Aging in Place - The Preferred Method of Aging

Harvard University, Joint Center for Housing Studies

A long-standing assumption has existed that as an individual grew frailer, he or she required a continuum of senior living facilities, physically moving from one residence to another, as health or housing service needs changed. Increasingly over the last ten years there has been growing acceptance of the idea that older persons do not necessarily need to relocate as their needs change, but can modify their environment by adding supportive services and reconfiguring their residence. This “revised view of the housing continuum therefore stresses the elasticity of conventional housing in terms of its ability to accommodate a wider spectrum of older persons.” It can be achieved by “creating a wider variety of options for frail older persons that facilitate aging in place in physically supportive residential settings linked with service,"1  Aging in place requires the coordination of health and assistance services to deliver a customized level of care in an individual’s current environment.  

In the last decade aging in place has not only become the most desirable way of aging but also in most cases it is the more cost-efficient way of aging. The AARP reported in May 2000 that “the desire to remain in their current residence for as long as possible becomes more prevalent as age increases. Seventy-five percent of those age 45 to 54, and 83 percent of those age 55 to 64 strongly or somewhat agree that they wish to remain in their homes as long as possible, while 92 percent of those age 65 to 74 and nearly all of those age 75 and over (95 percent) want to do so.”2 

Aging in place has become a part of the public rhetoric in the last ten years. Seniors and their children are starting to envision, and demand, a range of options beyond the nursing home. Policy makers generally agree that keeping elderly individuals out of nursing homes is the primary objective of aging policy.3 

Successful aging-in-place programs minimize the provision of inappropriate care, and therefore the costs, by offering a range of flexible services and calibrating those services to fit the needs of the individual. Rather than a rigid service-delivery system, aging-in-place strategies create both health-care and assistance options that provide support at the margin of need as defined by an individual’s personal desire and efforts to live independently. Aging in place works best as part of a comprehensive and holistic approach to the support needs of an aging individual and an aging community. 

Consequences of Aging in Place

Maintain social network. Aging in place promotes self-sufficiency, encourages interdependence between friends and neighbors in the community, and offsets social isolation. Rather than relocating individuals to a facility, allowing them to age in place keeps valuable social networks. Relocating can entail the loss of friendships, regular shopping and entertainment areas and familiar support personnel, resulting in a significant loss in the quality of life, personal control and dignity. Aging in place allows all of these powerful networks to remain intact, providing both quantitative and qualitative benefits.

 A recent study completed by the Department of Health and Social Behavior at Harvard University concluded that “compared with persons who had 5 or 6 social ties, those who had no social ties were at increased risk for incident cognitive decline after adjusting for a variety of socio-economic and physical factors.”4 

Limit the negative effects of relocation and dramatic transitions. The very act of moving an individual can be expensive. Searching for the appropriate facility can be time consuming and can often result in the expense of overcare. Any move can be traumatic, but a move resulting in the loss of functional independence is particularly difficult to recover from and can result in confusion and diminished self-help capacity. When an individual is allowed to age in his or her community with social support networks intact, costs are minimized and care is delivered in response not to a rigid service-delivery model, but to actual need. Communities save needed resources by reducing the amount of unnecessary service to individuals who could and would prefer to be more independent.

 1 Pynoos, John. “Current Problems and Future Directions.” Coming of Age, Federal Agencies and the Longevity Revolution, 1999.2 AARP.

Fixing to Stay: A National Survey of Housing and Home Modification Issues. May 2000.3 Author interview with Bobbie Sackman and Jennifer Fish, Council of Senior Services, New York, New York, July 16, 2001.

4 Bassuk, Shari. “Social Disengagement and Incident Cognitive Decline in Community-Dwelling Elderly Persons.” Annals of Internal Medicine, Vol. 131, No. 3, 1999

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