Barriers to Independent Living for Elderly

January 30, 1998 98-R-0161

(Revised)

TO:

FROM: Helga Niesz, Principal Analyst

RE: Barriers to Independent Living for Elderly

You asked for a brief description of the barriers to independent living for older adults and state or other programs that promote independent living and keep seniors out of nursing homes.

It appears that many senior citizens prefer to “age in place” in their own homes or in some relatively independent residential setting. They want to avoid going to a nursing home as long as possible. The state also has a policy and financial interest in seeing that its senior citizens live independently as long as they can and, when they can no longer live totally independently, that they have available to them a range of appropriate choices in a continuum of care options.

Barriers to independence include not so much age itself, but the ill health, frailty, increased need for medical attention, handicaps, and difficulties with the activities of daily living that are more likely to arise with advancing age. Another significant barrier can be lack of money. State programs provide financial aid and medical services, including long-term care, to low-income elderly. But many people are above the income and asset eligibility limits for these programs yet still do not have enough money to pay for expensive long-term home health care, housekeeping services, high-cost prescription medicines, or other medical services they need. Other barriers include lack of adequate transportation, lack of handicapped-accessible or senior-friendly housing in the private housing sector, and lack of family or social support that would enable them to continue to live independently. Sometimes elderly people who have become physically infirm or handicapped would like to stay in their homes, but the home needs renovations to make it handicapped accessible. Problems with home security or fear of crime in the community can also be barriers to seniors who want to remain living independently in their own homes.

The state provides very low-income elderly with financial assistance through the State Supplement Program, which augments the parallel federal Supplemental Security Income program (SSI). Low-income senior citizens can also qualify for food stamps.

Low-to-moderate income elderly can benefit from towns' circuit breaker programs, which give them a rebate on their property taxes if they are homeowners or their rental and utility payments if they are renters.

People who are not eligible for state assistance and own a home can consider a private reverse annuity mortgage (RAM). This is a mortgage for people who are “house rich” and “cash poor,” but do not want to sell their home and move to benefit from the equity they have accumulated. With a RAM, they can borrow the money in a lump sum or in monthly payments as needed for any purpose. The interest accumulates, but they do not have to pay the loan back until they sell the house or die. At that point, the debt is paid from the proceeds of the sale. Only a few lenders now make such loans. The federal government is starting a program to guarantee them.

The Connecticut Housing Finance Authority also makes very limited RAM loans, for a term of only five years and only to pay for long-term care for people who are under certain income limits.

HOUSING AND HEALTH CARE

People who want to stay in their own homes and need some type of long-term medical care or assistance with the activities of daily living can of course directly employ someone to provide these services if they can afford it. For people of more limited means, the state's Connecticut Home Care Program for Elders pays for home health care and homemaker services provided by a licensed home health agency. There are two parts to this program. One part, funded by Medicaid, pays for services to people who meet Medicaid's income limits. The other, state-funded portion pays for those who are above Medicaid limits but whose assets are under $15,804 for individuals and $23,706 for couples. There is a graduated scale of co-payments based on what these clients can afford. But it appears there are limits to what this program pays, which can result in the individuals having to go to a nursing home.

Another option for people still living at home who have some family or other support is to go to an adult daycare center during the day and return to their own home at night. The homecare program pays for an adult daycare center if it is appropriate for those who qualify financially. But most adult daycare is paid for privately.

Seniors who qualify financially (up to 80% of the area median income) and do not want to, or cannot, keep up their own home can live in public elderly housing, which provides only independent housing. For people who qualify financially but need a little more help, there is state-assisted congregate housing, which provides some housekeeping, limited personal care services, and at least one meal a day in a common dining room. The state Rental Assistance Program (RAP) provides a partial subsidy to low-income residents of elderly housing and congregate housing.

For people who need additional help, including more “hands on” nursing services, but do not yet need a nursing home, there is “assisted living.” These services are generally offered in a “managed residential care community, “ which can be a rental complex or other usually high-end retirement community. For instance, a number of continuing care retirement communities (CCRCs) provide assisted living services to their residents. CCRCs receive no state assistance and usually require an entry fee of $100,000 or more and a monthly fee of from $1,000 to $3,000. But they guarantee long-term care, usually in an attached or affiliated nursing home if it is needed. These high entry and monthly fees usually prevent lower-income seniors from choosing this option.

Medicaid, which pays for homecare for some low-income people, does not pay for assisted living services. The 1997 legislature authorized funding for a pilot program to bring assisted living services to lower-income people living in one state-assisted congregate housing complex.

Providing a whole range of these different living options for people at all income levels is one way of delaying or preventing more entries into nursing homes.

Transportation is a problem for many elderly. Some older people are unable to drive because of illness, frailty, or finances. Some of them, particularly older women, never learned to drive. And public transportation is not always available, convenient, or adequate. Finances may prevent frequent use of taxis and there may not be relatives or friends available to take them to doctor appointments or shopping. Dial-a-ride programs attempt to fill in these gaps, but their funding is limited.