“Every human has four endowments- self awareness, conscience, independent will and creative imagination. These give us the ultimate human freedom… The power to choose, to respond, to change.”

-Stephen R. Covey

Stephen Covey’s seminal work on how to create a better human species titled “The 7 Habits of Highly Effective People” was first published in 1989 and has sold over 15 million copies in 38 languages since first its release.

The concepts are timeless and can be broadly applied as I have done here with aging in place. What follows is The 7 Habits of Highly Effective People Aging in Place:

• Habit 1: Be Proactive

Synopsis: Take initiative in life by realizing your decisions (and how they align with life’s principles) are the primary determining factors for effectiveness in your life. Taking responsibility for your choices and the subsequent consequences that follow.

Aging in Place: Be Proactive; day-in-and-day-out you are faced with “choice points” that will have a cumulative effect on your independence. If you choose what’s easy now (not take that walk and stay on the couch—or not install that light on the stairs and put up with the dark steps); life will be hard later.

Many people wait until a crisis to begin the aging-in-place remodeling projects; and crisis-driven interventions are seldom as effective as proactive ones.

Proactivity is being anticipatory and taking charge of situations; adaptivity is about responding to change, proactivity is about initiating change.

• Habit 2: Begin with the End in Mind

Synopsis: Self-discover and clarify your deeply important character values and life goals. Envisioning the ideal characteristics for each of your various roles and relationships in life.

Aging in Place: Begin With the End in Mind is making the future a part of your current philosophy. According to the Aging in America study of several years ago, seniors fear nursing homes over death; so for most, independence is a deeply held value and goal.

Think seriously about how much you value the rituals and natural rhythms of your simple daily living at home that you’ve cultivated over the years. Coffee in the morning and reading the paper in your favorite chair perched in the front window; after you let the cat out. Or shopping at the grocer where the clerk knows you by first name—then imagine life without them.

Look around the house and determine what is going to potentially be a challenge in the coming years. Do an aging-in-place assessment and make a priority list of action items.

Is adding a bathroom on the first floor, installing a lift on the stairs, or an access ramp, something I can do now that will keep me in my home 5-10 years from now?

Hosting family over for traditional life events; and being able to have grand kids stay whenever you choose. Does being a grandparent mean having a home where grand kids can find refuge and a place to stay?

• Habit 3: Put First Things First

Synopsis: Planning, prioritizing, and executing your week’s tasks based on importance rather than urgency. Evaluating if your efforts exemplify your desired character values, propel you towards goals, and enrich the roles and relationships elaborated in Habit 2.

Aging in Place: Prioritizing remodeling goals with budget in mind. What are the “biggest-bang-for-the-buck” aging-in-place remodeling items?

Consult a Certified Aging in Place Specialist (CAPS);  Architect specializing in Universal design; or Ocupational Therapist trained in aging-in-place design.

• Habit 4: Think Win-Win or No Deal

Synopsis: Genuinely striving for mutually beneficial solutions or agreements in your relationships. Valuing and respecting people by understanding a “win” for all is ultimately a better long-term resolution than if only one person in the situation had gotten their way.

Aging in Place: Win-win means considering the concerns of spouses as well as adult children. Staying in one’s home may not be the best solution for all parties. Sometimes aging in place is not possible.

• Habit 5: Seek First to Understand, then to be Understood

Synopsis: Using empathetic listening to be genuinely influenced by a person, which compels them to reciprocate the listening, take an open mind to being influenced by you, which creates an atmosphere of caring, respect, and positive problem solving.

Aging in Place: Listen to partner/spouse and understand their wants and needs for aging-in-place remodeling; as well as to CAPS remodeling professionals for suggestions prior to making decisions.

•  Habit 6: Synergize

Synopsis: Combining the strengths of people through positive teamwork, so as to achieve goals no one person could have done alone. How to yield the most prolific performance out of a group of people through encouraging meaningful contribution, and modeling inspirational and supportive leadership.

Aging in Place: Synergize with other family members by sharing aging-in-place goals; ask for feedback and input; form a team-work approach with CAPS professionals.

Make the community part of your aging in place team strategy; employ senior services like meals-on-wheels; the local area agency on aging; AARP chapters; churches; See Aging in Place HELP for more resources.

• Habit 7: Sharpen the Saw

Synopsis: The balancing and renewal of your resources, energy, and health to create a sustainable long-term effective lifestyle.

Aging in Place: Keep up on new technologies for aging-in-place; visit web sites for developments in universal design; and educate yourself about what’s available in the aging in place market. Aging in Place Technology Watch will Keep you up on the fast changing home telemetry sector.

Keep physically and mentally fit (your body and mind need to be available to you) for successfully aging in place.

These 7 habits applied to aging-in-place can be a guide to independence and a more rich-fuller expression of who you are in the years to come.

Now get started…

See

Stephen Covey: Do the BIG ROCKS first

World’s Leading Authority on Aging in Place

Interior Design With Your Future in Mind

Science Daily: Aging in Place = Reduced costs, improved mental and physical outomes

For me context is the key; from that comes the understanding of everything.

-Kenneth Noland

Context Matters:

The dictionary defines Context as; the set of circumstances or facts that surround a particular event or situation.

