Figure 1: Projected Population of Older Adults by Age Groups in the United States
Figure 2: Projected Total Older Adult Population in the United States
25,000
83,739
79,719
20,000
72,774
55,969
15,000
43,145
10,000
5,000
2012
2020
2030
2040
2050
0
2012
2020
2030
2040
2050
Note . Adapted from Ortman, J. M., Velkoff, V., & Hogan, H. (2014). An aging nation: The older population in the United States. Retrieved from https://www.census.gov/prod/2014pubs/p25-1140.pdf.
65-69 years 85 years and older Note . Adapted from Ortman, J. M., Velkoff, V., & Hogan, H. (2014). An aging nation: The older population in the United States. Retrieved from https://www.census.gov/prod/2014pubs/p25-1140.pdf. 70-74 years 75-79 years 80-84 years Trends in living situations Living environments for older adults are comprised of multiple locations. Currently, 13.3 million (29%) older adults who are not residing in a facility live alone in a private house in the community, with 81% of those people being the owner of their home (AOA, 2015). This number is expected to increase, especially because Baby Boomers do not consider old age to begin until the age of 72 (Cohn & Taylor, 2010). Multigenerational housing situations are also on the rise, where older adults live with children and grandchildren under the same roof (Taylor et al., 2010). Older adults may also reside in 55+ communities, independent living facilities, assisted living facilities, personal care facilities, memory care units, and long- term care, depending on the level of assistance they require to complete their activities of daily living (ADLs). Communities advertised as 55+ resemble a neighborhood typical for the area. One of the more common configurations is that of a suburban subdivision with single-family homes. These homes may be designed in a variety of styles, but most tend to be ranch-style, single-floor dwellings. These communities have regulations regarding the age of people allowed to live in or visit the community for extended periods. The neighborhoods often offer certain home maintenance services. Many such communities place time restrictions on the length of visits of children under the age of 13, and will offer lawn keeping services as part of the homeowner association dues. These are still considered private homes in the community, and any services, such as light housekeeping, are contracted from outside agencies at the discretion of the individual. Independent living facilities are apartment buildings or might be a cottage-type house with no yard. People have the option to purchase services from the facility, ranging from light housekeeping and linen service to transportation and meal plans in a cafeteria or dining hall. Residents have access to a variety of social programs and other activities at the facility. The appliances within the units vary; most people will have either a kitchen or a small kitchenette. Independent living facilities normally provide access to community laundry machines with posted hours for use, though some people may have hookups for these appliances located within the apartment itself. To be eligible for independent living, prospective residents must not require any assistance with ADLs or be able to manage with an externally paid aide, who may visit for a couple of hours a day. Facility staff does not provide supervision as a matter of course. Many people choose to move into an independent living facility when they no longer wish to cook, maintain their home, or care for their yards. Other people are forced to move into the facility due to an inability to perform the above duties, or when they become homebound due to physical structures within their home, such as steps at the entry.
Assisted living facilities and personal care units are two terms used interchangeably, despite some differences between them. In practice, many can be indistinguishable from each other, but they are registered under different licenses by the state licensing boards. Both provide assistance with ADLs and can address medical issues; however, assisted living facilities are meant for people with more complex medical needs. People residing in personal care units will require staff supervision, but often hire external assistance to meet their needs. Although it is not a requirement, many assisted living facilities will have a director of nursing and provide health and personal services. To be eligible for an assisted living facility, a potential resident must require assistance for at least two ADLs a day, and have a need for 24- hour medical supervision by a skilled professional. The physical setup of assisted livings vary; many apartments are single rooms with a bathroom, sink, and fridge, much like a college dorm room. Some people have a roommate who is not their spouse for financial reasons. Others may have a small kitchenette and a living room, in addition to the bedroom. One facility the author worked in had five community bathrooms for thirty residents. As one can imagine, leaving a two-story home to move into a one-room assisted living apartment because of newly required assistance after a fall at home is not an ideal situation. Memory care units are specialized units in assisted living facilities for people with dementia who wander, are at risk of elopement, or have minimal but controllable dementia-related behaviors. These lock-down units have specialized nursing staff. The environment should be calming and provide visual cues to orient people to their surroundings and reduce confusion. Long-term care facilities used to be called nursing homes. Nowadays, they are often a unit within a skilled nursing facility. People move onto these units when they require 24/7 care at a higher level than can be provided at an assisted living facility. Insurance may cover part or all of a long-term care facility room, but rarely covers the cost of rent at an assisted living facility. Therefore, people may reside there for no other reason than that they cannot afford to live elsewhere. Also on the rise are continuing care communities, which have components of all the aforementioned residences. These communities intend for someone to move into the 55+ community portion, then progress to independent living, assisted living, and long-term care, as his or her needs change. This provides continuity; many of these communities have provisions for long-term residents that allow them to remain in the community even when funds become limited. These communities also typically include amenities, such as banks, pharmacies, physician’s offices, convenience stores, fitness centers, and active social programs.
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