Aging independently: a Chapel Hill perspective.

NC Med J March/April 2010, Volume 71, Number 2 One of the most important choices seniors face as they retire is where and how they are going to spend their retirement years. Some will choose to age in the home that they have lived in most of their life. Many who can afford it will choose to join a continuing care retirement community (CCRC) that offers a full range of housing choices, onsite health services and facilities, and a life-care contract. Others will choose one of the varieties of alternatives that are developing nationwide, including congregate living, co-housing, shared housing, senior retirement communities, and multilevel communities. Or they may simply downsize to a smaller home or condominium that they believe is more “senior friendly.” For many seniors, the desire to maintain the lifestyle and independence that they have enjoyed for years is of crucial importance. Most have worked hard in their early years to attain home ownership, and that has been fundamental to their sense of independence and control over their own lives. Among North Carolina householders aged 65 and over, 81.7% own their own home (with or without mortgages).1 Many, though, realize that living independently will become increasingly difficult as they age, and this realization has motivated the search for support systems. Three different types of support systems have developed across the country to meet the special needs of seniors who choose to live independently in their own homes: (1) the “Beacon Hill” or village model; (2) naturally occurring retirement communities; and, more recently, (3) universitybased retirement communities. The Beacon Hill models (discussed at more length in the sidebar of this article) generally center around a small professional staff assisted by volunteers in order to provide assessment of member needs, careful referral to vetted providers ranging from housekeeping to specialized home health care services, continual monitoring and quality control of services provided, and vitally important social networking and volunteer opportunities to help seniors living independently avoid social isolation. Naturally occurring retirement communities tend to be volunteer-oriented programs that focus on neighbor-toneighbor support building from informal networking at the start to provision of extensive volunteer services to seniors as they age. University-based retirement communities are of two varieties: (1) those that are essentially CCRCs that include health services and life-care contracts, and (2) those that are structured more like the Beacon Hill model, but with links to a specific university or college. A recent article by AARP specifies four criteria for a comprehensive university-based retirement community: “A location that is accessible to the school (within one mile of the university, preferably), formalized programming incorporating the school and community, a full program of continuing care from independent to assisted living, and a documented financial relationship between the university and the senior housing provider.”2 All three of these approaches include several important challenges that must be addressed in order to make a positive contribution to their members and the community at large: