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Long-term care fraught with uncertainties for elderly baby boomers

July 10, 2008

GAINESVILLE, Fla. - The continued decline of the nursing home - once the mainstay care for the frail elderly - and an upsurge in popularity of assisted living will lead to many dramatic changes in long-term care, according to a University of Florida expert and editor of a new book on the subject.

"The American public has expressed a strong distaste for going to a nursing home because it smacks of a hospital-like, institutional way of living and receiving care," said Stephen Golant, a UF geography professor and expert on elderly housing. "Assisted living has emerged as a highly attractive option for older persons who have experienced some physical or cognitive decline and feel less secure about receiving care in their own home."

Yet there are few certainties about either the future of assisted living for the elderly or the huge number of baby boomers who stand to be its recipients, Golant said.

"Although baby boomers will constitute a large market, it is unclear what share will have impairments and chronic health problems that make them candidates for assisted living," he said. "The emergence of an unexpected new medical or rehabilitation breakthrough, such as a cure or the discovery of a disease-controlling drug for Alzheimer's disease - could result in a substantial decline in the number of elderly Americans who need such care."

Golant and Joan Hyde, an assisted living provider and a senior fellow at the Gerontology Institute at the University of Massachusetts in Boston, are editors of the new book "The Assisted Living Residence: A Vision for the Future," published this month by The Johns Hopkins University, which examines elderly housing and possible care trends over the next 20 to 30 years.

The biggest competitors to assisted living are daughters and daughters-in-law who provide most elderly caregiving and determine whether their loved ones can remain in their own homes, Golant said. But the availability and attitudes of the current generation of female offspring who must juggle work and family responsibilities are unclear, he said.

"We know that women have succeeded in being comfortable in going back to work even when they have a baby less than a year old and assigning that care to somebody else," he said. "Now the question is how will they react when they confront the possibility of leaving their older parents?"

New technology may make that transition easier, Golant said. The development of sophisticated monitoring and surveillance devices that would allow grown children to track their parents' daily movements on a computer screen from home or work, for example, would revolutionize attitudes about nursing home and assisted living facilities, he said.

"Suddenly some of the downsides of not living at home would be minimized because sons and daughters could feel very much involved with the caregiving experience of their mothers and fathers even without physically being there," he said. "They could see parents in their rooms, walk with them to the dining hall and even communicate with them in real time."

Businesses and social service agencies are preparing for the surge of aging baby boomers, an estimated seven out of 10 of whom are expected to require long-term care at some point after they reach the age of 65, Golant said. Many will also face the issue of a parent needing long-term care before reaching that stage themselves, he said.

Nursing homes are increasingly gearing their business toward acute episodes, such as strokes, which call for short rehabilitative recovery periods, Golant said. When they offer long-term care, nursing homes increasingly serve poorer people and are funded through the Medicaid program, while assisted living caters to private paying individuals with higher incomes or salable assets such as an expensive home or stock portfolio.

To be competitive, nursing homes are trying to transform themselves into becoming more home-like and less like an institution; in short, more like assisted living facilities, he said.

Low savings rates and falling home equity raise the question of whether fewer baby boomers will be able to afford assisted living compared with their parents' generation, Golant said. The average one-year base price is close to $36,000, not including the additional supervision required with Alzheimer's disease and more serious medical conditions, he said.

"Assisted living is here to stay - and is now very much part of the ordinary consumer's lexicon," he said. "But its rate of growth and the number and share of older boomers who will choose this long-term care option in the future is very uncertain."

Frank Caro, senior fellow in the Gerontology Institute at the University of Massachusetts in Boston and editor of the Journal of Aging and Social Policy, praised the book as "essential reading for everyone with a stake in the future of assisted living in the United States."

University of Florida

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