The growing number of Solo Agers face unique challenges, especially when attempting to age in place in homes and communities ill-equipped to meet their changing needs. Senior living settings, with robust services and support systems for social engagement, already provide viable options for Solo Agers. With further enhancements to drive community citizenship cultures and innovative services, and a special emphasis on affordability, senior living can become a realistic alternative to aging alone.
senior living, community, community citizenship, services, Christian Living Communities
As a senior living professional for more than 25 years, I have always been curious about the choices and decisions people make about housing and care as they age. There are the “have to” decisions, mostly made by family members and based upon urgent care needs requiring assisted living or skilled nursing. And then there are the “want to” decisions, usually made by an older individual or couple, to move into residential or independent living. I often ask residents in our communities what prompted their choices.
One recent conversation highlighted the critical role that senior living can play in the life of a Solo Ager. A woman I’ll call Ruth explained that prior to moving into her life plan community, she and her husband had been living in a condominium in the area. With local family support, they thought they had a solid plan for the rest of their days. But then, Ruth’s husband passed away. After that, she said, the rest of her family “kind of disappeared.” She found herself alone and lonely. Her neighbors were nice enough but she said, “people who live in condos have their own lives, they’re busy. There isn’t a lot of opportunity for community building.” She realized she needed community, so she moved to a life plan community where she has friends—people, she said, “who really care about me like family.”
Ruth determined that her condominium neighborhood was lacking in the relationships, purpose, meaning, and belonging of a real community and set out to fill that critical need. She had identified what author and senior living strategist Ryan Frederick (2021) calls the critical role of place in healthy aging.
As Frederick (2021) described, place matters at every age. But as we get older, and especially if we’re aging alone, where we age can have a major impact on how we age.
Aging in the Right Place
The prevailing narrative of the ideal aging experience is “aging in place” in the home one has occupied for years, sometimes decades. The majority of older Americans say they plan to stay put as they age, and government policymakers and numerous businesses are focused on helping them do just that. In the media and in advertising, home- and community-based services are touted as the epitome of aging well. The problem with this scenario, Bill Thomas, MD, founder of The Eden Alternative and The Green House Project, explained to me in a meeting, is that both “home” and “community” are often inadequate.
Living a socially isolated life leads to myriad health concerns—from increased likelihood of dementia to a significant increase in mortality.
It is estimated that less than 4% of current housing stock is designed to support age-related changes in mobility, meaning that individuals may not have easy access to sleeping, cooking, and bathing areas (Molinsky, 2022). Some may not be able to navigate the threshold of the home to go outdoors. Outside the four walls of the home, many neighborhoods, especially suburban ones, are not designed for walkable or accessible community engagement. When interactions are automobile-based, long-held opportunities for meaning and engagement such as church and social gatherings often become more and more difficult to access as driving at night, or driving at all, may become impossible. On top of that, neighborhoods change, and long-term friends and neighbors pass away or move away. We can become, as architect, developer, and land planner Ross Chapin (2011) would say, “marooned on our own little island in a sea of houses.”
In essence, as we age our world can begin to shrink and, without moving to a locale that better meets our needs, we may end up living a life better described as “rotting in place” than “aging in place” (Kunkle, 2015).
Living a socially isolated life leads to myriad health concerns, from increased likelihood of dementia to a significant increase in mortality. This scenario is dangerous, especially for people aging alone who already may be at a disadvantage in terms of social engagement. An AARP study found that among those ages 50 and older, Solo Agers are more likely than others to report that they are lacking in companionship, are isolated, and/or feel left out (Thayer, 2021).
There are also stark, but often overlooked, realities of receiving care in the home. While the workforce shortage affects all aspects of aging services and support, the inefficiency of one-on-one care in physically dispersed locations makes home care more vulnerable to labor shortfalls than centrally located services. Workforce shortages were, in 2022, already leaving many older adults without needed care and services, and the need for in-home care aides is expected to grow exponentially.
The workforce shortage also drives up the cost of labor, meaning that available home-based services are becoming more and more expensive. Facing a of lack available and/or affordable services, family often fills the void. But for Solo Agers, who will be there to help? One AARP study found that only a third of Solo Agers ages 50 and older had someone who could help them manage household responsibilities if they were unable to do so (Jayson, 2022).
Frederick and Guest Editor Sara Zeff Geber (2022) are concerned about the headwinds facing all individuals, especially Solo Agers, when relying upon aging in place as a plan. In short, they say, it is not really a plan. It is denial.
