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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."
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