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Senior Citizen Opinions & Analysis
Aging In Place Is Not So Easy
The reasons may have more to do with social issues
than medical concerns
 By
Howard Gleckman, Senior Research Associate
Urban Institute
Oct 26, 2009 - 'Aging in Place' is the popular
rallying cry in the senior community. But living at home is not so easy,
either for the frail elderly or younger people with disabilities.
Interestingly enough, the reasons may have more to
do with social issues than medical concerns. Today, almost everyone
could receive the care they need at home, even if they suffer from
multiple chronic illnesses. But the frail elderly still move to assisted
living facilities or nursing homes. For many, that transition is driven
by a lack of qualified caregivers, an absence of basic services such as
transportation, no access to appropriate housing, and loneliness.
 Lets
look at these problems one at a time.
Caregivers:
Nearly two-thirds of those being cared for at home receive all of their
assistance from family members and friends. But these informal
caregivers are untrained, and face huge physical, emotional and
financial burdens. And they burn out.
In Japan in the 1990s, it was called 'caregiver
hell' and the backlash drove profound changes in the way that nation
financed elder care. We prefer to imagine family caregiving as a gauzy
Sunday night movie where families rebuild fractured relationships before
mom dies in peace. But, in truth, things rarely turn out that way.
Caregiving is hard.
A new
study by The Urban Institutes Brenda Spillman and Sharon Long finds
a major link between caregiver stress and a patients move to a nursing
home. The biggest cause: physical strain. But financial hardship and an
inability to sleep play a big role as well.
Spouses of the frail elderly may suffer the most,
since many face their own physical or cognitive limitations. But adult
children are hardly immune, especially those who must balance jobs and
kids with caring for parents. Long-distance caregivers face particular
challenges. And many of the very old may have outlived both spouses and
children, and now have no one to care for them.
Home health aides are a solution for some. But
quality care workers are not easy to find. It is no wonder: they earn an
average of less than $10-an-hour, rarely receive benefits such as health
insurance and are more likely to be injured on the job than coal miners.
There are many capable and loving aides out there. But there is far more
demand for help than they can fill.
Lack of Services:
The most important may be transportation. Something as simple as a
reliable ride to the supermarket or the doctor may be the difference
between staying at home and having to move. Yet, many communities are
scaling back transit programs for the elderly and disabled in the face
of budget problems.
Housing:
You cant live at home if you dont have a house. And finding one is a
challenge for the many seniors and disabled with low-incomes. Even if
you do have a home, it may need to be renovated to accommodate a
wheelchair or a walker, and that can cost more money than many seniors
have. And few government programs will help. Medicaid will pay for
nursing home care, and will provide limited benefits for home care. But,
with rare exceptions, it doesnt do housing.
Loneliness:
Staying at home can be extremely isolating, especially for a widow or
widower. Adult children may provide practical assistance, but they have
their own lives and often cant be there for simple companionship. Old
friends may find it difficult to visit as they struggle with their own
physical decline. For all their limitations, nursing homes and assisted
living facilities at least provide activities and companionship.
There are solutions. Better training is critical
for both family caregivers and paid aides, who also deserve higher pay
and better benefits. Respite care, including adult day centers, gives
caregivers a desperately needed break. Community-based programs can
match up volunteers with those who need rides or friendly visits.
All of this costs money. We can fund some of it
through a more flexible Medicaid program. But a better solution is
broad-based long-term care insurance that would give families the
financial resources they need to provide appropriate care to their loved
ones.
Well never keep everyone at home. Assisted living
and nursing home care may still be necessary for those with no families
or those suffering from severe dementia. But if we work at it, we can
postpone the transition for months or even years. It is worth trying.
Howard Gleckman, a resident fellow at the
Urban Institute, is author of "Caring For Our Parents" and a frequent
writer and speaker on long-term care issues.
View all previous columns by Howard Gleckman »
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This
information was reprinted from
kaiserhealthnews.org with permission from the Henry J.
Kaiser Family Foundation. You can view the entire Kaiser
Daily Health Policy Report, search the archives and sign up
for email delivery. © Henry J. Kaiser Family Foundation. All
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