Pandemic Changes the Game for Aging in Place

Older people, especially those at highest risk for infection by COVID-19, have pretty much stayed in their homes if they could for the past nine months. The friendly phrase for this is sheltering in place. The reality for many, however, is that our homes can also become prisons.This is especially true for people living on fixed and tight budgets and those who are frail and usually suffer from multiple chronic health problems. This describes tens of millions of older citizens, 90 percent of whom depend on Social Security for nearly all their income. With monthly benefits averaging $1,400 – less than $17,000 a year – the idea of remodeling bedrooms, bathrooms, and kitchens to enjoy that extra time at home is a pipe dream.

Living alone has always been challenging for older people. Isolation and depression are not uncommon. Maintaining a home can be hard when even getting up on a ladder to change a light bulb can be hazardous. Going to the grocery and out to even routine appointments at the doctor or beauty salon can become major issues for those who no longer can drive and don’t live near accessible public transportation.

The pandemic has raised the stakes for all of these activities, turning the idea of aging in place from an appealing idea, and attractive marketing phrase, into a mandatory way of living that can eliminate the choices and mobility that permitted older people to enjoy the social and cultural activities in their communities.

One solution, and it’s hardly a panacea, is to use technology to create virtual support groups and social spaces for people who are spending nearly all their time in the walls of their home. This is happening all over but it’s less likely an option for people without the economic means to afford expanded Internet services and subscriptions to online entertainment and information services.

Aging in place began becoming “a thing” nearly 20 years ago. Older people had always aged in place, of course, usually staying in their homes as long as possible and then initiating a common cycle of downsizing, moving in with family, and making what usually was their last stop in a nursing home.

Today, nursing homes may be the last place an aging person wants to be. Even well-run homes can become coronavirus hot spots. And we’ve learned that many homes are not particularly well-run.

One clear message from the pandemic is that the incoming Biden administration needs to provide more oversight and funding of nursing homes. Most government spending on nursing homes comes via Medicaid, so the solution must involve a lot more funding for state Medicaid programs.

Another message that is perhaps not so generally clear but nonetheless essential is that there must be a stronger government role to make aging in a place a more successful strategy, not only for residents but also for the landlords who own most of the housing that lower-income seniors occupy. I prefer the carrot to the stick here and would offer attractive tax incentives for property owners who upgrade apartments and homes with aging-in-place safety and living improvements that meet government quality thresholds.

Another boost to aging in place can come from a relatively new set of Medicare insurance benefits that cover non-medical services strongly associated with improved health and well-being.

These are identified under the label of social determinants of health (SDOH). They include things like grab bars in bathrooms, removal of steps and raised doorway thresholds, wider corridors that accommodate wheelchairs and walkers, elevated electrical outlets, and the like. They also include transportation to doctors appointments and grocery stores, and home-delivered meals for those recovering from major surgeries and illnesses.

Medicare Advantage plans offered by private insurers began covering these items a couple of years ago, but the uptake has been slow. I would provide Pandemic-related inducements for broader SDOH insurance benefits. They also should be extended to the nearly two-thirds of Medicare enrollees who use original Medicare and do not have Medicare Advantage plans.