“Unmet needs,” a term gerontologists use, refers to care or help you require but don’t get. If, when you’re elderly or disabled, you aren’t able to shop or cook, you lack the strength to go outside, you can’t keep track of your bank account or your medications — and no one assists you with those functions — you have unmet needs.
Older people who move into assisted living and other forms of supportive housing are primarily seeking ways to reduce unmet needs. Occasionally, someone moves because he feels lonely or she is trying not to burden her children. But usually, people stay in their homes as long as they can until unmet needs pile up.
What I have frequently wondered – and I’m sure lots of you have, too – is how often those supposed solutions actually provide enough services to merit their very high price tags. When someone is spending $3,500 a month for assisted living – the national median, according to Genworth’s annual survey – are there fewer activities the resident can’t manage? Does he or she have fewer unmet needs?
A national study just published in The Journals of Gerontologysheds some light on this, so let’s take a look.
The study uses data from the 2011 National Health and Aging Trends Study and pays particular attention to more than 4,000 Medicare beneficiaries over 65 who reported having difficulty with daily activities or received help with them, but did not live in nursing homes.
The great majority (82 percent) still occupied “traditional community housing” (their own apartments, homes or condos), in line with national statistics. Almost 8 percent lived in retirement communities or senior housing complexes that didn’t offer much in the way of services. Another 4.6 percent were in independent living facilities, and 5.8 percent in assisted living.
In interviews, “they were asked about things they had to go without in the past month, because they didn’t have the help they needed or it was too difficult to do those things on their own,” said the co-author Vicki Freedman, research professor at the University of Michigan’s Institute for Social Research.
She and her co-author, Brenda Spillman, of the Urban Institute, measured what resulted: “having to stay in bed, not being able to leave their homes or buildings, going without eating, not being able to get cleaned up, a variety of consequences,” Dr. Freedman said.
Both authors have investigated aging issues for years, yet “what surprised us was the sheer amount of unmet needs,” Dr. Freedman told me.
The numbers are unsettling: Of those who had difficulty or received help, about 31 percent of those in traditional housing reported having unmet needs in the past month. But so did 37 percent of those in retirement or senior housing, who were significantly more likely than community residents to have gone without hot meals, to have been unable to do laundry or go shopping, to bathe or to go outdoors.
In assisted living, where meals and laundry are typically among the services provided, the rates increased still further: 41.5 percent reported a consequence in the past month. The biggest problem? Residents were significantly more likely than community dwellers to be unable to get to a bathroom promptly. One in five assisted living residents reported being unable to use a toilet before soiling or wetting themselves. (The data showed no significant difference in unmet needs between community dwellers and those in independent living.)
So on the face of it, this looks as though moving out of your house and into a retirement community or assisted living facility doesn’t do much for you: Unmet needs are actually more prevalent there.
But that ignores the fact that the people living in these various places are different. The study collected information on age, health and physical and cognitive function and confirms what we might expect: “Assisted living facilities serve a clientele that’s older, more frail, more likely to have dementia,” Dr. Freedman said.
When the researchers controlled for those variables, the differences in unmet needs pretty much evaporated. That is, people in senior housing and in assisted living didn’t report significantly more unmet needs or negative consequences, over all, than those living in their own homes.
In fact, after those adjustments, people in assisted living were less likely than community dwellers to have negative consequences like not going outdoors, not moving around indoors, not getting dressed or managing medications.
“They’re less likely to have unmet needs,” Dr. Freedman said. “Someone is helping them.”
Which looks like a classic good news/bad news finding. On the one hand, seniors and families are getting something for that $3,500 a month and more (frequently way more) in assisted living: Even though they are older and more physically and cognitively impaired, they don’t have more unmet needs than younger, healthier seniors in their own homes.
The bad news, though, is that unmet needs remain too high in all these settings. In their own homes, in senior housing and retirement communities, in assisted living, lots of people aren’t getting the help they manifestly need.
~Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”