Aging in Place in China and Vermont
By Julia Hayton, AHI
In the coming decades, the world will experience a dramatic rise in the overall population of seniors and the percentage of the population that consists of seniors. These seniors will need supportive services and health care, but few countries are prepared to deal with the increase in demand for these services. Traditional senior support methods center around a senior “aging in place” by living with children or other relatives as they age. This provides seniors with an in-house support network to help them with daily living and medical care as they become frail. However, the increase in the senior population even as overall population growth slows has created an ever-widening ratio between seniors and their younger relatives. In countries like China and the United States, traditional senior care through cohabitation is becoming unsustainable. More and more seniors are left to their own resources, and have to depend on government programs or private institutions like nursing homes.
Nursing homes have long been established in the United States and Europe, and are gaining in popularity in China and other newly developed or developing nations, but they are also expensive when regulated strictly, and potentially inadequate when regulated loosely. In the United States, the average annual cost of a nursing home resident is $70,000. In China, some people feel there is a stigma attached to entering a nursing home, as it reveals that a senior has no family able and willing to take them in. Nursing homes are also loosely regulated, and the quality of nursing care can range from world class to barely adequate, depending on the cost of the nursing home. Nursing homes cannot solve the senior population boom problem: they are too expensive for many seniors to afford on their own, and too expensive for governments to fund for the total needy elder population.
When adult children can no longer support their parents and grandparents at home, and when seniors lack the resources to provide for their own care at home or in institutions, countries must develop new senior support programs that allow seniors to age in place. If senior social services do not increase to match the growing elderly population, elders or the social institutions that serve them risk bankruptcy. China and the United States are both struggling with this problem, and have formed two different approaches to the solution, both involving senior supportive services in seniors’ own homes. In China, neighborhood committee organizations are assuming responsibility for supporting seniors without the resources or family to support themselves.
In the United States, the state of Vermont has an innovative public-private partnership to help eligible seniors age in place in supportive housing, keeping them out of expensive nursing homes and allowing them to live independently for longer. Called The Support and Services at Home (SASH) program, it provides supportive housing to low-income seniors who are eligible to receive Medicare benefits. Supportive housing as a preventive care measure saves costs down the road. Through programs that encourage healthy living, medication management, fall prevention, and other preventive measures, the SASH model lowers the rates of expensive and debilitating emergencies like strokes. The United States will have to spend ever more on health care in the coming decades, making preventive care measures even more important, as they are cheaper and more effective than waiting until seniors are ill enough to qualify for emergency services.
Other programs have duplicated SASH’s supportive housing model, but what makes SASH unique is its public-private partnership. SASH is funded through the federal Medicare program and Vermont’s Medicaid system, making it a partnership between the federal government, Vermont’s Departments of Aging & Disability and Health Access, and Cathedral Square, the private non-profit organization that delivers the SASH program. Public-private partnerships will become more important as health care costs rise; states have already seen greater and greater percentages of their budgets to go their Medicaid programs, and as the senior population booms the trend will only pick up speed. With public-private partnerships, government organizations can fund socially-motivated private enterprises (such as SASH) once those enterprises demonstrate that their model (like aging-in-place with supportive housing) is cost-effective and delivers good outcomes. In effect, the private sector does the research and development for new programs so that governments can then choose the most effective ones and scale them up with government funding so they reach larger populations.
Scalability is a particular problem in China, which has an enormous and varied population; one solution they have implemented relies on local neighborhood committees to provide door-to-door senior support. In 1990, the Chinese City Neighborhood Committees Organization Law formed neighborhood committees that are tasked with supporting residents, including the elderly. These neighborhood committees take on some of the elder care duties for older residents without live-in family caretakers, providing services to elders while they age in place in their homes. Although many of these committees provide needed and valuable services to elders, the level of services provided by the neighborhood committees are not standardized, and vary widely across neighborhoods. They are also largely staffed by volunteers who do not receive state funding, limiting the resources they have to draw on. China’s government should recognize the important role these neighborhood committees are fulfilling; by standardizing minimum levels of support across committees and increasing funding to the committees, the government could build a community-level network to provide comprehensive care to elders who lack family support.
China and the United States are both focusing on aging-in-place programs funded in part by the national government, but will need to expand these services to cover the coming senior population boom. China’s neighborhood committees show promise, but as of yet have no standardized levels of care and little state fiscal support. Vermont’s SASH program is a proven intervention, that is potentially replicable in any state because of its federal funding, but currently serves only a fraction of the total elders in the United States. Both countries must find a solution and find it quickly, or risk a staggering rise in elder poverty and a massive drain on state resources.