As the novel coronavirus sweeps through nursing homes from Seattle to Texas to northern Italy, leaving behind a trail of death, we are painfully reminded that where we live and with whom we live matter, especially in our golden years.
According to the World Health Organization and AARP, an age-friendly world enables people of all ages to age successfully in place. Too bad for older Americans, since many communities in the United States — whether rural, urban ethnic barrios or suburbs — are ill-equipped to deal with aging populations and are underserved. Few community-based programs with limited funding, no matter how well thought out, are simply not sufficient in light of the leading edge of baby boomers, those born between 1946 and 1964, half of whom lack the financial resources to grow old.
We know that most older adults prefer to continue living in their communities and their homes for as long as they can. A home is more than an asset. It is a shelter for our bodies and our memories. Our attachment to a community where we have lived most of our lives is a powerful one. Staying in the family home for most is preferable to moving in with the children or certainly living in a nursing home.
However, except for those at the very top of the income and wealth pyramid, most older Americans face some level of uncertainty about whether we will be able to afford growing old comfortably — and sustaining a single-person household in old age does not come cheap. Many older people, then, do not have the luxury of choosing their living arrangements. Their options are constrained by their limited economic and social resources, as well as poor health.
As a result of these differences, the living arrangements and levels of independence of elderly people vary greatly by gender and ethnicity, with some populations such as Mexican-American women particularly vulnerable. These disparities are only going to increase as the proportion of racial/ethnic minority older adults doubles by midcentury, from 23% of the population ages 65 and older today to 42% in 2050.
A study we did recently challenges to some extent the notion of how truly committed the United States is in promoting and supporting aging-in-place policies. We compared income and wealth profiles of the population aged 60 and older who are living alone in the United States and 19 European countries. Our data revealed that living alone is far more common in places with old-age welfare systems such as Germany, Sweden and Denmark, partly because of generous social support and spending that allows even lower-income persons to continue living independently in their communities.
What we need here in the United States is a broad social commitment to provide sufficient resources for all members of our society to live and age with dignity. What it takes to deploy those resources smartly is the close coordinating efforts of various agencies and departments that provide long-term services, housing, welfare and other supports critical for independent living of older adults, especially those of limited and moderate means.
For example, state and municipal government departments can coordinate efforts to expand viable options for affordable housing, particularly for low-income seniors and those on modest and fixed incomes. To promote home equity, programs such as the Senior Circuit Breaker tax credit in Massachusetts, Senior Citizen Property Tax Abatement Program, and property-tax deferrals can assist lower-income seniors remain in their homes by providing tax relief.
Beyond senior tax exemptions, there are programs that aim to integrate the health aspect of aging-in-place. For example, the Support and Services at Home program in Vermont focuses on facilitating and coordinating access to various existing health and support services to facilitate continued independent living of older adults. It has shown promising results in keeping seniors at home and slowing the growth of their health-care costs relative to program nonparticipants.
These and other similar approaches should be scaled up to become available to all older Americans. Short of such efforts, aging-in-place may not be a viable option for many Americans, especially those of moderate means. And as the ongoing pandemic teaches us, such a shortsighted approach can have grave consequences.