Frail Seniors and Persons Living with HIV/AIDS Have Overlapping Needs

For the past several years in directing Village Care of New York’s Network of AIDS Services, I increasingly witnessed an overlapping of the care and services needed by both populations we serve:  Older adults and persons living with HIV/AIDS.

For one thing, AIDS has long stopped being a disease of the young.  As much as one-third of new diagnoses in New York City are now among those 50 and older.

Nor does HIV infection mean a quick and inevitable death as it once did.  Because of the treatment advances that emerged in the latter half of the 1990s, it is no longer unusual for those with HIV infection to live on for many years, as long as they adhere to medication treatment and clinical care

This has impacted AIDS care providers who find that a good share of those they serve today are older.  Half of the people who are in Village Care’s traditional HIV programs, for example, are over 50, and 19 percent are over 60.

That is not to say that life is rosy for those who are HIV-positive.  To the contrary, there are many deadly pitfalls awaiting along life’s path if you are infected with HIV.  

Village Care’s AIDS Network, which began some of New York City’s first HIV services, is there to intervene and to help with our many care and treatment offerings.      What we’ve been observing as the AIDS epidemic has matured is a great similarity in what is needed by those with the disease and by adults who are simply growing older.  None of us can be assured of living on without confronting intermittent and progressive frailty.

The shift in the needs for both groups – those with HIV/AIDS and seniors – is similar:
•    Nursing homes no longer need to provide long-term residential care for the majority of either group.
•    Housing that is affordable and supportive is sorely lacking in the metropolitan New York area for both seniors and for persons with HIV
•    There has been a literal explosion of home care and home health care services, which have enabled both older adults and persons with HIV/AIDS to receive services they need in the community.

In 2006, the AIDS Community Research Initiative in America (ACRIA) reported:  “It is disconcerting that those who now live with HIV will face a health care system and communities ill-prepared to care for them as they age with the disease.”

The irony of that statement lies in the similar-sounding statements that have been made over the past decade or so about Baby Boomers and the demands they will bring to health care and communities as their large numbers age, and as their need for care, services and support tests our conventional institutions.

The challenges facing Village Care’s Network of AIDS Services and SeniorChoices programs are similar, although there are special demands on the aging HIV-population in that their harsh, ongoing and unending treatments seem to be complicating medications they now need to take for age-related ailments such as high blood pressure, diabetes, osteoporosis and heart disease.

One of the particular needs that we are working to address is that of decent, supportive housing.  The state has given Village Care approval for Medicaid Assisted Living Program (ALP) slots for both seniors and for those with HIV.  We are close to opening some of those ALP slots at our senior living residence, The Village at 46th & Ten.  We are also working to see if it would be feasible to eliminate some of the nursing home beds at Rivington House, our AIDS residential care facility, and convert the space into an ALP for HIV residents.

The Medicaid Assisted Living Program is a valuable approach to meeting the housing needs of needy frail seniors and those living with HIV who require more than just a roof over their heads.   This is a challenge facing both populations – a challenge Village Care is working to address.