As America’s population ages, scenes like this will become commonplace. The population over age 65 is expected to double to 98 million by 2060. A new report by the National Academies of Science estimates that about 43 percent of those over age 60 are lonely and 24 percent of those over 65 are socially isolated. That’s those we see. “Invisible” elders no doubt raise those numbers. And communities are not ready.
It will take new investment, new partnerships and new thinking about how community is built and how connections are formed if we are to meet the rising demand of an aging population.
“Social prescribing” gains steam but more connections are needed
Today, health systems, community development organizations and others are beginning to take note of this growing issue. Most current approaches to quelling loneliness and social isolation aim to connect seniors to programs and supports. Doctors, for example, are beginning to do what they call “social prescribing,” which is just what it sounds like: making referrals for the isolated or lonely to programs and supports in community-based organizations.
Kaiser Permanente, for example, is connecting health care providers and social services agencies through its Thrive Local program in Oregon and southwest Washington. The program partners with local nonprofit and government agencies, and perhaps other health systems in the future. Thrive Local will be integrated into Kaiser’s electronic health record system as a way of tracking social needs and referrals to social providers.
Health navigators are also being put to use. While health navigators have been helping chronically ill patients navigate through the health care system for some time now, UnitedHealthcare expanded its Navigate4Me program in 2018 to individuals at risk for social isolation.
These efforts are a start and with time, the National Academies’ report argues, roles that health care providers are already performing — such as discharge planning, case management and transitional care planning — can also address social isolation and loneliness.
Yet for now, the National Academies’ report finds, this type of support is not yet commonplace due to the weak or nonexistent link between health care practitioners and community-based services. “Despite the profound health consequences — and the associated costs — the health care system remains an underused partner in preventing, identifying and intervening for social isolation and loneliness among adults over age 50,” said the report’s authors.
Rebuilding communities from the ground up
Beyond programs and supports, communities and the built environment can foster connections.
“We designed so much in the 20th century to create independence and autonomy,” said Linda P. Fried, dean of Columbia’s Mailman School of Public Health and chair of the International Loneliness Research Network, “but human beings are social animals who really need intimate personal connections.”
The good news is that the infrastructure we’ve inherited doesn’t have to define us. We can design a different future just like we designed the 20th century’s independence and autonomy.
Already, examples of different forms of housing and community life are emerging. Shared housing, for example, matches people who have unused space with people who need housing. The programs, however, can be hard to sustain. The prospect of a stranger moving in, despite background checks, is a major hurdle. Currently only 39 official programs nationally are listed on a national clearinghouse for home-sharing.
Co-housing is another option. With co-housing, a group of people buys land and builds a housing complex. They live in their own home but share a common house for communal meals, meetings and other functions. “The joke is, in co-housing you go check your mail and you’re gone for half an hour,” Karin Hoskin, executive director of the Co-housing Association of the United States, told the New York Times. Fifteen of the more than 200 co-housing communities serve older residents specifically. The first co-housing development for LGBT seniors is under construction near Durham, North Carolina, with plans to open this spring. Yet while promising, co-housing is also hard to sustain and can take up to seven years to get off the ground. And neither option has yet expanded broadly to low-income communities.