Where to Start: Aging in Place 101
Step 1 Do Basic Needs Assessment
- ADLs (aka Activities of Daily Living) Personal Care: bathing, eating, dressing, toileting
2. IADLs (Instrumental Activities of Daily Living) Household Care: cooking, cleaning, laundry, shopping
3. Health Care: Medication management, physician’s appointments, physical therapy
4. Emotional Care: Companionship, meaningful activities, conversation
Click here for Our Needs Assessment Worksheet
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Step 2 Find Resources Within Reach
Seek help from your local Area Agency on Aging for guidance. They can connect you with services in your (or your parent’s’) area. For example, the county in which you/or your parents live might have social workers who can evaluate needs and put you in touch with pertinent services like home care workers and help with meals or transportation.
Click here for our Resources on Caregiving services.
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Step 3 Match Needs to Resources
A. Have the Talk
With your spouse if it is for your own situation. If for your parents, then share
your concerns with your parent/s, talk to them openly and honestly. Knowing that you’re concerned about their wellbeing might give your parents the motivation needed to see their doctor and make changes. Consider including influential people to assist in the conversation, like friends or clergy (for us the Dr. was turning point in the conversation).
- Encourage Medical Checkups
Concerned about your partner or a parent’s mental status, depressed mood, weight loss, or other signs and symptoms? Encourage them to schedule a doctor’s visit. Offer to schedule the visit yourself or to accompany them to the doctor. Ask about follow-up visits. - Address Safety Issues
Use the NAHB Aging in Place Checklist or SAFE at Home Checklist by Rebuilding Together, to do a walk-through and identify potential safety issues with your parents. Next, develop a plan with them addressing problem areas; Age Safe America can helpto create a safer caregiving/living environment. - Consider Homecare Services
If you, a partner, or your aging parents are having trouble with Activities of Daily Living (ADLs) it might be time to consider in-home help to clean the house and run errands or a home health care aide. - If remaining at home is too challenging, you might suggest an assisted living facility.
Click here for our Resources on Caregiving services.
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Aging in Place is often a “Crisis Buy” because we usually wait until an emergency occurs with our elderly parents–then we spring into action. Unfortunately, you will find yourself playing catch up!
Local Area Agencies on Aging are providing what’s known as “diversion programs” to keep people living in their homes longer (Aging in Place).
Who they serve: Individuals Living with Disabilities and Elderly
Programs: Range from healthcare-related programs such as disease prevention, case management, insurance counseling, and respite care, to programs specializing in providing transportation resources, preventing elder abuse, and transitioning from hospital to home.
Quick Link to services here: State/Local Area Agency on Aging
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Catch Up with These Top 5 Home Modifications for Aging in Place
- Adapt the Main Floor of Home for One Level Living: Bedroom, bath, kitchen, laundry, and no-step entry all on the main floor.
- Widen Doorways to 36 Inches w/Offset Hinges on Doors: Wheelchairs can be a fact of life for many older adults, who may use them all the time or just on occasion. Conventional doorways usually are not wide enough to accommodate a wheelchair so widening the doorways is often required. Swing-out door hinges are also easy to install and inexpensive.
- Install Hand-held Showerheads and Grab Bars: Hand-held showerheads and grab bars are some of the least expensive changes you can make and are a great help to those with balance problems.
- Use Lever Handles on Doors and Plumbing Fixtures: Decreases in hand strength are a common problem with aging. The use of a simple lever eliminates the struggle with operating doorknobs and faucets.
- Use “Comfort Height” Toilets: Many older adults suffer from osteoporosis or arthritis and find it hard to stand up from a normal height toilet. A Comfort Height Touchless toilet commode chair that fits over the existing toilet helps to eliminate this problem.
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TWO “SUCCESSFUL” AGING IN PLACE STORIES
#1 Dad’s House: A Daughter’s 10 Step Aging in Place Success Story
Our first reaction was “He can’t live alone.”
How could he manage without her? She was his companion in the house they bought the year after they married nearly sixty years ago. A typical homemaker from the 50’s era, she cooked for him, washed the laundry, managed the finances, later drove him where he needed to go, and did a hundred other things. We assumed Dad couldn’t live alone primarily because the stroke he suffered nearly 15 years ago resulted in major right-side weakness. During the ensuing years, he began to depend upon a leg brace and cane to walk and he gradually lost most of the use of his right hand. He reluctantly gave up driving two years ago. And we knew he would be lonely.
So, we began visiting local senior citizens and assisted living complexes, thinking they would provide not only the necessities like his meals and clean laundry but more importantly, companionship and social interaction as well. Our plan was to narrow the choices to three, give him the opportunity to visit all three and let him decide where to live.
