When the Old Age Home Is Your Own

New possibilities are emerging for seniors to stay put

Most Americans, the assumption goes, plan to spend their golden years in some kind of retirement community. The reality is quite different. A majority, whether out of desire or need, expect to "age in place," growing old right in the homes where they now live. A study last year by AARP, a Washington (D.C.) association that focuses on issues affecting older Americans, found that 73% of Americans aged 55 and older "expect to always live in their current residence."

That means many communities must gear up to provide essential, affordable services--from visiting nurses to transportation--so seniors can stay put without compromising their health and safety. They can take their cues from several models that have evolved to address issues faced by what's called a naturally occurring retirement community (NORC). In short, that's a neighborhood not originally planned for seniors but where most of the residents have grown old.

The programs range from wholly private efforts started by residents to large-scale initiatives such as the "social HMO," a part of the Medicare program that provides social as well as medical services. Perhaps the most ambitious model is a pilot in Howard County, Md., aimed at coordinating both private and public agencies to provide comprehensive aging-in-place programs for the whole county.

Aging-in-place services vary, but what all these programs offer seniors is access to a staff of health and social-service professionals who can assist them in getting medical and other help, whether that means home repairs or home nursing care. Often, residents or members pay monthly or annual fees that go to support the staff. Members are charged for individual services, such as housekeeping, but often at below-market rates.

The model with potentially the broadest impact is the social HMO. A form of Medicare, it arranges for such services as housekeeping and home-delivered meals as well as medical care. Four plans are in place, covering Los Angeles and nearby counties, Las Vegas and southern Nevada, Portland, Ore., and Brooklyn, N.Y. All in all, more than 100,000 people are enrolled. Next year, New York's social HMO, Elderplan, will be opened to residents of Queens and Manhattan. Meanwhile, a bill pending in Congress would expand the plans to other areas.

DISCOUNTS. If you're 65 and you live in one of the four areas with a social HMO, you can opt to join it when you apply for Medicare. Kenneth and Sylvia Williamson of Long Beach, Calif., chose to join the 51,000-member Senior Care Action Network (SCAN), the social HMO in the Los Angeles area, even though they don't need its aging-in-place services just now. The Williamsons are planning ahead: "I've been pretty successful in the business world, but when it came to investing, I wasn't that shrewd," says Kenneth, 72. "So I don't have a big war chest to draw from" for intensive in-home help.

Should Kenneth or Sylvia, 68, develop a chronic illness or become frail, SCAN would assign a "personal care planner" to arrange for medical, social, and in-home services. To make use of a service under the plan, a member would have to get the approval of a case manager. While the services aren't free, they're less expensive than if you were to get them on your own. For instance, the co-payment for a home-delivered meal is $2, according to SCAN's 2002 fee schedule; it's $8.50 per visit for transportation to medical or dental appointments, housekeeping services, and help with bathing and dressing.

At the other end of the spectrum from social HMOs are the homegrown networks created by residents who saw a need as they and their neighbors grew older. Heritage Harbor Health Group in Annapolis, Md., is a nonprofit run by some 1,400 members who live in a suburban community of single-family homes, townhouses, and high-rise apartments. The $85 annual membership fee, plus charitable contributions, support an administrative staff and several nurses. The group guarantees free access to a nurse 24 hours a day, seven days a week. Residents can get their blood pressure checked and receive health screenings as well as get assistance in finding other services.

In the town of Northport and surrounding Leelanau County in Michigan, older residents depend on ShareCare for services such as those of Heritage Harbor. Members, who number about 400, pay a one-time $75 fee and annual dues that range from $50 to $150 per year depending on their age. In addition, about 100 members serve as volunteers, doing such tasks as driving other members to medical appointments.

Another aging-in-place approach combines private funding with city and state subsidies. In New York City's Chelsea neighborhood, Penn South, a 10-building apartment complex with some 6,000 residents, boasts an in-house staff of nine health and social-service professionals to serve its growing senior population. They provide such services as advice on medications, blood-pressure monitoring, and diabetes screenings. Penn South also has an adult day-care center. The costs of such services are paid by rent and by state and city subsidies. United Hospital Fund, a nonprofit that focuses on health issues, started the project in the 1980s because "we were seeing a lot of visits to the emergency room [by Penn South residents], and they looked preventable," says Fredda Vladeck, director of UHF's aging-in-place initiative. Now, New York State has 27 other similar projects.

Goldie Gold, 80, is a beneficiary of Penn South's program. She and her husband, Julius, 86, have lived in the complex since 1967 and have never considered moving. "When the weather is nice, I can sit in the little garden outside the building and chat with my friends. I just love it here," she says. When Julius, a diabetic, had gangrene in his leg, the on-site social worker arranged for a visiting nurse. Now that he has Alzheimer's, Goldie is thankful that he goes to the adult day-care program two days a week.

Just as Penn South has made aging-in-place services part of its range of perks, Maryland's Howard County is studying how aging-in-place can be an integral benefit of living in the county. Located south of Baltimore, Howard County expects the number of residents aged 60 and older to jump 260% in the next 20 years, to 72,000, or 23% of Howard's population.

Working with Horizon Foundation, a Columbia (Md.) nonprofit that has committed $600,000, the county has launched a pilot program that initially focuses on low-income seniors. It provides home visits by professionals to assess seniors' physical and mental health and connect them to medical and social services. They also arrange for home remodeling, such as building ramps for wheelchairs, and, in some areas, curb-to-curb transportation. Eventually, says Richard Krieg, the foundation's president, the county plans to have a high-tech medical-information and alert system so that a senior's health record is immediately available when an emergency call is made.

The number of aging-in-place programs remains tiny compared with the potential need as baby boomers retire. But the options are growing as more public and private groups experiment with ways to enable people to grow old in their homes--safely.

By Ellen Hoffman

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