The New Aging Enterprise - aarp

activities of daily living. These are small, family-size homes for six to eight residents, supported
by paid caregivers, six hours per day, who also serve as homemaker and friend. A licensed
practical nurse is on call 24 hours a day, and back-up technology aims to reduce paperwork and
improve the quality of care. This new model of community-based long-term care emphasizes a
“warm, smart, and green” approach. In effect, it de-institutionalizes long-term care and returns it
to a more human scale, as proponents of community-based long-term care have long
advocated. 34 Whether in an Edenized facility or in a Green House, this new vision of long-term
care attempts an affirmative and visionary answer to the question: “What are old people for?” 35
The answer we give will be an important part of the New Aging Enterprise in years to come.
Policy Perspectives. The success of the Eden Alternative and On Lok should be seen in
the context of the larger political economy of long-term care. 36 For example, in the past few
years, large private investment groups have acquired 6 of the 10 largest nursing home chains, or
9% of the total in the USA; private investment groups own smaller chains and are likely to
acquire more companies in the future. This trend reveals a significant dimension of the political
economy of long-term care because huge public expenditures are at stake: nursing homes
receive more than $75 billion each year from Medicare and Medicaid, and private investors are
reaping huge profits.
Ominously, this trend toward corporate takeovers has been accompanied by declining
quality of care. Federal and state regulators point out that, since 2000, serious quality-of-care
deficiencies have risen at every large nursing home chain after the chain was acquired by a
private investment group. During this same period, citations for deficiencies were declining at
other homes and chains. Big money is at stake in these corporate takeovers of nursing home
chains. For example, in 2006, a chain of 185 facilities was sold to General Electric for $1.4
billion. 37 We must wonder that at a time when private investors are cutting staff in nursing homes,
will they be interested in genuine “culture change” represented by the Eden Alternative and On Lok?
What Eden and On Lok have shown is that long-term care can be transformed in far-reaching ways.
Whether that promise can be fulfilled is a question for the future. 38
Health Promotion
According the National Institutes of Health, nearly 55 percent of Americans are
overweight, and some 22 percent are obese, with rates even higher for Americans over age 50.
In fact, there is an ominous trend toward obesity among aging Baby Boomers. 39 These facts
underscore that innovation is needed for health promotion in an aging society. 40 In 2007, the
American Heart Association and the American College of Sports Medicine published joint
guidelines for physical activity and health, suggesting that 30 minutes of moderate physical
activity five days a week is necessary to “promote and maintain health.” Concurrently, the US
Institute of Medicine and the International Association for the Study of Obesity, along with the
US Department of Agriculture (USDA), recommend exercise for up to 60 minutes a day to avoid
what the USDA calls “unhealthy weight gain.”
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