Thursday, July 7, 2016

Spaces of HealthAs our nation’s baby boomer population grows, the concept of “aging in place” is moving front and center. The desire for older adults to stay in their homes, neighborhoods, and towns is prompting action on local, state, and national levels to help prepare for affordable, age-friendly housing and services—and a shift in the way our society thinks about aging. According to AARP, 87% of adults ages 65 and older want to age in place. By renovating their homes, engaging in the "village" model, and using innovative solutions, it is now possible for aging adults to stay in their homes longer than ever before.

To explore the issues surrounding the aging-in-place movement, the Milken Institute School of Public Health at the George Washington University invited Anne Montgomery, deputy director of Altarum Institute's Center for Elder Care and Advanced Illness, to participate in a webinar as part of its #SpacesOfHealth series. Montgomery is an advocate for improved access to affordable long-term care services for the elderly and for the improvement of nursing homes and community-based services. She was joined by other aging advocates and experts in the field of home care, long-term care, and aging policy to discuss the nation’s aging population and the innovations and opportunities that exist that will allow older adults to age on their terms.

The webinar was moderated by Loretta DiPietro, Ph.D., who is the chair of the Milken Institute School of Public Health’s Department of Exercise and Nutrition Science. A well-known researcher and lecturer on issues pertaining to physical exercise and aging populations, Dr. DiPietro’s areas of expertise also include chronic disease and epidemiology.

Montgomery began the conversation by defining what is required for successful aging.

“Successful aging means being able to live in a place of your choosing, and being able to count on the services and support we need for daily living,” she said.

Panelist Phil Bongiorno, executive director of the Home Care Association of America, echoed her sentiments: “Successful aging means quality of life and aging in a healthy way, and preventing people from entering the hospital as they age.”

The panelists also discussed the very real issue of isolation. “Not being socially isolated is fundamental,” Montgomery explained. “It is now identified as being one of the social determinants of health.”

There are many reasons why an older adult becomes isolated or disconnected from family and community—an illness, loss of transportation, or being the caregiver for an ailing spouse. But it’s not about fixing one specific thing. All of the panelists agreed that communities have to examine all of the connections that make up a person’s life, and come up with ways to make sure connections stay strong.

“We should build our communities to help engage people,” stated Gail Kohn, coordinator of Age-Friendly DC.  “We need to keep their life continuum in mind.”

Montgomery highlighted the need for innovative solutions to help preserve the quality of life for older adults.

“We need to figure out how to blend medical and health care and community resources,” she explained. “In order to solve this puzzle, we have to be creative. We need initiatives that address the entire spectrum of needs.”  

One area of innovation highlighted in the discussion was the “village” concept of living, where older adults continue to live in their homes while receiving assistance that supports independent lifestyles. The arrangement provides help that bridges the gap for individuals with enough assistance from the village to remain in their homes. More than 190 villages now exist in the United States, with another 150 in development, according to the Village to Village (VtV) Network, a group launched in 2010 that provides assistance to new villages and tracks their growth nationwide. 

Another area of innovation that will help preserve the quality of life for older adults is the concept of co-housing, when two generations are living together. This has been a focus for many homebuilders, but the panelists cautioned that this might put an increased burden on caregivers who are simultaneously caring for aging parents and raising their own children.

“Family caregivers are fundamental to our system,” remarked Montgomery. But she pointed to the disturbing demographics at play. “The problem we face is that there will be fewer of them this century due to the many socio-demographic realities we are facing, so we can’t count only on family caregivers. We need to figure out how we relieve the strain on family caregivers to diversify our system of support. We need to draw the circle much wider, which is why we are talking about the role of community.”

Panelist Melissa Gong Mitchell, the executive director of the Global Coalition on Aging, agreed.

“Caregivers need peace of mind that their older loved one is being taken care of,” she said. “Peace of mind benefits the seniors, it benefits the caregiver, which benefits the workplace and the overall economy. So we’re looking at the big picture.” 

Montgomery pointed to growing evidence that low-cost supports can indeed address the social determinants of health and provide substantial savings to our health care system. “The evidence is there,” she said. “In the form of decreased hospitalizations, emergency room visits, readmissions, and avoidance of premature placement in long-stay nursing homes.”

One example discussed is the Medical House Call Program at MedStar Health in Washington, D.C., which provides primary health care to elders in the comfort of their homes. “The program now has 600 or more participants,” explained Kohn. “It’s a holistic concept that has shown evidence of fewer emergency calls and fewer hospital stays.”

For many older adults, their next adventure in life is all about freedom—and it all starts with independence at home. The panel discussion made it clear that our society as a whole needs to develop innovative solutions to help baby boomers age in place in communities that not only meet their basic needs, but also provide ample opportunities for engagement and high-quality health care.

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.



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