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Aging in Place

A Promise or a Prison?

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JASON CRING
  • Jason Cring

Where will you spend your senior citizenship? If you are like the vast majority of us, you want to stay in your own home as long as possible. This popular notion even has a quaint official phrase, "aging in place." It sounds idyllic, passing the golden years among the familiar comforts of home.

But for aging in place to be a healthy way to live, society must create infrastructure to bring people together. There is a dark side to aging in place—primarily, loneliness, a severe social isolation leading to depression, contributing to the onset of Alzheimer's, and resulting in increased mortality. Social isolation has been found to have a mortality rate approaching that of heavy smoking.

As cofounder of Edible Independence, a Kingston-based nonprofit that delivers frozen dinners to senior citizens in their homes each week, there is a sad scenario too often played out. "My weekly visitor," one elderly woman muttered sadly, as I delivered food to her comfortable apartment in Kingston. Of sound mind and with elderly health accoutrements such as a walker and almost always alone, she has over time grown depressed and barely expressive.

During these deliveries I see a dismaying pattern of isolation, pharmacology, and television. Dystopic as that sounds, it is already daily life for many elders, and may become the common reality as the number of senior citizens swells nationally and globally.

It is clear the system is already straining. Nursing homes and senior care facilities are full, and there is no way society can build enough residential facilities to meet the ongoing growth in senior citizenship. Paradoxically, the future is potentially bright for senior citizens. There are encouraging findings about relatively easy methods people may use to help them age well, and promising ways to assist aging in place psychologically and physically. Recent science on brain plasticity and the capabilities of seniors strongly posit that aging well is a matter of trying to do so, exercising mind, body, and social skills. While easily arranged for the small percentage of seniors in nursing homes, the challenges are unmet for those aging in place.

Simply put, seniors aging in place need someplace to go to see people and some way to get there. But if society doesn't embrace the responsibility to pay for what is needed, the future for many elders amounts to house arrest, sometimes even a sentence of solitary confinement, long stretches of isolation with only Andy Griffith on television for company, as overworked family visit only occasionally, so one's main link with the outside world becomes deliveries, especially from pharmacies.

21st-Century Aging Nation and Valley

The problem is already serious and will grow severe. Demographics showing the silver tsunami throughout the 21st century are clear. As of the 2010 Census, 11 million American senior citizens lived alone, and that number is growing rapidly. Our silver tsunami will have several waves. The first of some 75 million baby boomers turned 70 in 2016, 55 million Gen-Xers started turning 50 in 2015, and the first of 82 million millennials turn 40 in 2020. And on average, people are expected to live longer, and perhaps much longer, then ever before.

A stark example of how we are aging is seen in the Census data, which as recently as 1980 categorized its oldest count of elders as age "75 plus." By 2010, categories had to be updated for persons aged 75 to 79, persons aged 80 to 84 and persons attaining 85 plus. These trends are reflected globally.

The Hudson Valley is on the high end of current demographics. Data compiled on the website Mhvcommunityprofiles.org show that in all Mid-Hudson counties the fastest growing segment of our population is the oldest-old among us: "Since 2000, the 85 and over age group grew the fastest, at 53% for Dutchess, 50 percent for Ulster and 44 percent for the region overall. Orange was the only county in the region where the 60 to 84 group had the greatest increase (46 percent) followed by the 85 and over group (33 percent)."

The Hudson Valley is older on average than the nation. Fourteen-point-nine percent of the USA was 65 or older in 2015 using Census data. In Westchester, that figure was 15.8 percent, Putnam, 15.2 percent; Rockland 15.1 percent. Only Orange County was under the national average, with 12.9 percent of its people aged 65 or more.

Further north in the Hudson Valley, things look even greyer. Sixteen percent of Dutchess's population is over 65, a 2.5 percent leap in just five years from the 2010 Census. Ulster County has an over-65 population of 17.9 percent, an increase of over 3 percent in five years. Sullivan County is at 17.3 percent, Greene County at 20.5 percent, and Columbia County at 21.5 percent. All four of those final counties have a notable counterpoint, their overall populations are shrinking even as their senior population increases rapidly.

A business factoid perhaps best suggests the prospective isolation facing seniors aging in place. Companies including Toyota and IBM are working perfecting care-bots programmed to tend to seniors living alone. Merrill Lynch estimates the personal-care robot market could exceed $15 billion annually by 2020.

