For older adults, life can be divided into two phases. The first is the early post-retirement phase. This is often what we think of as the “Golden Years” as adults are still active and pursuing retirement interests such as hobbies, travel, and spending time with family. Older adults in this category are able to continue to maintain their homes and lawns, although they may choose to outsource some of these tasks to others.
The second phase is the final phase of life and the first phase transitions into this second phase over some period of time. In this phase, the older adult is moving from self-sufficiency to a dependence on others to perform tasks of living. This is a time when adults consider whether they want to remain in their homes or whether they want to move into a facility that can provide for their needs going forward.
Although there are many, many facilities available for different levels of care, studies have shown that it can remain less expensive to continue to live in the home (“aging-in-place”). But this isn’t necessarily the case for all individuals. In this post, I want to look at some issues that can be barriers to the option of aging in place. I wish to thank my colleagues at the Delaware Senior Resource Network for their input as people working with older adults who are aging in place.
Social Determinants of Aging Well: Racial Disparities and Health Equity
As social people, we like being around people who are like us and interacting with people who are not like us can result in stress. This can manifest itself when home health care is provided. When care is provided in the home, in many cases the care-givers and the older adults are of different ethnic or cultural groups.
This can be both a challenge and an opportunity for growth. An adult may refuse to allow certain populations into the home, which considerably reduces their opportunity for in-home services. In my recent experience, I have found that when an older adult has the opportunity to interact with caregivers of other races or cultures, both get to learn about the other and the relationship is beneficial to both.
Another more prominent racial disparity comes from differences in education both about services and about self-care and follow-through. One of the saddest situations comes when an individual needs assistance services, those services are available and affordable, but yet neither the individual nor their families know about these resources.
This may be more likely among some populations than others, and represents societal issues and discrimination which is beyond the scope of this post. But part of this issue is the fact that we neither want to know about these services until we need them, nor are we aware of them as we are other services. Everyone knows about Social Security and Medicare, but how many are familiar with the state organizations supporting the senior population?
Financial and Legal Barriers to Aging-in-Place
The challenge of communication goes beyond just the care services, but also is found with the financial community. As a daily money manager, I’ve heard more than once someone say that they wish they’d known about this service from a past experience.
People tend to look for an attorney or a financial advisor to plan for financial longevity of savings only after transitioning into that second life phase when it is often too late to provide many savings-protecting options. Likewise, the lack of financial education can constrain a person’s ability to save for this period in life. This can result in the inability to afford needed services, or the financial flexibility to care for a loved one as a caregiver.
Another financial barrier is the financial exploitation of the older adult population, either by stranger criminals or by loved ones and other family members. This ends up reducing the ability of an older adult to afford services, even when they have done everything right in terms of saving for their final years.
Caregiver Workforce Challenges
As mentioned, the caregiver industry is not well-supported and respected in our society. This results in many challenges in the area of providing caregiving services by non-family members. Governmental financial support decisions can have unintended consequences for low-wage workers. Recent staffing shortages in entry-level service businesses are having an effect on the caregiver business population as well.
These staffing shortages can result in substandard care for individuals due to the inability to staff caregivers at the level an adult may require. This may result in family members having to step in (resulting in time and financial impacts to them) to fill the gaps. Caregiver burnout is increasing both within the family members and professional caregiver groups. They are being called upon to do more at great personal costs to their own health.
How to Fix This
If only the problem could be fixed through legislation or by just doing more of this or that! Unfortunately, the situation we are in has developed over decades and are ingrained into our current society. Some of this comes naturally, as we don’t want to think about our mortality and do not want to think about a future of being old and dying. The solution to other problems may be addressed through a combination of actions.
While government won’t provide a panacea set of solutions, there can be value in investigating how state and local governments can assist individuals and groups. In Delaware, an aging-in-place working group has been formed “to identify and develop policy recommendations to improve Delaware’s home and community-based services infrastructure with the goal of allowing aging Delawareans to remain in their own home and community safely, independently and comfortably, regardless of age, income, or ability.” While not solving the entire set of issues that have been discussed, it brings hope that the lives of Delaware older adults can be improved as we continue into the 21st century.