I guess every form of refuge has its price…

-Eagles

I was listening to Dr. Bill Thomas describe the danger of creating “too safe” of an environment where individuals are not allowed the opportunity to take risks that would permit them to grow and thrive. He notes that the term “risk” simply means an outcome that’s different than expected.

In defining risk this way there are actually two sides; the familiar downside to risk which is the probability that things are going to turn out worse than expected—and the lesser known upside to risk where things actually turn out better than anticipated.

Upside of Risk

It is this upside to risk that seems to be lacking in Long Term Care settings; which according to Dr. Thomas are obsessed with the downside—and I agree. This is really a symptom of the “biomedicalization” of aging where the elderly are treated as a disease category to be cared for (paternalistically) by “experts.”

One aspect of this paradigm is infantilizing older people and turning them into “patients” to be subject to over-protection. The elderly are not seen as capable of human development and growth. The unstated here is that the end of the lifecycle is not worth risking for potential upside benefits. Thomas makes the point that in no other part of the life-cycle is risk aversion allowed.

The Upside Risk of Environmental Press

Aging in place is risky…Older adults are called upon to rise to the occasion daily to meet the demands of living at home: Drive to the market, mow the lawn, tend the garden, care for pets, and deal with home upkeep/repairs, security, ADLs, laundry, bills, cleaning, cooking, and many other related responsibilities that could, in some cases, be done for them.

These traditional “burdens of home ownership” that many seek to avoid, are really forms of what’s called Environmental Press (EP), or forces in the environment that together with individual need evoke a response. And it’s in meeting the demands of EP that older adults remain not just physically challenged—but mentally as well. For example, older men lose muscle mass at twice the rate of older women because in retirement women continue to do chores around the house—and “the life of leisure” may not be neuroprotective.

Perhaps it’s time we begin to equate aging in place with the upside of risk. As Bill Thomas states: Lives should include a balance of downside and upside, risks are part of a normal healthy life.

See

*It is not always physically, mentally, or economically feasible for many older adults to be aging in place—this does not work for everyone all the time.

Safety Surplus: The Benefits of Upside Risk

Environmental press model 

Biomedicalization of Aging 

neuroProtective 

(Photo Stoneybrookliving.com) 

I understand that we’re smarter than me. That’s one reason I like the idea of sharing.

― Toba Beta, Master of Stupidity

Silo: Noun 1. silo – a cylindrical tower used for
storing silage tower – a structure taller than its diameter; can stand
alone or be attached to a larger building

-TheFreeDictionary.com

The American Society on Aging Conference for 2012 proved
again to be a week of invaluable networking and mindshare with creative people
from across the country and around the world. Every year themes seem to
organically rise to the top like a thick amber head on a freshly poured
micro-brew—AiA12 was no different.

One predominate term surfaced repeatedly; “silos”
and became the rallying cry for aging- in-place collaboration efforts. Silos by
definition contain and separate; they’re fine for grain or missiles, but for
innovative ideas they can be counter-productive.

The term is borrowed from the world
of business:

Does your company operate as one coordinated enterprise or as a
collection of individual business silos? All too often, companies tend to
operate as a series of segregated business areas more commonly known as
business silos.

Are There any Benefits of Business Silos

Business silos are rarely beneficial to a company. Each business silo
creates their own individual set of systems, goals, strategy, processes and
business rules that may duplicate or conflict with those of other business
silos within the organization.

Fragmentize Aging in Place Market

Making connections between disciplines, innovative thinkers
like Louis Tenenbaum are seeking to overlay business and technology models to
solve one of the sociological issues of our times; aging in place.

Mr. Tenenbaum employs the analogy of the steering wheel
verses the car in the rush-to-market for the boomer/senior aging in place
sector:

Many (too many) entering this market place with (really)
good ideas are selling steering wheels, or tires, or windshields or rear view
mirrors or seat belts. Many (too many) entering this market place with (really)
good ideas are selling steering wheels, or tires, or windshields or rear view
mirrors or seat belts. NO ONE is selling a car. 
No one buys just a piece, hoping it will fit together sooner or later,
or when they need it.  And once they have
a car they need roads to drive on, stops signs and traffic lights to maintain
order and gas stations, repair shops, and parts stores to make the car
valuable.

The system we need is not too hard to understand, but
difficult to create. Entrepreneurs who think it will happen on its own, or is
nearly there, or the government will do it, are mistaken. It is our job to
create the Aging in Place industry to realize opportunities and serve older
citizens.

