As nursing homes dwindle, South Shore towns bracing for a population determined to age at home

Raimondo Dibona has lived in his South Quincy home for decades. He raised his children there, lived out his career as a teacher and is now navigating aging and retirement alone from the same neighborhood he's lived in most of his life.

Now in his 70s, Dibona is as independent as he's ever been. He teaches English as a second language twice per week in Boston, he navigates the Red Line, composts in his backyard, is involved in the Victorian Society and musical groups, and participates in activities at the senior center. If he ever needs help, his neighbors will shovel his driveway or help him move things around the house.

He may be getting older, he said, and he may need help every now and then, but staying active, knowing his neighbors and taking advantage of city services means he's nowhere near ready to leave Trafford Street.

"I want to stay because it's the family homestead," he said. "I have neighbors on this street who, from time to time, have offered to help me when I'm out doing things. There are younger people who live here and no matter what I ask them to do, they come right over. The city provides a lot of services for older people, and I appreciate that."

Dibona is determined to age at home, and he's not alone.

At least 190 Massachusetts nursing homes have closed in the last two decades, 20 have shuttered just in the past year, and the Massachusetts Senior Care Association reports that one in four skilled nursing facilities in the state are at risk of closure -- even as the population of older Americans surges upward. It's true that the facilities are facing unprecedented financial struggles as Medicaid and Medicare programs reimburse less and less for care, but nursing homes are also falling out of favor with a generation of seniors who are increasingly determined to stay in their homes and communities as long as they can.

"We know that people don't want to go to a nursing home unless it is absolutely the only choice available," said Mike Festa, the Massachusetts state director for AARP. "This generation has said, 'We aren't going to accept what our parents and grandparents thought were the only way to deal with aging.'"

This seismic shift has cities and towns scrambling to adapt and provide services to an aging population that is only expected to grow. From state-of-the art senior centers to age-restricted tax benefits and even bylaw changes that make life easier for those aging in place, South Shore communities have put an increasing emphasis on quality of life improvements for the elderly.

"Seniors today are rising to the challenge of staying active and fit, and our attitudes have changed toward what we think it means to be an elder," Tom Clasby, Quincy's director of elder services, said. "The whole attitude is shifting, and it's not slowing down."

There are roughly 49.2 million people over the age of 65 in the United States, and about 1 million in Massachusetts, according to the U.S. Department of Health and Human Services. The agency estimates about 70 percent of those adults will end up needing long-term skilled nursing care some point, but experts say today's seniors are far more likely to choose home or community-based care options than enter a nursing home or other facility.

"It has been years in the making," James Fuccione, executive director of the MA Healthy Aging Collaborative, said. "Older adults, in any part of the state, increasingly have more options to stay in the community, whether it's in their home with some degree of support, modifying their home, downsizing, going to assisted living, there is an increased awareness that there are more options if your preference is to stay in the community, and people are choosing those options."

And the number of people facing that choice is growing rapidly. The nation's over-65 population increased by 33 percent, to a total of 49.2 million people, between 2006 and 2016, the federal government says, and has more than tripled since 1990. The number of people over 85 years old is expected to double between now and 2040, and local communities say they're very aware that the number of people relying on elder services is about to skyrocket.

So, they're upping their game.

In Marshfield, town meeting voters recently approved a $50 million tax override package that includes $8 million to nearly double the size of its senior center. A bylaw adopted in Hingham increases opportunity for live-in caregivers by allowing accessory dwelling units, something elder affairs advocates say can be a game changer for home healthcare options. And this year's Quincy budget included money for a social worker dedicated solely to elder affairs.

Budgets for local councils on aging are up in almost every community on the South Shore -- Quincy's has increased 23 percent in just the last five years -- and a number of cities and towns have worked to become designated age-friendly communities, a distinction awarded by AARP to communities striving to better the standard of living for elders. Quincy, Marshfield, Scituate and Cohasset have all earned the distinction.

