Helping Seniors Grow Old At Home, Safely
NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan, in Washington.
It's called the silver tsunami, a slow-motion demographic tidal wave that starts to crash ashore next year when the first of the baby boomers turn 65.
As you probably know, Americans live longer than we used to. As you may not know, the vast majority do that at home, or in their kids' home. Only five percent of American seniors actually live in nursing homes or assisted-living facilities.
And as the baby boomers redefined youth culture in their day, they promise to redefine aging at home. You may have heard Jennifer Ludden's series on technology innovation and adaptation last week. She joins us in a moment.
We also want to hear your plans about how your family and your community are adapting to the graying of America. Our phone number: 800-989-8255. Email us: firstname.lastname@example.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.
NPR correspondent Jennifer Ludden joins us here in Studio 3A. Nice to have you back on the program.
JENNIFER LUDDEN: Hi there, Neal.
CONAN: And I think many people are surprised at the statistics on the percentage of seniors in nursing homes and in assisted living.
LUDDEN: I was. You know, I had a misperception. My editor had a misperception. We trekked back on those numbers over and again, and just didn't realize that people have always kind of wanted to stay in their homes. That's not new. It's not that's a new trend. But when you have so many more people - some 78 million is the estimate for baby boomers -about to enter seniordom and deciding to stay in their homes, what we found looking around is there's a lot happening to make it easier for them to stay in their homes.
And as you said, as we get - live longer, we're healthier, but still, you know, 90 is 90. And, you know, your - the home you've stayed in, I've got really steep, colonial stairs in mine, and it's not easy to get around sometimes.
CONAN: And adapting your home would be awfully difficult. One of the most interesting innovations that you reported on last week was something called The Village, and this is a group of people who get together to hire some people to help. It's a village. They don't necessarily live on the same street. In Capitol Hill, the area you defined, some would live on Second Street, some on Sixth Street. It's, though, a common effort to provide common facilities and common services.
LUDDEN: Right, and that's one of the - a theme throughout this. In high-tech and low-tech ways, it's really grassroots. You see communities starting this from the ground up, saying: How can we make this easier for each other?
And a village is kind of recreating that old-fashioned neighborhood or family network that we used to have. You know, when I heard - first heard about this, I thought, oh. This is a group of people getting together to do what my husband does for my in-laws, who happen to live in the same town. But if yours don't, you can have this network of some volunteers and then a few paid professionals to call upon to do just about anything you might need, from changing the light bulb to putting a rail on your stairs or getting you to the doctor's.
CONAN: Or to the airport, or indeed, I found one of the more interesting things, a little IT help.
LUDDEN: IT help, it's huge. You know, my husband does a lot of that with my mother-in-law. The new computer program this, and then the TV, and, you know, you've got TiVo, and then you've got Comcast doing their own cable recording. And, you know, the people who want to keep up have to kind of program all kinds of things now.
And even someone pointed out the, you know, thermostats these days, they're digital. I mean, I have trouble figuring mine out. And you have to, you know, program just to make sure the air conditioning comes on when you need it. And little things like that can be a big help.
CONAN: And this is not necessarily cheap, but it's not vastly expensive, either.
LUDDEN: A lot of these villages are cropping up in better-off neighborhoods. The supporters kind of acknowledge that. You've got, in Capitol Hill, for example, here in D.C., the average yearly fee is five to $800, depending single or a couple.
But there's a big effort to get private grants, public monies. Once you incorporate as a nonprofit, you can get donations. And they do subsidize, big subsidies for people who can't afford it, because they do want to be more inclusive.
CONAN: Technology, you mentioned, that's a fairly low-tech solution. But technology plays a big part, and it's controversial in places. You know, we're talking granny-cam here.
(Soundbite of laughter)
LUDDEN: This is huge. And again, this - what we found is, you know, some of this - there's a lot of research going on in big-name universities, people looking ahead and seeing, coming up with new technologies.
There's also just IT folks who have this happening to themselves, and they say, well, I can get this, you know, sensor monitor here, motion monitor. And I can connect it to the computer, and I can figure out how to keep track of my grandma. And then they're taking this and building businesses around it.
The one company that I talked to that actually has video cameras in the home, that's a new and growing field for them. They have been doing this in the disabled community. There's a lot of crossover.
