LeadingAge Magazine · November/December 2015 • Volume 05 • Number 06

Is “Aging in Place” the Answer?

November 15, 2015 | by Jill Vitale-Aussem

Is “Aging in Place” the Answer?

After managing retirement communities for almost 20 years, you’d think I’d have all the answers when it comes to supporting my own parents in their aging journey. At first glance, it seems like my folks have it all figured out. They’re both avid hikers and fitness enthusiasts. My dad logs at least 1,000 miles on his bike each summer, getting in at least one 100-mile bike ride before the leaves fall each year. My mom has been a walker and a hiker for years. They have lots of friends. They travel all the time. They’ve also done an amazing job with their financial planning for retirement.

Doesn’t sound like much of a problem, does it? Well, the reality is that my mom is losing her vision due to an irreversible retinal disease. Of course, my parents have taken steps to compensate for her vision loss, adding new lighting and other adaptations to their house. You see, they love their home. And, like most people, they want to stay in it as long as they can.

As a senior living professional, I’ve always understood the benefits of living in a retirement community. But I’ve honestly believed that my parent’s plan to maintain their independence and lifestyle by staying at home was a solid one. Unfortunately, as my mom’s vision loss has progressed, I’ve realized that what we’re doing is creating a situation in which my mom will eventually become completely dependent on my dad.

For a woman whose nickname is “Marge-In-Charge,” this plan does not bode well for my mom. Or for my dad. As my mom slowly loses that fiercely held independence, she’s experienced frustration, anger and sadness. And as her vision diminishes, she loses confidence in her ability to get out on her own. My siblings and I have been noticing the early signs of disengagement from the world. And we’re seeing the impact it has on my dad as well. It’s been a real eye-opener for me. As I start to better understand the realities of aging in place at home for my own parents, I’m seeing red flags for other older adults as well.

Staying in one’s home and remaining “independent” is such an appealing concept. So appealing, in fact, that, according to a Demand Institute study, 63 percent of baby boomers are just like my parents. They plan to stay put in their homes as they age.

Many businesses have sprung up to support this wish. Google “aging in place” and you’ll get 106 million results for home care agencies, transportation companies, home remodeling specialists and other organizations that specialize in helping people stay put as they get older.

But there’s a big wake-up call coming for many people as they get older, especially the boomers. The financial situation of many boomers simply doesn’t support their desire to stay at home. This is the first generation of people who are entering retirement saddled with excessive debt. A 2014 report from the Consumer Financial Protection bureau indicates that 30 percent of those over the age of 65 are still carrying mortgage debt. Further, the average amount that older home owners owed on their mortgages increased 82 percent from 2001 to 2011.

Complicating the financial quandary is the fact that, according to studies like that published by TD Ameritrade, the average boomer has shortchanged their retirement savings by about a half-million dollars.

A 2013 Gallup poll found that many people recognize this financial reality and that 50 percent of boomers plan to keep working past age 65. Ten percent say they will never be able to retire and will work until they drop. The problem is that “dropping” can happen much sooner than many people think. Many will develop health conditions that will limit their ability to work. Or require them to stay home to care for a spouse.

According to the Department of Health and Human Services, a staggering 70 percent of people turning age 65 can expect to use some form of long-term care during their lives. Receiving that type of care at home will be a financial impossibility for many boomers. Round-the-clock home care will eradicate their savings in no time.

Even for those who have the necessary cash, aging in place may not be the answer. As baby boomers age, the number of people in the traditional caregiving age group will shrink, limiting the pool of support. An AARP Public Policy Institute report highlights the dwindling number of people in the potential caregiver population, indicating that in 2010 there were more than seven potential caregivers for each person over the age of 80. By 2030, that number drops to four potential caregivers per elder. The reality may be that the time and cost of home health caregivers driving from home to home would be better allocated in supporting older adults in a congregate living setting.

Probably the most devastating, and often unacknowledged, fact about aging in place is that people often become isolated when they stay in their homes. Their neighbors and friends move, or pass away. The neighborhood changes. People begin having health challenges. It becomes harder and harder to get out into the world.

Some experts are taking a very critical look at the experience of aging in place. A Washington Post article describes the belief of Stephen M. Golant, a gerontology professor at the University of Florida, that the idea of aging in place has been oversold. Golant believes that we may, in fact, be doing a disservice to elders by perpetuating the myth that everyone can be independent in their own homes, an experience that ends up being one of “rotting in place” rather than aging in place for some older adults.

This is what keeps me up at night worrying about my parent’s plan.

In my field of work, I’ve seen what happens to people when they become isolated in their homes. Isolation and loneliness lead to depression, health issues, cognitive decline and even shorter life spans. Research studies show these outcomes time and time again. In short, being cut off from the world begins the cycle of “circling the drain” that is extremely hard to reverse.

At one point, I was hopeful that email, Facebook and phone calls could help keep my mom connected and engaged as her vision continues to decline. But while technology can play a role in keeping people connected from their homes, it alone is not a panacea. A recent study published in the Journal of the American Geriatrics Society found that older adults who have little face-to-face contact with others have almost twice the risk of developing depression. While social media was not part of the research, email and telephone contact was studied and does not reduce this risk.

Can aging in place work for some people? Absolutely. Naturally occurring retirement communities (NORC) and senior co-housing, available in some parts of the country, seem to provide an opportunity to stay at home and stay engaged. Unfortunately, there is nothing of the kind anywhere near my parents. They live in a small town with very limited support systems.

The more my family has honest discussions about the reality of our situation, the more we realize that aging in place doesn’t work for everyone. And a retirement community is likely the best option for my parents.

My mom is starting to see that she would not only maintain her independence if they lived in a community with transportation and other easily accessible support services, but she could get her own life back, stay engaged with the community, and become more independent.

My mom and dad are still hesitating on making a decision, though. And I think part of the hesitation is that even though they have experienced the possibilities that my organization offers, my folks have in the back of their minds the belief that retirement communities are institutions. That they’re places where people must give up their independence.

Providers made a lot of progress in moving beyond the retirement communities of the past. But it’s absolutely critical that we continue to rethink our cultures and living environments. After all, we are part of the reason that people would choose to wither away at home rather than move.

We need to continue abolishing paternalistic rules and institutional practices and create cultures of possibility, where people continue to live and grow, not just exist. Where a guy like my dad can have his bike handy and be able to jump on it and ride whenever he wants and my mom can meet interesting people who are engaged in life, challenge herself, and maintain her individuality and her confidence. If we all work hard enough at this, and continue challenging our dated practices and environments, community living can become a “want to” versus a “have to” decision.

But there will always be those who will want to stay at home. And, in truth, I wish there was a way for my parents to do that successfully. This experience has raised a lot of questions in my mind. How can we start to dispel the myth that aging in place is the answer for everyone and help people make better decisions? How can we better support those people who do choose to stay at home and make it easier to stay engaged with the community so they’re truly living rather than rotting away? What do you think?

Editor’s note: Do you agree or disagree? Send your thoughts to LeadingAge at gmitchell@leadingage.org.