News | April 24, 2017

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Aging in Place

As baby boomers reach their golden years, maintaining quality of life may require creative solutions

You’ve lived, loved, and maintained your home, be it ever so humble, for more than 25 years. It’s warm. Familiar – your favorite chair, family photos, memories. But now, your golden years loom. The living and loving is as strong as ever. The maintaining gives reason to pause. And that’s just for starters.

Aging in placeYou’re not alone. Possibly you’re one of the 76.4 million baby boomers in the United States who didn’t think about the “what-ifs” of aging. Didn’t plan. What if you can’t manage to maintain your home as you age? What if you develop health issues? What if you can’t afford in-home health care, an apartment in an assisted living facility or a room in a nursing home?

Seventy-six million is a staggering number with serious implications for the health and wellbeing of our communities as boomers age. Richard Behr, dean of the U.A. Whitaker College of Engineering, is concerned. Prior to coming to FGCU, Behr was director of Smart Spaces Center for Adaptive Aging in Place at Penn State. Its mission: “To create innovative and practical solutions to enable elders to remain at home as long as possible, while maintaining a high quality of life.”

Behr sees a rapidly aging world and believes that we, as a society, have much work to do.

“We must be boldly interdisciplinary,” he said, citing the need for health professionals, social workers, architects, builders and public policy makers to work together to effect meaningful change. Do we have the resources to support older adults wherever they choose to live? What kind of living space will seniors need to live life comfortably?

Behr suggests the answers lie in a more holistic approach to aging: increasing healthcare financing; supporting informal care networks; increasing elder social engagement; using assistive technologies; designing elder friendly communities, and more – a tall order by any measure. What-ifs loom large.

“There are many definitions of living space,” Behr said. “The physical space is just one – whether you live at home, in assisted living, nursing home, or with relatives. Then there’s the social and community space, the health and physical wellbeing space,” all driven, in large part, by the financial wherewithal of individuals and communities to provide the support and resources needed to ensure quality of life for seniors.

And that’s the rub. According to Behr, society is ill-prepared to meet the challenges of our aging population. The question of “to-age-in-place or not-to-age-in-place” is too narrow. It is, he contends, only the careful attention to each aspect of aging that will move communities and government closer to resolving what Behr sees as a “haunting societal challenge.”

“We need to ask ourselves what we can do as a society,” he said. “We need to look at public policy issues. We need to explore a different attitude to the extreme care that keeps people alive longer and longer.”

These issues are complex and multi-layered. If, as a society, we do little to address the challenges inherent in living longer, then we, as individuals, risk inheriting the apathy of prior generations and reaping the inaction of our own. We need to acknowledge and plan for the financial and societal realities of aging and forestall what Behr sees as the dire ramifications of inaction.
His point is well taken. According to the AARP Public Policy Institute in 2016: “Almost 22 percent of people age 65 and older live in families that depend on Social Security benefits for 90 percent or more of their income. Another 24 percent receive at least half but less than 90 percent of their family income from Social Security.”

Abbe Finn, associate professor and program director of clinical mental health-counseling at FGCU, acknowledges that the financial crisis facing elder care is overwhelming and that societal challenges exist, but she is optimistic about present-day resources.

“There are lots of issues,” she said, “but it’s not all dire. Many seniors are very happy living at home. Some are socially isolated, but that’s where community resources must come into play.” Finn said that seniors, or their caregivers, must reach out to “church members, neighbors and family, seek out and use the resources available to them.”

Technology, too, plays an important part in the socialization of seniors. “The idea that seniors don’t access technology simply isn’t accurate,” Finn said. “Seniors Skype with grandchildren; they own cell phones and have Facebook accounts.”

Jo Stecher, assistant director of FGCU’s Undergraduate Nursing Program, teaches Gerontological Nursing to first-year nursing students. Like Finn, she’s positive about the number and breadth of available resources but laments the fact that not enough older adults know they exist. Some services are the obvious ones – Meals on Wheels is a good example. Others, like the support available to veterans, are less known. That’s where a caregiver or elder attorney can help.

