As we develop affordable and appropriate housing solutions for an aging population in America, we must focus on helping many frail individuals to stay in their own homes or share their homes. Housing should not be considered in isolation, as it overlaps with issues of health, energy, transportation, and economic policy.
As a family physician in a small town for 25 years, who has been the Medical Director of nursing homes, assisted living facilities, and founded a network of small home-like neighborhood assisted living homes, I speak as someone who continues to care for older individuals in a variety of settings including nursing homes, hospital, Emergency Department, medical office and at house calls. In addition, I now run a small company to
blend technology, family support, robust volunteering, and “targeted” personal care so as to offer choice for older individuals seeking care options and housing alternatives.
By mid-century when US citizens over 65 triple to 85M, those over 85 quintuple to 21M, and those over 100 number 1M, ‘business as usual’ will not suffice. At present bed utilization rates, every population unit of 50K will need to provide 200 more nursing home beds and 400 more assisted living beds, costing $100M to build and $50M/ year to run. Every household in the community will need to ante up $5000/ year for the next
20 years to pay this bill for a solution most dread. There has to be and is a better way.
90% of seniors desire to stay in their own homes, and aging in place has been a policy-makers’ mantra for decades. Yet solutions to assist this effort have been very limited. Federal and state and health care system initiatives pay lip-service to holistic care, individual empowerment, patient-centered medical homes, coordinated care teams, home and community-based care, but most paths inexorably lead to residential care
placement for our loved ones. In nursing homes, 50% die in the first 6 months and 60% of the survivors have no visitors ever. In assisted living facilities, if you’re on state assistance, (and most run out of savings in 12-18 months) all but $70/month of your social security check goes to the state, leaving you insufficient funds for pay for telephone, cable, toiletries, a haircut, new underwear, or any other ‘discretionary’ spending.
We have over-medicalized aging, focusing almost entirely on medication administration, fall risk, bowel and bladder function, imaging tests and visits to specialists, while older individuals desire connections to family, friends, pets, community, and personal interests. Most importantly, they desire purpose and meaning in their lives, a reason to get up in the morning; to be useful and not just taking up space. They have a lifetime of experience to share, and are actually a ‘hidden resource’ to contribute to the solution of many problems. Our communities have many underutilized assets in schools, libraries, community centers, and restaurants that need to be reconfigured to help meet the needs of an aging population. We have a largely untapped capacity to volunteer to help our neighbors. Our technology right now offers the ability to connect every isolated elder with video-calling and video-conferencing, to help us work smarter as families and caregivers, and to bring
enriching content and services into every home, rural or urban. A paradigm shift is possible. Conserving existing housing, and leveraging it to serve more diverse occupants is indeed possible, and has multiple benefits. We must develop more comprehensive services to help older individuals stay in their own homes.
My company has been doing this now for 6 years, serving over 100 frail elders from ages 80-105 in their own homes for up to 4 years at 10% of the cost of residential care options. We recently applied to CMS for a national 3-year demonstration to serve 25 communities in 2012, 100 communities in 2013, and 500 communities in 2014 as a part of their “Innovation Grant Program.” We were turned down because the model was not yet proven in other locations, they doubted the wisdom of incorporating volunteers into a circle of care in an important way, questioned the ability of frail seniors to embrace technology, and most-telling, criticized us for “thinking outside the box.” Is it any wonder government is unlikely to create novel solutions? We projected savings of $340M over the first 3 years, and $21.5B annually over the subsequent decade with such an approach. To no avail. Even the Gates Foundation, the Google Foundation, and Robert Wood Johnson Foundation have few elder initiatives in their portfolios, and none to keep elders in their own homes.
Now that the Supreme Court has spoken, and ACO applications are rapidly increasing, some progressive health care systems are taking a look at our work. Grassroots interest has never been a problem. The approach resonates with community groups, churches, and small businesses. But policy makers struggle with such fundamental change. We need to embrace the dignity of risk for our elders to live where they desire. We need to promote similar common sense approaches to help those with disabilities, the traumatic brain injured, and disabled American veterans to also live full lives without limits in community. This is not a partisan issue. This is central to the lives of more than 25% of our population. This is for all our families. It’s time to act and not turn away.
Thank you for your attention. Allan S. Teel, MD, Founder Full Circle America. 1-888-873-8817.
(Testimony delivered July 25, 2012 before Senator George Mitchell, Secretary Henry Cisneros, and other
dignitaries at the Bipartisan Policy Center Housing Commission Hearing in Bar Harbor, ME) .