Aging in Place - What's Possible?

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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.
Blessings, Joanne

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Deb, this is my dilemna (see my earlier post on this thread). Our government gives lip service to the "aging in place" movement. But just try and find these service.
My mother, overall, is healthy and mentally sound, just having problems with mobility that would exclude her from most ALFs and she is certainly not a candidate for a NH.
So I have spent the last two weeks trying to find services for her as an independent but "house-bound" senior. I have gotten very little useful information and even a few snarky implications about placing her in an environment where she can get these services (ie: warehousing) The upshot is, there is nothing to be gained financially for all these companies and facilities if patients started receiving care in their homes. There have been extensive studies in Wa. D.C. that prove that in-home care, managed by family caregivers, will actually save taxpayers and unburden Medicare. The reason no one is championing the cause is because businesses that claim to help seniors find a "home" environment for their care are really just taking advantage of the system. And caregivers are too tired and busy to get "political."
So here you and I sit (and many others on this site)...trying to find appropriate levels of care for our parents in their homes. It is truly the healthiest, most humane, and loving environment for them to spend their last years. Why can't we take a small portion of the funds we are paying to Medicare related businesses and give it to family caregivers who are assisting their parents...many in their own homes?
We need a better solution i.e., care that can be adapted for the home environment. I, too, like the residential home care model...it is closer to what I would want for my Mom if I was unable to care for her.
So far, I have managed to find (beg, actually) a nurse practioner to come to Mom's apt. once a month. I could not find a doctor who does home visits, but I think I can coordinate the visits by the NP with the doctor's office. I have 2 in-home caregivers who help with personal care and a little light housekeeping. Everything else I do myself.
I figure I am saving the system grundles of money and keeping my Mom safe and happy in her own home. I think people who are doing the same deserve a little break...don't you???
take care,
Lilli
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I agree. Residential care homes sound like a great choice. They are the picture of a social model of care. In Missouri we have residential care facilities but the residents must by fully ambulatory or they are transferred to a higher level of care, ie nursing home. The obvious is, if mom was fully ambulatory she would still be in her condo. I have been obsessed for 3 months (not bad out of 3 years) trying to find alternatives and I keep coming back to 0. The few social models here are licensed as assisted living level 2, they are dedicated to memory care (this has the largest demographics) and when you can no longer pay privately you are in a nursing home medicaid bed. I do think that the adult family home should be better highlighted even for the few states that they can be found and I really like everything I have read about them.
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What about Residential Care Homes. Nobody talks about them. It is the most wonderful choice for elderly in need. We, because I am one of the owner/providers, take care of elderly 24/7 from level of just companion to the end of their lives. We never give up on them doesn't matter how heavy they will become. We have in home doctor visits, dentists, psychical therapist, occupational therapist, xrays, you name it. We are alos, licensed and inspected by the state. Some of us take Medicaid some of us don't. In different states these house are called either Adult Family Homes, Adult Foster Homes, Micro community, Boarding Homes, etc.
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6 months ago a St. Louis business journal reported that LESS THAN 0.5% of nursing homes are a social or household model. Is it any wonder that families struggle and elders dig in? While articles and TV shows may talk about a cultural change, 99.5% of the time we find absentee owners looking for a profit margin and institutionalized care and I apologize up front to any owner who is hands on their facility.
We have a surplus of houses in this country and a high unemployment rate. Could a grassroot movement force state governments to rethink the obstacles they have made?
I don't see the solutions being discussed, is there a different site for those caregivers who have it figured out?
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I seem to have touched a nerve here. I live in very rural Colorado, so you can imagine what the services are like in my county. We're part of six counties under a single Area Agency on Aging. To say the agency's resources are stretched thin would be a vast understatement.
As to the question about convincing MIL to move to assisted living, my recommendation would be to let her try it out. Many places allow for weekend or overnight visits. Sometimes it's done so the caregivers can have a weekend off, others it's simply a means of introducing potential residents to the facility. Assisted living is really beneficial because of the opportunities for socializing. Elders who live at home by themselves can be very isolated and that leads to drepression which brings with it a host of mental and physical problems. If she's reluctant, see if you can't educate her about the benefits through conversation about the dangers of isolation, and visits to one or more facilities so she can observe for herself how it would be to live there.
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..one more thing...try to find services that are closest to where you live....
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I have just spent the last several weeks trying to locate services in my new community. Every time I call a program, it is implied that I should place my Mother in a "facility." When I invoke the "aging in place" phrase that these admisitrators are found of throwing around, but have no intentions of supporting, I am met with resistance. I have come to the conclusion that the only people benefitting from these programs are those who are working for them.

However, change is on the horizon (at least I hope so.) For example, Senator Ron Wyden (D-OR) and Representative Edward J. Markey (D-MA) recently introduced the "Independence at Home Act of 2009" (S. 1131/H.R. 2560). This bill would amend Title XVIII of the Social Security Act to provide chronically ill Medicare patients access to coordinated, primary care medical services in lower cost and more comfortable treatment settings, such as their residences. A patient-centered health care delivery model is at the heart of a proposed three-year Medicare pilot project leading to an ongoing Medicare benefit.

Everyone recognizes that providing in-home care is a far more practical, efficient, cost-effective and humane way of helping the elderly. What is curtailing the process? The endless hordes leaches and scam artists who are bilking an outdated Medicare system. Our leaders worry about giving caregivers a few breaks so we can assist our parents, but they continue to fund programs that top-heavy with administrators who are far removed from their constituents. How can the elderly "age in place" without services that can come to THEM???

I have written letters to my local assemblyman, senator, and governor. In my letter I noted that caregivers are a silent, suffering majority who do not have the time nor engery to form political "action committess." Nevertheless, aging is an equal opportunity event....maybe when these polticos have parents who need assistance or need it themselves will they understand the tremedous urgency of our need.

Access to these programs should be streamlined and direct - this is not a privelege; it is a right that we have all paid for. If we don't speak up, nothing will change.
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I, too, watched that series on ABC tv. There are more options for elder care than ever before, but it is still difficult for many seniors in rural areas to find the help they need. We moved my MIL from a small rural community to our home in a suburban area because there were no services available near her home. We are now struggling with helping her understand why she needs to move to Assisted Living, since she has no personal experience with this type of living situation, having only seen skilled nursing care. How do you convince someone that Assisted living is a better life for them?
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When designing a home, it would be wise to plan ahead and have the bathroom wide enough and spacious enough to accomodate transfers, laundry on the first floor , bedroom first floor, etc. Also the entry to the home , at least one entry that is wide enough and has no steps.
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