Opinion — Having My Say: There's no place like home?

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The buzz in aging services for years has all been about home- and community-based services.

This buzz is so ubiquitous that it has become an article of faith – we in the field somewhat blindly accept the following premises:
• People want to stay in their homes.
• Technology will make it easier for people to stay in their homes.
• Someone staying in their home provides the best "outcomes" and solution.
• We should support and accommodate that desire.
State and federal officials have now adopted this as a rallying cry, and are supported by our associations as well as other powerful groups like AARP. You can't go anywhere without being told that consumers, and especially the baby boomers, are going to demand choices. The clear implication is that we, "we" being both the aging services field as well as society in general, should meet that demand for choices.
Let's consider the thought process and the analysis that gets us to that conclusion.
People want to stay in their homes.
The first question is whether this strong desire to stay in one's home will actually happen in any larger way than it ever has before – will the boomers demand that? Is staying in the home the same as staying in the house? In fact, seniors today and the boomers have been far more mobile in their lifetimes than the previous generation. People who have lived in the same house for 30, 40 and even 50 years are becoming rarer and rarer.
Any provider who operates continuing care retirement communities (CCRC) has anecdotes of new residents exclaiming that they "had no idea how great and full their lives would become when they moved in" or, "If they had only known, they would have moved years before." Statements like these should be a wake-up call for our industry.
The major benefit we provide is enhanced living. We need to be willing to admit that we have done a poor job communicating the product and advantages to the consumer. It remains largely viewed as a need-driven product rather than a choice-driven one. The task to tell this story to change this perception and to properly communicate the advantages of such a setting clearly falls to the providers.
It is clear, however, that current seniors and especially the boomers will be far more discerning than any prior cohort. To remain viable, CCRCs need to offer, and communicate, that they are a better alternative for the consumer.
Technology will make it easier for people to stay in their homes.
I get goose bumps when I hear about all the exciting products available today, and all the new technology on the horizon that promises to help seniors remain independent in their own homes – for instance, products such as robotic pill dispensers to reduce medication errors, safety sensors built into appliances and flooring or body software to track vital signs.
An entire house can be equipped with monitoring and management systems. However, what is/will be the cost to install and manage all this technology? How will we ensure that current seniors and even our techno-savvy boomer seniors will use it properly – if at all? How about social interaction? I have no doubt that someone is building or has created a robotic friend to talk to Grandma everyday. However, can all this replace the multiple human interactions that a senior-living community can provide? Remember, boomers like the real thing.
Staying home provides the best "outcomes" and solution.
Perhaps the most critical assumption is that we can deliver equivalent outcomes to someone staying "in their home." Nothing could be further from the truth.
My 92-year-old, nearly blind mother-in-law lives in the same house she moved into after she lost her husband nearly 35 years ago. She lives there because she loves it. Yet she is isolated, completely alone, and totally dependent on one of her daughters – who lives 30 minutes away – for everything. Her nutrition is poor and she has virtually no opportunity for socialization. As a result, she is profoundly depressed. She has no opportunity to make new friends, find new horizons, and begin a new life.
All aging services professionals know that the most debilitating effects of aging are isolation, poor nutrition and depression – precisely the outcomes we are causing and fostering by this "stay-at-home" policy.
We should support and accommodate that desire.
Again, choice is the accepted standard. I believe it is time to challenge that assumption. I believe people have the right to as much choice as they can pay for.
There is a misperception that keeping people in the community and delivering services to them is somehow less costly. That misperception is a result of faulty analysis – comparing apples and oranges.
When community-based services are considered, the cost of housing is ignored – but it is still there, and it is still a cost to society in total. n

Wesley Enhanced Living will host The Aging Revolution Summit in Philadelphia on Sept. 27. For further information, phone (215) 354-0565 or visit www.wel.org.

Jeff A. Petty is President & CEO, Wesley Enhanced Living.