Aging in Place: Whole Persons Living Well in Whole Communities

Helen Jung, DrPH, MPH

1. What is the ideal system?

2. What values underlie the

ideal system?

3. What are the necessary

components of an ideal

system?

4. What are the major

challenges and barriers to

an ideal system?

5. How do we achieve the

ideal system?

Aging in Place: Five Key Questions

Who Are the Baby Boomers?

Who Are the Baby Boomers?

The Silver Tsunami

January 1, 2011: Oldest Baby Boomers began turning 65.

For the next 19 years, 10,000 will turn 65 each day.

By 2030, 1 in 5 Americans will be over 65.

Aging in America: Roy’s Story

The majority of Americans want to remain independent in their own homes and communities (that is, age in place), rather than relocating to nursing homes or moving in with their grown children.

There is No Place Like Home

What is Aging in Place?

A home repair

contractor’s dream

come true?

According to CDC, aging in place is

“the ability to live in one’s own home and community safely,

independently, and comfortably, regardless of age, income, or

ability level.”

What is Aging in Place?

oCalifornia is home to the largest number of older adults in the nation (5 million or 12.9% of the total population).

o In 2015, California ranked 10th in poverty rates for older adults with 10.6% considered poor (100% FPL = $11,354)

oCalifornia has additional 777,000 older Californians who are among the “hidden poor” – those with incomes above the FPL but below a “minimally decent standard of living.”

oMost “hidden poor” are found among renters, Latinos, women, those raising grandchildren, and people in the oldest age groups.

Making the Case: Affordability

oSeniors can’t afford other options such as assisted living.

oIn California, the median monthly rent for assisted living is $3,750 (national median is north of $3,500).

o88% of US residents in assisted living pay privately.

oMedicaid is a major funder of long term institutional care (usually nursing homes) for older adults but seniors must spend down their assets to $2,000/person for Medicaid to cover long term care.

Making the Case: Affordability

Making the Case: Cost Effectiveness

Source: http://www.lao.ca.gov/reports/2010/ssrv/ihss /ihss_012110.aspx

o Aging in place enables individuals to draw on informal care (from friends, family, and neighbors) and then enhance these community supports with more in-depth public services as needed

o People live longer if their social networks are intact (just as good as smoking cessation and twice as beneficial as physical activity)

Making the Case: Social Networks

Making the Case: Aging in Place is What Seniors Want

o 9 out of 10 seniors want to stay home o Top 3 reasons for wanting to

stay home:üI like my home and don’t

want to move out (85%)üI have friends/family

nearby (66%)üI don’t want to deal with

the hassle of moving (50%)

1. What is the ideal system?

2. What values underlie the

ideal system?

3. What are the necessary

components of an ideal

system?

4. What are the major

challenges and barriers to

an ideal system?

5. How do we achieve the

ideal system?

Aging in Place: Five Key Questions

o An ideal system supports aging and living life to the fullest regardless of your age. In other words, it supports successful aging. o Successful aging is the ability to maintain 3 key behaviors or characteristics:1. Low risk of disease and disease related

disability (health)2. High mental and physical functioning (self

esteem)3. Active engagement with life (life satisfaction)

What is the Ideal System?

üPersonal Independence.

üRecognize that everyone ages differently

üServices centered around the individual and easy to navigate

üSafeguards against abuse and fraud (ensures wellbeing)

üRespect – not treating older adults like patients or burdens to society

üSocial inclusion – engagement in civic and social life of the community (no warehousing of seniors)

What Values Underlie the ideal system?

o Choice

o Flexibility

o Entrepreneurship

o Mixed Generations

o Smart Growth

What are the Necessary Components of the Ideal System?

oRange of affordable alternatives to meet the diverse needs of individuals as they age

oWith limited option, people end up in institutions regardless of their wish o as they run out of resourceso so they don’t burden their

familiesoWith limited option, minor

changes in physical or physiological condition leads to dramatic and radical changes in one’s life

Component #1: Choice

Program grows and evolves with the individual as they age. Delivery models are not rigid, one-size-fits-all solutions because everyone ages differently.

Component #2: Flexibility

o Capitalize on the Baby Boomers’ collective purchasing powero Foster new opportunities for affordable service delivery to aging adults

Component #3: Entrepreneurship

Examples: Child care in return for transportation to doctor’s appointments or small chores around the house for teenagers who need after school jobs.

Component #4: Mixed GenerationsoMaximize older

person’s capacity for self-help and community contribution

oRetain seniors as integral and productive members of their communities

oBridge the needs and skills of different age groups

Component #5: Smart Growth

What Are the Major Challenges and Barriers to An Ideal System?

o HousingoBuilt EnvironmentoSupports & Services

o Lack of affordable housing for low-income elderlyo New construction for Section 202 (Supportive Housing for

the Elderly Program) defunded in 2011o 48% of homeowners and 59% of renters over 65 pay more

than 30% of their income on housing (“housing cost burden”)o Lack of housing options for older adults who are

“overhoused”

Challenge: Housing

v Although walking or public transportation contribute to personal independence and quality of life, current physical environment does not promote independence for aging adults.

v Improvements in the community’s built environment (pedestrian accessibility, efficient public transportation, commercial and residential integration) enhances the quality of all its citizens not just older individuals.

Challenge: Built Environment

oMeasures broad community livability at the neighborhood level

oScores on 7 major livability categories: housing, neighborhood, transportation, environment, health, engagement, and opportunity

o Intended to inform and encourage people to take action to make their communities more livable

AARP Livability Index

How Does Loma Linda Compare with Others?

Housing: Loma Linda 33 vs San Francisco 62

Transportation: Loma Linda 43 vs SF 85

Challenge: Services & Supports

Source: http://www.lao.ca.gov/reports/2010/ssrv/ihss /ihss_012110.aspx

1. Think integration and coordination at planning level• Aging in place works best as part of

comprehensive and holistic approach• State programs spread across 6 major state

departments = lack of coordination and diffusion of accountability

2. Continue investing in wellness and prevention• 739 certified Geriatricians in California to treat 5

million older adults (1:6765)• Need 2813 more between now and 2030• Shortage of health care personnel available for

home visits for effective health care and appropriate nutrition (Nicoya, Costa Rica example)

How Do We Achieve the ideal system?

3. Form intergenerational alliances.4. Provide long term care planning information

for consumers.

How Do We Achieve the ideal system?

“Our most cruel failure in how we treat [the aged] is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to

sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that

transform the possibilities for the last chapters in everyone’s lives.”

- Being Mortal, Atul Gawande.

THANK YOU SO MUCH!