I‘ve been promoting Aging in Place for years, mostly because it just makes sense. Sometimes people say my work has been ahead of the curve. I never thought it would take so long to see shifts, pushing me to study the barriers to change. A recent conversation helped me recognize three biases that are strong barriers to seeing home as the natural and expected place for aging and care.
1. Bias against planning. Most of us don’t plan hardly at all. This is not just about retirement or aging but almost everything: Think about how well the airlines do raising rates a couple weeks before every flight. Even the one you have been ‘planning’ to take on your vacation.
In addition the behavioral psychologists show it is really hard for us to see beyond our own experience. We don’t know what we don’t know and no amount of imagination can help us picture it. That makes it hard to plan. Since none of us has been old before, and the last generation really did not live as long as we are living, our experience does not provide the tools to see into our own future sufficiently to plan very well. And when there are negative feelings and even fear about the unknown as there are with aging, the tendency to avoid thinking about it means very little or no planning occurs.
The fact is, Health problems often appear suddenly. Even long standing conditions become problems quickly. Our tendency not to plan catches us off guard frequently. That is bias.
2. Bias that older people live in institutional housing. As people started to live longer, and with multiple chronic conditions that made living alone in a regular house not designed for this purpose difficult, we rigged up, piecemeal in unplanned stages over years, housing and care to deal with the issues. Now it is the norm. Most doctors and social workers and, unfortunately families, just assume this is the next step when health changes occur. (see bias against planning, above)
Getting from ‘assume’ to something different is hard. There is no real systematic alternative. That is bias.
3. Bias to focus on poverty in aging. A good deal of programming, policy and conversation regarding older Americans focuses on the ‘dual eligible’, those who are over 65 and income qualified for medicaid. Of course, helping older and poor citizens is a good thing. But as increased aging has moved from 71 (in 1965 when medicare was conceived) to 79 (and probably 84 for most Americans) poverty is still a priority problem but not the only problem.
Difficulty finding, navigating and managing the services available from government or private providers is not limited to people who are poor. Suburbs and commuter conceived transportation systems make getting around really difficult. Even older consumers with substantial savings can be forced from their home because they can’t get in and out and live at home safely. These are just some of the problems that cross financial boundaries. There is no question poverty compounds every problem.
But when problems are framed as ‘low income’ it colors the way everyone; consumers, policymakers and providers look at the issues. Not about me. Not about us. That is bias.
We are starting to see shifts now as more and more people and programming realize aging in place is not just the best and most desirable way for older citizens to arrange their housing and care but also the most practical and cost effective way. I focus on incentives because of their power to change behavior. But there are biases behind the barriers to change. We have to face them. And alternatives must be known, workable, attractive, affordable and in place before crisis. Bias can be overcome when concrete alternatives are easy enough to become the norm. That is a big job, but we can do it.