Posted on May 28, 2024

By Rebecca Kasey, CQL Director of Personal Outcome Measures®

‘Aging in Place’ is the idea that you can stay in your own home as you age. This may require home modifications, adaptations, technology, new supports, and future planning. This article will review data from CQL’s Personal Outcome Measures® to discuss the outcomes of older adults and will then feature tips from CQL’s partner organizations and a state system on how to support people to stay in their homes as they age.  

Only 1 in 5 Older Adults Chose Where and With Whom They Live

By Carli Friedman, CQL Director of Research

Older adults (65+) face disparate outcomes compared to younger adults (<65). For example, when I analyzed Personal Outcome Measures^® (POM) data from approximately 6,000 people with disabilities interviewed between 2018 and 2023, I found older adults (65+) with disabilities were significantly less likely to live in integrated environments, participate in the life of the community, and choose where and with whom they live compared to people with disabilities who were not older adults (<65). For example, while 29.5% of people with disabilities less than 65 years old choose where and with whom they lived, only 20.4% of older adults with disabilities did. 

Outcomes by Age Group

This is likely attributed to the fact that older adults with disabilities were significantly less likely to receive individualized supports in these areas. For example, for every one-year people with disabilities increased in age, their odds of being supported to choose where and with whom they live decreased by 1.2% and their odds of being supported to live in integrated environments decreased by 1.4%. While this may at first appear to be a small number, over a lifetime it can significantly add up. For example, the probability of 18-year-old people with disabilities being supported to live in integrated environments is 54.3%. However, by age 65, the probability of people with disabilities being supported to live in integrated environments reduces to 38.1%. By age 80, the probability decreases to 33.3%. This is despite people with disabilities preferring to live in integrated environments and to age in place! 

Probability of Individualized Supports Being In Place By Age

Despite the lack of supports, person-centered supports can be tremendously impactful, especially for older adults with disabilities. In fact, when individualized supports are in place, older adults with disabilities are 41.7 times more likely to participate in the life of the community, 89.7 times more likely to choose where and with whom to live, and 93.5 times more likely to live in integrated environments.

Probability of Older Adults Having Outcomes Present when Supports Are In Place

When we listen to older adults about what they want and need, and provide them with person-centered supports, they are not only able to age in place, but thrive in place.

Tips to Support People to “Age in Place”

CQL interviewed several partner organizations and a state system to discuss tips for supporting people to “age in place”. A special thanks to all of CQL’s partner systems and organizations that contributed to this article: 

• Kim Zoeller, President & CEO, and Sharon Anderson, Director of Quality and Strategic Initiatives, at Ray Graham Association (Illinois) 
• Kristen Otto, Vice President of Professional Services, Emory Valley Center (Tennessee)  
• Mary Anne Tolliver, Director of Aging Services, St. Louis Arc (Missouri) 
• Miya Bassarath, Vice President of Policy and Organizational Development, The New York Foundling (New York) 
• Nancy Maier, Director of the Aging and Adult Services, and Erica Reiner, Nurse Administrator for the Adult & Aging Services, for Aging & Adult Services Section of North Dakota’s Health & Human Services (North Dakota) 

Supporting People as Needs and Desires Change

Providers and systems that have effectively supported people to age in place overwhelmingly mentioned that this was not a program, it was based on meeting the needs of people they already supported. Ray Graham Association said that this is not necessarily a program, “it’s a philosophy that centers around the Personal Outcome Measures^® that we use to support people to have customized plans to help them with what they want in their lives.”

Emory Valley Center echoed this statement explaining, “we don’t have a formal program in place, rather, our goal is to always support all people to remain in their homes as they age.” As the St. Louis Arc explains, “We have evolved and changed according to the needs of the individuals we are supporting.” The New York Foundling also acknowledged the need for people they were currently supporting by “recognizing and ensuring accessibility and inclusivity within residential home environments. These were paramount for promoting independence, safety, and individuals’ well-being, especially with aging.” Nany Maier and Erica Reiner from North Dakota’s Health & Human Services Adult & Aging Services Section explain that it has always been the mission of their services to make sure that “older adults are able to stay independent in their homes and live in their community as long as they want to.” 

Focus on Accessible Homes and Services

“Aging in Place” is reliant on ensuring people have accessible and safe homes and services are provided where the person wants live and participate in community life.  Ray Graham Association supported people to live where they wanted as they aged by building it “into strategic priorities as an organization, with a real focus on accessibility with the thought that people can age in place whenever possible.” Ray Graham “launched a capital campaign to acquire or renovate homes” based on the needs of the person and to focus on universal design and accessibility. Ray Graham has applied for Community Development Block Grants to renovate the homes of people who would like to remain there as they age, this has led to adding elevators, changing flooring, and ensuring people can stay there as long as possible. 

As Emory Valley Center explains, they support people to  ‘age in place’ and this includes technology, adaptive equipment, and environmental modifications like roll-in showers or widening doorways. 

St. Louis Arc explains that “Home modifications have been completed to provide more accessibility, such as moving laundry up to the first floor, increased lighting, and changing the floor from carpeting to laminate.” The St. Louis Arc has also modified staff hours to fit the changing schedules and needs of people who are aging; they have hired LPN’s to assist with expertise and hired a Registered Dietician. Training is occurring in specialized areas, there is a Holistic Aging Committee that reviews restrictions, and the St. Louis Arc has partnered with other service providers within their area. 

