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Reflection on the NJAAW Housing Series

A guest blog by William Cotrone, NJAAW intern

As the global population continues to grow/age, appropriate housing for older adults is now more important than ever. Most of NJ’s current housing stock was built for young able-bodied adults and nuclear families.

Currently, 30% of homeowners in the US are single and live alone. By 2030, 20% of the US population will be considered “senior citizens,” and most older adults would prefer to live in their own homes for as long as possible. But what if their home is not designed to accommodate them as they age? Fortunately, there are solutions.

Staying in Your Home

Adaptations and renovations can allow people to stay in their homes safely for longer.

For example, AARP has a free HomeFit Guide that explains how to incorporate universal design principles and products into homes, which are safe and easy to use. Most of the elements in the guide can be done without professional assistance

Another option is to hire either an occupational therapist (OT) or physical therapist (PT) who is also a Certified Aging-in-Place Specialist (CAPS). These individuals can make recommendations on how to repurpose your home to reflect your functional, mobility, and cognitive needs so that you can live safely and comfortably.

A CAPS will examine such things as the entry and/or foyer (Is it clutter free? Is there a rug that could cause a person to slip and fall? Is there enough light?). If an individual requires a mobility device such as a walker or wheelchair, are doorways and hallways wide enough to pass? In the kitchen, a CAPS will scrutinize chair height so that sitting and rising are made easier, floor space so that mobility devices can pass, lighting to assist people with visual challenges, etc.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here.

Probably the most important place to have examined is the bathroom, especially since 80% of falls occur here. A CAPS can make recommendations on toilet height, grab bars, slip mats or bathroom chairs for the shower area.

For the rest of the house, stairs should be well lit and have handrails. Another option is a chair lift to take older adults up and down. Smart technology devices might also be beneficial for such functions as turning on the lights or a faucet.

For outside the home, thoughtful landscaping or therapy gardens make a great addition. Engaging with nature has an immense list of health benefits, so make an outdoor space age-friendly. Comfortable furniture for the patio area, safe walkways, good lighting and smart technology increase the ability to enjoy outdoors safely.

Getting Help in the Home

Knowing when help is needed and how to find it can be challenging. One option is to hire assistance directly or via an agency. While Home Health Care (HHC) covers skilled support services (including RN/PT/OT) and is usually paid for by Medicare or insurance following a hospital stay or during recovery, older adults may need a lower level of care to assist them with activities of daily living (ADLs). These services, such as toileting, bathing, dressing, eating, moving, and grooming, can be provided by Certified Home Health Aides (CHHAs). However, CHHA services often have very limited insurance coverage, leaving most people to pay out of pocket.

When deciding what type of provider to employ, consider the following: A family member/caregiver who hires privately may save money, but the “employee” might not have the proper skill set or be insured. Engaging an agency is more expensive. However, such added benefits as knowing that the agency has supervision, specific hiring requirements, insurance, licensed staff, and compliance policies, are often worth the extra cost.

Another option is Adult Day Care. These programs provide care and companionship for older adults who need assistance or supervision during the day. This provides caregivers with a much-needed break and allows them to go to work, school, do housekeeping, etc. Research has shown that social interaction in a Day Care setting improves an older adult’s mental, physical and emotional health as well as reduces the risk of developing depression and dementia.

Finally, for people who need more help or are near nursing-level care, PACE (Program of All-inclusive Care for the Elderly) programs allow people to remain at home. While limited geographically, the number of PACE programs in NJ is increasing. More information can be found here.

Residential Options

When staying in one’s home is no longer possible, what are the options to choose from and how does one assess them?

First, independent living is an option for older adults who do not have severe physical or cognitive challenges. An independent living environment usually includes age-friendly features like grab bars, walk-in showers, emergency response services, community dining, age-appropriate entertainment, transportation services, etc. They are relatively affordable at market prices and many are designated as “affordable housing.” If needed, home care, paid by the resident, can be arranged.

The next option is assisted living. Residents of an assisted living community tend to have physical or cognitive challenges but are still able to retain some autonomy. Assisted living units are often smaller than independent living settings because they lack some of the customary rooms of a typical house, like a kitchen. Staff can help residents with ADLs and medication management.

The third option is a long-term care (LTC) facility or a traditional “nursing home,” which provides shelter and around-the-clock care for people with ADL and health difficulties. Reasons for seeking LTC might include that a person suffered a severe injury or medical emergency and needs rehabilitation to return home, or their physical/mental state is diminishing, which could make them susceptible to injuries or illnesses. Long-term care facilities can also provide hospice care and many offer memory units.

Pulling these options together is the “Life Plan Model,” also known as a Continuing Care Retirement Community (CCRC). Residents can transition their living situation and care level without having to transfer out of the facility. For example, a typical transition might be going from independent living to assisted living or independent living to rehabilitation. This may be the appropriate option for couples where one needs care services and the other doesn’t.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead.

For all of the options in getting help in the home, or relocating to an age-focused place, it is important to plan ahead. Unless related to a hospital stay, Medicare does not pay for home care or long-term care. If someone qualifies for Medicaid or affordable housing, eligibility should be established as early as possible. Long-term care insurance or private insurance may cover some costs, but most people will be paying out of pocket.

