Aging in Place: the Better Option After the COVID-19 Pandemic?

Nursing homes have been in the news recently as they grapple with the effects of the COVID-19 pandemic. These communities of vulnerable residents have been especially hard-hit by this deadly and highly contagious virus.

I imagine, by extension, it’s left a lot of people wondering if the positive aspects of living in a senior living community, such as a continuing care retirement community (CCRC or life plan community), are outweighed by the concerns about being exposed to a contagion in a multi-unit independent or assisted living environment. Maybe people are thinking that so-called “aging in place” is the safer route, especially during an event like a pandemic.

A unique health challenge for senior living

There are arguments to be made on both sides of this issue. As I’ve written about before, overall, the senior living industry is, in theory at least, well-prepared to deal with highly contagious illnesses like the seasonal flu and stomach viruses. A well-run organization should have strict patient care and cleaning protocols in place to contain the spread of such viruses.

But as we’ve seen in many states across the country, these protocols have clearly failed to stem the spread of COVID-19 in a number of nursing homes, which often house especially vulnerable people. By some states’ estimates, more than half of COVID-19 deaths in their state are among group home residents.

For some nursing homes, these devastating statistics are due to not following protocols properly. But for others, it is simply the result of challenges associated with asymptomatic spread (people who are contagious but symptom-free), the unavailability of proper protective equipment and sanitization supplies, and an absence of testing kits.

Without question, all of these factors make for a difficult dynamic for those living in and operating senior living communities — whether they are in independent living, assisted living, or a nursing care setting. (It’s worth noting that residents’ situations are likely different depending on their level of care. Residents in independent living are experiencing the pandemic differently than those in a nursing care setting, for instance.)

Issues tied to living in your own home

But there’s also an argument to be made that living in a senior living community such as a CCRC is actually preferable to living on your own during a time like this. In a recent blog post, I shared the thoughts of one Dallas CCRC resident, 94-year-old WWII veteran John Gould.

While the COVID-19 pandemic has forced him to change some of his routines and postpone some enjoyable group activities, Gould sees the positives of his particular living situation and is grateful for his CCRC “family.” He says that he and his neighbors in independent living are people who “share the good times and the bad times, so we’ll make it through this.”

Gould observed: “If you are an older person living alone, where you have to worry with utilities or tripping over rugs, those are the vulnerable people…that would be the pits right now.” He noted that those seniors who are living on their own without a support system are likely feeling extremely fearful and isolated during these trying times.

And I believe Mr. Gould is correct on many fronts. Indeed, I’ve heard his sentiments echoed by residents of other retirement communities across the country. While AARP surveys have found that upward of 90 percent of seniors say they want to remain in their home as they age, this pandemic has highlighted numerous downsides of that decision.

Social isolation and loneliness

I’ve written before about the mental and physical health issues tied to social isolation and loneliness. A 2019 University of Michigan survey found that more than a third of adults age 50 to 80 say they feel lonely. Among households of Americans living by themselves — about 2 out of 5 adults — 60 percent say they feel a lack of companionship, and 41 percent say they feel isolated. And this was BEFORE the pandemic and quarantine requirements.

Seniors who live on their own likely will be disproportionately impacted by loneliness tied to this time of self-isolation. Prior to the COVID-19 outbreak, much of their social life revolved around community centers, houses of worship, or other public group activities. Many of these venues across the country have been closed indefinitely during the pandemic.

Study after study has found that feelings of loneliness are strongly correlated to a variety of health issues including an increased risk for cancer, depression, dementia, and cardiovascular issues. Indeed, we may be in for a deluge of post-COVID-19 health issues or even premature deaths among vulnerable senior populations who have been quarantined while living alone.

Compare this to Mr. Gould’s comments about life in his CCRC right now. Yes, most senior living communities across the country have put visitor restrictions in place, but there is an inherent sense of community — even “family,” as Gould describes it — among CCRC residents. As he notes, they are there for each other in good times and bad. It is this very sense of community that draws many seniors to chose to move to a CCRC in the first place, and it is likely paying dividends for them these days.