There are, of course, more human-friendly options. European studies show seniors universally seek to get out more but feel they lack safe options. The researchers advocate creating low-cost, low-tech "short distances strung together with staging posts," such as safe sidewalks, benches, and bathrooms. Though this sounds simplistic, it is a starting point for elder health.

The discipline of gerontology cites the concept of "lifespace": The further a person travels from their bed every day, the stronger their health correlations. A smattering of so-called "age-friendly cities" seek to build on these findings, highlighting ways for improving mobility and inclusion through universal design initiatives for public spaces and public transport. While garnering strong theoretical support, age-friendly cities remain largely unfunded.

Meanwhile social isolation suffered by many seniors, besides being deadly, is enormously expensive. With Alzheimer's alone projected to cost $1 trillion annually by 2050, the choices and outcomes are already stark, and the stakes are only going to grow. Fortunately, low-cost initiatives are available.

Kingston as Template

Kingston, with 15 percent of its current population 65 or older, is emblematic of challenges facing small cities. What do seniors need to live well here?

"Transportation is number one. The most important piece for seniors right now is getting to and from places," says Francesca Ordolono, operations manager of two privately owned buildings in Kingston, the Governor Clinton building and Yosman Towers, that provide publicly subsidized apartments for senior citizens.

Public officials are aware of the problem. "We have a very active senior population who struggle with our poor sidewalks and inadequate public transportation system," says Kingston Mayor Steven Noble. The Broadway Streetscape Project, an infrastructure initiative by the city to be started this year will install ADA-compliant sidewalks and benches in adition to other safety features.

Kingston has plenty of company in confronting such problems. The National Association of Area Offices on Aging says transportation is the number one reason seniors call their national Eldercare hotline.

"There is no doubt we are going to need better services for seniors, and we know it," says Robert DiBella, director of Ulster County Area Transit. He estimates providing "demand-response" transit to pick up by appointment would double the agency's $5 million annual budget.

There is a lower-cost option, sidewalks, as the foundation for stringing together attractions. Hudson Valley's dense riverside cities like Kingston have an advantage toward becoming age friendly. In their very compactness, they foment opportunity for NORCs to develop. These are naturally occurring retirement communities, where long-time neighbors are facing the same challenges as they age together. But NORCs don't happen automatically; they develop best where seeds of infrastructure and assistance are designed to develop a community.

British gerontologist Dr. Sheila Peace describes the work as a process, not a policy, saying those creating NORCs must work toward "Neighborhood as a goal to be achieved, rather than a starting point."

Like most Hudson Valley cities, Kingston is full of surprise vistas and historic pocket parks, which are ideal to start stringing together staging posts to facilitate seniors. One theoretical opportunity exists behind the Governor Clinton apartments: Off Albany Avenue there is a peaceful oasis garden boasting a splendid vista of the Catskill Mountains. It hints at NORCs that could be created, regionally, using neighborhood assets around an existing senior building, and also illustrates the complications of upgrading facilities, using imagination and public private-partnerships.

The garden is on private property and not visible from the street, so insurance arrangements and signs would be necessary to take full advantage. The garden abuts a large but little used dining space that could be a thriving café, perhaps under public-private partnership.

Ordolono, the building manager, says the complications of senior citizenship require more than a building manager's help. Society, she says, will have to begin investing if aging in place is actually to benefit society. "It would be really helpful to have a social worker assigned here," she said, a combination ombudsman, social director and senior advocate.

"Gerontechnology" in the Country

Further afield are the suburbs and hamlets, the dense developments or lone historic houses spread among far-flung Valley environs. Seniors aging in our rugged region may have vistas galore, but no way to get groceries, let alone kick up one's heels among other humans. But the principle of stringing together attractions is applicable, although on a larger playing field.

For example, with a little imagination, but a large investment, one could imagine a future of self-driving cars assigned as chauffeurs for seniors living alone in suburbs and hamlets, taking them out to socialize. Routine doctor's visits could occur at home, over two-way screens. Far-flung families can monitor their parents aging in place in the old family home, using smart technology to control lights, thermostats, and even entertainment. They can have face time and visit via Skype on big screens, which, research shows, is effective at relieving isolation.

Such technology, termed gerontechnology, is a growing facet of aging in place. Products to service the market are beginning to cascade from companies realizing where the money is. Seniors may soon face a bewildering selection of options for living in their own home, but the nexus will always be that humans need company to be healthy.

Will we develop ways to keep each other company as we age? So far, the answer is no, but as pressures of demographics and economics grow, then, pardon the pun, time will tell whether aging in place is where seniors still want to be.

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