U.S. Census Bureau numbers document the geographic impact of an aging country. There has been a gradual but sustained move toward more concentrations of older people in 55-plus neighborhoods and age-restricted communities. Last year, there were 39.5 million households with a primary homeowner who was at least 55 years of age, nearly six million more than in 2001. But over the same period, the total of non-55+ households was unchanged, at about 65.5 million. By 2020, it's projected that 45 percent of American households will be headed by someone who's at least 55 years old.
"Aging in place" solutions represent what seniors overwhelmingly tell pollsters that they want. Furthermore, the astronomical price tag of putting millions of older Americans in nursing homes and other institutional settings is simply not affordable in an era of tight resources and stressed government budgets. While there are many programs and billions of funding dollars to provide medical services to older Americans, there has been virtually no government money to help them stay healthy and live independently in their homes.
Villages and other senior neighborhood programs rarely make headline news and survive largely on volunteer efforts and modest budgets. But while Congress once again grapples with the enormous price tag of healthcare, many of these programs might be looked at as test tubes of how to cost-effectively serve a graying nation.
In Madison, Wisc., for example, a program called Supporting Active Independent Lives, or SAIL, works with a geriatric pharmacist and university pharmacy students to provide personal health coaching to its members. "Older adults are oftentimes overmedicated," says SAIL Executive Director Ann Albert. "They are taking medications that over the years can build up in their systems, and have interactions that maybe a 40-year-old or 50-year-old person wouldn't experience."
In an intensive screening program aided by volunteer pharmacy students, nearly 80 percent of 30 SAIL members tested were identified as having adverse drug reactions. "Just in our home county alone," Albert says, "more than 1,500 seniors are hospitalized each year because of adverse drug events." The screening is free but can produce large savings for Medicare and other government programs.
ElderHelp of San Diego is testing a different model that provides intensive support services to a largely lower-income group of seniors. Supported largely by philanthropy, ElderHelp evolved from a more classic social agency with strong ties to local government service providers.
"The classic village model is that the members support the services" through annual dues payments, says Leane Marchese, executive director of ElderHelp. Such efforts make sense in more affluent communities, but ElderHelp's 180 members generally can't afford to pay for such a program. So she raises private funds to support an extensive professional and volunteer service network. The goal is to use the village model to demonstrate cost-effective solutions that traditionally have been provided by much more expensive government programs.
"Our vision is to make the villages a model that's going to make an impact by serving an older population that has a higher level of chronic disease and a higher level of need, but is lower-income," Marchese says. The key is to develop reliable revenue streams to support such efforts. This is more likely to come from new government programs than the private sector. For this reason, Marchese and other village leaders have been excited by the health reform law's provisions to fund wellness and long term care programs. "A program like ours that leverages volunteer aspects and lower cost labor and philanthropic support can offer these services at a lower cost," she says. "I do have this vision ... but we still have to prove that it works."
At Mt. Lebanon Village in Pittsburgh, director Ann Bateman oversees a new village with only about 35 members. In existence for 18 months, the program devotes a lot of energy to helping members stay connected to their local communities. It works with volunteers and schools to provide intergenerational activities, including a day of light sporting events and a personal history project, where seniors are paired with students who learn about an older person's life story.
In Washington, Gail Kohn manages Capitol Hill Village, which has grown to a solid membership base of 350 since being founded in the fall of 2007. Better funded and with somewhat younger members than most village programs, Capitol Hill Village has developed a broad range of active social and support activities. "Our membership is preponderantly aged from 50 to 70," Kohn says. "Most of them are active and running around, but 40 members are receiving personal care services or they couldn't stay" in their homes.
The village has student-senior mentoring programs and has also developed a network of young professional volunteers in the Washington area. "A third of our volunteers are 30 and younger," she says. They are often in Washington for career reasons and are separated from their families. "We offer them a little touch of home," Kohn explains. "They're looking for mom and a sense of normalcy, which means working with people of all ages." Also, half of Capitol Hill Villages members do volunteer work themselves.
Many villages are connected through the Village to Village Network, which offers website services and a schedule of village learning and networking events. Candace Baldwin, co-director of the network, says many villages have moved through their start-up periods and are now buckling down to prove their sustainability and broadening ties within their local communities.
The healthcare reform act, assuming it's not overturned or drastically scaled back, offers potential revenue streams that could help support the village service model. Funding wellness and other cost-avoidance programs outside the traditional healthcare system can be a game-changer for aging-in-place programs. "We don't know for sure what kinds of revenue streams this will create," Baldwin says. "But the opportunity is prime with community-based healthcare and accountable care organizations."