Not leaving home
The broken rib could have been a disaster for Claire Soroko. She had been saying goodbye to friends Christmas Day when she stumbled from an outdoor step and banged into an iron handrail, breaking a bone in her chest. Afterward, she couldn’t clean, drive or even dress herself.
“I really don’t have anyone,” says Soroko, a Park La Brea resident in her 70s. “My daughter and son-in-law are very busy. I couldn’t ask them to come and stay with me.”
Such accidents can often mean the end of living independently. Twenty percent of falls among elderly people require medical attention, and serious injuries, such as hip fractures, often require nursing-home care.
But today’s older Americans are increasingly adamant in their desire to avoid nursing homes or assisted living. And they now have a movement to back them up. Called “aging in place,” it has a beautifully simple premise: Keep seniors safe, well-cared for -- and in their homes.
In Soroko’s case, more than 500 Park La Brea residents 60 and older have formed a novel network to ensure that its members can remain in their homes despite illness or physical decline -- homes that many have known since the complex opened during World War II. Soroko called the agency’s office upon returning from the hospital. By the end of the day, the staff had lined up daily caregivers, transportation to doctor’s visits and the hair salon, and visits from neighbors who brought meals and encouragement.
As the nation’s demographic shifts to the old and older, such community associations are at the forefront of redefining how older Americans live. About 10% of Americans 65 and older live in nursing homes, assisted living or residential care settings. But that number rises dramatically among people who reach their 80s or 90s. Americans are living longer than ever--and their ranks are growing. The number of people 65 and older is expected to double in the next 2 1/2 decades as 78 million baby boomers, the oldest of whom are turning 62 this year, enter their golden years.
Together with businesses and technological advances, these associations could change the portrait of growing old in America.
Where the heart is
There is simply no place like home -- living surrounded by favorite photographs and worn furniture, familiar smells and the comforting rhythm of the neighborhood, from the thud of the mail arriving each morning to the whoosh of the school bus passing by each afternoon.
“We have an image in our heads that as soon as you retire you sell your home and move to Florida,” says Elinor Ginzler, director of livable communities for AARP. “But according to census data, less than 10% of people 60 and older had moved in a five-year period. We’re connected to the house we’re living in and the neighborhood we’re living in.”
In fact, 90% of adults 60 and older say they want to stay in their home or community rather than uproot themselves late in life, a 2006 AARP study found.
In the past, there were few resources to help people remain at home amid the problems and frailties of old age. But changing demographics, economics and attitudes are making “aging-in-place” ever more possible.
“The baby boomers are a generation of problem-solvers,” says Peter Bell, president of the National Aging in Place Council in Washington, D.C. “We use education, technology and resources to change things -- not just accept them as they are. I think we also recognize we can do things better collectively rather than individually.”
Remaining in one’s home might even help put the brakes on aging. Older people report a better quality of life, more control, more independence and feeling less stigmatized when they live on their own -- less old, in other words.
Says Peter Notarstefano, director of home- and community-based services for the American Assn. of Homes and Services for the Aging in Washington, D.C.: “I think we have more of an independence mentality now. . . . The seniors now are very different than the seniors 25 years ago. They are more active. Can you see Bob Dylan in a nursing home? I think this generation will want something else.”
The marketplace and local governments have begun to respond to these new demands, Ginzler says.
Referrals and requests
The telephone rings every few minutes in the cozy LIFE (Living Independently in a Friendly Environment) office in building 49 in Park La Brea. Seniors call with questions:
“Can you refer me to a dentist within walking distance?”
“What is the name of that company that installs shower grab bars at a decent price?”
“Can I still sign up for the field trip to the Natural History Museum?”
News filters in. Mrs. Abraham went to Cedars last night with back pain. A new play that seniors might like is showing at UCLA. Mr. Barker is going to visit his daughter in Arizona for two weeks.
A volunteer -- usually another senior living in Park La Brea -- answers the telephone and provides information and referrals. Between calls, the volunteer has a list of seniors to check up on -- friendly telephone calls to battle loneliness and isolation.