He’s right, solutions will require collaboration—which is a
challenge when competing interests are involved. What’s in it for me?
Lies near the thin surface of most human endeavors. The question came up early
during the Aging in Place 2.0 FUTURE of Housing and Services dinner hosted by
Louis Tenenbaum, The Aging in Place Institute, and LeadingAge.

This question may have to be addressed first before any real
cross-pollination-efforts take shape. The industry is new and part of the
excitement is that we’re all making this up as we go…As Chris Kennedy noted, it
feels like the Silicone Valley back in the early 1990’s, there are BIG problems
to be solved—which also means there are BIG opportunities.

We have smart energetic people making the parts in silos,
and while this arrangement encourages specialization, it also prevents
collaboration, creates boundaries of responsibilities (and blame), discourages
knowledge-sharing and creates duplication of effort.

Why think about the future? 

Richard Alder said he’s involved in gerontology because he wants to create a future he would want to
live in. He also noted you can be prepared—or you can be taken by surprise.
Preparing for the future can provide foresight, leading to insight, and finally ending in action.

It remains to be seen if the social issue of our times
(aging in place) will be addressed by collaborative effort in the near future.
The first meeting of Leading Age was an energetic start—and like snow fall, a little bit stuck…laying the foundation
for further discussions.

See

Aginginplace 2.0  

LeadingAge.org 

Harvard Business Review: Silo Busting 

(photo apartmentthearpy.com)

Prevention is better than cure.

-Desiderius Erasmus

Common Scenario for Aging in Place

Mrs. Campbell is an eighty-seven-year-old widow who
resides alone in her home of thirty-five years. For the past eight months her
health has been on the decline due to congestive heart failure, arthritis which
limits her mobility, and diminished vision due to cataracts and glaucoma. It
takes Mrs. Campbell considerable effort to maneuver around her home
environment, which is strewn with stacks of magazines and newspapers along the
pathways, and with numerous throw rugs. In addition, she holds on to the shower
curtain when getting in and out of her combination bathtub/shower and utilizes
the toilet paper holder to support herself in getting on and off the toilet. A
recent professional assessment of her home environment and functional abilities
indicated that: 1) the clutter along the pathways should be removed and throw
rugs should be secured or, preferably, removed 2) a grab bar and tub transfer
seat should be installed; and 3) a raised toilet seat with nearby grab bar
should be installed. Mrs. Campbell flatly refused all professional
recommendations, stating that she is managing adequately with her home as is.

 –Staying Put:
Adapting the Places Instead of the People p.80

This aging-in-place scenario is all too familiar to the
professionals in the field. The recommendations for logical home adaptations
are not embraced; and therefore not acted on. The actual prevalence of home
adaptations has historically been low. And current economic forces are only
adding barriers and making the resistance greater.

Compliance Criteria

From the literature on medical compliance and experience of researchers
with home adaptations, seniors use four criteria in deciding whether to make professional
recommendations:

1). Susceptibility to the target problem

2). Severity of the problem if the adaptation is not done

3). Likely effectiveness of the adaptation

4). Costs (financial and behavioral) of the proposed adaptation

“It’s the psychology, stupid”

During Bill Clinton’s successful 1992 presidential campaign
against George Bush, the phrase: “It’s the economy, stupid.”
became widely used in politics. Although fitting here too, perhaps even more
essential to keep in mind would be: “It’s the psychology, stupid.”

See

Free Senior Housing Guide

Strategies for Home Modification and Repair by Jon Pynoos, PhD

Ohta J. R. and Ohta M. B. (1997) The Elderly Consumer’s Decision to Accept or Reject Home Adaptations: Issues and Perspectives. In Staying put: Adapting the places instead of the people. Edited by Susan Lanspery and Joan Hyde (pp. 79-90). Baywood Publishing: Amityville, NY.

(photo Virginia Tech Center for Gerontology)

Don’t fight your *problem. Know that there is a solution.

-Joseph Murphy

 I came across another content rich article written by a Physical Therapist and ergonomics expert, Shane Haas that is exceptional. Mr. Haas is in the business of solving problems for aging in place; enjoy his insights and remember there is a solution.

Therapists help patients see that home ergonomics modifications can work.

by Shane Haas, PT, MSIE, CPE
The benefits of applying ergonomics to the home are happier, safer and more independent patients. Ergonomics is the science of creating the best fit possible between people and their surroundings. Developed in production-based work as a way to reduce injuries, improve job productivity and increase employee satisfaction, ergonomics has since grown into other industries, including home care. Despite being long removed from the factory floor, the goal of home ergonomics remains true to its roots: adapt the environment to fit the individual.

