A Place for Aging | Illumination

A Place for Aging. Story by Anita Neal Harrison.

The U.S. Census Bureau projects that the population of Americans aged 65 to 84 will more than double over the next 44 years, from today's 31 million to some 65.8 million, by 2050. Those aged 85 and above, the age group that most uses nursing homes, will nearly quintuple over the same period, from 4.2 million to nearly 21 million.

As this boom unfolds, Rantz says, our government will not have sufficient funds to support the millions of seniors who will either enter nursing homes on Medicaid or become Medicaid-eligible after spending down their life savings. "That simply, mathematically, isn't going to work as we more than triple the over-85 population," Rantz says.

Numbers aside, she continues, aging Baby Boomers are demanding alternatives to nursing homes. Most older people, like Marjorie Shaw, simply want to age in their own homes. And for good reason.

"Moving can actually precipitate an early death," Rantz says. "That's been demonstrated in care-delivery research, so you have to be very careful about moving people. It's stressful, and if you've got any kind of unstable chronic illness, that additional stress makes it more unstable. It's actually called 'relocation trauma' in some nursing diagnostic circles."

Despite the risk, many seniors find themselves moving multiple times as they age. It is not uncommon for them to move from their homes to a "senior congregate living" arrangement, then to an assisted-living facility before, finally, living out their days in a nursing home. Common problems that force resident relocation include incontinence, poor personal hygiene, inadequate nutrition, injuries such as Shaw's hip and -- perhaps the worst culprit -- mismanagement of medication. Rantz has long thought that, with early intervention and monitoring, most of the problems forcing senior relocation could be prevented or controlled. To show how, in 1996 she and several other members of the nursing faculty began developing a project to demonstrate intervention and monitoring in practice. They envisioned the project as a new model of care, one that would allow seniors to "age in place, in the home environment of their choice, with supportive health care services as needed."

In 1999, they established Senior Care (now called Sinclair Home Care), a licensed, Medicare- and Medicaid-certified home health care agency, and obtained a $2 million grant from the federal Centers for Medicare & Medicaid Services. They used the funding to investigate the effectiveness of aging in place as a community-based, long-term care program.

More than 700 seniors participated in the two-year study, which assigned participants to nurse care coordinators. The coordinators completed a comprehensive admission assessment for each participant and then put together a "care plan" that coordinated the efforts of all the participant's physicians. Such a plan is important, Rantz says, because seniors often see multiple physicians who prescribe numerous medications. Without proper coordination, the drugs can interact and cause serious problems.

"When you go to seniors' houses and go through their shoeboxes of medicine, they've got stuff left over from God-knows-when, and they still take bits and pieces of it and don't tell their physicians. That's why they need the nurse care coordinator within the home to see that and help solve it."

At the end of the study, the researchers concluded they had postponed or prevented nursing home admission for more than a third of the study's participants. They also found participants walked better, were less depressed, had better short-term memory and experienced less pain than their counterparts in nursing homes.

Published by the Office of Research.