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Assisted Living and Wishful Thinking

By Harry S. Margolis


An op-ed article in The New York Times highlights how the assisted living industry in part profit from a mirage about the realities of aging. No one wants to go to a nursing home, which are seen a depressing dumping ground for ailing or demented seniors who have no other choice. Many seniors and their families choose assisted living as a much preferred option.

For those seniors who are healthy, assisted living can be wonderful. They provide meals, community, activities, and some assistance with the activities of daily living. Living in assisted living is often a much better alternative to an isolated existence in a single-family house.

As a result, the assisted living industry is booming—the number of facilities almost tripling nationwide over the last 20 years, to 30,000 today. At the same time, nursing homes are closing and their residents have become older and sicker. The average length of stay in a nursing home has dropped over the last two decades from almost two and a half years to one year (though these numbers come from different sources, so I’m not certain they’re using a consistent methodology).

Aging in Assisted Living

The problems, however, arise when residents begin to require more than minimal care. Assisted living facilities often urge (pressure?) families to hire additional care for their loved ones, which can be costly since this care is not covered in the assisted living fee. Often, the move to the assisted living facility in the first place was motivated by a desire to avoid both the cost of such care and the intrusiveness of in-home caregivers. The cost of assisted living often is much more than that of living in the community—sometimes leaving little money left over for paying caregivers.

Undermining the Mirage

The aging of assisted living residents also can create a marketing problem for the facilities. When a facility opens, the new residents may be healthy, active seniors in their 70s. Ten or 20 years later, the bulk of the residents may be in their 80s and 90s—many needing more care or suffering from dementia. It then can be difficult for the facility to attract new, younger residents who don’t see themselves ready to join this older community.

This can especially be a problem for continuing care retirement communities (CCRCs) which provide a spectrum of living options for aging in place, from assisted living to independent living to nursing home care. They often bar assisted living and nursing home residents from their independent living dining rooms, both for marketing purposes and for the comfort of the independent living residents who may not want to see what may well be their own futures. These rules often apply even when a healthy resident wants to dine with her failing spouse.

Both assisted living facilities and CCRCs, to some extent, are selling the mirage of healthy, vital aging throughout old age and neither model is totally equipped to respond to the ultimate deterioration of all but a few lucky seniors. CCRCs are better equipped, since they offer the full extent of care, but residents and their families still are often surprised by what this means in terms of choices they have to make.

So, Is There a Better Option?

The writer of The New York Times article, Geeta Anand, suggests that we follow the Japanese model. As the oldest country by age of citizens in the world, and one that does not welcome immigrants, who provide the bulk of senior care in the United States (not county care by families), Japan is already facing demographics that will confront us soon.

Japan has mandatory long-term care insurance and heavily subsidizes home health care and adult day health care to help seniors stay at home safely.


Related articles:

Aging 2.0 Conference Paints Challenging Picture for Baby Boomers

Where Should You Live as You Age?

Assisted Living Keeps Growing in Massachusetts

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