elderly are among the fastest growing segments of the population in the United States today. Moreover, this growth is projected to continue well into the mid-21st century as the baby boomer generation reaches retirement age. Although estimates vary, it is also projected that about one in five of this elderly segment of the population will need some level of alternative living arrangement, including residence in a nursing home or long-term care facility. There is a consensus that most elderly people want to remain in their own homes as long as possible, but there comes a time in many people's lives where physical or mental problems force them to move into some type of alternative living arrangement where the daily care they need can be provided. Because there are some inevitable adjustment problems associated with moving from independent living to an institutional setting, it is important for elders or their caregivers to select the least restrictive alternative living arrangements possible. The purpose of this study was to identify what alternatives are available and how many elders are currently relying on these living arrangements in the United States.
Elderly Living Arrangements in the United States
On the one hand, the types of living arrangements that are being used by the elderly (those 65 years and older) have become a hot topic in recent years (Goldstein & Damon, 1999). According to Kamo and Zhou (1999), "Living arrangements of elderly persons have been extensively studied in the United States. Particularly at issue has been whether the elderly live in an extended family household, a nuclear family household, live alone, or in an institution" (p. 544). As a result, there is a growing body of evidence concerning what types of living arrangements are needed by the elderly that indicates human capabilities are not predetermined by aging, but are rather a function of the interplay of physical health, behavior, and the environment (Bucher, 2005). On the other hand, though, while the living arrangements themselves have received a great deal of attention in recent years, less attention has been paid to the quality of life issues that surround these alternatives. In this regard, Bucher notes that, "Just as advances in medicine have created possibilities for men and women to experience aging more positively, the ostensibly more mundane physical settings of daily life shape life in ways that are often unexamined" (2005, p. 118).
One of the most important aspects of how the daily life of elders is shaped concerns accessibility to the types of care and services they require. In this regard, Durant and Christian (2007) note that, "It is a well-established fact that the United States is an aging society. Increasing longevity and life expectancy has increased the number of elderly persons with chronic health conditions who are in need of special social services and caregiving" (p. 37). Because the elderly segment of the U.S. population is projected to more than double by 2050, it is important determine what resources are currently available so that steps can be taken to ensure that the elderly have a sufficient amount of appropriate living arrangements available to them in the future, an issue that relates to the problem investigated by this study which is discussed further below.
At some point in the lives of many older persons, a precipitating event such as a fall causing a broken hip, the death of a spouse, or a combination of factors such as diminished cognitive abilities and increasing frailty compel these elders to make a hard choice about where they should live. In this regard, Cox (1999) emphasizes that, "The overriding desire of most older persons, including the frail, is to remain in their own homes. However, the ability of these individuals to do so is often restricted due to few housing options or alternatives" (p. 101). Moreover, there are a number of environmental factors that can affect the ability of the elderly to remain in their homes. For example, Heumann, McCall & Boldy point out that, "The very location of a home can be an impediment. Homes located in areas with high crime, high pollution, steep topography, no pavements/sidewalks and heavy traffic with no safe way to cross streets, are all examples that can limit mobility and trap the frail elderly person in their homes" (2001, p. 31).
Likewise, there are a number of barriers inside elders' homes such as staircases, insufficient heating and lighting and even the types of furniture and how it is arranged, can all contribute to making life too difficult for elders to remain in their own homes. Even if all of these constraints are addressed, there may be other limitations that prevent the elderly from remaining in their own homes past a given point in their lives. In this regard, Heumann et al. add that, "Certain forms of living arrangements -- be they alone, with family or strangers -- can limit the ability to empower a person with desired support options. Even homes that are adequately furnished and located can be impediments if they are too costly and difficult to manage and keep clean" (2001, p. 31). The alternative living arrangements that are available to elders are can no longer reside in their own homes span the continuum of care from absolutely no care provided to skilled nursing facility and hospice care where the elderly receive intensive healthcare services (Scheve, 2010).
Rationale for the Study
The elderly population in the United States is projected to more than double between the present and mid-21st century to around 80 million. By that year, as many as 1 in 5 Americans could be elderly. Most of this growth should occur between 2010 and 2030, when the "baby boom" generation enters their elderly years. During that period, the number of elderly will grow by an average of 2.8% annually. By comparison, annual growth will average 1.3% during the preceding 20 years and 0.7% during the following 20 years (Sixty-five plus in the United States, 2010). Unfortunately, although there has been an increasing amount of attention paid to just how many older people the United States will have in the future, there has been far less attention paid to the quality of life issues that surround the continuum of care that is offered in the various types of alternative living arrangements that are available for the elderly in this country. There have been some recent political and social trends that have made this type of analysis all the more urgent. For instance, Szinovacz emphasizes that, "The rise in alternative family structures (divorce, children raised by grandparents, stepparenting) and current political pressures to cut programs for the elderly and poor may pose a serious threat to the safety net of future generations of older persons and may place undue burdens on the younger generation, especially those who are single parents" (1999, p. 700). Taken together, the business axiom, "Prior planning prevents poor performance" is highly applicable to the need to plan today for the alternative living arrangements that will be required by the elderly in the United States in the future.
The need for appropriate housing for older adults has become the focus of an increasing amount of attention from the public and private sectors in recent years, and current trends indicate the problem of finding suitable living arrangements for the elderly is going to become particularly acute in the future. Currently, about 10 million people who are 65 years of age or older in the United States rely on care that is provided by family members, and this figure is projected to double by the year 2040 (Future needs for long-term care, 2007). Other current estimates of the elderly population in the United States are as follows:
1. The elderly population, ages 65-74 years represents 7% (18,759,000 people) of the total population;
2. The elderly population, ages 75-84 years, represents 4% (11,145,000 people) of the total population;
3. The elderly 85 and older are 1% (3,625,000 people) of the total population; and,
4. The total elderly population, aged 65 years and older, represents 13% of the total population (Rubin, 2009).
Figure 1. Numbers of elderly in the U.S. By age group as of 2009
Source: Rubins, 2009
Clearly, the tens of millions of elderly must live someone, and while the optimum choice for many is to remain in their homes as long as possible, age-related disabilities and diminished cognitive and physical abilities frequently require alternative living arrangements at some point along the continuum of care that is provided for the elderly in the U.S. According to Sheve (2010, "When older family members are still too independent for full-time nursing-home care, many need a much lesser degree of help with daily tasks. These tasks include bathing, cooking, eating, changing clothes and getting safely into and out of the bathtub" (para. 3).
On the continuum of care for the elderly, assisted living facilities fall in the range between independent living arrangements at home alone or with…