And so now they're moving into the older community to say, you know, it might work for some people if their children or a professional can keep an eye on them through video monitoring.
CONAN: Video monitoring and motion sensors so you know - well, you know your parents' - if they're your parents - daily habits: what time they get up, what time they go to, you know, sit down in the chair to read the morning paper.
LUDDEN: Right. There's a lot of - most of what's going on is using motion sensors, and people - a lot of people don't want the cameras. But you can use them to figure out when your mom gets up. Her feet hit the floor. She goes into the bathroom. She goes - opens the refrigerator door.
You can plug in a coffeepot to a sensor and know that she made the pot of coffee at 7 a.m., like she does every day. Or oops, she didn't. Maybe you want to call her up: How are you doing? How are you feeling?
CONAN: Let's bring another voice into the conversation: Elinor Ginzler. She is AARP's senior vice president for livable communities, a job that includes housing, transportation, walkability, as well as developing social services to serve seniors. And it's very nice to have you here with us in Studio 3A.
Ms. ELINOR GINZLER (Senior Vice President for Livable Communities, AARP): Great to be here. Thank you.
CONAN: And are most people accepting of the idea that they're old and need services?
Ms. GINZLER: Well, I don't think any of us really love the notion that we're getting older. I think that'd be true asking anybody almost at any age. In fact, our research shows that no matter how old you say you are, or how old you are, you think old is about 10 years later.
(Soundbite of laughter)
Ms. GINZLER: So that's true for the 60-year-old. It's actually also true for the 85-year-old, who will tell you I'm not old. A 95-year-old is old.
CONAN: Ninety-five is old. And you and Jennifer are ageless.
(Soundbite of laughter)
Ms. GINZLER: Absolutely. And boomers are, too. So none of us are going to ever die if we have our way about it all. But I do think the issue of technology to provide continued independence is the frame that's going to make it work the best for families as they encourage older family members to embrace some of this technology.
CONAN: Yet some people are going to say, wait a minute. I don't want to be on camera. I'm not sure I want people peeping into my life, even if they're my kids.
Ms. GINZLER: And, you know, I think AARP would say very strongly there needs to be at all times an aura of respect and dignity behind all of these ideas.
In many ways, this will work if it is positioned as a way to stay independent. If it is positioned as a way to take over someone's life, I think it's actually a recipe for disaster.
CONAN: Let's see if we can get some callers in on the conversation, as well: 800-989-8255. Email us: email@example.com. We want to hear what's going on in your life, your community in terms of innovation for - well, there's going to be a whole bunch of older people in America, and we're all part of it.
We'll start with Kate, and Kate's with us from Menlo Park in California.
KATE (Caller): Hi. Pleased to be with you.
CONAN: Thanks for the call.
KATE: I'm calling because I'm part of a group who are starting a co-housing community in Mountain View, California, which is in Silicon Valley. Most of us are baby boomers, and our emphasis is on not only designing our units the way we want them to be, but on self-governance, so that we are going to decide for ourselves what we do in terms of green design, energy efficiency.
We've got land in a place that's so convenient to the downtown area that we're going to be able to do walking that way. And we are also talking about this idea of monitoring kinds of things, in terms of monitoring movement, things like that, for safety's sake.
CONAN: And I expect that the meetings you've having about this are short and decisive.
(Soundbite of laughter)
KATE: No, the meetings are long and laborious and grueling.
(Soundbite of laughter)
KATE: But I think we probably, in this kind of context, are not going to have to worry about that issue of privacy that was brought up because we know each other, and we're getting to know each other very well.
So it does go, I think, there is a family kind of feeling about it, even though we're each going to be in our own separate condominiums and have the right to, you know, fully handle our own living if we want to do it that way.
CONAN: Elinor Ginzler, does this sound familiar?
Ms. GINZLER: Absolutely. At AARP, we would call co-housing an intentional community. And as Kate is describing, these are people who have come together on purpose at the absolute beginning of their community.
CONAN: Some might call it a contentious community, too.
(Soundbite of laughter)
Ms. GINZLER: Yes, that's for sure. But it's that village model all rolled back in terms of it starts at the ground floor of how do we want to shape, physically, how our living arrangement is going to be.
