Have you ever thought about what would happen if you or a loved one:
• Are they so afraid of falling in the shower that they stop bathing?
• Has food insecurity because they can’t get to the grocery store, can’t open cans or packages and are afraid to use the stove?
• Wear the same clothes for several days because they can’t carry the laundry basket down the stairs to the washer and dryer?
• Stop medication because arthritis makes it difficult to open pill bottles?
• Suffer from social isolation due to no longer being able to drive or navigate public transportation?
The U.S. Centers for Disease Control and Prevention defines aging in place as: “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” According to a 2021 AARP survey, 77% of individuals aged 50 and older reported that they wished to age in place.
At some point in most of our lives, we will be faced with aging-related choices that involve an older parent, spouse and even ourselves. Utah is currently the fastest growing state in the U.S. and, according to the Kem C. Gardner Policy Institute, will have more older adults than school-aged children by 2060. The need for home and community-based services will only continue to grow.
As people age, the choice for independent living can be challenging due declining health and mobility, which can affect a person’s ability to drive, cook, manage finances and maintain social engagement. In the 1980′s, federal and state agencies introduced home- and community-based service programs that support a person’s choice to remain living safely in an independent setting. These programs can help to prevent premature admissions to institutionalized long term care. In addition, the cost of home and community-based programs are significantly less when compared to facility based long term care.
The COVID pandemic has complicated access to services. Home providers such as personal care agencies are struggling more than ever to recruit, retain and maintain staff. While their services are in high demand, the job is hard, and the average pay rate is $11-$15/hour. A typical day for a personal care agency employee involves going into client homes alone, where they may encounter poor living conditions and clients who have cognitive and physical illnesses such as Alzheimer’s or are bedbound.
The shortage of personal care workforce not only affects current clients receiving services, but also the ability to enroll new clients from waitlists. Home- and community-based programs depend on and appreciate contracted providers, as they serve as the eyes and ears regarding client well-being. They are often the ones to first discover a client who has fallen during the night or notice changes that may need immediate medical attention.
Home- and community-based programs can provide in-home services such as assistance with bathing, laundry, proper nutrition, caregiver respite and companionship. These programs can also provide emergency response systems, shower chairs and safety grab bars. Most importantly, there is an assigned case manager or registered nurse who conducts an in-home assessment for program eligibility and then navigates through all existing insurances and program funding to coordinate recommended services.
Client choice remains priority. No one is forced to accept services they don’t want. It is considered a success when home- and community-based programs and services have been able to prevent a recipient from being prematurely admitted to long-term care or when they are able to die at home rather than in an institutionalized facility.
Salt Lake County Aging & Adult Services is one of 12 area agencies on aging throughout the state that operates home and community-based programs that serve the most vulnerable, medically frail, and homebound in our community who want to age in place. In addition, there are also programs, education and support for caregivers who are experiencing compassion fatigue and burnout. To learn more about and how to support these programs, contact your local area agency on aging.
Tanya Nagahiro is the Supported Aging Section manager who oversees home- and community-based programs for Salt Lake County Aging & Adult Services. She is a licensed social service worker who has worked with vulnerable populations for almost 30 years.