Other providers and systems have explained the need for accessible homes and services, with the New York Foundling explaining this is “paramount for promoting independence, safety, and individuals’ well-being, especially with aging. Implementing age-in-place features such as accessible elevators, ramps, and open floor plans facilitates easy navigation and autonomy in daily activities, contributing to enhanced quality of life for our individuals.” The New York Foundling has also installed specific lighting features for those that need that adaptation. They have updated flooring options for enhanced safety and they have created multi-sensory gardens to offer therapeutic spaces.  

State systems have also focused on home modifications, as North Dakota’s Health & Human Services Adult & Aging Services Section has seen a 43% increase in the number of people using home and community-based services. Each state has an assisted technology organization and North Dakota has used their services to help seniors who need basic equipment or specialized equipment. These organizations can assist people with getting equipment like grab bars, reachers or grabbers, lighting options, and smart home features.

Utilize Technology and Adaptive Equipment

The speed of technology changes has truly impacted people’s ability to live more independently in their homes. Ray Graham Association mentioned remote supports being a technology that is being used more often. As Ray Graham Association discussed, remote supports are increasingly used to support people “to accomplish what they wish to do, and try and find the right technology for the person”. 

Emory Valley Center discussed more readily available remote supports and explained that they support “several people who use Alexa as a reminder for daily things they would like to do, or need to do.” Emory Valley Center also explained that people use personal pendant systems, sensors for people getting out of bed who are at risk of significant injury from falling, and ensure that people have specialized technological supports.  

The St. Louis Arc explained that many of the people they support “…have gravitated to using tablets and AI assistants, such as the Echo Show for reminders, music, and connecting to family.” Other than using these technologies, people use hoyer lifts for safe transfers non-invasive sensors for safe sleeping, low-tech graphics and visual strips, and a multitude of adaptive equipment from “weighted spoons to walkers, to gait belts and wheelchairs, installed ramps and modified restrooms and showers with walk and roll-in abilities.” The organization uses OT assessments and home safety assessments to better understand the needs for technology and adaptive equipment.  

The New York Founding discussed installing an accessible elevator with lights and auditory announcements and how they have used technology and adaptive equipment like home devices, medical alert systems, and telehealth services. 

North Dakota’s Health & Human Services Adult & Aging Services Section mentioned how they assist people with emergency response systems; some of their services use virtual supports, and they have excellent ways for people to use a phone number to easily find services for which they may qualify. The use of smart homes, technology modifications, and adaptive equipment has increased within North Dakota, with the system explaining they have completed more modifications within the last year than they’ve ever done.

Create Partnerships with Other Providers

Due to the complex needs of people as they age, providers and systems have to partner with other organizations across their communities to provide the right services to people. Ray Graham Association mentions this and explains that “Over the many years, connection and partnership with hospice agencies has been key.” They also mention how partnerships with hospitals, specialists, and funders have led to more people being able to age in their homes. 

Emory Valley Center provides insight on the changing partners that organizations have, explaining that “Everything is very person specific based upon wants and needs … in the past, it seemed like as people aged the nursing home was the only answer for the care they required. We’ve evolved in the way we think about services as a whole, which is a great thing!” 

The St. Louis Arc echoes the need to partner with hospice and palliative care agencies, explaining that “Hospice is often intimidating to our younger staff, but after receiving education and providing increased management support, the teams prosper and generally feel privileged to have supported people through their final journey in life. They are also given the opportunity, with no judgement, to transfer to another location. This is seldom chosen. Loss and grief training have also been provided to both the staff and people we support.” 

North Dakota’s Health & Human Services Adult & Aging Services Section mentioned partners within the government, as well as providers and additional agencies. One of the areas that the Section highlighted is that people do not just go into nursing facilities now, because of the options available across their communities to stay in their homes and receive services there.  

Final Thoughts

CQL’s partners have provided practical tips for individualizing support to help people “age in place” by staying in their homes and communities. Partners focused on meeting people where they are and supporting them as needs change, focusing on accessible homes and services, utilizing technology and adaptive equipment, and creating partnerships with other agencies. The partner organizations also provided several suggested resources, which can be found below. 

Useful Resources and Information

CQL Resources:

• The Relationship Between Ageism and Ableism 
• The Quality of Life of Aging People with Disabilities with Higher Support Needs 
• Aging in Place: Home and Community Based Services for Older Adult 
• Older Adults: Evolving Outcomes and Supports 
• Understanding Outcomes for Older Adults  

Suggested Resources from Contributing Partners and System:

• Adult Down Syndrome Center | Advocate Health Care 
• National Association for Down Syndrome | Adult Down Syndrome Center 
• Thinking Ahead Planning Tool: Thinking Ahead — My Way, My Choice, My Life at the End 
• Falls Prevention Awareness Week Toolkit 
• Older Adult Falls | Fall Prevention | Injury Center | CDC 
• Falls and falls prevention | National Institute on Aging  
• National Task Group on ID and Dementia Practices – NTG – Early Detection Screen for Dementia 
• North Dakota Adults & Aging Website 
• North Dakota Adults & Aging – Homecare 
• North Dakota Aging & Disability – Resource Link