Given the challenges of aging or living with a disability, the vast majority of patients still wish to remain living at home. The problem is that many homes, once places of comfortable living, become source of obstacles. Few homes are built with consideration of the changing needs associated with aging or living with a disability. To meet these challenges, adaptations to the home are often needed. A basic understanding of home ergonomics will help ensure such adaptations are a success. It should be noted that fall prevention efforts are more effective when adaptations are combined with other strategies (e.g., exercise, medication management, dietary supplements, footwear management).

Home Ergonomics

It is the focus of this article to highlight ergonomic modifications to the home environment. Home ergonomics deals with a population that is often old and physically limited. In industrial ergonomics, a young and physically fit population is more common. In industry, common hand tools of interest include hammers, wrenches and drills. In home ergonomics these are replaced by canes, reachers and walkers. In home ergonomics, the focal point is a single user, the patient, with particular attention being paid to his unique capabilities and limitations. In contrast, in industrial ergonomics the focus is on multiple users with attention to trends and population-based data. In industry, solutions are based on information from organizations like NIOSH and OSHA; in home ergonomics, it is the Americans with Disabilities Act (ADA).

To better fit the surroundings to the individual, the typical ergonomics approach is to reduce or eliminate risk factors in the environment. The most common ergonomic risk factors in the home are excessive force and awkward posture. Excessive force is exemplified in tasks that require significant strain or call for more strength than the patient is able to generate. Patients are often too limited physically to safely lift or control their own bodyweight which leads to struggles with basic tasks like getting up from a chair or climbing stairs. Limitations in hand strength creates other unique problems such as the inability to remove lids and tops, manipulate kitchen utensils and controls, and handle items in the bathroom.

Awkward posture is a significant deviation of the body from a neutral position. Whether sitting or standing, the further the deviation from neutral the more awkward the posture. Examples of awkward posture include low chairs or commodes that position the knees higher than the hips. The lack of adequate space under a sink forces awkward posture, as wheelchair users must twist to the side to access the sink. Narrow doorways create awkward postures as patients turn walkers sideways and use small, choppy steps to get through the door.

We will review five common activities of daily living and discuss possible ergonomic improvements for each. These improvements target reducing or eliminating excessive force and awkward postures, in order to create the best fit possible between the patient and the home. Solutions listed focus on inexpensive adaptive aids and not larger, more expensive home renovations.

1. Transfers into and out of the shower. Does the patient need to hold onto anything (e.g., wall, faucet, towel rack) while getting into and out of the shower? Is the patient able to safely lift the legs over the edge of the shower or tub (up to 18 inches)? If a lack of secure hand holds is noted, consider adding grab bars. Follow ADA standards for grab bar selection and placement. If grab bars are not able to be installed due to lack of landlord approval, poor wall durability, etc., consider alternatives such as a suction-cup grab bar, tub cane or security pole. If an inability to safely lift legs over the edge of the shower or tub is seen, adding a transfer bench can increase safety as the patient is able to remain seated during the transfer. Other showering aids to consider include anti-slip mats or strips, hand-held showers and long-handled sponges.

2. Transfers on and off the commode. When seated, are the knees positioned at a height noticeably higher than the hips? Does the patient need to push off of or hold on to anything (e.g., toilet paper holder, corner of the sink) during the transfer? To help correct low seat heights (typical height is 15 inches), consider adding an elevated toilet seat, placing a frame over the toilet, or changing out the commode with a taller bowl (17 inches). If pushing off is noted, think about adding toilet safety rails or grab bars. A flip-up grab bar may be needed if there aren’t walls near the commode. For steadiness upon initial standing, consider an angled grab bar which allows the patient to both push off and hold onto once standing.

3. Transfers into and out of home. Are there steps or stairs to get into and out of the home? If so, are there adequate handrails? Is the patient able to lift and place the assistive devices (e.g., cane, walker, crutch) on the steps safely? Can they open, close and lock the door? A ramp may be needed if the patient is unable to safely ambulate up and down stairs. If already in place, does the ramp comply with ADA standards? Common ramp-related mistakes could be the slope is too steep, a lack of sufficient landing space, inadequate hand rail(s) and poor structural integrity.

If wheels aren’t needed, but balance is still limited, consider adding handrails or secure hand-holds at the steps or stairs to help increase steadiness at these transition points. For rolling walkers and wheelchairs, doorway thresholds higher than ½ inch can impede rolling. Think about adding a threshold ramp. Threshold ramps come in various materials and sizes, ranging in height from 1- 4 inches. If opening or closing doors is a problem, consider removing a storm door (or the door closers on the storm door) or adding an automatic door opener. If manipulating door handles and locks is a problem, consider using lever handles and remote deadbolts.

