Aging in Place: Fixing a Hole in the Safety Net
By Mike Andrew
“Aging in place” has become a fashionable catch-phrase for sociologists writing about seniors.
The Centers for Disease Control and Prevention (CDC) defines the term as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.”
According to a 2012 National Livable Communities study, 90% of people over 65 would prefer to stay in their current residences as they age. Of course. Who wouldn’t?
And yet, our national healthcare system prevents many people from aging in place, because it does not provide longterm care for most seniors.
“You never really know about something,” the old saying goes, “till it happens to you.” And I got a crash course in the complications of aging in place this past winter.
Just before Christmas my 86-year-old mom had a bad fall at home. The fall stunned her, and she couldn’t raise herself up to get to the phone, so she lay there for hours until my brother – worried that she hadn’t answered his calls – came by to check on her.
She soon recovered from the effects of the fall, but the incident convinced her it was no longer safe for her to live on her own.
However, apart from her mobility issues, she’s pretty healthy. She doesn’t need hospitalization or skilled nursing care, she just needs someone to help her get in and out of bed, prepare food, wash clothes, and clean.
In that respect, she’s not much different from many seniors. In fact, my grandma – my mom’s mom – also required in-home care during the last years of her life. According to the Department of Health and Human Services, 70% of Americans who are 65 today can expect to need longterm care services of some kind before they die.
Aging in place was relatively easy for my grandma. She originally bought our old house in San Francisco in 1946. After my parents married in 1950, they moved into the main part of the house, and my grandma moved into the in-law apartment downstairs. There was no reason she couldn’t remain there, and she was able to live out the rest of her long life in the same home she’d known for almost 40 years.
That wasn’t possible for my mom, however, and it’s even less possible for seniors who aren’t as well situated as she is.
My dad died relatively young, at 69. My mom has been living on the survivor benefits from his pension and Social Security. It’s not a lot of money, but it was enough so that my brother and I never had to worry that she couldn’t pay her bills and buy food.
Already that puts her in a better place than many workers nearing retirement age will be, because defined benefits pensions are becoming a thing of the past. And for many gay and lesbian seniors, we’d never even get Social Security survivor benefits, because until very recently we’ve been prevented from marrying our partners.
So my mom is fortunate. But not fortunate enough.
According to an analysis by Genworth Financial, a Fortune 500 insurance company, the yearly cost for a home health aide in California is $52,624, and the cost is predicted to increase by 2% every year. Costs in Washington State, by the way, are estimated to be about the same.
This is actually more than the median household income calculated by the U.S. Census Bureau.
Medicare paid for my mom’s hospitalization, physical therapy, and home care as she recovered from the injuries she sustained in her fall. But it won’t pay for a home health aide to provide the longterm assistance my mom needs for her day-to-day living.
Medicaid might pay for longterm care, but that program is designed mainly for patients who “are typically not in the condition or capable of aging in place,” and in any case Medicaid won’t kick in until an individual has exhausted their own financial resources.
What could we do? Reluctantly, my brother and I came to the conclusion that it was time to sell my mom’s house.
While she agreed, losing the home she’d been in for 60 years – and the accumulation of things in it – was traumatic for her. Like most seniors, she wanted to remain independent and in her own home.
Some of her things were valuable, some were not, but all of them had memories attached. This was a birthday present, that was a souvenir of an especially fondly-remembered vacation. There was even a cookbook her mother-in-law gave her right after her wedding, in hopes that she wouldn’t let my dad starve (she didn’t).
My mom now lives with my brother and his family in San Francisco, and she still keeps in touch with many of her old friends.
My brother and I have kept some of her things as mementos, but we each have our own accumulations of stuff and it just wasn’t possible to keep all the things that were meaningful to her.
Real estate prices in San Francisco have gone through the roof, and our old stucco rowhouse brought in one hundred times what my grandma paid for it in 1946, but that is the subject for another story.