As promised, here comes some good news about aging. For the most part we old folks are doing pretty well—at least those of us that are in reasonably good health for our age and have enough income to get by. There are more housing and health care options available for us seniors now than ever. Medical care continues to improve, and there is income support from Social Security and SSI, health care support from Medicare and Medicaid, and nutrition support from food stamps. Before the 1930s there was nothing, and before the 1960s only Social Security. (These are the targets, by the way, that the Freedom Caucus plans to hold hostage to the debt ceiling vote.)
We humans tend to keep going as long as we can, given our health and abilities. It is part of our nature. Many of us go on cruises and travel. We join clubs. We volunteer. We go to concerts and plays. We remain active in our neighborhoods and cherish friends and families. We continue to exercise. We serve on nonprofit boards. We stay politically engaged. Some work part time in jobs they love.
The big differences in quality of life for us septuagenarians and octogenarians have to do with our health, our financial resources, and our personal relationships, especially with friends and family. Some of us have been dealt better hands than others.
The existential question we old folks face as we age is this: what happens next? We know that we will not all die peacefully in our sleep after living fulfilling lives and with just enough time to say goodbye to loved ones and make peace with the Divine. If only this were so. Sometimes, however, it does happen or comes close. The retired Bishop of the Episcopal Diocese of Washington, Jane Dixon, who was a good friend, an inspiration, and much loved by Episcopalians throughout the diocese, died in her sleep (from a heart attack) in 2016 after tucking in her grandchildren on Christmas Eve. Still, she was much too young (age 75), and no one was prepared for her sudden death.
Now I happen to be an expert in housing options for seniors. My career was mostly devoted to assisting nonprofit housing providers build seniors housing, mainly “continuing care retirement communities (“CCRCs”), now also called “Life Plan” communities. The idea behind these communities is that they tackle the “what’s next” question directly as people get older and need more services to maintain their independence. They do this by providing three levels of care—independent living (with meals and housekeeping included), assisted living and long-term nursing care—all in one building or on one campus. Many communities now also provide memory care. These communities—most are not-for-profit– require a front-end entrance fee and a monthly payment. I have been a big fan of these communities and have many friends who smartly have moved into a CCRC. One would expect we would be the first to sign up. But no, not Embry and me. “The cobbler’s children have no shoes.”
There are also rental, market rate supportive housing options, known as “congregate housing,” which provide meals, housekeeping, activities and supportive services and often include assisted living. There are group homes typically accommodating 3-10 people and providing similar services, and often more affordable than other market rate options. And there have been a whole bunch of assisted living communities built during the last 25 to 30 years, some including memory care. There are many more options now than were available 50 years ago when my generation was entering the work force and our parents were getting old.
Why haven’t we moved to a Life Plan community or one of the market rate, senior housing options? Well, we are happy where we live now. This is the usual excuse. In 2015 Embry dragged me kicking and screaming out of the house we had happily lived in for over 40 years. Why move, I asked? Because Embry could see the “what’s next,” problem then, and she was right. Climbing stairs for me now is a killer with my bad knees. We moved all of a few hundred yards away to a 450-unit apartment building, which is a quintessential “NORC” (naturally occurring retirement community) where there are a lot of people our age (but also younger people and young families), a strong residents’ association, spacious apartments with fireplaces and balconies, a fitness center and indoor lap pool, and lots of activities. It was the perfect solution, thanks to Embry. We love it and have made many new friends. It is a short walk to our old neighborhood and our church and shopping, restaurants, and Metro. Why move again?
Enter the nagging “what’s next” question. We are now eight years older than when we moved in. I will soon be 81. Embry is 76. There are no supportive services offered in the apartment building where we now live. We have witnessed friends and neighbors deal with losing spouses and how hard it is to find suitable supportive housing options or homecare support. Some have had to separate from a spouse who had to move to assisted living or memory care off site. While there are now even more options than ever that try to address this question– senior “villages” where seniors volunteer to help each other, care managers that help people get in home care or find other solutions, and “life care at home,” — there are no solutions that solve all the challenges of aging, no silver bullet. And making the decision to move to a CCRC is difficult for us since we are city people and have so many friends here. We are probably typical in putting this off to the last minute and are just starting to struggle with that question.
A bigger challenge is for people with limited financial resources. The majority of seniors are not able to afford to live in the NORC where we live or any kind of “market rate” seniors housing with supportive services, especially the CCRCs, which are limited to people with substantial assets and solid retirement incomes. My guess is that at best only about a third of the over-75 population can afford these options. What about the other two-thirds?
The news is not all bad there either. There has been a lot of subsidized housing for seniors built over the years starting in the 1960s. I worked on a number of these properties as well and currently serve on the board of three such properties. The HUD 202 Program was the best and produced many thousands of apartments affordable by seniors with incomes up to 50% of area median. Rents are pegged at 30% of income. The most active housing production program today is called the “Tax Credit Program” which pegs rents affordable to residents at 30-60% of the area median income. Some of the HUD 202 properties provide meals and also have service coordinators. Accessing services for residents usually involves utilizing independent home and community-based service providers. If long term nursing home care is required, Medicaid is available in most states to make the care affordable (requiring residents, however, to spend down all their assets and is available only to those who have extremely low incomes.) The housing options for poor people are not perfect, and we need more affordable housing with services—especially for those in-between seniors who do not qualify for subsidized housing but can’t afford market rate senior living; but overall, I give the options for people with more limited financial resources pretty high marks.
So, we old folks have lot to be thankful for. The senior population is healthier and better off today on the whole than we have ever been, but that does not mean that more does not need to be done. So, the picture is mixed. But you can’t help admiring folks older than me who are still going strong and making the best of their lives . The challenge we all face is how to grow old gracefully and how to squeeze those last drops out of the lemon.