The places we visited were bright and clean, some livelier than others, with lots of seniors living in them. They were filled mostly with women because women tend to live longer than men. It became clear that, despite his physical handicap, Dad was far too well for an assisted living facility. However, one of the problems with many of the senior apartment complexes (as well as assisted living facilities) was their sheer size – the walk to the dining room would exhaust him. And he would be moving in with complete strangers. Slowly, it began to dawn on us that maybe Dad could stay in his own home.
Over time, we discovered he had a network of friends in his neighborhood who were visiting him regularly, walking with him, and bringing him things like a plant for the front porch, a pumpkin in the fall, a meal, or a dessert. Looking over his home, we realized it was a manageable size at about 1,200 square feet, and Dad knew every inch of it. We just needed to make it as safe and convenient as possible for him, so he could live independently.
The first measure of comfort for everyone was the alarm Dad agreed to wear. He can press the button if he needs assistance, and the monitoring company calls one of his children and sends EMS immediately. The second and most important change was the bathroom renovation. Because of his right-side weakness, Dad can’t maneuver his leg to get into the tub to shower, so he would go downstairs to the basement where there was a walk-in shower. That was a terrible accident waiting to happen.
We hired a contractor who was certified by the National Association of Home Builders as an aging-in-place specialist (CAPS) to rebuild the first-floor bathroom. He installed a walk-in shower with grab bars and a hand-held shower; new lighting; and made the doorway, vanity, and toilet wheelchair accessible, if that need ever comes up in the future.
In addition to the grab bars in the bathroom, the contractor installed several throughout the house after Dad and an occupational therapist walked through it to identify the places where he needed them the most. The contractor jokes he could use Dad’s house as a “grab bar showroom” for his other clients.
Dad’s doctor has been an outstanding ally. At our request, he got Dad into physical therapy for a “tune-up”, and he had an occupational therapist evaluate the house – all so Dad could continue to live there independently.
Dad can cook breakfast – he makes a mean omelet one-handed with “Eggbeaters” – and manages lunch and dinner, but we knew he’d appreciate meals he didn’t have to prepare, especially home-cooked ones. “Meals on Wheels” was a possibility, but we were particularly fortunate to find a neighbor who was very willing to prepare dinner for Dad three nights a week for a small fee. We pop in with a meal now and then, as do his other neighbors, and there’s no shortage of desserts delivered to his door.
The next step was to brighten up the house with new carpeting and a fresh coat of paint. And just before the first snowfall, Dad had a natural gas insert installed in his fireplace in the family room. Years ago, he would build roaring fires everyone would sit around, and later, it would be just he and mom after the kids moved out. Within the last several years, however, they didn’t have any fires, because it became too difficult for him to carry in the wood and mind the fire. Now in the evenings, he sits in his chair and hits the remote, not just for the television, but to turn on the fireplace – and regulate the height of the flames. We’re not sure which the better investment was the renovated bathroom, or the fireplace insert.
On the horizon is a DVD player so he can watch M*A*S*H reruns and other programs and movies he so enjoys. And he’s on the waiting list for “Honor Flight” next year, a program that transports World War II veterans to see their memorial in Washington, D.C.
The “Aging in Place in America” research study, commissioned by Clarity and The EAR Foundation and released way back in October 2007, showed that most senior citizens want to age in place, or grow older without having to move from their homes. In fact, senior citizens fear the loss of “independence” and moving out of their home into a nursing home far more than death (nothing has changes in all these years).
It would have been a big mistake to move our father. Even with limited physical mobility, he stills enjoys his “independence” in his own home. His house is safe and comfortable, and he has a support network that includes his children, neighbors, doctors, and the wonders of technology. And there are myriad other private care agencies to help us should we need to call on them in the future.
Sharon R. McMurray is a writer and former director of corporate communications for a major Midwestern bank. She lives in suburban Detroit with her husband and two rescued Australian Shepherds
Sharon’s Path Step-by-Step:
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- Being “well-daughtered” When it comes to taking care of aging mothers (& fathers too), biology is destiny. Or to be more precise, biology plus geography equals destiny. –Paula Span / Having extended family of “Informal Caregivers” very often daughters.
- Aging-in-Community Network of friends in his neighborhood who were visiting him regularly (cultivate social capital; develop networks in your community by being a good neighbor too).
- Aging-in-place Technology The first measure of comfort for everyone was the alarm Dad agreed to wear.
- Aging-in-place Remodeling w/ UNIVERSAL DESIGN Features throughout the home hired a contractor who was certified by the National Association of Home Builders as an aging-in-place specialist (CAPS) to rebuild the first-floor bathroom.
- OT home assessment Occupational therapist walk through home-assessment to identify the problem places.
- Medical Professionals Dad’s doctor has been an outstanding ally. At our request, he got Dad into physical therapy for a “tune-up” (includes in-home care).