This denial could enact a heavy toll on Solo Agers. One in 10 adults older than age 50 are textbook Solo Agers—they have neither a spouse nor partner nor children. That number increases to nearly one in four older adults when considering children from whom they are estranged or when children are either physically or mentally unable to provide support or could not be trusted to do so (AARP, 2021)
An Alternative to Solo Aging
Senior living settings offer one solution to the challenges of aging in place—the opportunity for a community-based life of freedom and independence with easy access to a safety net of services and support when needed. Weather constraints and other issues such as being unable to drive no longer preclude social gatherings and unit and building design, plus off-site transportation ensures easy access to amenities and medical services.
The ideal situation is a community offering Solo Agers multiple levels of care and services, where individuals can move in during the “want to” phase of life, immerse themselves in the social fabric of the community, and receive any future services on site in that same community. Most life plan communities have a strong culture of inclusion, where residents can continue to fully engage with friends and neighbors in familiar spaces.
For people with adequate financial resources, life plan communities make good sense as many contractually promise that under most circumstances the resident will never have to leave the community due to healthcare needs or financial circumstances.
When done well, senior living can go beyond solving the basic challenges of aging alone at home. It can truly become an alternative to solo aging. Senior living providers that embrace community cultures of belonging, citizenship, partnerships and innovation, and affordability can help Solo Agers build a web of support and live their best lives.
An intentional focus on belonging is essential. While it may seem that moving into a community would lead to social engagement, this is not automatically the case. Simple proximity to others is not enough. One study conducted in a life plan community found that one in four independent living residents was socially isolated (Stein, 2017). Another study, conducted in affordable housing, found that 70% of residents were moderately or severely lonely (Schoenherr, 2018). A third study estimates that 10% to 20% of senior living residents experience bullying behaviors from other residents (Kreimer, 2012).
Frederick and Geber say aging in place is not really a plan; it is denial.
While policies and grievance processes are sometimes touted as a solution to marginalization and isolation, it is only by creating a true community culture—one where healthy norms of inclusion are fostered and enforced by those who live in the community—that a sustainable culture of belonging will emerge. Artifacts of such a culture may include group dining tables open for anyone to join, structured ambassador programs to welcome new residents, and ongoing honest resident group discussions about belonging—what is going well, what is not going well, how might it be done better?
It is important that such work include traditional diversity, equity, and inclusion principles as well as addressing the stigma and prejudice that exist regarding dementia or the need for assistive devices. Education about supporting LGBTQ+ individuals is also critical. Ninety percent of older LGBTQ+ individuals have no children to help care for them, either because they are childless or because they are estranged from their families. They are also more than twice as likely than their heterosexual counterparts to live alone (The LGBT Older Adult Coalition, 2022).
Creating a culture of true belonging hinges on another critical shift that must occur in senior living: moving from a customer to a citizen model. The traditional model of senior living—that of a resort-style experience where one can put their feet up for the rest of their days—frames older people as nothing more than consumers, dependent upon the community for services and support. Concerns about the loss of independence are well-documented among all older adults. However, Solo Agers may be even more concerned than others about losing their independence. This makes sense given that “freedom to do what I want” and “not having to answer to anyone” top the list of the benefits Solo Agers say come with living alone (Thayer, 2021). This group of people is more likely to seek out, and demand, freedom and true agency in their living environments.
The citizenship model also is instrumental in creating an awareness of, and responsibility for, playing an active role in making the community stronger and more cohesive. Community builder and author Peter Block (2009) explained that there is a stark difference between citizens and consumers. Citizens have roles and responsibilities and accountability to the whole, while consumers become helpless and entitled.
Christian Living Communities, a nonprofit multisite organization based in Denver, has pioneered this model of citizenship—putting ownership for one’s life decisions and responsibility for the well-being of all into the hands of residents. In this model, staff are there to support, not serve. Rather than living in a community where decisions are made by paid staff, the residents, along with Christian Living leadership and team members, work together to create a thriving, welcoming community. This type of culture is extremely effective in meeting the needs for meaning and purpose.
My dad lives at one of the communities owned by my Christian Living Communities. He and my mom moved in six years ago, more for her well-being (she was living with vision loss) than his. But after my mom passed away, he became a variation of a Solo Ager and has said many times how grateful he is to be in a real community. There is a shared understanding of the reality of grief in a senior living organization. The community offers the kindness and support he needs as he learns to navigate the world on his own. And probably more importantly, he is a citizen of his community—he has meaningful roles to play in working with community leadership, mentoring team members, and up until recently, facilitating the resident assembly.
Opus Communities, an innovative model from 2Life Communities, a Massachusetts nonprofit senior housing provider, is taking citizenship one step further by making volunteer-based meaningful roles a requirement of residency. Residents must volunteer 10 hours per month—a model that not only provides meaningful purpose but also reduces the need for staff and keeps rates as low as possible for residents. 2Life calls the model a “kibbutz versus a cruise ship” (Schectman et al., 2019).
