Is Aging in Place Always the Best Option for Seniors?


"Elder orphans" is the phrase du jour about aging. It describes seniors who are single or widowed; they have no children, at least in the area, and no support system. They find themselves alone with no one to help care for them should they need it.

This group of “orphans” will increase sharply as baby boomers age and as average life expectancy in America continues to stretch toward 80 and beyond.

Like most seniors, I want to “age in place”—a frequent topic on this blog. In two previous posts, I explored the prospects for the rest of my life. Will I be able to remain at home, or will circumstances force me to move into a senior residence?

My musings reflect my own wish to age in place, a desirable goal... for me. But many elder orphans—and their families—surely see things differently.

Independence or imprisonment?

Aging in place can be dangerous, especially for vulnerable elder orphans. The risks they face are detailed in a case study by Maria Torroella Carney, MD, chief of geriatric and palliative medicine at the North Shore–LIJ Health System.

Almost two million Americans 65+ rarely or never leave their homes. Another six million are "semi-homebound."

It's easy to understand why so many of us wish to remain at home. We like our familiar surroundings, and we fear "institutionalization" and the financial drain it brings. We often fight to remain in homes we can rarely leave.

In fact, for those of us 80+, more than three quarters remain in their own homes. In spite of the positive perceptions of aging place, a study published last year found that people in assisted living facilities actually got outside more often than people who remained in their own homes.

While aging in place may bring seniors a sense of control, it requires a variety of services, especially for elderly seniors. Providing those essential services requires a support team, money, and a flexibility among team members to manage many ever-changing responsibilities.

It's a tough job. I can attest that the support of family and friends is crucial.

Here is an example of the difficulties faced by an elder orphan named Jim:

Jim is not a real person, but a composite of several people I know or know about.

Now 74, Jim had been CEO of a large manufacturing company in Cleveland. He stayed on the job beyond age 65 because he enjoyed it. Tellingly, he also said, "If I'm not president of this company, then I'm not sure who I am..."

Jim has had Parkinson's disease (PD) for nine years. The disease finally forced him to retire four years ago.

He and his wife Marie enjoyed an active social life while he was CEO, but Jim's work buddies faded away during his retirement. In time, he realized they were just business acquaintances, not friends.

But Marie had several good women friends, and she and Jim continued to socialize with them and their husbands. Then, a year and a half ago, she lost her five-year battle with breast cancer.

Peter is their only child. He's gay, and he lives in San Francisco with his partner and their adopted Vietnamese daughter. It took time, but Jim eventually accepted Peter's sexual orientation. They're now on good terms and speak often by phone.

Thanks to his excellent long-time executive assistant, Jim never needed to use a computer on the job. As a result, he now struggles to email his son and to order the murder mysteries he loves online. As his PD progresses, these tasks become increasingly difficult.

Jim and Marie designed and built their lovely home, an hour's drive from downtown Cleveland. He was an avid gardener, but he now depends on hired help to do the work he loved. He had to stop driving.

Peter is understandably worried, as his dad's world gets smaller and smaller. Peter also sees some warning signs of dementia in his dad. He has been urging Jim to move into an upscale senior residence nearby, explaining that the move will bring him social contacts and activities that will make him happier and healthier.

But Jim says he loves the house with its reminders of Marie and the wonderful life they shared. "I can still get around, more or less," he says.

As in Jim's case, this progression into 'orphanhood' isn't typically sudden, and often cannot be easily foreseen. Although we all want to remain in our own homes that are filled with memories and personal comforts, it is important for seniors and their loved ones to acknowledge that alternatives to aging in place may be more beneficial in the long run.

Washington, DC, resident John Schappi blogs about aging, exercise, diet, pills, supplements, and his life with Parkinson’s disease and prostate cancer. Once upon a time, he was addicted to nicotine, alcohol and sex. These days, his passions include gardening, playing bridge, meditating, going to the theater and traveling.

Aging, Parkinson’s, and Me

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Personally, I am lost as to why everyone wants to 'age in place'. When my Mom was just short of her 90th birthday I urged her to move out of her 4 room apt in a 4 apt private home. It was in a city and the streets were hard to walk, roads and sidewalks were rarely shoveled keeping her indoors for a good chunk of winter; and the supermarkets near her had closed down and she had to take a bus to get groceries and then walk. This was not the place where I was raised but she had been there 30 years. She was familiar with it and thought she had friends - and she did. BUT residents in the area didn't have finances to do senior trips or activities. In hindsight, she 'wasted' too many years there.