- Help with preparation of Meals “Meals on Wheels” was a possibility, but we were particularly fortunate to find a neighbor who was very willing to prepare dinner for Dad three nights a week for a small fee.
- DIY Home Improvements Fresh coat of bright paint, new carpet, natural gas insert to replace fireplace w/ remote! DVD player to watch old reruns/movies (add brighter bulbs throughout).
- Something to look forward to In the near future on the waiting list for the “Honor Flight” Program WWII veterans.
- Anticipating and Lining up future resources As needed when circumstances change; there are myriad other private/public care agencies to help us should we need to call on them in the future.
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#2 The Model Client Aging in Place Success Story
Solo Aging
- 72-year-old retired Ph.D. scientist living alone in Baltimore County
- In a single-family home where she has lived for the last 45 years.
- Divorced many years ago, no contact with a former husband.
- The only sister lives in North Carolina and has been asking her to move to a retirement village near her home.
- The client has two grown children with busy families of their own, closest child 1 ½- 2 hours away, and they have not been to her house in over 5 years.
- She usually goes to them because of the many people involved. They have busy lives and visit each other only every 4-6 months, although they maintain regular phone contact. She has begun to limit her driving, but still has a car, and occasionally uses it. Not sure if she feels safe venturing to daughter’s house anymore, as it’s near DC and unfamiliar, congested area. Her children have no idea of her financial situation and have let her take care of her own finances/affairs up until now. They are noticing cognitive decline which concerns them, confusion, and forgetfulness at times, and they are wondering if she can safely stay home by herself. The family has asked, with her permission, for GCM to do an assessment.
- Minimal medical treatment and has blood pressure issues and a heart condition.
Assessment Findings:
- Hoarding for years! Stacks of newspapers, trash, and discarded household items in every room of the house. Only a small path from front door to living room chair, through the kitchen, and to bed, only ½ of which is clear to use.
- She has a “nice couple” down the street who are now taking her to store in her car weekly. Recently, she has said they can just keep the car at their house since she’s not using it anymore.
- Unendorsed checks sitting around the house, in plain view of visitors.
- Stacks of opened mail in piles, and she’s verbalizing that she has no idea what it all means. (much of it junk mail, some investments, retirement package info etc.)
- Getting late notices and collections call on bills due.
- Dish of crackers and milk on the kitchen floor to “feed the poor, hungry mice.”
- No POA, no advanced directives and no clear idea of benefits available in a medical package. Needing medical evaluation/follow-up for heart condition and blood pressure matters.
- The confusion is noticeable upon assessment, but hard for outsiders to detect.
- No support system locally doesn’t really know neighbors well. Young teen boy will shovel her walkway or take out the trash. She prefers to “keep to herself,” and has always been that way.
Steps to Successful Aging in Place for this Scenario
Step 1 Hire Geriatric Care Manager
The initial assessment findings were discussed with senior and family and a report with recommendations outlining:
A. Immediate/acute concerns
B. Short-Term Concerns
C. Long-Term Concerns
Step 2 Hire Elder Law Attorney and or CPA
Inventory assets, piece together a financial profile, insurance coverage, estate planning, wills, Trusts, Power of Attorney, Healthcare Directives, and Medicaid eligibility, etc.
Step 3 Hire In-Home Care Assessment
Determine if home care was a possibility; complete a health history and assessment to develop a plan of care.
Two potential outcomes:
A) In-home care to help the client keep organized and safely get through the day and night hours; schedule and level of care all dependent upon an assessment
B) A decision that it was not safe or possible financially for the client to remain at home with one-on-one care
Step 4 Hire (consider) A Reverse Mortgage
Can help borrower use the money to pay for the services needed. For example, home health
care, medical costs, property taxes and others (Powers of Attorney are acceptable if necessary)
Step 5 Purchase an Emergency Response System (encourage daily use) consider BestBuy.
Step 6 Hire a Senior Move Manager to help de-clutter and organize the Living Space
A. Immediate clear out and clean-up of clutter and mess in the home to address safety and hygienic issues
B. If aging in place (client staying), downsizing and more in-depth cleanout over time
C. If the client is moving to an assisted living or retirement community, provide moving assistance including but not limited to packing, unpacking and set-up of new living situations.
Step 7 Hire Senior Care Organizer the Organizer would collect and put into order, all bills and other important papers and create an easy to use a filing system.
Step 8 Hire an Aging-in-place CAPS certified Remodeler has been trained in:
-The unique needs of the older adult population
-Aging-in-place home modifications
-Common remodeling projects
-Solutions to common barriers
(Source of case study National Aging in Place Council)
This case study is an example of successful interventions when financial resources are available.
Aging in Place click Here Resource Page