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Who are we kidding -- our houses aren't the enemy, we are

Denial of need, current and future, has been a recurring theme lately.  We have a push to get people out of nursing homes and into independent living, we have boomers who want (mostly) to age in their own homes, generally in the suburbs. Although they want lots of technology and community services, they don't see a priority for wide doorways or separate showers that could make bathing safer, according to the latest NAHB/MetLife 55+ Housing Study.  Meanwhile, the worldwide home health monitoring market was estimated at $11 billion in 2008. Which raises a question -- should everyone at home who is monitored for chronic disease really be there? And where are the transportation systems that will support suburban seniors who can no longer drive?

There are cracks in assumptions and reality -- crack # 1 -- maybe not our house.  Twenty-six percent of those surveyed by NAHB and MetLife were actually not sure if they would stay in their current home. This undermines the generally held view (surveyed and endorsed by AARP) that this is what people want and/or where they should receive care. But the NAHB/MetLife responder uncertainty could arise from a look around the house and the cost of retrofitting it.  Or maybe responders faced the reality of watching or caring for aging parents -- remembering that 50% of all baby boomers have at least one parent still living. So if those 55+ are uncertain, where will they go and where will they end up?

Unsafe at home is better than the alternative -- crack # 2 -- no nursing homes. Today I visited a rehab facility where a 92-year-old still-sharp woman who had been found in her home on the floor by EMTs decided she would head home after 8 days of physical therapy, not yet discharged by medical staff. Rehab PT said she wasn't ready -- but off she went with the help of a case worker (who filed a complaint on the resident's behalf).  The case worker told her that she should just go home. But is the home environment a safe equivalent for someone who has no family nearby and no live-in help? Of course she wanted to go home --  nursing homes are feared more than death or disaster. But are they really finished for those who live long enough to be at risk or do they just need to be reinvented? This has been talked about for decades, but instead of fundamental change, little transformation is visible.

Aging with intent -- crack # 3 -- but what if we lose intent? More than 5 million in the US have Alzheimer's (or what appears to be Alzheimer's) today, a number that, to understate the future, isn't shrinking.  Assisted living and nursing homes, however, have only 3 million (total) residents, including those with other disabilities. The difference clearly represents long-term suffering for caregivers in the home and potentially horrendous neglect, as a recent Florida case underscored.

Technology is enough -- crack # 4 -- guilt, cost, quality are the issues. No doubt, monitoring technologies are useful for caregivers. But those who have dementia have lost all intent to age gracefully and manage their own care.Their families, however, make rock solid promises, no nursing homes. For the well-intentioned, guilt and those promises prevent caregivers from finding more accommodating and social settings that might deliver professional care. And because we don't demand those settings, the price points remain unaffordable or the settings themselves are intolerable.

Perhaps this general denial of destination (and destiny) is the 'elephant in the room' of our society -- in the face of the elephant, we'd better see dramatic improvements in technology availability for the home -- we're going to need it, whether we admit it or not.






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