So she moved to the independent side of a continuing care community. WOW did her life change. ALL level walking paths, beautiful and safe grounds, bus service from her door to just about everything she would want to get to. AND a list of activities that didn't stop. As I anticipated, within a few months, I couldn't get in touch with her as she was always on the run. Always with others. Day trips, theater, volunteer opportunities on the campus, entertainment etc.

When the time came, I did move her out of that facility to an Assisted living place near me despite there being one in the continuing care community. The one near me allowed me to visit daily and had a better reputation.

I have been VERY involved in caregiving for 5 people. I have learned a LOT - more than I wanted to know about the subject. I have helped move a 96 year old new widow out of her home of 50+ years. Her idea! The house had her original mattress, TVs that didn't work, sofas with springs popping through, etc. She thrived in her new place, with her new furniture. She got meals that were nutritious in her independent community and made new friends.

I can't convince my spouse to move to an active adult community. I WANT the lifestyle they offer. Yes, I have a good life and I am active wher eI have lived for 30 years. But I have enough experience to know that full attics and basements, large yards and extra bedrooms are locking me into house cleaning I'd rather not do. We don't have children and between statistics and my spouse's health I realize there is an excellent chance that I will be the surviving spouse. I don't WANT to clean up the accumulations we've made. I don't WANT to move by myself and have to make friends at 'the new widow'. I want to enjoy an easier lifestyle.

To sum it all up -- downsize and move while you can. Make new friends and to me THAT is the ultimate control. Choosing for yourself.
John, in the instance of the man in your story I think that assisted living is the way to go. The only other option I see is hiring a full-time caregiver. The trouble with houses is that they usually aren't designed for people with certain limitations. Steps or narrow doorways are not problems for people when they are younger, but become hurdles to work through each day for people as mobility changes. There is also isolation that happens when someone hunkers down in the familiar place.

Some people consider having one of their children move in. But really, is it fair to ask one child to give up so much to avoid the inconvenience of moving? It is like asking someone to potentially ruin their own lives for the sake of being more comfortable. I could personally not ask that of anyone.

I believe there will be a day when people view moving into a retirement community as a normal part of life. It makes more sense than trying to scotch tape a life together requiring so much sacrifice from others. It also allows a person to remain more independent, since they aren't having to depend on others to do for them.

The only obstacle I see in community living is the escalating cost of elder communities in the US. The way that costs are going, typical people will not be able to afford community living for the length of time that they need them. I think that this is the main push behind the "aging in place" movement. I've always wondered why elders pay so much more than younger people for the same types of places.
Here in northern Virginia active 55+ communities are popping up all over the place, so that tells me there is trend going on. Two of my cousins, who are in their 70's have made the move to such communities in their States.

I tried to get my parents [who were in their 90's] to get out of their house with all those stairs, but a team of wild horses wouldn't budge them. Or so I thought....

My Mom recently passed, and 2 weeks later my Dad said he wanted to look at Assisted Living. He wanted out of that house. Turns out Dad was scared of the stairs even with a Caregiver helping him. Before the caregivers were on-site [Mom refused Caregivers], he and Mom would help each other up and down the stairs, and they had a few falls, which I learned after the fact. It was Mom who didn't want to move.

I took Dad to see Sunrise Senior Living, and as soon as he walked through the front door and saw the really great lobby, he said "where do I sign?". He's happy as a clam living there in his large one-level apartment, and now I can breathe... whew. Now when the phone rings, I'm not jumping out of my skin. My parent's house had aged me 20 years over the past 7 years !!

Dad is so glad not to worry about shoveling snow, as Mom would have him out there shoveling in his 90's.... no worry about lawn care.... if there is a bad storm, no worry about the power going out. He likes his privacy yet he doesn't feel alone as the Staff there is fantastic. Yes, there is a cost, but he and Mom had saved for these "rainy days", and it is storming out there, thank goodness he has enough to tie him over for many years.