4. Transfers into and out of bed. When preparing to get into bed, is the patient able to sit on the edge of the bed with hips far enough back to prevent sliding off? Can he lift his legs up and into the bed? Does the patient grab and pull onto anything (e.g., head board, side of mattress, night stand) when trying to get out of bed? If the bed is notably high, e.g., the patient is unable to sit far enough back on the bed to get in, consider adding a footstool with a handle. A leg lift can be used to help lift legs into the bed. If the patient grabs and pulls on anything to get out of bed, think about adding bed cane or rail to provide a secure hand hold for transferring out of bed and give support upon initial standing.

5. Transfers on and off a seat. Similar to transfers on and off the commode, when the patient is seated in their recliner, couch, or chair of choice, are the knees positioned at a height noticeably higher than the hips? Does the patient need to grab or hold on to anything during the transfer? If the seat is too low, consider adding furniture risers. Stackable risers are available for graded adjustments in seat height. Specially designed risers are also available for the uniquely shaped bases on recliners. Adding a couch cane will provide a secure hand hold to aid in standing. While not recommended as the best first option for seating problems, if patients need assistance beyond furniture risers and couch canes, consider replacing recliner with a lift chair.

In home ergonomics, small changes can result in big improvements in the fit between patients and their surroundings. Removing sources of excessive force and awkward postures eliminates obstacles in the home. Fewer obstacles helps return the home to a place of comfort and security, fulfilling the benefit of home ergonomics: happier, safer and more independent patients. 

 Shane Haas, PT, MSIE, CPE is Senior Fall Prevention Specialist, Adapt It Ergonomics. He graciously granted permission to reproduce this article.

See

Lighting for the Aging Eye by Shanna Casey

 (photo epicturs.com)  

*note the image shows a lovely tub that is not an aging in place solution and could be a problem for older adults.

To be idle is a short road to death and to be diligent is a way of life; foolish people are idle, wise people are diligent.

-Buddha

 It was another lovely weekend in the Pacific Northwest and I was having coffee and planning my daily activities with the local talk station as back-drop. Living in a home built in 1930 (and not the least bit handy) I tune into Around the House with Handyman Bob to pick up relevant/practical ideas on home improvement.

Today’s topic: Radon

Radon is not something I think about; in fact when we moved into our lovely money pit, we had it tested for Radon—and thought nothing of it again when the tests results showed it wasn’t an issue. Today’s program brought radon back on my radar screen. Handyman Bob began with statistics like those offered by The EPA: 

Radon is the number one cause of lung cancer among non-smokers, according to EPA estimates.  Overall, radon is the second leading cause of lung cancer.  Radon is responsible for about 21,000 lung cancer deaths every year.  About 2,900 of these deaths occur among people who have never smoked.

Bob’s delivery is kindly yet authoritative, he’s local, cares about the community and it’s palpable in every show. This edition took on a tone of warning and the statistics grabbed my attention and got me thinking about how this relates to aging in place. 

Aging in Place with Radon

Aging-in-place professionals talk of home safety in terms of the built environment and support services, seldom do I hear any one mention radon. January is National Radon Action Month and this is as important as any universal design kitchen or 24/hr alert button worn around the neck. Get your home checked—period.

Proactive Steps

1. The EPA provides maps of Radon Zones around the country—check it to see if your aging in place home is in a hot zone by clicking the link here: Radon Zone Map

 2. Find a Radon Professional in your area by clicking the link here: Radon Professionals

We lock our homes at night, use smoke detectors, remodel for bathroom safety, leave on nightlights, eat right, don’t smoke, visit the doctor and countless other measures to ensure successful aging in place in the homes we love—yet a silent killer could end it all…

Be wise, be diligent–get your home checked; I’m in favor of your aging in place for many years to come and I know The ol’ Handyman is too.

See

Radon Expert Gary Hodgden

Rutgers University/Bill Broadhead 

Listen to Around the House with Handyman Bob: On Radon The Silent Killer

Radon Show 1/12/12

Radon Show 1/14/12

Radon Show cont’ 1/14/12  

EPA: Get Your House Tested

(photo uglyhousephotos.com)

He that will not apply new remedies must expect new evils; for time is the greatest innovator.
-Francis Bacon

Jean is 91, I know she won’t mind my telling you her age—she’s proud of it. She is a walking endorsement of “Successful Aging.” And just what is SUCCESSFUL AGING? The most accessible definition comes from the book by John Rowe, MD and Robert Kahn, PhD based on the Longitudinal MacArthur Foundation Study.

