A friend and I went to see “Moving On”, the latest Jane Fonda/Lily Tomlin picture. I am so grateful that these actors are finding vehicles that shed light, albeit Hollywood-tinged lighting, on the challenges of growing old in this country.
Lily Tomlin plays Evvie, a former professional musician who downsized and now lives in an assisted living facility. She proudly points out that she is still in the independent wing. Her situation is all too familiar to those of us who are facing challenges with caring for ourselves financially as well as physically as we age. And our options are limited.
It Wasn’t All that Long Ago . . .
It was only two generations back that the only housing option for older people who had no money was the poor house. People lived in boarding houses or rented rooms. If you had family, maybe there was a shared bedroom or you slept on a sofa. If you didn’t have family, you might find housing in a board and care home.
Back in the 1960’s, a guy named Del Webb bought up a bunch of desert property in Coachella Valley and hit on a new idea. “Retirement Living”. Folks 55 and older could buy into this planned community, have access to pools, golf courses, and other amenities. They could live the good life, surrounded by folks just like them. Modest homes cost, on average, $10,500.
The Housing Trajectory
Where you go to live as you get older today in the United States (and most European countries) typically follows a four-stage process. Stage 1: Moving from where you raised your family or spent your professional life to a smaller place (downsizing; moving closer to the kids). Stage 2: Adapting that place to meet changing physical challenges (building ramps, widening doors, refitting bathrooms). Stage 3: Moving into a congregate facility (assisted living, CCRC). Stage 4: Hospital-skilled nursing-long-term care (24-hour care).
Fewer and fewer of us remain in the same home or town that we grew up in. And more and more of us want to age in place as long as possible. This is only a problem when the demand exceeds the supply. And that is the precipice we are standing on right now.
Lucy and Ethel and the Chocolate Factory
Just like that wonderful episode of the Lucy Show, in the beginning there were only a few of us who were needing housing or special care. Skilled nursing facilities were brand spanking new, had room for 20 or 30 folks at a time, and expected most of them to stay no longer than a few weeks or maybe three months.
But then the assembly line began to speed up. People were living longer and were not moving back into their former abodes. Many did not have sufficient savings or insurance coverage to pay for the services after the 100-day limit that Medicare covered, yet still needed the care and services provided.
Shifts in Culture and Values
I am not a sociologist, but as a member of the Boomer Generation, I am keenly aware that my generation looks on family and aging very differently than my parents or grandparents did. We have a self-hatred of getting old and seem to value Youth above Wisdom. We prefer for old people to hideaway in facilities, rather than integrate into our communities.
This shift in values and culture contributed to the economic investment boom that has become the Assisted Living industry. The boom in building of these facilities happened in the mid- to late-1980s. This option meant Mom and/or Dad could remain independent, be cared for, and not cause us worry. Out of sight; out of mind. (Of course, this is an exaggeration . . . at least I hope so!)
Wait Lists and Fees
If you scan the websites for these assisted living facilities, you will quickly see that marketing consists of selling you on meal plans and floor plans. You will also get the skinny on fitness, leisure, activities, and the arts. Photos always include smiling residents in lovely settings.
These places ain’t cheap! Actual costs are rarely shown on the website – if you want to know, you need to call. Wait lists are also not shared, but, anecdotally, I am aware of a couple of local places that have waiting lists of years, not weeks or months.
Bottlenecks and Barriers
If only we could control all the variables, then there would be an orderly progression of older adults downsizing, moving into assisted living, progressing on to memory care or 24-hour care, and then dying. This would allow for the predicable availability of apartments, managing the demand for caregivers, and elimination of wait lists. But we can’t. There are too many Boomers living too long!
I live in a small community in the San Francisco Bay Area. We have three skilled nursing facilities and seven “assisted living” places. I use quotes here because the term is commonly used but can mean anything from a lovely large home (4-5 bedrooms) tucked away in a quiet neighborhood, to a large, two-story apartment complex, taking up several city blocks, with over 105 one and two-bedroom apartments. But this is not enough supply to meet the demand for housing!
From a Population Perspective . . .
As a generation, the Boomer Bubble means we are trying to fit a whole bunch of people into a small supply of specialty housing. And that’s the issue. It is about so much more than a meal plan and a floor plan.
Meeting the needs of a group of older adults who are experiencing physical and cognitive decline requires increasing numbers of trained staff. This includes facility managers to keep the apartments safe and functional, food prep staff, servers, cleaning folks, caregivers, licensed providers (especially when there are memory care and physical health needs), transport staff, front office staff, finance and business office, and management/HR and employment recruiters.
Boomers Are Like the Century Plant
We didn’t reproduce like our parents did. There are fewer descendants to take care of us. And fewer of them even want to work in jobs such as these! Turns out, we’re a difficult bunch to please!
We are like the Century Plant that grows and grows and grows for a hundred years, then dies off. What will be left behind are facilities that will need to be maintained until the last resident is gone, then either repurposed or demolished. There isn’t much economic incentive to build more of these places, in spite of the need, because the investment is short-term.
Is This Just Another Boom/Bust?
Where will you live as you grow old? You may have limited choices not because of anything you have done (or haven’t done), but just because there is no room at the inn. Aging in place will become the only option.
My advice? Take some time to scope out what is available NOW. Think about how you want to spend your time and with whom. If you haven’t lived with others in a while, it may be quite a shock! Or, it may be the best decision you ever made. At least that is what the sales people tell me!
One response to “Where Will You Spend Your “Golden Years”?”
Mary, thank you for yet another wizard/thoughtful overview (you are TOO a “sociologist!!!”) — and “wake-up call” blog. Thank you.
There is one tiny iota within today’s blog which I shall fixate on(!): You are SO right that this culture instills a “self-hatred about getting old” (valuing youth over wisdom). That’s likely understated! All of that is merely the result of our having been born into and endured a culture – which systematically instills self-hatred ALL THROUGH LIFE (see for example, most modern “Christian” religions [long-since having distorted its Founder’s actual teachings] – those hammering away at us from the cradle – that we are Basically Bad, and “therefore” – must be continually “forgiven” and “redeemed.”
Then, throw in a “side-order” of 24/7 ad industry bombardment, which So Cleverly depicts as well that we are ALSO “not good enough” (unless we BUY their blah blah product). So, no wonder that – when the easy golden frills of youth do fade away – we get to “hate ourselves . . . EVEN MORE!” What could possibly be wrong with such a terrific “system?” Hmmm . . .
TO ALL OF THOSE LIES (ironically, as Nancy Reagan once said) — my (aging) hubby and (aging) me, JUST SAY NO, and instead continue to love ourselves FIRST, and each other SECOND . . . to bits. (“Those who cannot love themselves, cannot truly love anyone else.”)
The preceding realization would be (ahem) . . . “wisdom over youth.” Meanwhile, great blog (including about the “industrialization” of elder care).