It’s likely you’ve heard the phrase “It takes a village” when it comes to raising children. But for those of us going through “aging in place” (either for ourselves or our loved ones) we know it often takes a village to provide support and services to older adults living in the community. No one person or even one family can easily manage it all, though at times circumstances may force them to. And while there are community supports and programs available to address specific needs, there are rarely comprehensive and coordinated programs that knit together a seamless system to address both medical and non-medical (but often equally important) needs. As one commentator recently wrote, “Aging in place is all the rage, but it is not easy.”

There is one program available that does attempt this seamless support, but it is not widespread or even advertised. The program is called PACE (Program of All-Inclusive Care for the Elderly) and is jointly funded through Medicare and Medicaid. The goal of the program is to allow older adults to continue living in the community even when their needs suggest that they would be eligible for admission to a skilled nursing facility or nursing home. The comprehensive array of services through PACE includes everything from primary and specialty medical care to transportation to help with meal shopping and prep to prescription drugs. You can get a quick overview of the program by clicking here. Sounds wonderful, right? The problem is that the program is not widely available. Only about 60,000 older adults are currently served by this program and 21 states don’t even have it. And with all the care and support the program provides, you would think that it costs a lot. But in fact, data suggest that PACE programs cut hospitalization and ER visits, shorten nursing home stays, and even help enrolled patients to live longer. In essence, despite the up-front costs, PACE programs end up saving these systems money. Patients who don’t qualify for Medicaid can still buy into programs for a monthly cost. While the number of programs is expected to increase over the coming years, unfortunately, the available support in no way meets the needs of the millions of older adults who want to stay in the community but need help to do so.

So what else is available? As we’ve previously mentioned in agebuzz, there are “village” programs in many communities, either run by volunteers or paid organizers, that allow older adults in the community to network, swap ideas and resources, and support each other while living in the community. In fact, there is a nationwide “Village to Village Network” that provides support to individual community-based programs and can help you locate a program in your area. Volunteers are usually older adults as well, though there is a trend beginning of younger members of the community also volunteering, especially as they see the value of this resource for themselves as they get older. However, not unlike PACE programs, these Village programs serve only a small group of seniors, especially white, middle-class communities which is where they got their start. While there are now over 40,000 people belonging to this community support program, the reality is that it remains a “boutique” option available to only a select few. Moreover, many of these programs lack sustainable funding or need to look for community partnerships to keep them going financially. 

However, some Medicare Advantage programs are showing interest in just such partnerships and now have permission to provide non-medical benefits to their customers well beyond the traditional Medicare program. Nearly half of all Medicare enrollees get their coverage through Medicare Advantage, so this may be a growing area where non-medical community supports can mesh with more traditional medical care to keep older adults healthy and thriving in the community. One such “perk” that many Advantage programs now offer is a collaboration with Papa, a community-based companionship program that provides surrogate “family” companions to older community-based adults. These companions are available to run personal errands, take up light housekeeping, or just lend an ear and provide a comforting presence. While the goal of these companionship “pals” is noble, there is some concern that the private insurers who run Advantage programs are using Papa companions to gather data and potentially make more profit off their customers. So while it’s valuable that the social needs of enrollees are being met at the same time as their medical needs, there must of necessity be a watchful eye over these collaborations to make sure the needs of the enrollees are front and center when a companion pal stops by.

But all of these programs are limited in scope and availability right now. That means that millions of older, community-dwelling adults struggle to get basic needs met- getting to appointments, paying for medications, easing social isolation- and at best have a patchwork of community services that are already stressed from insufficient funding and staffing. It’s not easy aging in place- and not cheap either. While it may be the desired place to live out your life, that may also come at the cost of having needs unmet or family members extremely stressed.