CONAN: And Kate, would there be professionals on staff to provide services for you?
KATE: No. We'll decide - again, as a group, through our homeowner's association - whether we want to hire people for a particular reason. Individual households, though, if they need assistance with activities of daily living, will have to hire their own people.
We are going to make it possible for a caregiver potentially to stay on site, and particularly, the units are going to be big enough so that people could even have somebody living with them if they had to.
CONAN: And who's designing the units? Obviously, if you're designing for an older population, well, one floor, for example, might be beneficial.
KATE: Almost all the units are one floor, except for one couple who decided that they wanted to have two floors. The designer is an architect named Chuck Durrett, who has designed over 50 co-housing communities around the United States.
And we work with him very much, saying we like this. We don't want that. You better make more of this other thing.
CONAN: Elinor Ginzler, you smiled in recognition at that name.
Ms. GINZLER: Yes. Chuck is Mr. Co-housing for the United States, and literally brought this idea over from Europe, probably, almost two decades ago. And I think it's going to become more and more popular as that 78-million baby-boomer cohort comes into its own.
CONAN: Kate, I would only have one piece of advice for you: Don't be the recording secretary for the meetings.
(Soundbite of laughter)
KATE: I am definitely not doing the recording secretary, but if people are interested in seeing what this thing is about, they can go to mountainviewcohousing.org.
CONAN: And if you didn't scribble that down quickly enough, we'll put a link to it on our website, at npr.org. Just click on TALK OF THE NATION. That'll be up after the show.
Kate, thanks very much for the phone call. We appreciate it.
KATE: Thanks for speaking with me.
CONAN: We're talking about new innovations in terms of housing for people who want to grow old in their own homes. Jennifer Ludden is with us, also Elinor Ginzler from AARP.
Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.
(Soundbite of music)
CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington.
The number of seniors in the United States will more than double in the coming decades. As we've heard, the vast majority want to grow old in their own homes.
All last week, Jennifer Ludden reported on some of the new services and technology helping to make that possible. We've posted a link to that series at npr.org. Click on TALK OF THE NATION.
Today, we're talking with her about what she's learned. We also want to hear about your plans. How are your family and community adapting to the graying of America? 800-989-8255. Email firstname.lastname@example.org. Again, the conversation is on our website, too, npr.org. Click on TALK OF THE NATION.
Also with us, Elinor Ginzler, senior vice president for livable communities at AARP. And let's go next to Laurie(ph), Laurie with us from Cleveland.
LAURIE (Caller): Hi. I'm actually on the road right now to (unintelligible) to care for my mother, who is older. And a lot of the assumptions, what people have been talking about so far, are dealing with healthy people, which most of the people I know, we're young baby boomers, are dealing with unhealthy, older parents. And I wondered how, what the innovations they have for that.
CONAN: Jennifer, can you help us here?
LUDDEN: I'm going to throw it to Elinor, but I will say that, you know, it's true. It's true. A lot of these places that were the things we've been talking about do work only up to a point.
The people who like them say, look, if we can do this and keep mom or dad in their home or our home for a few more months, a few more years, this is good, it's worth it, it's good financially, it's good for our family, it's good for their well-being.
But it is true. There may come a point in time when it just doesn't work.
CONAN: Elinor Ginzler?
Ms. GINZLER: That's absolutely true. And actually, Laurie represents one of what AARP found to be 44 million people in the United States taking care of a family member who is 50 years of age and older. So Laurie, you are in very good company.
And in spite of the phenomenal technologies that are emerging on the scene, nothing's actually really going to ever completely take the place of those family caregivers.
Hopefully, more and more technologies will help as literally an assistant to that family caregiver.
CONAN: And Laurie, one thing, please drive carefully.
LAURIE: Oh, I will, thanks.
CONAN: Okay, thanks very much for the call. Here's an email from Pam(ph) in Woolstock, Iowa. I have a friend whose 92-year-old mother insists on staying on the farm. My friend is retired and drives 100 miles to spend three or four days a week, every week, with her mom.
Her mom has resisted getting a cell phone or some kind of alert gadget. Last week, she fell off her golf cart and lay outside for hours before someone found her. It's too bad she had to have an accident before she agreed to get some help from modern technology. Most of us are willing to do what we can to help aging parents, but the parents have to cooperate.
