As we age, most of us claim we want to age in place—to stay in the familiar homes we love throughout the rest of our lives. But many seniors don’t think this decision through and wind up unsafe, unsupported, lonely and even housebound.
“Elder orphans” is the phrase du jour in the elder care industry. It describes seniors who are single or widowed and have no children (at least locally) and no support system. They find themselves living alone in the community 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 the United States continues to stretch toward 80 and beyond.
Like most seniors, I want to age in place—a topic I cover frequently in my blogs. 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?
There is no one-size-fits-all roadmap for aging. I have made preparations that will hopefully enable me to remain in my home and receive the support I need, but many seniors fail to plan accordingly. Elder orphans—and their families—surely see the concept of aging in place differently.
Aging in Place: Promoting a Senior's Independence or Isolation?
It’s easy to understand why so many of us wish to remain at home. We like our familiar surroundings and we fear institutionalization, the loss of control we feel it signifies and the financial drain it brings. We often fight to remain in homes we can barely maintain or navigate safely. However, this desire doesn’t negate the fact that almost two million Americans aged 65 and older rarely or never leave their homes. Another six million are considered “semi-homebound.”
Aging in place seems ideal, but it can be dangerous, especially for vulnerable elders who have few or no community ties. The risks they face are detailed in a case study led by Maria Torroella Carney, MD, chief of geriatric and palliative care medicine at Northwell Health in New Hyde Park, New York.
“As independent individuals, isolated seniors have functioned sufficiently well on their own and thus do not actively plan for their medical future,” explains Carney and her fellow researchers. “As they age and decline, they realize, often too late, that they can no longer complete many of the tasks that they were previously able to do. Stemming from this inability, elder orphans may no longer access the care that they need, and acute, possibly preventable, medical events occur that can easily lead to hospitalization.”
For those of us aged 80 and older, more than three-quarters still live in their own homes. This may seem inspiring at first glance, but a 2014 study found that seniors in assisted living facilities actually got outside more often compared to those who remained in their own homes.
While aging in place may bring seniors a sense of control, it requires a variety of services and supports to be a successful long-term living arrangement, especially for the oldest and frailest of us. Seeking out and managing most of these essential services requires a support team, money and flexibility among team members to manage a senior’s ever-changing needs.
A Common Aging in Place Scenario
Aging is tough. I can attest that the support of family and friends is crucial, regardless of whether one wishes to age in place or not. To highlight some of the difficulties isolated seniors often face, I decided to create a fictional character named Jim. He’s not a real person but a composite of several people I know or know about.
Now 74, Jim had been the CEO of a large manufacturing company in Cleveland. He stayed on the job beyond the usual retirement age of 65 because he enjoyed it. Tellingly, he had been known to say, “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, and 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 friendships with work colleagues faded away once he retired. In time, he realized they were just business acquaintances, not true friends. Fortunately, Marie had several close girlfriends, and she and Jim continued to socialize with them and their husbands until she lost her five-year battle with breast cancer about a year ago. Not only did Jim lose his beloved wife, but he also lost his only connection to a social life.
Peter is their only child. He lives in San Francisco with his partner and their adopted daughter. They’re on good terms and speak often by phone.
Thanks to his wife and an excellent long-time executive assistant, Jim never needed to attend to many of his own personal and family needs. As a result, he now struggles to email his son and shop online for the murder mystery books he loves to read. As his PD progresses, daily tasks become increasingly difficult.
Jim and Marie designed and built their lovely home located an hour’s drive from downtown Cleveland. Unfortunately, the large house is a lot for one person to manage by themselves, even without PD. Jim was an avid gardener but now depends on a landscaper to tend to his yard and beloved plants. He recently had to stop driving as well, so he spends most of his time at home alone.
Peter is understandably worried, as his dad’s world gets smaller and smaller. He also sees some warning signs of dementia in his father, but there’s only so much he can do from afar. He has been urging Jim to move into an upscale senior living residence nearby, explaining that the move will provide him with social opportunities and activities that will make him happier and healthier. But Jim says he loves his house and its reminders of Marie and the wonderful life they shared. “I can still get around more or less,” he protests.
As in Jim’s case, the progression into “orphanhood” isn’t typically sudden and often it cannot be easily foreseen. Regardless of individual circumstances, it is important for seniors and their loved ones to acknowledge that alternatives to aging in place may be more beneficial overall.
The Truth About Aging in Place
Many seniors are adamant about remaining in their own homes, which can be a possibility for several years, but this requires careful planning and forethought. Truly aging in place is not about inaction, denial or avoiding change. In fact, for many elders, a realistic plan for aging in place requires downsizing and moving into a more senior-friendly home. But even with a proactive approach to aging, finding the proper in-home supports and putting them in place can be difficult and very costly.
Without a comprehensive plan, seniors often wind up in unhealthy and unsafe living conditions, isolated, and with a reduced quality of life. Instead of fully enjoying their remaining years with their peers and with supports designed to extend their independence, they jeopardize their health and resign themselves to struggling to maintain the status quo.
The truth is that refusing to accept help or change one’s environment or daily routines is typically what contributes to serious health setbacks, eventually forcing the move to senior living that the elder wished to avoid all along. If their condition is grave enough at that point, then it is likely that they won’t be able to fully participate in deciding where they’ll move to.
In aging, as with all challenges we face, it is best to hope for the best and plan for the worst. Without a strategy in mind, there’s no guarantee that we’ll have any control over how and where we age. This is a common, deeply rooted fear for most of us as we grow older, yet many of us allow it to become a self-fulfilling prophecy through our own inaction.
Sources: Epidemiology of the Homebound Population in the United States (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2296016?resultClick=3); 2011 National Health and Aging Trends Study (https://www.nhats.org/)