The components of successful aging include:

• Good health, low risk of disease and disability.
• High mental and physical functioning.
• Active engagement with life, an active life.

Jean has all 3 in abundance. She does a light workout at the gym daily; along with regular check ups. She is the front-desk-go-to-person at my gym, and not only drives across town to get to work, but keeps the books, signs up new members, answers the phone, trouble shoots/problem solves an aging infrastructure, and interacts with a vast generational continuum. I’ve seen Jean baby sit for active mothers in yoga class, watch pets for iron-pumping baby boomers, and consult moody teens—all in the course of my work out. She also has her nose in a book or paper when not busy with her duties.

Without knowing, or pursuing it directly, she’s aging successfully by her lifestyle; it’s complex, engaging, purposeful, and active. I know, I’ve made an informal study of her over the years. So when she speaks, I listen… 

Aging in Place Remodeling

One day she mentioned to me in passing that she was having her bathroom remodeled. I asked if she was adding any Universal Design features (we’ve talked before about aging-in-place design) and of course she did. “I added a grab bar and a tiled-floor non-barrier shower. The bathroom remodel is so beautiful I want to have a party to show it off!” 

I inquired if she had done any other remodeling to her home—turns out she has done extensive work and plans on staying put! Just how much surprised me; not only did she invest in a new lovely bathroom remodel, but also added a new roof, new front door, a full kitchen remodel and painting, as well as having her 47 year old home’s foundation lifted after many years of settling. “I fixed it so the doors would close correctly.” She also had the decaying and unsafe deck rebuilt and covered—adding a new living space that had been neglected for years.

Reverse Mortgage to the Rescue

Jean had been putting off much needed home improvements due to the prohibitive costs involved—but then she reported: “I got a reverse mortgage and it made it all possible.”

A well-known financial institution in the area supplied the reverse mortgage, walked her through all the steps and made it happen for her. She was also lucky to find a wonderful contractor who is orchestrating all the sub-contracting jobs and overseeing the project. Jean could not be happier. She loves her “new home,” feels safer in it, and it has added to the quality of her life experience.

Effect of Aging in Place with a Reverse Mortgage on the Economy

As I listened to Jean proudly report the progress of her aging-in-place remodeling it occurred to me how much economic stimulus was being generated by her acquiring a reverse mortgage. Jean was a stimulus package unto herself! Thinking in terms of systems, imagine all the economic transactions involved in the following list: 

1. New Front Door

2. New Roof

3. Newly remolded Kitchen and floor

4. Newly remodeled bathroom

5. Painting

6. Redoing the foundation

7. New deck

All the economic activity generated by just one reverse mortgage—work that would not have been done otherwise. Not to mention the added security, safety, and pure joy of living in a remolded home…what a win-win! 

Saving the Economy one Home at a Time

In the United States (not to mention the rest of the world) we have an aging building stock that requires remodeling to accommodate the demographic transition. By the end of 2011, 28% of America’s housing inventory will be 56 years old or older; 52% will be 35 years old and getting older. There are over 41 million houses in this age bracket, and many are homes of rapidly aging occupants. Even if limited percentages are reverse mortgage candidates imagine the potential boost to a sagging economy.

Couched purely in economic terms, putting workers back on the job, purchasing needed products, keeping people in the community verses early institutionalization (huge cost savings) and employing companies that provide reverse mortgages, all makes sense. Add the value in safety, preserving aging housing stocks/neighborhoods, social equity of an employed public, and quality of life enhancement for older adults—it’s a “slam-dunk.”   

The Bathroom Remodel Party

Jean will have her party in the new bathroom; I’ve been invited and look forward to seeing the end product. May her ranks grow one-by-one, neighborhood-by-neighborhood, city-by-city, coast-to-coast. It’s been said: If you want a BIG opportunity…find a BIG problem. This is both, and something to consider carefully.

See 

Reverse Mortgage Information.org

8 Elements of a Home in High Demand for an Aging Population

(photo newburghrestoration.com)

Thousands of candles can be lighted from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared.

 -Buddha

One of my favorite songs is James Taylor’s The Secret O’ Life is Enjoying the Passage of Time; and the holidays remind me that another year will soon be past. As I hung the paper-star lanterns in the front window, it seemed like I had just put them away…and now it was time to ponder gift-giving once again. 

Something You Want

I read a post about an older adult named “Bob” whose step-son asked him what he wanted for a gift this year. His response…”I really don’t need anything.”  The step-son replied “Bob, I am going to get you something, it might as well be something you want.”  What I read next simply delighted me with its practicality and possibilities.