"I really see age-friendly efforts coming to the forefront," Carol Hamilton, director of Marshfield'sCouncil on Aging, said. 'There are some simple things you can do and but also there are things that are, obviously, going to take longer. We're all thinking about what will work for this population that is ever changing."

Every community in the state is required by law to have a council on aging, or COA, but that's where most of the state versight ends. Clasby, Quincy's elder services director, said says local authorities are left to design the department themselves, and every community does it a little differently.

"They are the local experts on aging issues in that community, but there is a lot that goes into the process," Fuccione, the MA Healthy Aging Collaborative director, said. "When you think about aging in a town, your first through is the COA, but businesses can me more welcoming, policies can be more senior-friendly when it comes to helping people remain at home -- there is just an amazing array of options."

COAs are facing a growing demand in particular for venues and programs that encourage seniors to spend more time with each other and with other people -- often called "socialization" -- instead of becoming socially isolated and cut off from their communities. In the last two decades, cities across the South Shore have invested millions of dollars in senior centers that offer hundreds of different classes and activities each year, from exercise classes to talent shows and Christmas pageants. Some have rooms where they offer things like physical therapy, pedicures and health screenings, and most offer practical classes on keeping up with technology, preventing memory loss and avoiding common phone and online scams.

Marilee Comerford, activities director for Marshfield's senior center, says the last decade has seen a rise in senior's desire to participate in lifelong learning classes, and that preserving mental and physical health is at the forefront of what people expect from their senor centers. In the 15 years since the Marshfield center was built, elder services staff have paid careful attention to requests from residents and trends in elder care, and as a result, the center's new addition will include a drop-in coffee shop and small library, lecture room, health room, outdoor pickle ball courts and a gym.

"People want things now that address the whole person, mind and body," Comerford said.

Clasby, Quincy's elder services director, said the activities offered at senior centers are great, but that even more important is the opportunity to do it with other people . Nationwide, 28 percent of people over the age of 65, or 13.8 million seniors, live alone, according to the federal government.

"Conventional thinking is 'Oh, you lived to be 100 years old, you have good genes. But data says genes are only 30 percent of it," Clasby said. "The other 70 percent comes down to obvious health choices, like exercising and not smoking, and socialization, forming friendships and having a reason to get up in the morning. It's not just about having a nice place to go, but about enabling them to live productive, healthy lives."

But it's not all fun and games. Activities like chair yoga, bingo and crafting have their place, experts say, but cities and towns are also increasingly finding themselves responsible for the more serious aspects of aging, such fall prevention, memory care, transportation to health care providers and stepping in when someone can no longer feasibly live independently.

"More goes into healthy aging than what we see on the surface," Fuccione said. "The entire town has a stake in making sure its seniors are aging healthily, everyone in the community has some role to play . . . It's a demographic shift, and the bottom line is that the population growing and people living longer is an opportunity to reshape and rethink how our communities look and operate to be supportive of people of all ages."

Festa, of AARP, says there are dozens of ways communities can work to better serve the aging population, from small jobs like installing benches along walking paths and building accessible community gardens, to big-time changes like adopting property tax deferral programs for seniors or putting forth bylaws that allow accessory dwelling units for caretakers.

"A community that is age friendly is looking at their policies around housing, zoning, taxes and diverse housing opportunities. There are so many things a community can do," he said. "A lot of communities that are doing it right in Massachusetts have a lot of volunteer, community activists leading the charge. These are often seniors themselves, and they are really at the forefront of making sure the older population isn't left behind."

And while cities and towns should be making these concrete efforts, Comerford says, being age-friendly is also about promoting an invisible shift in attitude about growling older and a senior's value to the community.

"We're really hoping that with age friendly, all the things we are doing here will ultimately spread into this interconnected web between town departments and residents of all ages," Comerford said. "Something that will make it second nature to care for seniors, check in on your neighbors and all the other things that make a town a real community."

Reach Mary Whitfill at mwhitfill@patriotledger.com.

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