I am a part of the human services "industry" and, as such, you can count me among those who have this crazy belief that we could live more fulfilling lives (as in "Life, liberty and the pursuit of happiness") if we had a more rational approach to aging.
But this is also very personal with me. First, I am of an age where one thinks about one's professional career and the rest of life. Second, my wife and I are, and have been, helping older relatives navigate the complex options, bureaucracies and complications that are now a part of their lives. So let me lay out an argument, from both a personal and a professional perspective, of the need to revolutionize our approach to providing services for the aging.
Let's face it...the U.S. does not really have a policy for how we will progress through the stages of aging in ways that are humane, cost-effective and fulfilling. I fully realize that we do have the Older American's Act, Social Security and Medicare, each of which play a very significant role in improving the lives of older adults. However, if you try to replace the word "policy" with the words "plan" or "strategy" or "rational approach" and it becomes clear we, as a nation, just let it happen instead of making it happen.
You can say that the options seniors have are market-driven, but that is only partly the case. It is more special interest industry-driven. Nursing homes and retirement communities, both of which are needed and have their place in an overall approach, tend to define our options. But what does the market want? What do you want for yourself and your older loved ones?
What we once thought of simply as aging now has at least three phases: early retirement years, later retirement where people experience more limitations in terms of activities of daily living, and advanced aging where many people are frail and require significant help. This gets to the question of what Americans want in how they age. Baby boomers, who have begun to dominate the early retirement public, will, thanks to science, be well for a couple of decades after they retire or as they move into other work-volunteer options rather than retire. And then there is the overall phenomenon of Boomers wanting to replace the givens of the past to meet their presumably more active and engaged needs and interests. Save the steady diet of golf, bridge, and communal meals for later in our seventies or eighties.
What will boomers want when they reach the middle phase of aging? What do people in this age group want now? We know the answer. I have spoken with lots of people and groups and it is always the same. If they can't be around their children and grandchildren fairly regularly, which is often the case, they want to be in the community they know, to get any help they need in their home, to be around and connected with caring people of all ages, to participate in the civic and social events that are familiar to them, to eat what they want when they want it. I appreciate independent living facilities and retirement communities and expect to be ready for one at some point but segregating older people is not the only option and probably not the best option for many of us.
In-home services have grown dramatically but they could be more diverse, in terms of the range of assistance provided, more accessible, and more prevalent. Smaller elder housing options could be much more prevalent and fulfilling as they are in the community, keep older people connected daily with others of all generations, and are less regimented. Homes and community facilities could be retrofitted for accessibility and public transportation systems could be redesigned to allow older people to get around in the community.
There are economies of scale with large retirement communities and skilled nursing facilities but they may not always be the cost effective set of options for folks who are reasonably well, could get along with help in their home and treasure the privacy and familiarity of their own home or apartment and services in a community of people of diverse ages.
It is not an either/or. We need really great and affordable independent living, assisted living, rehabilitation and skilled nursing facilities and programs accessible everywhere. We also need in-home and in-neighborhood multi-generational options as the number of older Americans rises.
We could be more purposeful as a nation about developing a full continuum of options for older adults. Parts of our "system" of aging are well developed; others are not. Sometimes the marketplace could use a little push from government, insurance companies, and consumers. If in-home care of certain kinds is not accessible or affordable, if there are not options for those who want to live in multi-generational settings, we've set a policy--the status quo. Or more entrepreneurs could define and develop other options and legislators, consumers and advocates could push for a renaissance in the American approach to aging...well.
We have a choice. Let's make it the right one.