Bob:

I thought for a while and finally said: “Give me three light bulbs and the promise that you will install them as needed.” The beauty of the gift is that I have not been on a ladder in over a year and thus have avoided the risk of falling. 

The Gift of Aging in Place

Each year getting older adults gifts (or yourself for that matter) can actually be counter-productive; see hoarding and clutter. How many times have we heard the “I don’t need anything” line, and a desire to give gets even more clouded by feelings of obligation or tradition. And in today’s climate resources are tight for many, so here are some thoughts on capitalizing on two trends affecting all of us; the aging population and the economic downturn. Give the gift of aging in place, because according to AARP this is what 89 percent of boomers/seniors want.

Get creative and make a coupon book, or single coupons for the following aging in place gift ideas:

10 Aging in Place Gifts that cost only your time

1. One home safety inspection: Then on the coupon date, go over the CDC/MetLife foundation Check List for Fall Prevention and Home Safety with the home owner and identify possible needed home modifications.

2. To put up/take down Christmas lights

3. Be their chauffeur for a day (you will drive them in their car anywhere they desire)

4. Walk the dog each week for a year

5. Cut the grass every two weeks/or shovel snow

6. Give a caregiver the weekend off and you do the caring

7. Cook dinner in-home one night for the senior

8. A deep-cleaning of the home

9. Tech-session (computer tutoring) help them set up a Facebook page or email

10. Wash/wax/change oil/vacuum the car  

10 Aging in Place Gifts under $30

1. Home Smoke Alarm battery changes every 6 months

2. Change out lower watt bulbs with 3 higher/brighter energy-saving ones

3. Replace 3 toggle light switches with 3 rocker-style ones

4. Put in a Lever handle door opener to replace an old round doorknob    

5. Install a toilet seat raiser

6. Put non-skid strips in the tub/shower

7. Paint the steps a brighter color (or paint the ends of the steps a bright contrasting color)

8. Place 2 Sensor LED Lights; one at the top and bottom of the stairs

9. Install a Duro-Med Expandable Door Hinge

10. Add a Wide Angle Peephole Viewer in the front door

10 Aging in Place Gifts $100

1. Rubber Threshold Ramp with Beveled Edges

2. The MemoryPlus amplified BIG button phone

3. Replace old worn bedroom slippers with new with nonSlip sole ones

4. Clamp-on tub rail

5. DRILL-FREE Slide Bar with Handheld Shower and Showerhead

6. Snapfon “ez ONE” Cell phone for seniors w/ big buttons

7. Switch Sticks Walking Cane

8. Outdoor Motion Sensor Solar Security Light

9. Toro Electric Power Shovel

10. JitterBug (GreatCall) Phone

Marjorie Holmes said; “At Christmas, all roads lead home.”  This year make aging in place the gift; because home is the most important place on earth to enjoy the passage of time…

See

Tip: The Goodwill often has aging-in-place items like walkers, shower chairs, canes and wheelchairs (look there first to save)

Aging in Place Gifts

Laurie Orlov’s: Tech Gifts for Seniors

The Secret O’ Life by James Taylor

My Safe Home

NAHB Aging in Place Checklist

Hire an AIP CAPS Professional  

(photo angel-lifestyle.com)

*Note these items and actions do not guarantee successful aging in place-but they can increase the odds

“Discovery consists of seeing what everybody has seen and thinking what nobody has thought.”

 — Albert von Szent-Gyorgy

Louis Tenenbaum is the father of the aging in place movement in this country; when he speaks/writes, I for one, pay attention. Here is a guest post by Louis on being inspired in Beantown. Within these words is some gem lying in waiting; enjoy.   

I am an innovation immigrant. 

I don’t often feel inspired. But I am inspired by the incredible third annual Aging Means Business Conference held Friday in Boston associated with the Gerontological Society of America annual meeting.  This was my second time at this conference organized by Greg O’Neill and his team of Sarah Wilson and Dani Kaiserman from the National Academy on an Aging Society working with Mary Furlong and this time with the always provocative and fun (and of course, natty!) Joe Coughlin from MIT AgeLab.

I have been involved with Mary’s events for a few years…having been a semifinalist in the first year of her Boomer Venture $10,000 Business Plan Competition and on the winning team a few years ago. This time the results Mary has been working toward really came together. There was a healthy mix of long dedicated and newly interested business thinkers. The energy was palpable. Just being in this crowd was fun.

The air of excitement started at a Friday night reception hosted by First Republic….a bank that is doing things differently. As we learned in one of the next day’s presentations, they are paying attention to their customers! What a novel idea! The innovation I heard that sounds great?…NO music! (Turns out I am not alone unable to hear and concentrate with music playing in the air around me. I avoid retail and restaurant experiences for this problem. This bank listened.)