Nutrition

Seniors who live on their own right now also have to figure out how to keep their pantry shelves stocked with nutritious food. Some grocery stores are offering special hours for seniors to shop in an attempt to help them avoid large crowds, but there is still concern about potential exposure to COVID-19 when out in public.

Grocery and meal delivery services may be an option for seniors who live in cities, though likely not in more rural areas. This is a nice option for some seniors, but the fees can be expensive. And there is still some concern about whether proper sanitation precautions are being taken by personal shoppers and food delivery servicepeople.

Yet CDC statistics show that even before the pandemic, proper nutrition was an issue, especially for seniors who live in their own homes. Over one-third of adults aged 60 and over are considered obese, a number that is trending upward. But also, the number of underweight seniors also is trending upward, nearly doubling from 0.9 percent in 2007 to 1.7 percent in 2014. I imagine the lack of access to healthy food created by COVID-19 quarantine restrictions and concerns about safely shopping will only exacerbate some of these statistics.

Compare this to the meal services provided to residents of CCRCs. While communities have had to adapt to COVID-19 by closing their communal dining areas and cafes, or limiting them to take-out only, residents are still provided with professionally prepared food, often overseen by a nutritionist. In many cases, meals are being delivered to residents’ doorsteps by staff who are trained on sanitation protocols. Many CCRCs also are offering grocery shopping and delivery services to residents at no charge to ensure people are getting proper nutrition.

Care needs

According to the American Association of Long-Term Care Insurance, somewhere between 50 and 70 percent of people over the age of 65 will require long-term care services at some point in their life. This means they’ll need assistance with at least a couple of activities of daily living (ADLs), such as eating, dressing, or bathing, and possibly even a higher level of care. Others need help with instrumental activities of daily living (IADLs) like handling household finances, laundry, or other chores.

For those who live in their own home, those care needs don’t stop because there’s a pandemic. As Mr. Gould describes above, these seniors still have to worry about getting the utility bills paid on time or having an accidental fall at home. So, there are basically three options: either allow caregivers to continue to come in and out of the house, hire a full-time caregiver so they don’t leave the house (which would be exorbitantly expensive) …or forsake the care that is needed.

Of course, the latter is undesirable at best, and dangerous at worst. The former, however, is also potentially concerning when the caregivers visiting the house could be unknowingly carrying the COVID-19 virus. Not to mention that depending on the care needs and the service provider, it could be different caregivers visiting each time, further exposing the senior to potentially infected people.

Contrast this again to people who are living in a CCRC or other senior living community. CCRCs have strict protocols in place about staff-resident interactions right now. They are being diligent not only with infection prevention measures like sanitizing and PPE, but many have also implemented daily staff health screening procedures, like temperature checks, to help prevent the spread of COVID-19 to vulnerable residents.

No perfect solution

There are no simple answers to a problem as complex as the COVID-19 pandemic. It’s a difficult virus to rein in given its virulent nature and the wide spectrum of presentations among those infected — from zero symptoms to life-threatening complications. The majority of severe cases of COVID-19 — those requiring hospitalization and sometimes resulting in death — are among those over age 60. The situation is even worse for people with pre-existing health conditions.

For those seniors who are living in their own home, especially those living alone and/or in need of some level of assistance on a regular basis, it is potentially a very frightening time. In many cases, they are isolated from loved ones as well as their social support system. Some are worried about running necessary errands to the grocery store or pharmacy. Others are putting off important doctor’s visits for fear of crossing paths with an infected person. It is potentially a very lonely and stressful situation for them, and one that could have dire health consequences in the long-term.

For people who reside in a senior living community, there are concerns too since these communities are comprised of potentially vulnerable seniors living in relatively close proximity. Nursing home populations have been especially hard-hit by the virus, and those residents are oftentimes among the most at-risk of severe complications and even death if they become infected with COVID-19.

There is no perfect solution right now. But when you weigh the two senior living scenarios — living on your own in your home, or living in a CCRC or other senior living community — it easily could be argued that, on the whole, the pros of living in a CCRC still outweigh the cons and are preferable to the many challenges presented to those who are isolated in their own home right now.

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