Pynoos Discusses Senior Housing

Jon Pynoos, a professor of gerontology policy and planning at University of Southern California, talks to Michele Norris about the state of senior housing.

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MICHELE NORRIS, Host:

And for more on the options for America's aging population, we turn to Jon Pynoos. He's a professor of gerontology policy and planning at USC. He says the average cost of an assisted-living facility ranges from $3,000 to $6,000 a month. And for many people, it may be better to try to stay in their own homes.

JON PYNOOS: Most homes are what I call Peter Pan housing. They're designed for people who are never going to age nor grow old. They do have stairs. They often have inaccessible bathrooms. Some of them have inadequate lighting. They don't necessarily have safety features that will help people avoid falls. And some of them present actual hazards to people. So what we recommend for baby boomers, in fact all people, is they assess their own homes and make modifications as they need them.

NORRIS: So there's the physical structure, but there's also the question of additional support, if people need someone to come in and help them bathe, help them cook, give them physical therapy. Will there be enough of that?

PYNOOS: Well, that depends on what people can afford and what the government provides. It gets very costly if you need around-the-clock care, for example. If you only need someone coming in a few hours a day to help you bathe or help prepare a meal, that's more economical. But in reality, a lot of the care is provided by family. And you have to see it as a system what people can do for themselves, what kind of needs they have and where it can be provided from.

NORRIS: As we just heard from Julie Rovner, there seems to be some confusion as to what Medicare will or will not pay for. Could you help us understand the role that Medicare potentially pays in some of this coverage?

PYNOOS: So Medicare primarily pays for health care. It doesn't pay except under some circumstances for homecare. So ongoing care for people who have chronic problems generally is not paid for by Medicare. If you are poor, Medicaid can provide those kind of services. But Medicaid is still biased towards care in nursing homes. And to get Medicaid to pay for it, a state has to create a waiver, and it has to be approved by the federal government - that's the easiest way - basically saying they can provide services that might have been provided in nursing homes for people who are living in their own places. And then, there's the added complication of can that be provided in assisted living. And in some cases, it can. States vary considerably in terms of how they use the Medicaid funds that are available to them.

NORRIS: For people who enter this world either because they're getting older or because they're helping a family member who is aging, you hear this term called spending down, that someone has to move through their assets before they might be eligible for any kind of assistance from the state or the federal government. What does that mean?

PYNOOS: That means that you can't have too much money in the bank, but you can keep your house. So the house is not counted as an asset. But basically, you have to spend down your own money before you're eligible for a program such as Medicaid. So they force you to use your resources first. And when you get down to a low level, then you're eligible for the program. And that's a way, I think, the government tries to protect itself from paying for services that otherwise people could afford. But it puts older people into a very serious predicament because they might need funds for a lot of different things. And to have to spend down leaves them fewer resources for other kinds of needs they might have.

NORRIS: Jon Pynoos is a professor of gerontology policy and planning at the University of Southern California. Mr. Pynoos, thanks so much for being with us.

PYNOOS: My pleasure.

NORRIS: And you can find our complete series on life and retirement this week at npr.org.

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