Earlier this month, ABC World News looked at a variety of issues surrounding care of aging parents, the last of which was aging in place, or allowing parents to stay in their homes.
The “everyman” subject of the segment was an 85-year-old man who insisted on living in his home because he didn’t want to go to assisted living which was “full of old people.” It was, from my experience, a pretty typical example of the level of stubborn denial that keeps a senior in a home past the point of safety.
But what can you, as a caregiver do when you’re met with this adamant refusal to move?
ABC looked at two options: paying for senior support services which cost this family $20,000 a year, which was contrasted to $40,000 that assisted living would cost or $80,000 for a year in a skilled nursing home. The second choice mentioned was the Village Movement, a type of pay-in cooperative which provides some assistance, such as transportation and home maintenance to enable seniors need to age in place. The most famous of these is the Beacon Hill Village in Boston, MA.
As good as that sounds, it’s really limited to a few urban locations such as Beacon Hill, where the needs and service providers are located quite close together. There are only 60 in existence at the moment. For folks in suburban or rural settings, it’s not a viable choice.
An excellent book on this subject, which I recommend, is Stages of Senior Care: Your Step-by-Step Guide to Making the Best Decisions by Paul and Lori Hogan, the founders of Home Instead Senior Care. Given their business of supporting seniors who don’t want to leave home, this is a remarkably unbiased and objective look at the choices and the means of making them.
They list 10 choices for senior care. These are not exclusive of one another, but may be used in combination:
• Aging in place through adaptation of the living space to the individual’s mobility needs, and through use of Village Movement type of cooperatives for maintenance of the home.
• Family care in which the senior either stays at home under the family’s care or moves in with the family.
• Senior Centers which are available for social, educational and meal programs for seniors who are active enough to walk to the center or drive.
• Adult day care centers where a senior spends most of the day. These are used when family members charged with the seniors’ care are working.
• Non-medical care at home which involves paid home helpers and companions through businesses such as Home Instead Senior Care, aging Grace, Aging Care and a host of others.
• Medical care at home for conditions requiring medical aid for respiratory problems, intravenous feedings or assistance with medications.
• Independent living communities, where seniors live in their own apartments and have access to restaurants, shops, theaters, museums and parks.
• Assisted living centers are similar, but with the availability of medical assistance. Meals are generally taken in a common dining room.
• Skilled nursing facilities are more than mere warehouses for disabled seniors. The best include mental and physical therapy as well as music, art and other mentally stimulating activities.
• Palliative care and hospice, which is now extended beyond the original end-of-life criteria. Palliative care is another name for care management. Hospice services and facilities now take in a wider range of patients beyond those who are about to die. The emphasis remains on comfort care, rather than medical intervention to prolong life.
There is no magic wand that can be waved over the issue of aging in place to solve the myriad of problems that it entails. One worthwhile suggestion from the ABC series was to begin conversations on the topic with your loved ones as early as possible. Don’t wait until your loved one has fallen, or some other crisis has occurred. Start talking now, get an understanding of what your parent wants and doesn’t want, and why. And keep checking in. Their circumstances and opinions may change over time.