Of all the horrors of the COVID-19 pandemic, among the most heartbreaking is the number of outbreaks in senior communities that house the population most likely to perish. The New York Times reports that as of April 14, more than 2,500 of 15,000 continuing care retirement communities across the country have experienced COVID-19 breakouts, and more than 3,800 residents have died. The cruel irony within the spectrum of services in senior communities is that those who require the most high-touch assistance in nursing care cannot effectively socially distance … and are therefore most likely to sit in a hot zone. Seniors with financial means who move into these facilities often do so primarily because of concerns about the safety of living independently at home. Risk assessment is included in the basket of former truths that the Coronavirus has rendered false. Perhaps it’s time to rethink the risk calculus of warehousing our elderly into facilities as they age.
The model for aging in the United States has been crying for disruption for a long time. It’s not that the care in senior communities is inhumane or the food is terrible, although both are possible. Rather, people are reluctant to lose autonomy and privacy regardless of their age or their health. There’s a good reason why seniors in these facilities refer to themselves as “inmates” and often go into them kicking and screaming. Furthermore and perhaps most importantly, these facilities are staggeringly expensive, even for the well-heeled. In fact, senior facilities are beyond the financial reach of many millions of middle-income seniors.
Despite their vaunted entrepreneurship, baby boomers have done little to change the model for aging in the United States. Instead, they have created gussied-up facilities that advertise gourmet meals, luxurious accommodations, and lush, country club-like settings. These places have ads picturing white-haired, ascot-wearing (okay, I jest) models, sipping Cabernet, enjoying the company of their glamorous friends. Beneath the glossy veneer of these fancy retirement communities, just like the Chiclets veneers on these model’s teeth, they have the same regimented dining hours, and the same populations that continue to get older and sicker as their more reasonably priced but still pricey, old-school cousins.
It should be noted that since the Pilgrims landed in 1620, seniors have been aging in their homes without official community programs, often with help from family and neighbors. The more recent government programs of the 20th century like the Social Security Act (1935) and the Older Americans Act (1965) have further enabled the elderly to age in place.
It’s a part of some other cultures that children take in their parents in their old age. American children want to house their elderly parents as much as the parents want to live with their adult children. Although housing one’s aged parents is probably the best solution, a cultural turnaround in this country is unrealistic. As the death toll at senior facilities continues to ratchet up, the “Aging in Place” (AiP) approach becomes more appealing. The AiP concept originated in Boston’s Beacon Hill neighborhood in 2001 by a group of residents who wanted to remain in their homes as they aged. They formed a nonprofit called Beacon Hill Village and a movement was borne. The AiP movement has since spread to numerous communities across the country. Currently, AiP is a patchwork of grassroots services and programs loosely held together by civic-minded volunteers. The basic model for AiP is that younger volunteers act as facilitators until they eventually become consumers in their old age, and a new crop of volunteers comes onboard. This pandemic renders those who have long espoused AiP, the prescient ones.
There are 77 million baby boomers in the United States and every day,10,000 of them turn 65. The emergence of this pandemic, the aging boomer population, and advances in technology provide fertile ground for a second generation AiP movement.
To achieve wide acceptance and participation, these are some of the contours that AiP 2.0 might present:
- Funding – An AiP 2.0 movement could influence changes at the Federal level. The dire warnings about reduced Social Security benefits could be replaced with a bolstered program that supports the socio-economic and geographic diversity demanded by AiP 2.0. Note that an extension to social security, the PACE programs, already exists to enable the most frail of the elderly to remain at home.
- Smart Utilization of Emerging and Current Technology – Current and emerging technology now supports AiP 2.0, especially with the 5G network. From AI-based voice assistants to food delivery services to ride sharing to autonomous vehicles, the technology is present, or nearly so. This plethora of technology should be woven into a cohesive AiP 2.0 fabric instead of existing separately as a mish-mash of cool single point solutions.
- Emerging Ecosystem of Complimentary Businesses and Services – The demand for AiP 2.0 may spawn new businesses and services that couldn’t have existed before. For example, medical practices may move away from the on-premise-only model to a hybrid of telemedicine, home visits, and on-premise visits. Brew Pubs could partner with ride-sharing services to promote 2:00-5:00 Senior Happy Hours. Undoubtedly, home health care will experience significant growth and change. The possibilities are vast. Those who live in populous areas will be better able to utilize AiP 2.0 than those in isolated locations.
- Volunteerism 2.0 – Although AiP 2.0 may have additional government funding, volunteers are still essential. One of the positive dividends from Coronavirus may be a newfound sense of civic responsibility among the nation’s youth. For example, during the pandemic in March, a couple of selfless Montgomery Blair High School (Silver Spring, MD) sophomores recognized the difficulty seniors faced getting groceries. They started up Teens Helping Seniors, to shop for groceries and medicine and provide contactless delivery to seniors in their area.
- Humanity over Technology – Technology is a means, not an end – AiP 2.0 will use technology to facilitate participation in one’s community. AiP 2.0 will seamlessly utilize the latest technologies, but the focus is on harnessing this technology to further human interaction.
AiP 2.0, like its predecessors, will focus on engagement in community while retaining independence. This pandemic has afforded all of us the experience of video calls like Zoom. Anyone who watched the recent SNL At Home, where quarantined cast members put together a show from their homes, probably left with three takeaways: 1) Gotta love these people for trying their best to entertain the rest of us, 2) Tom Hanks and Rita Wilson have an awesome kitchen, and 3) When the cast can’t be together and physically play off one another, the show is missing its essential ingredient. Similarly, now we know that there’s a time and place for a Zoom call, but it cannot replace the in-person experience.
Even in this wretched time of profligate death and sadness, there are also points of brightness. In a thoughtful sermon, the rabbi and spiritual leader of Temple Emek Shalom (Ashland, OR), Joshua Boettiger, likens the Jewish Sabbath, a period of stillness, silence, balance – to the mandated Coronavirus slowdown we’re all experiencing now. This is a time when communities are coalescing, helping one another, and showing vulnerable elders special concern. One positive that may emerge from this pandemic is the realization that seniors add to the fabric of the community and shouldn’t be ferried away as they age.