Home-based care providers are constantly pushing the idea of “aging in place.” But what sometimes goes overlooked is “aging in the right place.”

For seniors, the most immediate component to aging in place is having a home in which to grow old. After that, though, seniors — and the providers that care for them — must consider whether current surroundings best meet future needs, according to Bob Kramer, founder and strategic advisor at the National Investment Center for Seniors Housing & Care (NIC).

For home-based care to continue flourishing, housing may need to act as a pillar that every other senior care industry can lean on.

“I think one thing for home care providers to be careful of is embracing the concept that aging in place is always going to be good for their clients and, therefore, for their business,” Kramer told Home Health Care News. “Because even though that’s a really popular phrase now with politicians and policymakers, and everyone says we’re giving the consumers what they want, the real issue is obviously aging in the right place.”

In the next 10 years, the number of seniors experiencing homelessness in the U.S. is expected to nearly triple, according to a University of Pennsylvania study. The study was conducted just before the COVID-19 pandemic, which has since worsened the health of many U.S. seniors while exacerbating issues that lead to homelessness.

Boston-based 2Life Communities – a provider of affordable housing communities that works closely with home-based care providers – has eliminated using the term “aging in place” altogether.

“We use ‘aging in the community,’ because we think community is the right place to age,” Lizbeth Heyer, the chief of retail and innovation for 2Life, told HHCN. “The term aging in place refers to staying at home, maybe the one where you raised your kids or where you’ve lived all your life. But it may be a home that, as you age, may not physically or socially meet your needs.”

Founded over half a century ago, 2Life Communities is a nonprofit retailer and senior housing provider that houses over 1,600 individuals. Its main goal is to address two of the biggest issues facing seniors today: economic insecurity and loneliness.

Generally, 2Life views home care as one of the necessary “three legs of the stool” for senior care. But it views the other two legs of the stool, housing and social support, as equally important.

“Take the cost of personal care, though, for example,” Heyer said. “For individuals who are not Medicaid eligible, it’s a dealbreaker. I mean, it bankrupts people. And it forces people into nursing homes because they run out of money.”

Dr. Robert Schreiber, the vice president and medical director of the PACE organization Summit ElderCare – which works with 2Life – also sees economic headwinds as a threat to home-based care models in the future.

“Shelter is the key, essential ingredient,” Schreiber said. “And I would say that there’s multiple groups of individuals that, as they age, are going to be increasingly vulnerable. The lower- to middle-income types of seniors are at a very high risk of losing their housing due to health care costs.”

Developing an integrated model that includes housing and home-based care, Schreiber believes, is one of the ways to solve that issue.

“I work with a number of PACE organizations that have developed a housing-integrated health care model,” he said. “And it appears that people are dramatically better off. They’re healthier. They’re more functional. They appear to be able to stay out of the hospital. They don’t go to the emergency department. And most importantly, they don’t end up needing long-term care.”

How providers can adapt

For home-based care providers, an opportunity lies in viewing housing as the pillar of senior care moving forward.

“I think the opportunity for home care providers is to get into value-based care by connecting with providers that are truly dealing with population health management,” Schreiber said.

While emphasizing housing is a way to guide seniors to a better future, it can also guide home health and home care providers to a better future, so long as they’re willing to recognize the importance of the issue and adapt.

Kramer believes that the first step to adapting is an investment in technology.

“That’s absolutely key because they need to be able to be more efficient,” Kramer said. “Technology enables better matches, but it also enables greater efficiency and the use of your care teams.”

The next step is making the right partnerships.

“Whether they’re naturally occurring retirement communities or senior housing ones, there are many communities where there are significant concentrations of older adults,” Kramer said. “And again, those provide opportunities for home care and home health care providers to be able to provide services.”

That natural connection between the two is one reason why home care providers like the Chicago-based BrightStar Care are opening up their own senior living communities.

BrightStar has successfully built out senior living communities across the Midwest, allowing the organization to seamlessly pair home care with housing opportunities for seniors.

“Families wanted to be able to move their loved ones out of the home to something with more socialization, and they were looking for recommendations from us for assisted living, dementia and memory care communities in their area,” BrightStar Care founder and CEO Shelly Sun previously told HHCN, explaining her company’s reasoning for investing in housing.

Finding ways to attack the issue creatively could define the next era of home-based care and senior care overall.

“I think we’re going to see a lot of experiments moving forward. Some will work, some won’t,” Kramer said. “But my point is, on the one hand, this is where trends are going. On the other hand, because of limited and fixed incomes, providers are going to have to be creative in how they do it.”

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