I have been a physician for 44 years. Besides my office and hospital practice, I also make house calls for less mobile older adults. We all want to stay in the homes where we raised our children, cared for our gardens and became part of the community. The reality is that we lack the tools and financial resources needed for seniors to “age in place.”
My house calls, though, have provided insights into potential solutions to help seniors in the future.
Currently, as older generations age, many will likely end up in nursing homes because in-home caregiving remains expensive. The estimated monthly out-of-pocket cost for a 24-hour in-home caregiver is around $20,000. Insurance like Medicare, Medicaid, or long-term care usually doesn’t cover these costs.
While some can afford this, most will find the monthly cost prohibitive. Some may have savings, but many will need to rely on their home equity to cover these unavoidable expenses. On the other hand, if you are a renter, it might be easier to qualify for Medicaid (Medi-Cal in California), which helps pay for most nursing home costs.
Either way, there is concern that funds will be depleted or Medicaid nursing home care will face budget cuts. Additionally, unforeseen obstacles could threaten your ability to stay in your home or access the equity in your property investment.
For instance, there has been an increase in natural disasters destroying homes, such as firestorms, floods, and tornadoes. The ongoing struggle with insurance companies continues, as they often “deny” payments to recover the true value of your house.
Other factors that could affect financial resources include rising health care costs, like a new cancer medication that even now costs $30,000 a month. Also, if you’re a senior involved in a car accident, you might face blame and lawsuits. All those lawyer commercials on TV can target your home and put a lien on it. Furthermore, older adults encounter more scams than anyone else in society. Who knows what other challenges you might face in the future?
The median monthly out-of-pocket cost for a nursing home in the United States is about $9,000. If you are on Medicaid, the nursing home receives a lower payment to cover its costs, which could put you at risk of eviction, especially if the facility is for-profit.
Many nursing homes rely on Medicaid, and recent legislative cuts could result in closures. Seniors are the fastest-growing homeless group. If evicted, where will these residents live besides becoming homeless?
Providing house calls to senior patients has given me insight into how “age-friendly homes” are not yet part of the structural vernacular used to support those who want to stay in their homes.
As we age, living in a multi-story house can become more challenging than in a single-story home. Wider hallways and doors make it easier for people using a wheelchair or walker to get around. Designing homes to be flexible with outdoor ramps helps residents go out for doctor visits, shopping and other daily activities.
Installing motion-activated lighting throughout the house can help prevent falls. Grab bars should be installed in all bathrooms, and roll-in showers can provide safer access. Using floor mats similar to gym mats may reduce the risk of injury if a fall occurs.
Having eye-level shelving for stoves and microwaves increases self-sufficiency, especially for people who use a wheelchair.
Using cameras in strategic locations with “intercom” capability can reassure family members outside the home (whether across the street or across the country). Additionally, having easy-to-use computers for communication with doctors, health care professionals and family members is essential.
Currently, we use Hoyer lifts, which are bulky for transferring patients from beds to wheelchairs. This process should be made more efficient with computerized, on-demand devices that can lift patients back and forth, even into a car.
If not these lifts, a readily attachable exoskeleton on the body could also be used to move them around.
If a person is bedridden, we can offer tools to help them bathe, change clothes or a diaper, wash their hair, and even comb it.
What we aren’t doing in our country to help older adults to “age in place” is using advanced technology like robots to support seniors’ mobility and activities of daily living, keeping them out of nursing homes.
We therefore need to design and build “age-friendly homes.”
Some doubters reading this might say it would be too costly, but the most advanced computerized device currently in use is the autonomous car, which can drive older adults to their destinations without a driver. They are becoming more affordable, and so will all of these innovations in the future.
Our country could lead as an innovator by bringing the “aging in place” technology into homes.
I have never had a patient say, “Please, Dr. Dorio, put me in a nursing home.”
Vice President Hubert H. Humphrey once stated, “the way we treat our elderly in the twilight of their lives is a measure of the quality of a nation.”
Aging in place should be the top priority, while admission to a nursing home ought to be a last resort.
Dr. Gene Dorio
Saugus