And it's not just that issue, Elinor, it's one of the most contentious issues: driving. At some point, the kids need to take away the car keys.
Ms. GINZLER: Yeah, though at AARP, we would say we never take away anything, but we absolutely engage in very important conversations with our older family members about the decision to maybe hang up those car keys.
And clearly, this is I know everyone has problems with this conversation. I don't think it's at all unrealistic to realize how hard a conversation that is because, quite frankly, we're a car-dominant country. And when you tell somebody that they're not going to have the capability of going where they want when they want, you are truly changing their lifestyle.
CONAN: And changing their identity.
Ms. GINZLER: Absolutely, without question. It is a symbol of who we are.
LUDDEN: And can I just say, this was, kind of leads to a big topic I did not get at in this series but kind of put in the back of my mind, which is whole communities looking at this and planning for aging.
And there are some cities that are saying, you know, as we do want older people off the roads, we need to provide public means of transportation for them. And our current public transportation system is woefully inadequate.
You know, you want bigger sidewalks, longer amount of time to get across the street if you have people walking more slowly. And communities are, a few are looking at that. But that's a very big issue.
CONAN: Let's go next to Rich(ph), and Rich is with us from Sioux City in Iowa.
RICH (Caller): Hi, good afternoon, everyone.
RICH: Great conversation. I wanted to interject into that that there have been quite a few actions on the federal level, when we talk about what the nation is doing. There had been some traction for requiring a percentage of homes in new subdivisions to be what's called visitable, which would include, you know, zero entry, no steps, wide doorways, adaptable bathrooms and kitchens, so perhaps there are no grab bars, but the bracing behind the walls would be there.
And we're seeing a lot within the Americans With Disabilities Act for that exact thing because we all understand that aging does include disabilities. And consequently, we're seeing what's being really termed a green movement, aging in place as an environmental factor, not moving people but designing for 10 years down the road or 20 years down the road.
CONAN: And Jennifer, this was one area you did explore.
LUDDEN: Absolutely, and there is a movement. And, you know, some of the developers say, you know, the homebuilders are like, well, we need a little more here.
There are dozens of communities around the country who are taking little steps, either as Elinor explained, you know, they give a carrot or a stick to encourage homebuilders to include, make a house visitable and have some of these basics, no-step entries and wide doorways and so forth.
But, you know, it's still, you've got right now, if a homeowner can do a special order for someone and make more money off it, you know, they might not want to change the system, whereas you have some homebuilders who say if you just plan for this from the beginning, you can find a way to build these kinds of homes for about the same price and get more out of it.
CONAN: And I was fascinated at the marketing of this idea. Obviously, if you're selling it for, hey, you won't fall down and won't be able to get up, you're not going to sell too many places. But if you say, that doorway, wide enough for strollers...
LUDDEN: I could've used that, yeah, absolutely.
RICH: Universal designing takes into account everyone. So, women with children, pregnant women. The other aspect of this, too, is that people are, you know, recognizing the importance of staying put and having family members be able to visit them in their home that they pick without having to relocate them later. So it's similar to the village effect.
CONAN: And Elinor Ginzler, let me ask you also about the part of this which, in terms of zoning requirements or housing standards requirements, that sort of thing.
Ms. GINZLER: Absolutely there's a lot of work to be done in the policy arena if we really want to pursue this. As Jennifer's made reference, there are a handful, quite frankly, of communities across the United States at the city level or the county level whove taken this on, whove passed policy that says all homes built, most extreme and wonderful, Pima County, Arizona.
CONAN: You're an extremist.
Ms. GINZLER: Yeah, all homes that are built, new homes, have to be visitable. In many cases, if it is a requirement, it's a requirement related to using public funds. If you're going to use some public money, you have to build to these standards.
And in some cases, it is, as Jennifer referred to, just an inspired request of the builders. If you're willing to build with these design features, we're going to encourage that by giving you, for example, an expedited building permit.
CONAN: Rich, thanks...
RICH: I haven't been able to verify this, but I have heard that those homes sell first. So, those ones tend to be much more marketable. And it might be good to hear from the realtors on that particular issue.
