Growing old in a good home

By: Joseph P. Shapiro
May 21, 2001

Innovative ways for seniors to get care without going to a nursing home 
 
It doesn't take a mind reader to know that you don't want to end up in a nursing home. Nobody does, it seems. Which is why the number of nursing home residents dropped by about 10 percent during the past decade–a period when the number of Americans over 75 grew by 27 percent. So if older Americans aren't in nursing homes, where are they? Franklin Alexander has one answer. At 92, he's living in his dream house with a sweeping cliffside view of the ocean, caring for his wife, Myrtle. She's 95 and has dementia. But the couple wouldn't have that choice without the help of an innovative California HMO that provides in-home aides and medical supplies. "We're staying in our home looking out at the blue Pacific," says a grateful Alexander, "instead of going into a nursing home." 

The Alexanders and millions of other seniors are making aging a better prospect for the rest of us by demanding–and getting–a growing array of alternatives to the nursing home. Many nursing homes provide high-quality care, especially for people with intense medical needs. But fears over loss of privacy and independence are driving more seniors to other options. Today, there are just 1.5 million nursing home residents over age 65. Assisted-living facilities–private apartments with staff to provide some care–now serve about 800,000. Independent apartments with simpler services, like prepared dinners, serve 1.5 million. Another 625,000 seniors live in continuing-care retirement communities, which offer all the levels of care people need as they age, from independent apartments to full nursing care. Tens of thousands more live in group homes and adult-foster-care facilities. And some 6 million chronically ill and disabled older people get help at home, sometimes even with ventilators, IV tubes, and other complex medical procedures. 

Opting for these arrangements means opening your wallet–wide. Government picks up the tab for nearly 60 percent of nursing-home costs nationwide. But it won't help much with these new forms of long-term care. Though 38 states pay for some assisted living, the programs are minuscule, covering fewer than 100,000 poor people. Medicare covers home care, but just for 100 visits in the weeks following a hospital stay. So seniors increasingly are paying their long-term care bills out of their own pockets. "It's remarkable. It's a rejection of the traditional way we've taken care of frail seniors in the United States," says David Schless, president of the American Seniors Housing Association. For some seniors and their families, insurance can help with the cost, which can reach tens of thousands of dollars a year.

And finding these new alternatives is not always easy. Nearly 40 percent of the beds in assisted-living facilities are in just three states–California, Florida, and Pennsylvania. Those fortunate enough to live in states like Oregon or Washington, where experimentation in long-term care is encouraged, find more choices. Don't rely on your doctor to point you toward the best option; studies have found that doctors tend to be among the least informed about alternatives to nursing homes. And don't wait until a crisis happens–the day Mom falls or Dad is diagnosed with Alzheimer's disease.