noted, aging in place (compared to Healthcare Unbound) has at its underpinning the element of hope for the future.

But if we can't get over the hype around aging in place, let's just rename the whole thing to 'aging successfully' -- whatever the place.


* AAHSA - American Association of Homes and Services for the Aging

    ALFA -  Assisted Living Federation of America

    ASA -   American Society on Aging

    NCOA - National Council on Aging






Hi Laurie,

Indeed the silos exist in some of the elder care industry associations.  ALFA is one of the biggest culprits.  Example: we tried to nominate someone for one of their awards who had done some truly fantastic work and were told that we had to buy a membership in order to have the opportunity for that good work to be recognized.

You should also spend some time talking to Chuck Gould with Volunteers of America.  I interviews him for my Leaders in Elder Care series, and they are doing some really interesting experimentation with alternative care models.  Here is the link to the interview:


In my humble opinion, that is what would really help in suburban and rural areas. . . and not that where you ride for TWO hours to go 5 miles to the grocery store...

We will keep 2 cars going for the forseeable future unless we get some kind of rides that work

Two things:

First, I hope you get a lot of commentary on the idea of merging all the senior living organizations into one. A single professional association serving everyone in the senior living space is the best way to generate innovation in senior living. Or is it? Are there reasons there are a number of different associations in this space? Hmmm...

Second, Ryan is right that ALFA has limited its ALFA Champions of Senior Living awards to its members, i.e., those who participate in the organization. Participation in ALFA, in part, means freely sharing best practices, writing for our magazine, attending our Advocacy Fly-In to meet with elected officials, volunteering to speak at our Annual Conference, helping change some onerous state regulation, joining our executive networks to create solutions to industry problems, i.e., giving as much as taking. Thus, it has not been our practice to give awards to non-member companies who don’t participate with us in raising the bar for the senior living industry—central to our mission.

HOWEVER, ALFA is a learning organization and we've changed our rules. We know there are thousands of heroes whose companies are not in ALFA's membership and who come to work every day providing selfless, loving, quality care to seniors. Our “Aha!” moment came when we realized that it is not the fault of these heroic staff, caregivers, nurses, volunteers, executive directors and others who serve seniors that their company doesn’t participate in ALFA. Thus, we changed our rules to make everyone eligible.

If Ryan were to submit a nomination for the Champions of Senior Living Awards this year (made easier because it can all be done online at www.alfa.org/hero), his nominee is now as likely as any ALFA member to receive a Champion of Senior Living Award. I’m certain he is right that his nominee would greatly deserve to be recognized.

Rick Grimes
Assisted Living Federation of America

Laurie, You've got some really good ideas, but I'm reminded of Al Gore who had to be an ex-VP before people started to listen to him. Shel