Stecher believes, in general, the community is “doing a good job in a society biased against older adults.” That may sound like a one-step-forward, two-steps-back response, but Stecher is a realist.

As to aging in place, she said, “In theory, that’s a wonderful idea. But it’s not for everyone. If it’s a case of staying at home on principle but with no thought to socialization and no safety measures in place, then it’s not the best choice.”

Advanced planning, then, is key. Behr’s research into “Adaptive Aging in Place” underscores its importance; a 2015 first-quarter Home Designs Trends Survey by The American Institute of Architects adds a glimmer of hope, noting a jump in requests for aging-in-place-friendly accessible additions. The organization’s third-quarter survey speaks to a societal shift, finding that “design elements such as access to public transportation, multi-generational housing, walkable neighborhoods, and mixed-use facilities dominate homeowners’ preferences.”Aging in place by the numbers

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Thomas Felke, bachelor of Social Work program director and interim chair of Social Work, would agree that government and communities need to step it up when it comes to reengineering living
space for older adults in order to maximize quality of life, although he recognizes the enormity of the task, both financially and politically. He acknowledges that excellent resources exist, but said more are needed.

“The biggest thing I find is that seniors who need services are far less likely to take advantage of them,” he said. “The lowest utilization rates for food stamps, for example, is among seniors, yet we know many seniors are living below the poverty line.”

As a boots-on-the-ground social worker, Felke has studied the issue of aging up close and personal. In 2014, he conducted an in-depth qualitative research study focusing on the needs of seniors in Collier County. He conducted small focus groups with seniors as well as interviews with senior care providers.

Felke’s study received national attention, in part because the perceived demographic of Collier County as wealthy was in stark contrast to the findings that revealed alarming pockets of poverty. In 2014, 6,419 Collier County seniors older than 65 were living below the poverty line; in 2015, this number jumped to 6,994.

This national attention attracted a sizable donation, which led to building the first senior center in the county – the Senior Center at Jewish Family and Community Services. Today, more than 800 Collier County seniors access the center on a regular basis.

Felke’s research also exposed a gap in perception and reality. When providers were asked what, in their view, seniors needed most, they cited food and safety. Conversely, when seniors were asked their greatest need, they expressed a desire to be around people.

These findings wouldn’t surprise Finn, who likened the social isolation of seniors to solitary confinement in our prisons. “It’s the worse curse we can give to anyone,” she said. “Certainly, being alone is a serious mental health issue,” and one which seniors who choose to age in place must guard against.

While family and community resources can help alleviate the effects of isolation, safety in the home complicates things. This is where assistive technologies and advanced planning really come into play.

“The biggest factors for loss of independent living,” Behr said, “are falls and medication management. Of course, anything a person can do to mitigate the risk of falling is low-hanging fruit.” As to technology, widely available remote monitoring systems, medicine dispensers and emergency alert systems are good examples of assistive technology that allow seniors to age in place safely and longer with impressive financial benefits.

As early as 2008, Carnegie Mellon Today published an article positing: “If the technology we develop can ensure that people remain in their homes instead of in assisted living or nursing home facilities for just one month longer, we can save our nation $1.2 billion annually.” What must the savings amount to now, nine years later?

However, all becomes a moot point if cognitive decline or chronic illness strikes. “Safety issues, increased depression, paranoia …,” said Finn. “This is where others need to step in and recommend an alternative living situation.” An assisted-living facility or nursing home might be the only option.

Or is it?

This brings us back to Behr’s greatest concern. Not for the level of care, but for the daunting financial burdens it presages for individuals and society. According to the website, Paying for Senior Care, the 2015 average nationwide annual cost of an assisted living facility was $43,200; a skilled nursing home, $80,300.

“People do not have the resources for these options,” said Behr.

In the end, it all boils down to a simple question, the answer to which will positively or negatively impact millions of older adults for generations: “What must we, as a society, do,” Behr said, “to manage this exit plan?”