Curiously (or NOT- maybe expectably) that issue rose again later in the day. Gretchen Addie and Jose´ Colucci  from IDEO, the quintessential design and innovation consulting firm, engaged us in a process throughout the day rather than just giving a presentation. Innovation worksheets were on the tables when we came in. We were encouraged to state ideas, note the participants, explain the idea, make a sketch and then hang them on a board. Gretchen and Jose´ reviewed them, then shared their take on a few, putting our new ideas in a context of some of their previous projects. We saw how they help ideas grow.

One of these ideas related to the bank practice- Cones of Silence for restaurant tables – allowing diners to dial the background ambiance/noise up or down to balance their desire and threshold for atmosphere and conversation. BOY would I love that!

Matthias Hollwich, the keynoter was a real hit. Matthias is a co-founder of HWKN and the design leader of the BOOM senior communities. Those of us in the senior community design field for many years might say there is really nothing new here, other than wild looking/futuristic house forms. That misses the point. The point is a young, excited and out of the box designer came to this field cold, with no prior knowledge or assumptions and came to the same conceptual conclusions about lifestyle and community we have been promoting for years. That is totally validating! Second, his work is evidence of fresh and growing interest in these opportunities. Third, he brings fresh ideas for reaching the solutions. This young and really pleasant architect and…. just  plain….leader,  pulled together an extraordinary team, bringing real excitement to housing older folks in community.

True to form, Matthias would not be satisfied with the same old survey data. He engaged Hunter Tura of Bruce Mau Design, also new to this field, to develop a tool (looks like an app, folks) to gain customer insight. They hit the nail on the head.

I was excited, but not inspired, when I went to bed. I woke up ready to work, and, reviewing some materials, the inspiration hit.  What turned up the volume? Two more stories.  Do you have the patience?

1. I was so happy to see Jan Hively when I walked into the room Friday morning. Jan Hively, human extraordinaire, is lively, engaged, committed and she gets things done! Jan showed me a brochure from the European Union AAL program (Ambient Assisted Living- the EU term for aging in place or community). The EU has declared 2012 as the European Year on Active Ageing and Solidarity between Generations.  Saturday morning I downloaded the ‘brochure’, a catalogue really, of projects- and started looking for individual project pdf’s to download for reading on the plane home. I was bowled over by the sheer number of ideas they are pursuing in the EU effort.
2. That reminded me of a conversation I had at the conference with Marcus Wilhelm, Research Director from Redstar. Marcus, like Matthias, is an innovation native.  He explained the way his company building company works. They generate eight ideas a month, winnow them down through research with the goal of supporting a few startups per quarter. I had heard this sort of thing before but never got much of a handle on it.

I have been trying to get a handle on innovation for a few weeks. I thought I had it recently- thinking it was about leaving assumptions behind. That is part of it. Now I think it is about the process of rapid idea generation. That fits the pace of the digital/internet world, where I am also an immigrant.

This is exactly what Gretchen and Jose´ did with us.  It clicked for me as I paged through the plethora of ideas being pursued in the EU.  The process of innovation is to generate lots of ideas and consider them. For we immigrants it is a new way to think.

I feel inspired to generate lots of new ideas for the problems I am trying to solve, many of which are identified in Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge

Trust me there was much more to think about and many other exciting, even inspiring, people at this conference. I may get another post or two out of it.

Congratulations and THANKS to those who worked so hard to pull this together. Inspiration is a gift. I appreciate it. I hope I see all of you at next year’s conference November 14-18, 2012 in San Diego.    Why miss a chance for inspiration?

See

Aging in Place Ideas

(photo cupboardsonline.com)

We must embrace pain and burn it as fuel for our journey.

-Kenji Miyazawa

This past week I took care of a younger woman who had a long list of co-morbidities ranging from depression and morbid obesity to cervical cancer. But it was her 51 year old mother who I felt needed most of the attention during the patient’s stay.

Betty’s Story 

In 1899 the Commissioner of the U.S. Patent Office, Charles H. Duell, was reported to have said: “Everything that can be invented has been invented.” I almost feel this way about the topic of caregiving; what more can anyone say that hasn’t been covered? But as the limited vision of Mr. Duell‘s statement has shown there are always going to be new developments.

The patient’s mother, lets call her “Betty,” was taking care of her daughter (and there were multiple issues), as well as caring of an 82 year old mother with newly diagnosed Alzheimer’s. Further, Betty had a heart attack five weeks earlier and continues to smoke (her only release). Her sister is not contributing to her care, and an additional source of stress; so the duties have fallen solely on the shoulders of Betty–alone. 