Social worker Rosalie Rapas, one of two paid staffers who run the program, handles the more serious stuff, talking to faraway family members concerned about aging parents and making home visits to assess the needs of members. “We are as cutting edge as you can be,” Rapas says.
LIFE started in 2005 as a federally funded pilot project designed to see if such communities -- called naturally occurring retirement communities -- could help people remain in place as they age. Loosely defined, the communities are neighborhoods in which a large segment of the residents are older adults. The goal of such a supportive services program is to help these seniors maintain their independence, safety and connection to the community as they age in their own residence. The programs are operated by a lead agency, often a nonprofit organization, but are directed and propelled by the community itself.
“You know the saying, ‘It takes a village to raise a child’? Well, it takes a community to support an older adult,” says Susan Alexman, director of senior services for Jewish Family Service of Los Angeles, which operates the LIFE program at Park La Brea.
About 80 supportive services programs have sprung up in naturally occurring retirement communities in recent years in the United States, Notarstefano says. About half were funded by Congress as pilot projects. Another elderly services program exists in West Hollywood, and Jewish Family Service is exploring opening another LIFE community in the Valley later this year. Two programs recently opened in the Bay Area, and another exists in San Diego.
Though many programs are nonprofit organizations that do not charge member fees, others are springing up in affluent areas of the country that operate with dues paid by members. One of the first supportive services programs was established by residents in the Beacon Hill neighborhood in Boston in 2000. A nonprofit corporation, Beacon Hill Village operates with annual membership fees that give people preferred access to vendors who have been pre-screened.
Such programs tap into existing services wherever possible -- fitness classes at nearby senior centers and long-established Meals on Wheels programs, for example -- and create new services only when a gap is identified.
The LIFE staff at Park La Brea was initially surprised to find a disjointed community behind the gates. Even though many people had lived there for decades, most didn’t know their neighbors. Older adults, roughly 15% of the residents, largely fended for themselves.
The staff began to knit those seniors together. Employees launched several social initiatives, including regular field trips, the telephone call line and a friend-to-friend home visitation program. They also started a balance-and-gait exercise class because a fear of falling was one of the biggest concerns about living alone.
“We found people were hungry for interaction,” says Laura Diepenbrock, LIFE program manager. “The neighbors now not only know one another, they can rely on one another in case of emergencies. It’s really neighbor helping neighbor.”
The model is efficient and cost-effective.
“Maybe all you need is someone to come to the house three hours a day to help with a bath and meal preparation,” she says. “That is appealing to people. They decide what they need and how much they want. Feeling in control of the world is one of the best goals.”
Keeping LIFE going
Park LA BREA seniors have grown attached to their program. When it briefly lost its federal funding last year, members worked together to save it, says Sally Miller, 75, a LIFE member who also volunteers in the office. They wrote to lawmakers and sold note cards decorated with their own artwork to raise money. The program survived and has received a fresh infusion of federal funding.
“People feel even more ownership of the program now,” Miller says.
Park La Brea has changed because of the program, she says.
“This is a big community,” she says. “It’s easy to be isolated. This program has brought us a new sense of community and connectedness. You walk around and see people you never would have known if it were not for the program. Before, you might only know a neighbor or two.”
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The cost of care
Older adults may save money by remaining in their own homes as they age. The following statistics show average costs for various types of care.
* Average national cost per year of private-room nursing-home care: $77,745*
* Average national base rate per year of assisted-living care: $35,628**
* Average cost per year of one hour per day of home healthcare provided by a licensed practical nurse: $13,468***
* Average cost per year of one hour per day of care provided by a home health aide: $6,916***
*Average nursing home costs in Southern California are closer to $100,000 per year.
**As much as several hundred dollars per month may be added for such services as diabetic care, medication management or additional meals.
***For total costs under these scenarios, housing and living expenses should be factored in.
Source: MetLife, AARP