Over the next 40 years, the population of Americans over age 65 is expected to double from 40 to 80 million, and the population over age 85 is expected to more than triple from 6 to 20 million. Complicating these demographic trends is the desire of most elderly Americans to â€œage in place,â€ or stay in their own homes and communities as they age. On January 9, 2013, HUDâ€™s Office of Policy Development and Research convened a panel of experts to discuss these looming demographic changes, their implications for American society, and models that enable elderly Americans to access the services necessary to successfully age in place.
An important context for the discussion was provided by panelist and former HUD Secretary Henry Cisneros, who, like many Americans, approaches the subject through the lens of his own experiences with his parents. â€œMy mother is 89 years old and lives in the home she and my dad bought 2 years before I was born,â€ said Cisneros. After some time spent in a nursing facility, his motherâ€™s return home was accompanied by an â€œalmost a palpable expression of peace and joy as she walked through the house.â€ For most Americans, the prospect of aging in place is not an esoteric policy discussion; instead, it strikes an intensely personal chord, touching on life, death, and the importance of family. Given the visceral connection most of us have to our homes and communities, institutions at the local, state, and the federal levels must tackle the challenges of our nationâ€™s aging population and develop solutions that permit people to comfortably age in place.
Obstacles to Aging in Place
Although most Americans want to age in place, the reality, according to U.S. Department of Health and Human Services senior policy analyst James Toews, is that too many individuals enter long-term care institutions unnecessarily or prematurely. Homes and communities frequently are not designed to address the needs of seniors. Many seniors need assistance performing activities of daily living and live in environments that do not accommodate their functional limitations.
Following a catastrophic health event, 25 percent of elderly Americans who temporarily enter a nursing home will find it too difficult to leave. Toews identifies caregiver burnout as one of the primary barriers to aging at home â€” in the United States, family members provide about 85 percent of all caregiving. These family members may be unable or ill-equipped to provide the complex medical procedures their elderly relatives need, and the medical community offers them little support. In fact, this lack of support is a more significant factor in caregiver burnout than the complexity of the procedures.
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