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Eldercare Crisis
Moving the Elderly from Institutions to Their Own Homes

Could the era of nursing homes be coming to an end? WaPo reports that Washington DC has launched a new program to help the elderly residents of nursing homes move back into their homes. According to the piece, DC residents are taking advantage of the new support for home-based care, but the best news is that this move is part of a larger national trend:

[A]bout one-third of the people in nursing homes are capable of receiving services at home, [said John Thompson, executive director of the D.C. Office on Aging.]

The numbers are part of a movement away from institutionalization. In the past 20 years, the percentage of people 65 and older who live in nursing homes has steadily decreased, from 5.1 percent in 1990 to 3.1 in 2010, according to the Census Bureau.

During that time, there has been an estimated 125 percent increase in investment in keeping people in their homes and communities, said Elaine Ryan, AARP’s vice president for state advocacy and strategy.

We’d like to see this process continue (and it should be noted that insofar as the ACA is encouraging this, the law is having some good effects). At-home care is of course cheaper than hospitalization or institutionalization: an average annual per person cost of $30,ooo–$60,000 versus $110,000 in a DC nursing home, according to the WaPo piece.

More importantly, the dignity of being able to die in your own home, surrounded by loved ones, should be as widely available as possible. One way to help de-institutionalize eldercare while also shoring up financial support for struggling families would be to pay informal caregivers some kind of wage or tax credit for looking after elderly family members who need constant or daily attention. Given just how severe the caregiver shortage will be, and growing economic insecurity among the working-age population, incentivizing at-home care in this way could help kill two birds with one stone.

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  • Jane the Actuary

    Actually, I’m not really convinced that at-home eldercare is the way to go. If we’re talking about grandma living with her son or daughter’s family, that’s one thing (though in such a case, the “cheapness” of the care comes from the fact that the care is unpaid), but if it’s a matter of a “shut-in” as they used to be called, that seems pretty lonely to me, and fixing nursing homes to restore dignity seems a better way to go. I’ve also never understood how in-home care can be cheaper, for an individual requiring the same level of care, since there are no economies of scale to a 1:1 home health aide caring for a single elderly person vs. a more cost-efficient ratio in a nursing home.

    • Jim__L

      Well Jane, you’re welcome to go to a nursing home if you think that would work for you.

      I hope we never get to the point where a bureaucrat gets to make that decision for everyone.

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