Aging is like the weather. You can plan for it, and anticipate what will happen, but you won’t know until it actually happens. Like the weather, aging and finances can change unexpectedly. Older adults deserve to live with dignity and comfort. They deserve affordable, appropriate and accessible housing and must plan ahead and know their options.

Click here for a summary of NJAAW’s Housing Series and links to the four recorded sessions.

William Cotrone recently graduated from Bates College with a degree in psychology and is and future medical student (hopefully in a field related to aging). He previously interned at senior residential sites in Lewiston, ME.

As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

As Senior Population Swells, State Needs to Lift Moratorium on Adult Day Care

¬†By Roberto Mu?±iz, President and CEO, The Francis E. Parker Memorial Home Inc.

 The NJ Department of Health and Human Services has documented the many financial abuses in the adult day care system, reporting numerous providers who have scammed Medicaid to reap small fortunes off the backs of taxpayers.

Negative stories abound in the media:   Day care providers telling the elderly to lie to state investigators about their needs, people with disabilities placed in wheelchairs when they are able to walk, and even one case where a client with alleged heart failure and severe asthma was spotted cutting the center’s grass.  All these examples illustrate the extent that unscrupulous providers will go to collect Medicaid payments.  

With investigators suspecting that nearly one-third of the state’s adult day care centers committed some form of Medicaid fraud, according to published reports, it was no surprise that the state stopped issuing new licenses for adult day care centers in 2008. And, in an April 16th decision, that moratorium will be in place until at least November 1st of this year.

But while the NJ Department of Health and Human Services remains hesitant to allow any new centers to open, the demand in New Jersey for home and community-based long term care services is growing and adult day care is a cost effective option.

 Adult day care centers, if operated honestly and ethically, are enormously beneficial.  They make life easier for older New Jerseyans, giving them a safe and supportive place to receive quality care throughout the day.  Services vary among centers, but include medical care, stimulating activities and exercise, and nutritious meals and snacks.  They also provide transportation within a designated service area, making care and support accessible, and give caregivers, such as a spouse or child, a break from 24-hour-a-day care.

 Center staff is trained to monitor medical issues and communicate changes in health to caregivers.  For example, a scratchy throat or a fever could ultimately become a costly stay in a hospital if left untreated. Having a hot, fresh, nutritious lunch supports a daily balanced diet minimizing risk of dehydration or malnourishment.  An engaging walk with friends around the grounds can replace another inactive hour in front of a television.

Adult care centers, which receive $78.50 a day from Medicaid for each person served, are saving taxpayers a small fortune. Consider this: if not for these adult day care centers, many more seniors would be placed in skilled nursing homes, where the government would be spending significantly more to care for them, 24 hours a day, seven days a week.  Aside from cost, adult day centers honor every senior’s wish to remain home for as long as possible.

  Around New Jersey there are a variety of adult day programs.  At Parker, we offer two types, supporting both the social and medical needs of seniors.   The social program available five hours each weekday is for socially isolated elderly, who need motivation and support to maintain an active lifestyle while managing aging issues. Participants benefit from the wellness center, take in a movie, use the hair salon, attend rehabilitation therapy and engage in a host of other stimulating activities. 

 We also offer a medical program, available eight hours each weekday that provides health services, such as monitoring glucose levels, managing medications and providing clinical support for elderly with functional or cognitive challenges. Additionally, the program provides many activities that support the social and emotional needs of participants. 

 In addition to the much needed respite from the challenges of daily caregiving, Parker offers supportive education to caregiver families and assistance with long-term care options as participant needs grow.   

 The time is now for New Jersey officials to plot a future for adult day care, as statistics show there are now 1.13 million seniors living in the state and the numbers are quickly growing. As the Baby Boomers age and hundreds of thousands of New Jerseyans require care, there will be an enormous burden placed on the system.

  We are grateful that the state identified the unethical sources of fraud in adult day health services, and put corrective actions in place.  Now it’s time for state officials to lift the moratorium on new adult day centers, so that more high quality adult day programs can become available. 

 As the state is encouraging long-term care funding to move to home-and-community based services, supporting the growth of adult day programs makes fiscal sense andis the right thing to do for a growing demographic of New Jerseyans who want to remain at home with the support of affordable community resources.  

Roberto Mu?±iz, MPA, LNHA, FACHCA

President and CEO, The Francis E. Parker Memorial Home, Inc.

¬†Roberto Mu?±iz has more than 20 years of senior executive experience with health care and long-term care service providers.¬†¬† In addition to his current role as Present and CEO of Parker, Mr. Mu?±iz is extensively engaged in leadership positions with several New Jersey state and national associations that foster the availability and quality of aging services.¬† Mr. Mu?±iz holds a bachelor‚Äôs degree in public health administration and master‚Äôs degree in public administration from Rutgers University. He is a licensed nursing home administrator (LNHA) in both New Jersey and New York states.

Roberto Mu?±iz is the Chair of the Board of Trustees of the New Jersey Foundation for Aging, Inc.¬†