Aging in place will create a crisis of opportunity for CCRCs

CCRCs as destiny? Unlikely. Over the past few weeks, various statistics have caused me to roll my eyes (40% of doctors now consulting online -- huh?). But this one got my attention: the Wall Street Journal article about Continuing Care Retirement Communities (CCRCs). The article, which was about financial risk, cited an AAHSA estimate that "at least 745,000 older adults live in [1900 of] these communities", comprised of independent, assisted living, and nursing homes. Given the 39 million people over the age of 65, even if CCRCs double in capacity before 2020, they will reach a small percentage of that year's 55 million seniors.

Assisted living or nursing homes? Unlikely.  Assisted living facilities, 39,000 of them serving 1 million residents, are now seeing the frail population that used to live in nursing homes and for various reasons -- state Medicaid funding cut-backs in nursing home payments coupled with a growth in Medicaid payments for home care -- the result is that nursing home beds are disappearing. But if you add everyone together, fewer than 10 percent of the senior population is in any of the above.

Retirement communities for the 55+? Not so likely anymore. Meanwhile, the love affair with 55+ communities has slowed to a low-growth crawl: as AgeLab's Joseph Coughlin's thoughtful article noted, growth in the previously popular retirement counties has stalled, right along with the economic flexibility of prospective 'retirees'. Home modification is in, moving is out. But today's boomer is tomorrow's senior (actually January, 2011, just 5 months away, when the first of the 78 million tip into a their demographic bracket.)* So what will happen to all these folks who want to age in place, mostly in the suburbs, in 10 years when the population of 75 and older will have soared, the population with dementia will have skyrocketed? 

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  Private pay home care costs will have caught up to today's assisted living.  Today's home companion care aides are the lowest paid workers in the US -- but Congress will have long ago passed a law (bill filed a few weeks ago) granting them minimum wage status. Along with regulations about working conditions (reviewed in 2011 and many times after), the world of home companion aides, managed generally by small business owners or franchisees, will become a regulated and increasingly high cost service, with 24x7 care available only to the wealthiest (as with private pay assisted living today) or certifiably poor.

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  Ramps'R'Us: Products and services fill in the gaps of home deficiencies. Given the vast majority of seniors will be living in the homes they were in a decade prior, the pace of home modification will have accelerated, providing a solid remodeling market. Devices that mitigate vision, hearing, dexterity, and mobility limitations will be booming categories, as will products (including cell phones) that integrate GPS tracking, fall prevention and detection, two-way communication, and emergency response. But none of the above will be enough to really keep seniors safe as they age at home in 2020 and beyond -- caught between their suburban locations and home care visits.

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  Home is where the sensors and cameras are.  Today, remote home activity monitoring is an at-the-margins industry, comprising fewer than 10,000 units (compared to a million or more PERS devices) in the US today -- provided by a handful of vendors. Few are sold directly to consumers, and product quality and safety are unregulated. Not so, in 2020. Prices will have fallen in inverse proportion to the cost of home care -- and upfront equipment purchases will be replaced with rental of devices that are consumer-installable in 1 or 2 steps. Television and internet providers will provide remote activity monitoring add-on subscriptions; service call centers will be cross-trained; sensors and home health devices will be FDA-approval mandated. And built in and well-placed cameras will be required to monitor senior well-being and home care aide job performance.

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  And will that be enough to age in place successfully? Even still, I think not for many. Aging in place will strand the 25% or more who end up alone -- at risk for social isolation, suburban sprawl transportation void, depression, confusion, undetected accidents, and poor nutrition. The frailer living with spouses and adult children will present a caregiving challenge that will exhaust and drain resources and the health of the caregivers, especially towards end of life, as 50% of the 85+ population suffers from at least some form of dementia.

Which brings us full circle to...the CCRC.  Within 10 years, the housing market will (hopefully) have recovered, new development with the services described in the Coughlin article will be ramping up again, and people will come to their senses and begin to back away from the oh-so-yesterday and lonely aging in place. And it will be in spite of the rise of home health and companion care, the evaporation of nursing homes, and the commitment of families. Instead, communities along the lines of CCRCs that are loaded with boomer-turned-senior-friendly technology, social connectedness, and educational opportunities will draw in a new wave of by then 75-plussers and beyond -- who look at their older friends and family in their homes, and say, not for me. But in the meantime, CCRCs have a decade to reinvent the services and cost models that will make their offerings appeal to more than 10% of the aging population.

*Beginning in 2011, 10,000 Americans will turn 65 every day, only half will maintain their standard of living in retirement, one in four will be dependent on government programs. Today, suburban populations are aging faster than those in the cities. Today there are 4.2 million people age 85 and up. Source: "The Futurist," Authors: Cetron, Davies; May-June, 2010