Seniors Aging In Place Have Unmet Needs

Finally, someone with a national voice is speaking out for “my people.” You and I, presently self-sufficient, older adults aging at home. I’ve been active on Buncombe County’s Aging Plan Committee and the regional Aging Coordinating Consortium. I find the attention of both groups drawn to the rural frail and poorest among us. Although I understand these currently pressing priorities, I also feel it’s shortsighted to allow middle-class aging at home needs to go unrecognized and under-supported.

This article by Judith Graham, which appeared in Kaiser Health News, February 14, 2019, gave me hope that someone is paying attention to our cohort. Graham asked for comments, so I responded. My comments on the needs of currently self-sustaining older adults aging at home are below the article excerpts. Unless we speak up for ourselves and encourage those advocating for us, there will be precious little trickle down for us proactive older adults as we become more frail and less financially stable.

Family and Disabled Bathroom at Jasmine Caravan Park
We may all need help one day.

Excerpts from Kaiser Health News Article

About 25 million Americans who are aging in place rely on help from other people and devices such as canes, raised toilets or shower seats to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities….

The study, by researchers from Johns Hopkins University, focuses on how older adults respond to changes in physical function — a little-studied and poorly understood topic. It shows that about one-third of older adults who live in the community — nearly 13 million seniors — have a substantial need for assistance with daily activities such as bathing, eating, getting dressed, using the toilet, transferring in and out of bed or moving around their homes; about one-third have relatively few needs; and another third get along well on their own with no notable difficulty….

Has Medicare Done Enough?

For older adults and their families, the report is a reminder of the need to plan ahead for changing capacities...“The reality is that most of us, as we age, will require help at one point or another,” said Dr. Bruce Chernof, president of the SCAN Foundation and chair of the 2013 federal Commission on Long-Term Care. Citing Medicare’s failure to cover so-called long-term services and supports, which help seniors age in place, he said, “We need to lean in much harder if we want to help seniors thrive at home as long as possible.” …

That’s begun to happen, with the passage last year of the CHRONIC Care Act, which allows Medicare Advantage plans to offer supplemental benefits such as wheelchair ramps, bathroom grab bars, transportation and personal care to chronically ill members. But it’s unclear how robust these benefits will be going forward; this year, plans, which cover 21 million people, aren’t offering much. Meanwhile, 39 million people enrolled in traditional Medicare are left out altogether.

“We’ve had discussions with the [insurance] industry over the last couple of months to explore what’s going to happen and it’s a big question mark,” said Susan Reinhard, director of AARP Public Policy Institute, which publishes a scorecard on the adequacy of state long-term services and supports with several other organizations.So far, she said, the response seems to be, “Let’s wait and see, and is this going to be affordable?”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente. Read Graham’s entire article here.

Let’s Not “Wait and See”

Below is my response to Judith Graham. If you have additional thoughts, please send them to her and/or me.

“It’s encouraging to see KHN report on the LTSS needs of Medicare recipients not poor or frail enough (yet) to receive assistance through Medicaid. Being the unnoticed self-reliant “middle older adults”, we are one major health crisis, one added chronic condition, or one economic downturn away from falling into eligibility. Technology (telehealth – coordination of care) is only a part of the answer. Our Western North Carolina regional Area Agency on Aging hosts the Senior Companion Program and Project C.A.R.E. Exemplary yet underfunded programs.

Policy and Practice Must Change

“I am a 72 year old woman with an 81 year old spouse. My husband and I are climbing the wait list for a CCRC, but would prefer to remain in community. So for 18 months we worked with 7 other “households” to establish an “elder cohousing community;” ultimately stymied by the high cost of land and construction in Asheville, NC – and no government housing planning policy or tax incentives to boost our self-help effort.

“Our Willen-family personal team and aging-related paperwork is in place: an elder attorney, trusted CPA, a geriatric care manager (“my rent a daughter”/quarterback). I also initiated a “Got Your Back” group of 28 people who gather monthly and “do for” each other in between. And yet, the future is still perilous.

“My peers are proactive, well-educated, highly skilled, relatively self-sufficient, and middle-class (possibly even upper middle class). We are the 20% most likely to do the right thing to keep ourselves out of harm’s way and least likely to cost the government money. So our changing needs are understandably, but foolishly ignored. Providing limited financial and technical support to “the missing middle” and the neighborhood networks we create now, while we’re still able, is the best way to assure we remain contributors to rather than an expense to our local communities for years to come.

“There’s only one thing that exceeds the looming threat of mental or severe physical disability in my mind. That is the conundrum involving the inadequate labor pipeline of qualified personal and healthcare aides, the profit motivation that results in non-competitive salaries, and the ever-more-complex EMR/CMS coding and reporting requirements that add a level of complexity to an already difficult person-to-person job. My stepsons live in NY and FLA. My “Got Your Back” partners are about as old as I am. Even if I can afford in home care, will knowledgable, reliable, caring help even be available? And will I be well enough to access it and protect myself from being financially or physically exploited by whoever comes through our doors, digitally or in person?

“Please keep reinforcing positive models of broad coordinated community-based home health care by and for seniors aging at home and help us uncover appropriate new ways to measure the tangible and intangible return on investment we exchange for every dollar spent.