Does Aging-In-Place Work? What We Don’t Know Can Hurt Us.

Retirement

Aging-in-Place — most of us think of this as the decision, as we get older, to stay in our longtime family homes, even as increasing infirmity or cognitive decline makes this harder. We know there are support programs available, providing home health aides, assistance with yardwork or a wheelchair ramp, a “senior freeze” to keep property tax increases at bay, and so on. And our homes hold so many memories and are a source of affirmation of the success we’ve had in our lives.

But is aging-in-place really the right decision? Or, put another way, does it “work”? Is it the right path for us all to take as we age, or would we be better off if we moved somewhere more suitable — a single-level house, or a condo in an elevator building, or a home near public transportation, or any of the communities designed for older adults? Would we miss our neighbors in our old communities, or quickly adapt and be glad we’d gotten past our hesitancy?

In the book Aging in the Right Place from 2015, author Stephen Golant provides a number of reasons why that “right place” might be the longtime family home:

•The advantages of a familiar neighborhood: the individual knows the shops and services and can navigate the area well even after physical or cognitive decline.

•The advantages of a familiar home: spatial competence (finding your way when the power goes out, navigating steps out of familiarity)

•Preserving familiar relationships – friendships and service providers.

•The attachment to possessions and pets is not disrupted (e.g., vs. moving to no-pets home); the home not only contains memories of the past but also reminders of past successes.

•The home affirms one’s self-worth; one fears (whether rightly or wrongly) that others will consider the person a “retirement failure” upon moving.

•Maintaining privacy, vs. moving from a single-family home to an apartment, or to Assisted Living, shared housing, or living with family.

At the same time, there are many quite considerable costs incurred in Aging in Place, not just direct financial costs, for which we can argue about whether the government should shoulder these, but less tangible costs:

•Financial costs: the cost burden of maintaining large older home with yard vs. smaller but newer space with maintenance covered by association/landlord

•Physical costs: the steps/stairs and narrow doorways can make home a prison for the physically-impaired or place the individual at risk of falls.

•Social costs: the idealized neighborhood relationships might not be real, and turnover in the neighborhood may mean that there is more likelihood of social connection with the intentional social opportunities of a senior community.

•Health costs: isolation can mean lacking help for medical emergency – even to the point of dying unnoticed. More mundanely, homebound seniors have less ability to cook healthy food, travel to doctors, etc.

•Finally, there are particular challenges for those experiencing cognitive decline, especially when there is no family member to notice or when decline is hard-to-notice.

Golant doesn’t beat around the bush, but writes that

“Older adults are now bombarded with a singular and unrelenting message: They should cope with their age-related health problems and impairments in their familiar dwellings. . . . Older people cannot turn on a TV, search n the Internet, read books about old age, or pick up a newspaper without getting this persistent stay-at-home message” (p. 63).

In a somewhat older article, in 2009, William H. Thomas and Janice M. Blanchard offered a sharp critique of the Aging in Place model, in “Moving Beyond Place: Aging in Community.” They acknowledge the fear of nursing homes but write

“The bitter truth is that an older person can succeed at remaining in her or his own home and still live a life as empty and difficult as that experienced by nursing home residents. Feeling compelled to stay in one’s home, no matter what, can result in dwindling choices and mounting levels of loneliness, helplessness, and boredom.”

This is a stark message. But here’s an even more discouraging problem: in my research on the issue, I encountered one repeated refrain. There is no solid scholarly research which asks the question: “which choice is the better one, in terms of future quality of life, to stay or to move?” It’s not an easy question, to be sure: simply looking at the quality of life of the elderly and comparing those who live in single-family homes vs. various kinds of “elder-friendly” housing would not adequately distinguish between those who moved due to some sort of health problem and those who moved with the aim of preventing future health problems, for example. But there’s a data source that scholars have mined creatively to answer all manner of questions about retirement and aging, the Health and Retirement Study, and economists and similar researchers have been very creative in identifying “quasi-experiments” to answer this sort of question.

Discouragingly, though, given the relentless policy advocacy of supports for “aging-in-place,” it seems rather likely that this advocacy has discouraged researchers from considering that question in their research, depriving us all of what would otherwise be rather important information.

As always, you’re invited to comment at JaneTheActuary.com!

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