Partnerships and Innovation
In addition to culture work, providers must continue to enhance services and support to better meet the needs of people aging alone. While there are many supportive services in place in these settings, it has been my experience that there is a general underlying assumption that adult children will be available, willing, and able to help when needed. But what happens when there is no family available?
This gap in services became apparent to me when my mom had several emergency-room visits and a hospital admission. Even though she and my dad lived in a life plan community and a clinical liaison followed her progress and worked with the hospitals to ensure a smooth transition back to home, the majority of communication with the hospital, the social support during her stay, and the advocacy for her well-being fell to my dad, my siblings, and me. It was an extremely stressful time and, as my sister and I debriefed the situation, we were both troubled about our own futures. Being child-free, neither of us, nor our spouses, will have a support network. What will happen to us as we get older and possibly need acute medical care? Who will advocate for us? Go to doctor appointments with us? Visit us in the hospital?
Solo Agers are more likely to seek out, and demand, freedom and true agency in their living environments.
Senior living providers are well-suited to fill these gaps, either through internal services and amenities or strategic partnerships. Additional services in senior living communities may include care navigators and care managers, on-site medical clinics, educational programs, and assistance for residents who have not yet identified their desired healthcare supports. Facilitated workshops could help residents identify and formalize care networks of neighbors who are legally able to advocate for one another and provide agreed-upon support when needed.
Through strategic partnerships, senior living providers can offer services critical in keeping Solo Agers out of hospitals and in their familiar surroundings. For instance, Christian Living Communities has, for many years, partnered with Dispatch Health. The organization reduces emergency room visits by bringing that same level of care to patients in their homes. Under this model, physician-supported advanced practice providers make house calls equipped with the tools, technology, and diagnostic capabilities, including mobile lab and X-ray, to treat a wide range of illnesses—from urinary tract infections (the leading cause of infection-related hospitalizations in older adults) to influenza and more.
At the same time, community members and care teams can be kept in the loop and bring in supplemental services and supports as needed. This continuity of care and support is essential for those aging without traditional family support.
A discussion of senior living should never conclude without addressing affordability. As with most aspects of life and aging, options are more bountiful for those with financial resources.
It’s critical that policy makers and providers work together to identify more options for elders living alone. Traditional senior living, which is often all private pay, is beyond the financial reach of many older adults. To compound that, those who are not married and have no children have a high poverty rate (Liz & Dalaker, 2021). Affordable housing options are often standalone buildings, meaning that people needing skilled nursing or assisted living must leave their affordable community, which is disruptive for anyone, but more so for those making the move without a spouse or adult children.
One solution is to create communities that serve a range of economic needs and care levels. Christian Living Communities’ Clermont Park Life Plan Community in Denver is an excellent example of a community that supports older people with a wide range of financial needs. The community offers independent living options in HUD section 8, moderate monthly rentals, and life plan apartment homes. For people needing higher levels of care, there are limited PACE-funded opportunities and a Medicaid licensed skilled nursing community on site. This means most residents can live out their lives in the community, among friends and their “chosen family.” Christian Living Communities also operates two Medicaid-licensed assisted living communities in Colorado. While Medicaid-licensed assisted living communities are in short supply in the state due to poor reimbursement, these communities serve a very important need.
Innovative physical design also may help in meeting the needs of Solo Agers in senior living, especially those with limited financial resources. William Brummett Architects has created a new design called Hanai House (Concerto Consulting, 2022).
Hanai is a Hawaiian word meaning chosen family. The homes are designed for four unrelated adults with a shared kitchen and common area and a special focus on privacy, community, and meaningful roles. The homes can be standalone structures or part of a multiunit building.
When implemented as a living option in a senior living community, this design can provide for the human need for different levels of privacy and social engagement, including the small family environment of a home with easy access to larger social groups, services, and amenities. Brummett estimates the design could result in a reduction of nearly 30% in construction costs when compared to typical apartment-unit senior living design, which could then result in lower monthly service fees to occupants (Concerto Consulting, 2022).
As we age, it is critical for all of us to understand and plan for the critical role of “place” in our aging journeys. For the growing number of Solo Agers who are often lacking the support usually provided by adult children, it is even more important. Senior Living communities provide a viable alternative to aging alone by offering a community-based life of freedom and independence with easy access to a safety net of services and support when needed. By understanding the needs of Solo Agers and further developing culture, services and amenities, and a plan for affordability, these communities can help Solo Agers live their best lives.
Jill Vitale-Aussem is the president and CEO at Christian Living Communities in Colorado and author of Disrupting the Status Quo of Senior Living: A Mindshift.
Photo credit: Shutterstock/wavebreakmedia
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