August 15, 2014

Enabling Seniors to Remain in Their Own Homes: Three Models

Last month, I wrote about the scourge of over-using antipsychotic drugs in nursing homes. I mentioned that this practice – common in facilities for the elderly to make them more “manageable” – is one of many reasons why I want to stay in my own home as long as possible… here in the Palisades neighborhood I’ve loved for almost 60 years.

In June, the National Aging In Place Council (NAIPC) held its annual meeting in Washington. As described in a June 16, 2014 article by Liza Kaufman Hogan carried by, the NAIPC focused on this one question:
If 90% of adults over 65 want to remain in their homes as long as possible, as a 2011 AARP study suggests, why do so many wind up in retirement communities, assisted living facilities and nursing homes?

At that meeting, presenters offered three different models to address the issue. It’s a big issue, too: projections suggest that by 2030 there will be 89 million Americans over 65, and 20 million over 80 (the country’s fastest growing segment).

The Technology Model
Dr. Allan Teel created his for-profit telemedicine support program – Full Circle America -- for the oldest residents in his own home town, Damariscotta, Maine. They didn’t want to leave their homes for assisted living or nursing home environments; even if they did, many of them didn’t have the means to do so.

Teel identified a way to keep his fragile and proud neighbors in their own homes by thoughtfully combining several elements:
  • Digital medical tools to track their health
  • Paid caregivers
  • Family members
  • Volunteers
Full Circle America members receive a kit that includes a web camera, blood pressure cuff and stethoscope to monitor their health. Those tools enable doctors and family members to keep an eye on their patients and loved ones without always being physically present.

A combination of paid caregivers, volunteers, and family members performs most of the duties that the oldest seniors living at home require -- like grocery shopping, gardening, walking the dog, providing transportation to medical and other appointments, etc.

The service isn’t cheap, but compared to monthly fees at assisted living or nursing home facilities ($5,000 to $10,000 a month), the "bargain" value of Full Circle America’s services comes more clearly into focus. Here’s what members pay:
  • A one-time cost of $500 for the equipment,
  • Monthly fee for the technology and paid caregiving of $100-$400, depending on the level of monitoring required,
  • Monthly fee of $500 for the telemedicine service.
After the modest initial cost, this service comes to less than $1,000 per month. Most of all, Full Service America enables its elderly members to stay at home.

The Village Concept
This non-profit model is one I know well; last year I joined my own Palisades Village community as an associate member.

It’s designed to help people, including more and more Baby Boomers – perhaps less frail, needy, and elderly than Full Circle America members – stay safe, comfortable, and active in their own homes. Their requirements aren’t so critical, but they need support to stay where they are.

At the June NAIPC meeting, the Capitol Hill Village (like my Palisades Village, it's one of 14 Villages in DC and 40 in the greater metropolitan area) explained the services provided, including:
  • Help with home maintenance,
  • Provide transportation for errands and appointments,
  • Locate necessary in-home care,
  • Sponsor classes  and social activities
The Capitol Hill Village charges an annual fee of $530 for individuals, and $800 for households. It now serves over 265 members and offers financial assistance for people who qualify.

My associate membership in the Palisades Village costs $250 a year ($500 for individuals, $750 for a household (like husband and wife). I’d use it more if my needs were greater, and if I didn’t already have wonderful support from my Nepali housemates and from family, neighbors, and friends.

The Purpose-Driven Model
Generations of Hope was the third model presented at the NAIPC meeting. It offers affordable housing for residents 60 and up in communities that need their help.

The original Generations of Hope program in Rantoul, Illinois, worked by pairing these older residents (who received the affordable housing) with families raising foster children. The resident seniors offered at least six hours of support each week, doing things like:
  • Babysitting,
  • Tutoring,
  • Gardening,
  • Serving as a crossing guard
Other Generations of Hope communities have been created in other places to serve different constituencies, like families with autistic children or military veterans with traumatic brain injuries.

These different communities share the same structure: they are multi-generational communities created to address specific social needs, where the seniors provide support and services as volunteers.

The Generations of Hope concept is expanding. Among the new communities across the country are two projects in development here in Washington, DC.

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