Most experts in the aging services field agree that senior isolation is a major problem in the United States. The solution is largely up for debate, but home care companies of all shapes and sizes have a business- and mission-driven mandate to combat the problem.
Socially-isolated older adults are individuals who rarely leave their home or visit with loved ones because of frailty, economic standing or other unique circumstances. Compared to seniors who have maintained strong social ties, those who live in isolation are more likely to be sicker, die sooner and have higher health care expenses, past studies have found.
Tackling senior isolation has become a priority for many in-home care providers in recent years, from large franchise-based companies like Cincinnati-based FirstLight Home Care to small but growing operations like Edina, Minnesota-based Lifesprk. It’s also been an important point for Lafayette, Louisiana-based LHC Group (Nasdaq: LHCG), one of the two largest home health providers in the nation.
In fact, the desire to solve senior isolation has played a significant part in its strategy to further grow its home- and community-based services division, Don Stelly, LHC Group’s president and COO, told Home Health Care News. LHC Group added to the segment when it finalized its merger with Almost Family earlier this year.
“We saw this need to expand our breadth of services to these senior populations outside of the normal skilled service,” Stelly said. “We took that opportunity about three or four years ago and decided this is where the mainstream of our services needs to move toward.”
The exact number of older adults living in isolation is unknown, but it could be as high as 14%, according to a 2017 report for the AARP Public Policy Institute.
Overall, social isolation and its health consequences costs the Medicare program an estimated $6.7 billion in additional spending every year.
“Senior isolation has always been an issue, but I think it’s increasingly becoming a bigger issue because we’re in this period where aging in place is where the whole story is,” Howard Gleckman, a senior fellow at The Urban Institute, told HHCN. “Nobody wants to go into residential care and everybody wants to stay where they are. In theory, that’s all fine, but living at home … it’s a real challenge.”
Isolation ‘a real issue for seniors in this country’
In any given year, LHC Group admits about 300,000 patients across its home health, hospice and personal care services operations in more than 780 locations in 37 states.
More than one-quarter of that population population lives alone, according to Stelly.
“[Isolation] is something we take extremely seriously as we develop our plans of care and work with physicians to make sure patients stay independent and living the best life they can in the confines of their own home,” he said. “This is a real issue for seniors in our country, and it’s an issue that’s at the heart of our mission.”
As a company, LHC Group addresses senior isolation in a variety of ways through its home- and community-based services division, as loneliness typically develops long before a defined medical condition requiring skilled nursing comes into play. The provider’s more routine efforts include helping aging seniors with activities of daily living to make them more mobile, taking them to appointments and bringing them to the grocery store.
A focus on senior isolation and personal care services becomes even more important when considering expanded Medicare Advantage opportunities, bundled payments and alternative payment models aimed at strengthening care coordination along the continuum, Stelly said.
“We truly understand there is an opportunity to take care of the patient population from pre-acute all the way through the death and dying process,” he said. “[Personal care] is absolutely paramount to our five- to seven-year strategic plan, and we fully intend to make that service offering an associated part of our business equal to what we do in skilled service as the decade moves on.”
Similar to LHC Group, FirstLight caregivers help prevent and counter senior isolation by helping clients with activities of daily living, Jeff Bevis, FirstLight CEO, told HHCN. They also provide companionship services to older adults and help with meal preparation, he said.
“We don’t statistically track isolation from a categorization or environment standpoint, but I would tell you it’s very common and that we see it on a regular basis,” Bevis said. “It’s heavily driven by family or lack of family, lack of social network in their immediate area as they age.”
Isolated seniors are more likely to be male, white, live in cities and have lower incomes and wealth.
FirstLight provides non-medical home care services to clients in more than 30 states. Since launching its first franchise in 2010, FirstLight has grown to more than 160 U.S. locations.
In addition to companionship and meal prep, FirstLight also plans to launch new services geared toward neuroplasticity, or brain flexibility, in clients within the next 30 days, Bevis said. The franchisor expects those services to also help combat senior isolation as well.
About 92% of people over the age of 65 want to stay in their homes as long as possible, according to AARP research.
“People want to stay in their community and in their home,” Lifesprk CEO Joel Theisen told HHCN. “And I sincerely believe home-based services of all kinds are unique opportunities to do better and meet people where they’re at.”
Lifesprk is a whole-person-focused provider of in-home care services and one of the fastest growing companies in the Minneapolis area. Lifesprk’s approach to wellness is spearheaded by a personal care manager who helps patients develop, implement and execute a custom-built life plan that is largely focused on social health happiness. Since it was founded in 2004, Lifesprk has worked with more than 14,000 patients in total.
“Every person that we go and see, our process mandates that we go in and discover what’s important in somebody’s life,” Theisen said. “By having that dialogue and hearing a person’s story, really listening to that story, we’re able to identify what starts to pop out and what makes them tick, what’s creating a possible environment of loneliness.”
Competitive edge for senior living providers
Despite the best efforts of LHC Group, FirstLight, Lifesprk and other home care providers, assisted living communities and residential settings are inherently positioned to better address senior isolation, Gleckman said. Assisted living communities, for example, can offer intergenerational settings where seniors mingle with those who are younger, along with social events and community activities.
It’s a competitive advantage that senior living companies are quick to promote and that home care providers simply cannot meet, he argued.
“It’s easy for people to criticize residential care, whether it’s independent living or assisted living or even nursing homes … but one of the potential benefits is—and of course is depends on how well facilities are run—you’re with other people,” Gleckman said. “I honestly don’t think that home care agencies are the solution to this problem.”
Still, senior isolation is also prevalent in residential settings, home care providers point out. Likewise, older adults living away from their homes are also frequently removed from the organic social supports they’ve possibly developed over the years, they said.
“You don’t always have authentic connectedness,” Theisen said. “You’re also sometimes putting strangers with strangers, and that takes people away from families, friends and the people and things people love.”
Some senior living providers may tout isolation prevention as a competitive edge, but home care providers aren’t in direct competition because there isn’t a “one-size-fits-all solution,” Bevis said.
“I really don’t think that we compete with it nor do we need to compete with it,” Bevis said. “There are differing environments and different preferences across the board, and in many cases, we’re inside facilities helping augment their staff and their services to prevent mini-isolation or sub-isolation inside the facility.”
LHC Group’s Stelly echoed that idea.
“I think it’s an advantage for the patients that feel like [assisted living] can meet their needs for the rest of their life,” he said. “The majority of our patients don’t want to leave where they’ve been for 10, 20, 30, 40 or 50 years, to go into that environment for the sole need of needed that socio-desire. It’s an opportunity and it’s an option for some, but we actually do not see that as a competitor whatsoever because it’s a different patient that we’re in the home [for].”
Written by Robert Holly
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