CONAN: If they find any homes that sell at all in this market, I think they'll be anxious to tell us about it. Appreciate the phone call.
Here's an email from Francis(ph) in Sonoma County: How timely. I just returned from visiting my father, who will be 91 in November. He doesn't believe he's old enough to go to the senior center or assisted living.
We toured an assisted living facility and found out about available services to seniors in his town. The most difficult part is convincing him that these services and possibly moving into an assisted living facility is in his best interest.
It is emotional for him and for my sister and I. Living alone requires that he be aware enough to care for himself, which is in question.
I wish there were adequate tools to help him stay in his own home, but managing long distance is quite difficult. Is there a way to convince one's parents that giving up a small amount of independence can free them/him to get the most out of the balance of their life?
And I wonder, Elinor, if you could help us out here?
Ms. GINZLER: You know, your caller is dealing with the real world, absolutely. And, you know, I dont think there's a magic bullet here at all. And I think that she shouldn't stop having this important conversation with her dad, who doesn't think he's old at 90-whatever she said he was.
And I think that, frankly, in the United States today, we allow adults who are able to think for themselves to make their own decisions, even if some those decisions have some risk involved in them.
We all lead lives with a certain amount of risk. So AARP says don't stop having those family conversations. Keep on trying. Use other people as examples. If he's got some friends who moved into an assisted living residence who had a successful experience, that could go a long way.
LUDDEN: I would also say short of moving into the assisted living home, some of the companies that are selling these, you know, motion sensor programs to kind of monitor realize and they want to build in something that's of value for the senior themselves.
And so you portrayed as you can have more independence if we know you're okay, and they put things like on the computer screen that monitors the motion sensors, they make these very easy, even for people who don't like the Internet, little program where you can see pictures of your family.
They can download, here's the birthday party we had, here's the trip to the park. And that's a social outlet for them. You can kind of Skype and interact with them.
Some of them have scheduling components to help the family at large manage all the trips to the doctors and so forth. But the interaction that the senior gets with their family, you know, easy to use, is an added benefit.
CONAN: Let's go next to Sheryl(ph), Sheryl with us from Tampa.
SHERYL (Caller): Hi. I'm a home care provider. I go into hundreds of houses a year here in North Florida. And the level of elderly in our communities living in financial abysmal situations, with the lack of good nutrition, lack of medical supervision, lack of everything, I'm just wondering how will something that you're talking about, which sounds wonderful, sounds like a dream world to me, how do you get that to the financially indigent, the population who is out there living and dying in trailers?
CONAN: And thanks very much, Sheryl. And, indeed, some of the systems that Jennifer was reporting on where you could monitor - use systems derived from NASA to monitor what's exactly in the fridge and what's exactly in the larder. But, yeah. The issue is price.
LUDDEN: It is price. But I think the only thing you might want to think about is if you all remember the very first VCR that came out on the market and how much that cost, and it was absolutely a high-end piece of technology. And as time goes on, that price plummeted, and actually the technology improved. So we can only hope that as we get more sophisticated in being able to provide these kinds of tools that not only will they be better tools, they will drop in price significantly.
CONAN: And if, Jennifer, there is a - some sort of subsidy for people available?
LUDDEN: Right. Well, for like a village, for example, that would include - they do have subsidies. You know, for the monitoring system, I don't really know. But...
CONAN: Is there any way that insurance can pick up some of this?
LUDDEN: Well, good question. I'm sure that some people are hoping that will happen. I know that the company that I spoke with, ResCare, that has video monitoring, says - told me that for their disabled clients, just this year, the Centers for Medicare and Medicaid has approved that as a waiver option in some cases. I'm sure that there's hope that that may move into the senior area as well. But that's not the case right now.
CONAN: You talked earlier about the comparison with the disabled. This email from Zoe(ph) in Orleans, Massachusetts. The issues of independent living are by no means new to the aging baby boomer population. In fact, people with disabilities have long struggled to be accepted in communities. Our culture has historically been very reluctant to accept people who need any kind of help for their activities of daily living, very slow to provide widespread wheelchair access, et cetera. I hope that the increasing visibility of this issue with the senior baby boomers will also increase awareness of the needs of the disabled population of all ages.
