Aging in Place

I’ve touched upon the issue of where we live as we age in previous blogs.  I want to spend some time in this piece looking at core elements foundational to meeting the goals of what is a common desire for so many of us – living and dying in our own home.

I experienced this on a very personal level with my grandfather, his sister, and my mother.  My mother was very clear that she didn’t want to end up in a nursing home.  She was a widow and living alone; however, in her mind, she was surrounded by “family” and felt a deep duty to preserve and maintain all family heirlooms. The home she lived in had been in our family for several generations.  It contained memories that went back to the 1890’s and had furniture, pictures, books, and collectibles that were passed down from her great-grandparents.

She was adamant that she remain in this home and not go to a nursing home, which is what happened to her father. My grandfather was a dynamic and independent sort, who had recovered from a broken hip while in his early 60s, but had slowly lost physical functioning over many years.  In his 70s, he was in a wheel chair but still living independently with caregiving provided by my mother and myself.  The precipitating event that changed this was a stroke.

While he recovered from the stroke, he needed a much higher level of care than could be provided by my mother or myself, and so he went to skilled nursing.  This was in the 1970s when these facilities were first expanding.

SNFThe nursing home was brand spanking new, had lots of bells and whistles, and he actually transitioned fairly well.  I say “fairly”, because the unspoken reality was that this was where he was going to die.  There was no way he would be able to go back home, since his home had only one bathroom on the second floor, and he was unable to go up and down stairs.  Adding a bathroom to the house was not feasible, both for architectural and financial reasons.  So, he stayed in the nursing home for the last 8 months of his life.  In the 1970s this was just beginning to be the standard of care.

His sister’s experience was slightly different.  She lived independently in her home up through her early 80s.  While she had functional limitations (poor eye sight and poor hearing) she managed to take care for herself.  Her home also had one bathroom upstairs, but unlike her brother, my great aunt was able to go up and down the stairs without any problem.  In her case, the precipitating event was having to be hospitalized for kidney failure.  Her condition was so dire that there was really never any thought that she would return home.  She remained in the hospital until she died, several weeks after being admitted.

These were the templates for what my mother expected to happen for her.  It was not, however, her path.  My mother experienced gradual cognitive decline rather than physical decline.  She became quite anxious and was unable to adequately see to her own needs.  There were several options for her, one of which was to have in-home care which she refused.  Another option was to move to assisted living.  She was adamant that she would never leave her home.

After a series of falls she reluctantly accepted the fact that she was unable to care for herself any longer.  I was able to secure a spot for her in a local assisted living facility where she moved, in her mind, under duress.  Once there, she went into a deep period of grief and loss.  While she put on a brave face, it affected her overall ability to function.  Her depression took two years to lift, even with the support of staff and friends.  All this while she participated in the activities of the facility and was deeply loved by the staff.  She remained there for several years before her cognitive condition declined and she was admitted to a nursing home where she eventually died.

There are several things I want to point out using these examples.  First, many nursing homes were built during the late 1970s and 1980s.  These facilities are aging and many are filled to capacity.  Few new nursing homes are being built in spite of there being a need for them.  Partially this is due to the model of care being too costly both in terms of hiring and keeping qualified staff (nurses, certified nursing assistants, social services and food preparation folks) and partially because people are living longer and beds are not available.

Why?  Because most of us want to stay in our homes!

Is this realistic?  It certainly wasn’t in the case of my family members.  I am going out on a limb here and saying that not only is it realistic for Baby Boomers to stay in our homes it may be our only option.  This puts a different spin on aging in place.

aging-in-place

There are many reasons to age in place.  If you can plan for the inevitable changes that come with aging and live in a location that can accommodate these changes, then you stand a good chance of achieving this goal.

What is your plan?  How will you go about making sure you can continue to live in your home until you die?  What are your needs?  How will you find the resources to meet those needs as they change over time?  There are essentials such as people who can drive, make repairs to your home, and cook and care for you. One size does not fit all.  There are things unique to location (rural vs. urban), personality (folks who prefer to be alone vs. those who thrive in groups), and activity levels (mobile vs. adaptive) that need to be identified.

Aging in place requires putting together a financial plan to insure you won’t be left high and dry.  It requires conversations with your loved ones about how you want to live out your days in detail, not in vague terms.  Often this is the most challenging!

And it also must include the possibility that you will not be able to stay in your home.

There are many different ways to structure and organize around getting these needs met.  Best practices suggest that starting sooner rather than later in building this network is a good idea.

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