I’ve learned in the clinical setting at times the “patient” is the family, and the most therapeutic thing you can do is just listen. Betty was willing, almost anxious, to share her situation (while her daughter was sleeping); not complaining—only reporting. 

The Cost of Informal Care

The value of unpaid family caregiving services in the U.S. is estimated at $375 billion a year, more than twice what is spent nationwide on nursing homes and paid home care combined. At present, 29 percent of the U.S. population, or approximately 65 million Americans, provide care to an adult relative or friend, according to Caregiving in the United States, National Alliance for Caregiving. And nearly 10 million adult children over the age of 50 care for aging parents.

These family caregivers are themselves aging and providing the bulk of unpaid care (hence the term “informal care”) at a time when they also need to be planning and saving for their own retirement. The effect of informal care on work, wages, and wealth has been well documented and studied. The toll on the human experience is what’s endless in scope…

“Most eldely males have informal care; most elderly females do not.”

-Cynthia M. Taeuber

Aging in Place Often Requires Informal Care

The majority of seniors prefer aging in place, and Betty’s mom is no different. For now, at 82 and in the early stages of a brain-ravaging disease, her time at home is coming to and end. Soon challenging decisions will have to be made and despite the best of intentions, caregivers like Betty also need to balance the demands of their own families and professional lives together with the needs of their aging parents. Sometimes aging in place isn’t possible—or even desirable.

The numbers are titanic, the challenges systemic, and yet it takes just one human encounter to bring it home—make it real. I haven’t been able to shake Betty’s visit from my mind. She and I are similar in age and most everyone I know has there own story; or they will have. Rosalyn Carter said it best: “There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.”

Another Caregiver Story

One night I was taking care of a woman admitted to the ICU after an extensive surgery for cancer. She was a lovely optimistic soul who wrote a weekly column for a senior newspaper and was a gerontologist. We had professional interests in aging and much in common. She had written several books on gerontology; including one on caring for the caregiver. She sent her husband Tom out to the car for a copy of her latest to give to me.

The next day Tom relayed a story. Taking a break from his bedside vigil, he strolled over to the Starbucks across the street from the hospital for a cup of joe. He sat down to drink his coffee consumed with thoughts of his wife; noticing a newspaper lying on the table next to him, Tom asked the man if he could borrow it. They struck up a conversation and Tom told the man about his sick wife. The generous man offered not only the paper, but kind words suggesting he be sure to take care of himself. He then mentioned a book that helped him get through caring for a sick family member. The book as the very one Tom’s wife had written…

See

The Intentional Care Giver  

Leeza’s Place

Aging in Place and Care Giving

Gail Sheehy on Care Giving

National Care Givers Library 

The Far Shore of Aging 

Behind The Old Face

Women and Health Care Under the ACA

(photo dailyhealthsquare.com) 

Life’s most rewarding challenge lies in defeating the temptation to merely exist.

- Laurie Harper,  A Taste for Life (1983)

I called my friend Frances the other day; she’s in her 90’s and residing in a traditional nursing home. Our conversation always gets around to her anguish over being “stuck in this “godforsaken place.” Her home defined her in a very real sense; it was her life’s purpose.

She now depends on a wheelchair for mobility and her mind has atrophied from the lack of stimulation. I miss our challenging conversations in her home office and watching the squirrels together, under the tree in her yard.

When Aging in Place Doesn’t Work

Howard Gleckman wrote a thought provoking piece on the challenges with aging in place. His premise was thatfactors having to do with social issues, more so than medical concerns, are often the barriers to aging in place:

-Lack of qualified caregivers

-Lack of services such as basic transportation

-Lack of housing or funds for repairs

-Lack of social networks and isolation

His solutions include more flexible Medicaid programs (they pay for NH, but limited benefits for home care) and anemphasis on long term care insurance which will provide financial resources to care for loved ones.

Gleckman concludes that we can’t keep everyone home (i.e. those with severe dementia), but postponing institutionalization of the elderly, by even months or years, is a goal worthy of our best efforts.

I agree keeping the dream of aging in place alive is not easy, and neither is telling a loved one they must leave their home…

Listen to: Convincing an Aging Mother to Take a Hard Step

See

Aging in Place is not so Easy

The Death of Nursing Homes

Can Aging in Place Reduce the Cost, Increase Quality of Healthcare?

Swedish “Night Patrols” Help Elderly Stay out of Nursing Homes

(photo photonet.com)