We're talking about adaptation and innovation in terms of housing for older people. You're talking - you're listening to TALK OF THE NATION from NPR News.
And let's see if we can get another caller in. And this is - excuse me, this is Kathleen(ph), Kathleen with us from Athens, Ohio.
KATHLEEN (Caller): Yeah. Hi. I've spent the last three years in nursing homes and assisted living my father who fell three years ago. And we tried to bring him home and then had to put him back in. And my whole attitude about nursing homes and assisted living has changed a lot because I hadn't really been in any of them prior to this. And, I mean, a lot of these places are just filled with incredible people with a lot of wisdom. They are treasure troves of information from a lot of our seniors.
So I wanted to just ask about sort of our attitude, our cultural attitude towards nursing homes and assisted living. And, again, I encourage people to go into these places and check them out because there are a lot of abandoned people. And then I wanted to ask also about technology. If we head towards technology as far as people staying at home, that sense of isolation that I hear about from many of our seniors, can you talk about how technology could create more of a sense of isolation?
CONAN: Well, first, we'll go to you, Elinor Ginzler, in terms of, well, people abandoned in nursing home.
Ms. GINZLER: Yeah. I think it is, without question, a concern for AARP and for anybody that stops to think about it. Even though the vast majority of people are getting older in their own homes and communities, the unfortunate truth is that too many people who are in nursing homes aren't even visited on a daily basis by any friends or family. And that's actually as much isolation as being at home with technology.
So I think we all should open our minds to the opportunities potentially to get involved in some social volunteering. And an example of a great program is where pets - if you have a pet who is a kind pet, they will bring pets into nursing homes and assisted living residences and bring joy to the residents.
CONAN: And, Elinor - excuse me - Jennifer, I know that one of the things you were talking about in your series is this idea that, yes, technology connects us but it also might provide an opportunity for people to be abandoned in their homes, just monitored by monitoring sensors and cameras.
LUDDEN: Yeah. There's a lot of concerns. People feel like, oh, it's -you're outsourcing the care of your parents and, you know, this is just, you know, one more erosion of the human touch. You know, I was just thinking the other day, I probably call my mom less because I email her more. You know, what's better? So it's kind of a - in one way, you can Skype with your grandkids and feel more engaged with them or you don't have as many visits and feel more isolated. And, you know, it's something that families are going to have to grapple with on their own.
CONAN: Kathleen, good point. Appreciate the phone call.
CONAN: This email from Cynthia(ph) in Minneapolis. I have such trouble listening to this line of thought. It works while seniors are healthy. But then, when they weaken and get sick, they must be uprooted and plunked into a strange environment. Why not accept the positives involved in living in a continuous care community, from independent housing to nursing home? That way, when you get sick, you aren't leaving your friends. You don't have to make a new life right when you have the least energy for it.
My parents live at Willamette View in Portland, Oregon. Independent living at the moment, it's going to - it's like going to college. They're having so much fun. When the time comes and they need assistance, they don't have to start all over again. They get to stay in their community with its vegetable and flower gardens, woodworking shops, project viewing room, science classes, book talks, movie clubs, etcetera. And this is the kind of facility where you can go in and need minimal help or you might need a lot of help.
Ms. GINZLER: Absolutely. And so, Cynthia reminds us that there are a variety of housing options out there. And what she's talking about is what we call the continuing care retirement community, otherwise known as a CCRC, where all levels of care can be provided. And, you know, for people who are what I call the planners, they're going to think ahead. That kind of decision is going to be great for them.
CONAN: Again, price is an issue. Elinor Ginzler, thank you so much for your time today.
Ms. GINZLER: Very glad to be here, thank you.
CONAN: Elinor Ginzler, senior vice president for livable communities at AARP, also the co-author of the book "Caring for Your Parents," with us here in Studio 3A. Jennifer Ludden also with us here in the studio, a national correspondent at NPR. We've posted link to her series at npr.org, click on TALK OF THE NATION. We should also mention she'll be on the other side of this table next week when I'm off. Good luck with that Jennifer.
(Soundbite of laughter)
CONAN: Appreciate you coming into substitute for me.
LUDDEN: Thanks, Neal.
CONAN: Listen out for her starting on Monday. Coming up, a conversation with mystery writer Sara Paretsky. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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