A new national survey shows a stark gap between the desire and ability to age in place in America, with nearly 2 in 3 adults saying they have a goal to age in place (65%), while only 1 in 3 think they realistically will (33%).
The findings are one part of a larger survey examining aging in place commissioned by Fresenius Medical Care North America (FMCNA), the leading provider of products and services for people living with kidney failure.
Aging in place refers to the ability of an adult to live in their existing home or community regardless of age, income, or ability. The survey of 2,750 U.S. adults revealed three main factors that influence individuals' ability to age in place: social determinants of health (SDOH), presence and availability of one's caregiver network, and the perceived quality of care.
"With adults living longer than ever before and a looming shortage in caregivers, it is critical for the healthcare community to commit to a future where older adults can age on their own terms," said Bill Valle, Chief Executive Officer of FMCNA. "This is why our organization is leading efforts to provide more access to home therapies and connected health that will allow individuals to thrive in the settings where they feel most comfortable."
As the U.S. government has pushed for expansion of home dialysis, telehealth, and other technologies aimed at treating chronic disease at home, FMCNA decided to further investigate specific attitudes toward aging in place. With demonstrated expertise in chronic healthcare and treating more than 200,000 people with kidney failure, FMCNA continuously interacts with patients and caregivers at various care touch points, creating a unique opportunity to better understand the realities and barriers one faces as they age.
"This research further demonstrates the importance of addressing social determinants of health to improve patients' quality of life and the chances for aging in place successfully," said Felicia Speed, Corporate Director of Social Work Services at Fresenius Kidney Care. "It also suggests we must continue to help educate patients about all the resources now available for people to receive care in their own home."
The full survey results can be found here. Highlights of the results include:
Social Determinants of Health
Certain SDOH have an outsized impact on the general population's ability to age in place. There is an immediate need to address SDOH so older adults can achieve their goal of aging in place.
- Food insecurity (50%), health literacy (47%), and housing security (46%) were the top factors affecting an individual's likelihood to age in place, decreasing likelihood by approximately 7%.
Individuals living with CKD are highly motivated to age in place. In fact, 82% of CKD patients express a desire to do so compared to 65% of the general population.
- At the same time, fewer than half of individuals with CKD (40%) actually believe they can achieve their goal of aging in place due to significant SDOH burdens.
- 50% of CKD patients experience six or more SDOH challenges as measured in the survey (compared to 37% of the general population).
A strong caregiver network is a key factor for adults being able to age in place. More than 1 in 3 U.S. adults say they are caring for a family member with a chronic health condition (34%) and nearly half of them are millennials under the age of 38 (41%).
- Caregivers most often manage these common chronic conditions: Diabetes (25%), hypertension (22%), and mental health conditions (17%).
- CKD caregivers are more likely than the general population to see aging in place as a goal for the adult they care for (86%).
Quality of Care at Home
Survey findings show that even patients with kidney failure on dialysis do not fully understand existing, beneficial home care options. Recent research confirms that home dialysis often leads to better outcomes while introducing greater independence and flexibility.
- Despite this research, 50% of patients on dialysis believe the quality of care would be better in a clinic or hospital setting than home dialysis (25%).
- 54% of these patients would in fact prefer home dialysis if they simply knew it was equal in quality of care.
- CKD patients are more highly motivated to age in place and taking actions to do so (42%).
FMCNA is committed to closing the gap in the ability to age in place through education, technology, and efforts to address SDOH. These include:
- Patient Education: FMCNA believes patients should be fully informed of all treatment options, including home dialysis and transplant, and the organization prioritizes education on these topics for all patients. In 2019, FMCNA educated 45,000 patients with kidney disease about home dialysis through its KidneyCare:365 program. Recent growth in home dialysis modalities has been encouraging.
- Home Care: FMCNA encourages patients to seek care that best suits their goals and needs regardless of physical barriers. With new portable, easy-to-use machines, FMCNA envisions the concept of home dialysis "without walls" could involve patients dialyzing at their local community center with family or friends or while traveling.
- Integrated Social Work Access: Care at FMCNA includes assistance from a dedicated, award-winning force of licensed social workers who help manage the complex cases and living situations of both patients and their caregivers. Through a separate intensive program, additional attention is given to those facing significant burdens—such as housing insecurity or homelessness—to mitigate further complications in their routine chronic care.
- Caregiver Support: FMCNA has created an assessment specifically designed to support caregivers and routinely evaluate and protect their mental health through the duration of their loved ones' care. In partnership with their designated social worker, caregivers can learn how to address their everyday needs and identify FMCNA resources such as transportation alliances that can relieve the burden of accessing care.
- Food Insecurity: FMCNA is aligned with community-based initiatives such as Community Servings and Food Is Medicine Coalition to increase access to food and nutrition services for people with severe and/or chronic illnesses, including those with CKD.
- Connected Health Technologies: FMCNA launched TheHub in 2019, a new connected health platform that supports better collaboration, seamless home record retrieval, and remote monitoring among patients, care teams, and providers. Continued investment in these technologies helps FMCNA improve adherence, reduce emergency room visits and hospitalizations, and lower overall care costs.
For more information on the detailed survey findings and how FMCNA is beginning to address barriers to aging in place, please visit fmcna.com/aging-in-place/.
About Fresenius Medical Care North America
Fresenius Medical Care North America (FMCNA) is the premier healthcare company focused on providing the highest quality care to people with renal and other chronic conditions. Through its industry-leading network of dialysis facilities, outpatient cardiac and vascular labs and urgent care centers, Fresenius Medical Care North America provides coordinated healthcare services at pivotal care points for hundreds of thousands of chronically ill customers throughout the continent. As the world's largest fully integrated renal company, it offers specialty pharmacy and laboratory services, and manufactures and distributes the most comprehensive line of dialysis equipment, disposable products and renal pharmaceuticals. For more information, visit the FMCNA website at https://fmcna.com.
About the Survey
The data are findings from a survey conducted by Edelman Intelligence, an independent market research firm, on behalf of Fresenius Medical Care North America. A sample of 2,750 U.S. adults aged 18 years or older were interviewed online, in English during August 9-20, 2019. For more information, please visit fmcna.com/aging-in-place/.
About Edelman Intelligence
Edelman Intelligence is a global, full-service market insights and analytics firm that provides corporate, non-profit and government clients with strategic intelligence to make their communications and engagements with stakeholders the smartest they can be. The firm specializes in measurement, tracking and analysis in reputation, branding, and communications. Edelman Intelligence is part of Edelman, the world's largest public relations company. Edelman Intelligence has more than 200 employees and 12 offices around the world.
For further information, please visit https://www.edelmanintelligence.com.