Aging-in-Place and Assisted Living: Pros and Cons of Each

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One of the diverse topics concerning aging is whether older people would prefer to update or remodel their current home — often referred to as aging in place — or look into assisted living. Many surveys, including one from AARP, indicate that most aging Americans would rather stay in their own homes.

In the following email interview, Romilla Batra, M.D., chief medical officer at SCAN Health Plan, a not-for-profit, senior-focused organization that offers one of the largest Medicare Advantage plans in California, updates us about current thinking when it comes to the pros and cons of each type of planning. Dr. Batra is a board-certified internist with more than 15 years of experience as a medical director, clinician, and educator.

HealthCentral: Dr. Batra, what, in your experience, do you see as a preference for most seniors: aging in place or assisted living?

Dr. Romilla Batra: Seniors’ preferences towards aging in place vs. assisted living usually depend on socioeconomic factors. While assisted living can support an individual, it is not one-size-fits-all.

In general, people want to stay in their homes as they age. Aging in place costs less than moving to a retirement home and allows them to remain in comfortable, familiar surroundings. I would say that the top three reasons seniors want to age in place include:

  • They like to feel in control and remaining in their own homes allows them to feel safe and in control in their familiar environment.
  • They have developed an ecosystem in the community they live in and want to remain there.
  • They perceive nursing homes as sterile, rather than personal, due to the restrictions these facilities can often place on residents.

Alternately, some assisted living communities provide seniors with individual homes, which offer many of the comforts of aging in place, while also ensuring ease of access to different levels of support and care.

HC: What are the benefits to aging in place?

RB: The benefits to aging in place include:

  • It costs less to remain in your own home than to move to a retirement home.
  • There is an ecosystem of familiarity. For example, seniors may have a preferred pharmacist who helps them with their weekly or monthly prescriptions and value having that connection to their community and its services. There can also be family support to prevent feelings of social isolation.

HC: What are some negative consequences of aging in place?

RB: The negatives of aging in place include:

  • Not having a senior-friendly home: It was reported by Freddie Mac, the Home Loan Mortgage Corporation, that over half of all Americans age 55+ have at least one physical limitation, and the same holds true for three-quarters of seniors over 75. Seniors often need a wheelchair ramp, walk-in bathtub, or alternate modifications to the home that require making costly and material changes.
  • Social isolation: People without a family or social support system will feel isolated, which can have a negative impact on health. One example of this is with older couples. Should one pass away, the living spouse may not have the social infrastructure established to engage or remain engaged with others.
  • Lack of necessary care: When seniors live alone, there’s not an extra set of eyes on that individual to ensure their safety. Falls are very common and if there is an accident, it could go unnoticed and have severe long-term consequences.

HC: What are the benefits of assisted living?

RB: The benefits of assisted living include:

  • Special support: Residents have the luxury to get as little or as much help as they need.
  • Less could be more: Moving to assisted living means that seniors can downsize from a big home to something small and manageable.
  • Peace of mind: In assisted living, there is always an extra set of eyes watching out for residents and ensuring they are safe.
  • Access to services: Assisted living facilities provide access to services such as house-cleaning, laundry, meals and transportation—eliminating work that was once second nature but has become more difficult.
  • Access to necessary care: Assisted living facilities design their buildings with seniors in mind and, with many, there is access to medical care and nutritional support which means these needs are met, even for those who cannot adequately care for themselves.
  • Psychosocial wraparound for the patient: Social isolation can have an overwhelming impact on health, well-being and mortality. Assisted living builds in social connectivity, as there is a community of similar individuals within close proximity. Forbes recently published an article on how “Loneliness might be a bigger health risk than smoking or obesity,” which notes that loneliness and social isolation have extreme comorbidity with a whole host of other issues. To the point of this article, loneliness causes many detrimental effects, and many seniors do face loneliness when aging-in-place.

HC: What are the negatives of assisted living?

RB: The negatives of assisted living include:

  • Cost: Many seniors have difficulty in affording the cost for assisted living, which can run between $4,000 and $9,000 a month.
  • Giving up control: When seniors move into assisted living, they must follow the rules of the facility.
  • Leaving the community you have been a part of, are familiar with, and with which you have a history and memories.

HC: Do you have a specific recommendation when it comes to aging in place vs. assisted living?

RB: Overall, the recommendation for choosing assisted living is case by case. It can be a great alternative for certain individuals, as it is unsafe for seniors to age in place if they have chronic conditions and cannot care for themselves — especially if they are living alone. For these individuals, it may make sense to move to assisted living to create a better health outcome and live a longer life.

HC: Is technology helping seniors as they age, especially when they choose to age in place?

RB: There have been many conversations recently surrounding telehealth (a collection of means or methods for enhancing health care, public health and health education delivery using telecommunications technologies). For instance, recently Apple CEO Tim Cook, IBM CEO Ginni Rometty and Japan Post CEO Taizo Nishimuro announced an initiative that will provide seniors with custom applications intended to remind them to take medication, stick to diet and exercise regimes, and offer access to social service agencies. In this case, this population is experiencing the benefits of technology to ensure they stay healthy. While technology is not the end-all solution, it definitely can be part of the solution to help them age independently.

HC: Thank you for your time and expertise, Dr. Batra. It’s helpful to have input from the medical community when people consider choices that they will likely need to make as they age. We appreciate your help.

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