Title: Paper presented at Symposium on Aging in Place in South Carolina: Challenges and Solutions May 10, 2
1Paper presented atSymposium on Aging in Place
in South Carolina Challenges and SolutionsMay
10, 2005
Aging in Place or Moving Golants Four
Commandments
- Stephen M. Golant, Ph.D.
- University of Florida
2Higher-income older adults have more choices than
ever to age in place outside of nursing homes
- Conventional dwellings
- Senior Apartments and Coops
- Congregate/Independent Living Communities
- Assisted Living Residences
- Continuing Care Retirement Communities
3Lower-income older adults have fewer affordable
options, especially in some states
- Board and care facilities/adult foster care
- Affordable rent-assisted buildings integrated
with supportive services - In some states, affordable assisted living
residences made possible by - State SSI supplement
- Medicaid state plan
- Medicaid waivers
- Section 8 Vouchers
4Assessing the limitations of aging in place
especially important with fewer noninstitutional
housing options
- Increased likelihood that lower-income older
adults will occupy inappropriate residential
settings - Inconsistent with their preferred life-styles
- Inconsistent with their chronic health problems
and functional and cognitive limitations - At greater risk of being over-served or
under-served - Greater undesired burden on family members and
thus a greater risk of incompetent care
5Assessing Aging in PlaceFour Commandments
- Compare and contrast alternative residential
contexts - Establish the unequal salience of residential
features - Consider the past, current, and future
residential settings of older individuals - Assess how individual differences matter and
examine their trajectory of change
6Four commandments are relevant to multiple
stakeholders
- Older consumers
- Family members
- Housing providers
- Service providers
- State policymakers
- Researchers
7So what is a residential setting?
- Social, built, and organizational environments of
the - Dwelling
- Neighborhood
- Community
8The dwelling environment
- More than a dwellings physical condition,
comfort, safety, and user-friendliness - Includes affordability in short- and long-run
- Includes its equity (if owned)
- Includes the instrumental and expressive supports
of its occupants/visitors - Include personal belongings having emotional and
symbolic meanings
9Neighborhood and community
- Physical and social conditions (safety,
assistance from neighbors, accessibility) - Sustenance grocery stores, restaurants, churches
- Feasibility of delivering or accessing long-term
care - Transportation availability
- Community resources
- Access to family members
- Public programs that can be packaged
10Commandment 1 Compare and contrast alternative
residential settings
- Assessing place tradeoffs is crucial whether
expressed in dollars or psychological well-being
timeline may be crucial - Aging in place may not be appropriate for
everyone Dont over-romanticize - Service delivery may be more cost-effective and
timely if delivered to a congregate housing
setting than to a private single-family dwelling
11Breaking Commandment 1 The marketing of
reverse mortgages
- Reverse mortgages encourage the aging in place of
low-income older homeowners - Occupants receive cash advances by borrowing on
the equity in their owned dwellingspostpone
repayment until move, sell, or die
12Why typical reverse mortgage evaluations violate
commandment 1
- Infrequent comparisons with other ways of
releasing dwelling equity e.g.,
selling/re-invest - Absent assessments of whether expected dwelling
appreciation will offset loan costs and the
maintaining or upgrading of an older dwelling - A reverse mortgage is not just a loan transaction
- It can result in older homeowners living alone in
cost-inflated and physically inappropriate
dwellings - Residential life-style and long-term care
delivery strategy must be compared with
alternatives
13Commandment 2 Establish the unequal salience of
residential features
- Avoiding the elderly where to live community
guidebook fallacy - Community may rank first for active retirees, but
last for vulnerable old seeking affordable
assisted living - Only a handful of issues may be the most salient
in residential decision-making - Inaccessible family member may undermine aging in
place, despite a dwellings great design features
14Commandment 3 Consider the past, current, and
future residential settings
- Older peoples lives dont begin when they meet a
case manager or complete an interview or
application - Older people evaluate their current and future
residential settings from a life-time perspective - Some people have always lived in less than
perfect places and will always be difficult to
satisfy
15Commandment 4 Assess how individual differences
matter and examine their trajectory of change
- Demographics, economic well-being
- Current and past lifestyles
- Personal resources (e.g., behavioral competence,
coping styles) - Likely trajectory of change of personal resources
- Personality styles
- THUS, ONE SIZE DOES NOT FIT ALL
16Assessing desirability of aging in place Four
commandments
- Compare and contrast alternative residential
settings - Establish the unequal salience of residential
features - Consider the past, current, and future
residential settings of older individuals - Assess how individual differences matter and
examine their trajectory of change