Aging in Place Seniors Need Additional Assistance

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About 25 million Americans who are aging in place rely on help from other people and devices, such as canes, raised toilets or shower seats, to perform essential daily activities, according to a new study documenting how older adults adapt to their changing physical abilities.  

A substantial number of these seniors, however, do not receive adequate assistance. Nearly sixty percent (60%) of seniors with seriously compromised mobility reported staying inside their homes or apartments instead of getting out of the house. Twenty-five percent (25%) said they often remained in bed. Twenty percent (20%) of older adults who had significant difficulty putting on a shirt or pulling on undergarments or pants. reportedly don't get dressed. Of those who required assistance with toileting issues, almost thirty percent (27.9%) report accidents where they soil themselves.

The study, by researchers from Johns Hopkins University, focuses on how older adults respond to changes in physical function.  Response to physical impairment is poorly understood, and infrequently studies.  The study suggests that about one-third of older adults who age in in place, nearly 13 million seniors, have a substantial need for assistance with daily activities such as bathing, eating, getting dressed, using the toilet, transferring in and out of bed or moving around their homes; about one-third have relatively few needs; and another third get along well on their own with no notable difficulty.

For older adults and their families, the report is a reminder of the need to plan ahead for changing capacities.  It is also a reminder that families and communities may need to be more proactive in identifying and assisting those whose physical needs change.

"The reality is that most of us, as we age, will require help at one point or another," Bruce Chernof, president of the Scan Foundation and chair of the 2013 federal Commission on Long-Term Care, told Judith Graham, author of special report for the Washington Times, and reprinted in an article for the The Berkshire Eagle. Citing Medicare's failure to cover long-term services and supports, which help seniors age in place, he said, "We need to lean in much harder if we want to help seniors thrive at home as long as possible."

Previous reports have examined the need for paid or unpaid help in the older population and the extent to which those needs go unmet. Notably, in 2017, some of the same Johns Hopkins researchers found that forty-two percent (42%) of older adults with probable dementia or difficulty performing daily activities didn't get assistance from family, friends or paid caregivers. Twenty-one percent (21%) of seniors with at least three chronic conditions and high needs lacked any kind of assistance, according to the prior study.

But personal care isn't all that's needed to help older adults remain at home when strength, flexibility, muscle coordination and other physical functions begin to deteriorate. Devices and home modifications can also help people adjust.  Technologies, too, can aid seniors, their families, and communities in providing assistance.

Until this new study, though, it wasn't clear how often older adults use "assistive devices" such as canes, walkers, wheelchairs and scooters for people with difficulties walking,  shower seats, tub seats and grab bars for people who need help bathing, button hooks, reachers, grabbers and specially designed clothes for people who have difficulty dressing,  special utensils designed for people who need assistance eating easier, or raised toilets or toilet seats, portable commodes and disposable pads or undergarments for individuals with toileting issues.

"What we haven't known before is the extent of adjustments that older adults make to manage daily activities," Judith Kasper, a co-author of the study and professor at Johns Hopkins Bloomberg School of Public Health told the Washington Times.

The data comes from a 2015 survey conducted by the National Health and Aging Trends Study, a leading source of information about functioning and disability among adults 65 and older. More than 7,000 seniors filled out surveys in their homes and results were extrapolated to 38.8 million older Americans who live in the community (excluding those who live in nursing homes, assisted-living centers, continuing care retirement communities and other institutions).

Among key findings: Sixty percent (60%)of the seniors surveyed used at least one device, most commonly for bathing, toileting and moving around. Twenty percent (20%) used two or more devices and thirteen percent (13%) also received some kind of personal assistance. Five percent (5%) report difficulty with daily tasks, but didn't have help and hadn't made other adjustments yet. One percent (1%) received assistance only.

As expected, needs multiplied with age, as sixty-three percent (63%) of those 85 and older reported using multiple devices and getting personal assistance, compared with twenty-three percent (23%) of those between ages 65 and 74.

The problem, experts note, is that Medicare doesn't pay for many of these nonmedical services, with some exceptions. As a result, many seniors, especially those at or near the bottom of the income ladder, go without needed assistance, even when they're enrolled in Medicaid. Medicaid community-based services for low-income seniors vary by state and often fall short of actual needs.

A companion report on financial strain experienced by older adults who require long-term services and supports illustrates how marginal are some seniors financial lives. Slightly more than ten percent (10%) of seniors with high needs experienced at least one type of hardship, such as being unable to pay expenses like medical bills or prescriptions (5.9 percent), utilities (4.8 percent) or rent (3.4 percent), or skipping meals (1.8 percent). Some people had multiple difficulties, reflected in and among these statistics.

These kinds of adverse events put older adults' health at risk,  contribute to avoidable hospitalizations, and result in avoidable nursing home placements. Given a growing population of seniors who will need assistance, "I think there's a need for Medicare to rethink how to better support beneficiaries," said Amber Willink, co-author of both studies and an assistant scientist at Johns Hopkins Bloomberg School of Public Health.

That's begun to happen, with the passage last year of the CHRONIC Care Act, which allows Medicare Advantage plans to offer supplemental benefits, such as wheelchair ramps, bathroom grab bars, transportation and personal care to chronically ill members. But it's unclear how robust these benefits will be going forward; this year, plans, which cover 21 million people, aren't offering much. Meanwhile, 39 million people enrolled in traditional Medicare are left out altogether.