The continued decline
of the nursing home – once the mainstay care for the frail elderly – and an
upsurge in popularity of assisted living will lead to many dramatic changes
in long-term care, according to a University of Florida expert and editor of
a new book on the subject.
"The American public
has expressed a strong distaste for going to a nursing home because it smacks
of a hospital-like, institutional way of living and receiving care," said
Stephen Golant, a UF geography professor and expert on elderly housing.
"Assisted living has
emerged as a highly attractive option for older persons who have experienced
some physical or cognitive decline and feel less secure about receiving care
in their own home." Yet there are few certainties about either the future
of assisted living for the elderly or the huge number of baby boomers who stand
to be its recipients, Golant said. "Although baby boomers will constitute
a large market, it is unclear what share will have impairments and chronic health
problems that make them candidates for assisted living," he said.
"The emergence of an
unexpected new medical or rehabilitation breakthrough, such as a cure or the
discovery of a disease-controlling drug for Alzheimer’s disease – could result
in a substantial decline in the number of elderly Americans who need such care."
Golant and Joan Hyde, an assisted living provider and a senior fellow at the
Gerontology Institute at the University of Massachusetts in Boston, are editors
of the new book "The Assisted Living Residence: A Vision for the Future,"
published this month by The Johns Hopkins University, which examines elderly
housing and possible care trends over the next 20 to 30 years.
The biggest competitors
to assisted living are daughters and daughters-in-law who provide most elderly
caregiving and determine whether their loved ones can remain in their own homes,
Golant said. But the availability and attitudes of the current generation of
female offspring who must juggle work and family responsibilities are unclear,
he said.
"We know that women
have succeeded in being comfortable in going back to work even when they have
a baby less than a year old and assigning that care to somebody else,"
he said. "Now the question is how will they react when they confront the
possibility of leaving their older parents?"
New technology may make
that transition easier, Golant said. The development of sophisticated monitoring
and surveillance devices that would allow grown children to track their parents’
daily movements on a computer screen from home or work, for example, would revolutionize
attitudes about nursing home and assisted living facilities, he said. "Suddenly
some of the downsides of not living at home would be minimized because sons
and daughters could feel very much involved with the caregiving experience of
their mothers and fathers even without physically being there," he said.
"They could see parents in their rooms, walk with them to the dining hall
and even communicate with them in real time."
Businesses and social service
agencies are preparing for the surge of aging baby boomers, an estimated seven
out of 10 of whom are expected to require long-term care at some point after
they reach the age of 65, Golant said. Many will also face the issue of a parent
needing long-term care before reaching that stage themselves, he said.
Nursing homes are increasingly
gearing their business toward acute episodes, such as strokes, which call for
short rehabilitative recovery periods, Golant said. When they offer longterm
care, nursing homes increasingly serve poorer people and are funded through
the Medicaid program, while assisted living caters to private paying individuals
with higher incomes or salable assets such as an expensive home or stock portfolio.
To be competitive, nursing homes are trying to transform themselves into becoming
more home-like and less like an institution; in short, more like assisted living
facilities, he said.
Low savings rates and falling
home equity raise the question of whether fewer baby boomers will be able to
afford assisted living compared with their parents’ generation, Golant said.
The average one-year base price is close to $36,000, not including the additional
supervision required with Alzheimer’s disease and more serious medical conditions,
he said. "Assisted living is here to stay – and is now very much part of
the ordinary consumer’s lexicon," he said. "But its rate of growth
and the number and share of older boomers who will choose this long-term care
option in the future is very uncertain."
Frank Caro, senior fellow
in the Gerontology Institute at the University of Massachusetts in Boston and
editor of the Journal of Aging and Social Policy, praised the book as "essential
reading for everyone with a stake in the future of assisted living in the United
States."
Writer: Cathy Keen, University
of Florida News Desk, ckeen@ufl.edu
Source: Stephen Golant, 352-392-0494, golant@geog.ufl.edu
