Why the Elderly Have Better Outcomes in Their Own Home
In eldercare, the revolution of the past decade is the increased ability and desirability of elderly people choosing to agein the familiar surroundings of their own homes.
This option has become a reality for a variety of reasons. The availability of high-quality, affordable home care is one. Flexibility in the provision of medical services is another. The combination of factors leads to better outcomes for all when the elderly remain in their own homes.
Perhaps the most significant outcome for both the elderly and their families is financial. Around one-fifth of people over 65 own their own homes outright, having paid off their mortgages. Another substantial percentage can access the equity in their homes from federal programs or reverse mortgages.
Senior care facilities — from independent living villas to nursing home beds — are more expensive. Independent living facilities frequently require a major buy-in (the proceeds of the sale of the home), as well as monthly fees. Assisted living costs are around $5,000 - $6,000 per month, while skilled nursing facilities run $7,500 - $10,00 per month.
Living in the home, even with the expenses of home care and home health care, reduces the drain on personal and family resources. It also lowers the costs to Medicare and Medicaid.
Personal independence is taken for granted by many people until it is lost. Aging in place at home can preserve the individual’s sense of independence far longer than in even the best facility.
The familiarity of the person’s own home helps to preserve that independence and ability to live life as wanted. Looking around at your own things in your own home can also be a great comfort.
Medical needs and issues
The Home and Community-Based Services (“HCBS”) program under Medicaid provides Medicaid services for recipients in their homes and communities. While much of the research has focused on low-income recipients, many of whom are in public housing, the outcomes from these services are promising.
One study compared elderly aging in place and in nursing homes. In all four areas studied (cognition, depression, activities of daily living and incontinence), the scores of the aging in place group improved or stabilized, while those for the nursing home group deteriorated.
Medicaid’s Program of All-Inclusive Care for the Elderly (or “PACE”) program demonstrates similar, better outcomes. Based in elderly day care programs, PACE allows nursing and medical care to come to where the elderly live in a community. And the elderly are in a social and fun environment, rather than a sterile clinic or facility.
Care management programs for the elderly also work well to help people stay in their homes. Working with primary care health care providers, care managers visit with the elderly frequently — either at home or in the medical office — ensuring consistent personal and coaching time.
Coordination is required
Obtaining better outcomes for the elderly also requires coordination between many people. The elderly person and his or her family must synchronize their efforts to make the arrangement work. They need to coordinate with the health care providers (including the case manager, if there is one), and others.
The naturally occurring retirement community (“NORC”) is an example of such coordination. NORCs, as the name suggests, are not planned communities, but are areas in which a sizable proportion of the residents are elderly. NORCs evolve from established communities, people moving into a given area (usually an urban center) or the out-migration of younger people from rural areas.
NORC programs arise when many people coordinate needed services and activities. Social services and health care providers work with philanthropic organizations, government agencies and, most importantly, the elderly residents themselves to ensure better outcomes on all levels.
Outcomes reported include a decrease by one-half of the hazards in the home, which might lead to injury, as well as a decrease in the percentage of falls from 28 down to 4. The percentage of members feeling “very confident” they could remain in their homes tripled, to 71%.
Having the conversation
Successfully remaining in the home requires having the conversation. Not only do elderly parents and their adult children need to talk, but the elderly need also to be self-advocates with health care providers, community organizations and each other.
Simple things can be done. Door knobs can be replaced with handles to ensure access. Handrails can be installed appropriately throughout the home. Coordinating with home care services helps boost the confidence of the elderly in their own homes.