A man was driving up a steep and narrow mountain road. A woman was driving down the same road. As they passed each other, the woman leaned out the window and yelled, “PIG!” The man immediately leaned out his window and replied, “BITCH!” They continue on their way and as the man rounded the next corner, he crashes into a pig in the middle of the road.

The unfortunate encounter with the pig could have been avoided—provided he knew the context of the woman’s warning…

I’ve employed this old story to make a point about the importance of context in human affairs. And the concept is easily applied to aging in place.

Aging in Place is Contextual

Much of the aging-in-place talk focuses on the physical or built environment, and for good reason. Obstacles to staying home are often environment-caused and it’s the obvious point of entry.

Put a handrail on the stairs, get a raised toilet, and remodel a bathroom to accommodate a wheelchair…These are physical changes that can be marked off a check list and seen as making tangible progress. Important as these accommodations are to the changing physical needs of the aging home owner, if not done in a larger context of support, aging in place is unlikely to be successful.

I’m reminded by Meda Ling  about the economic and social aspects of true “sustainability” (and the humane quality of life factor) when designing for an aging population.

She notes:

…And of even greater importance to this line of thought: no matter how well an individual home may accommodate and adapt to the changing physical needs of a homeowner over time, if it does not encourage social interaction or a sense of ‘belonging’ to a supportive community- whether intentional or serendipitous – ‘aging in place’ is unlikely to be an option. One must ALWAYS consider the context of a home within the greater environs of a neighborhood or community. Are the homes sited in such a way that people are encouraged to interact and know their neighbors? How does location of a home or development relate to the greater community and access to transit options, shopping, health care, entertainment and passive and active recreation such that it encourages a healthy lifestyle? How does the home and the neighborhood relate to the environment – does it make sense in terms of land use, water and air quality objectives of sustainability?I have strong reservations about the concept of ‘aging in place’ as a sustainable model for a humane quality of life. From the perspective of a site architect, I consistently find myself reminding my professional colleagues to step back and see the forest for the ‘kitchen cabinet’ selection — and ask that we consider the quality of LIFE as the guiding principle of how we design, how we use the land, how we build. Rather than designing/building for ‘aging in place’, please consider designing/building for ‘LIVING in COMMUNITY.’

Her request is a systems thinking approach. When planning for Aging in place the key understanding must be that it happens within a larger system of community and the goal is an increased quality of life for everyone; now and in the future.

Failure to consider the contextual elements of aging in place and narrowly focusing on remodeling as the solution is flirting with disaster. Building with beautiful Universal Design in isolation is lipstick-on-a-pig…Look out ahead!

Successful Aging in Place: Contextual Considerations

1) Physical Health Status: Is your body/mind available to you? Do physical or mental limitations affect your ability to manage at home?

 2) Informal Care: Do you have a close circle of family, friends, church members, or neighbors who can provide care for you? If you have a spouse are they able to provide the care giving? And can you get your health needs met at home?

 3) Finances: Do you have the resources to pay for in-home help if needed? Home care services are not often covered by insurance; Medicare provides limited short term home health care under specific guidelines, and long term care insurance might not meet home care requirements. Do financial institutions provide easy access to information on Reverse Mortgages in your area?

 4) Community Services: What services are available in your community? Is your city an age-friendly community? Do you have a local Area Agency on Aging? Is your City Planning for “New Urbanism” or revitalizing old neighborhoods? How about public transportation? Are there community building opportunities available for older adults?  

5) Cultural Construction of Aging: Does your culture view aging from a “peak and decline” perspective or see aging as an opportunity no less than any other phase of life? Is aging in place a societal value? Does your neighborhood value multi-generational living? Or want its elderly age-segregated?

6) Physical Home Environment: Is the home age-friendly? Are you able to get around in the living space? Are stairs becoming a problem? Do you use a walker or wheelchair? Can visitors with physical limitations enter/exit (“vistability”) your home? Is home maintenance becoming burdensome and beyond your physical level? Are repairs too costly or even unsafe for you to take on?

For help with aging in place contextual considerations consult a Geriatric Case Manager. These are professionals working in public and private settings trained to help manage the care you or a loved might need to remain home by choice.

For help with aging-in-place remodeling consult the National Association of Home Builders /CAPS directory  

For help with Contextual (systems) thinking consult Fritjof Capra: The Systems of Life

See

What is a Professional Geriatric Case Manager? 

WingSong CoHouisng

(Photo windsong.bc.ca)

Guest post: I found Sharon‘s story about the journey to aging in place with her father so practical (step-by-step approach) and compelling, I asked her if I could share it here. Before you place a loved one into a facility, read Dad’s House and consider the possibilities.  

Dad’s House

By Sharon R. McMurray

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 50s 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 citizen and assisted living complexes, thinking they would provide not only the basic 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 down stairs 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 in October 2007, showed that the vast majority of 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.

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

See

(photo by the talented Katy Raddatz)

“Most elderly males have informal care, most elderly females do not.”
- Cynthia M. Taeuber

 
 
Anyone who provides assistance to those who need it to maintain an optimal level of independence is a care giver. Families provide the majority of care giving, which is commonly referred to as “informal care” because it’s unpaid.

If the care recipient is married the primary caregiver will be the spouse; otherwise adult children, typically, adult daughters or daughters-in-law will assume the care giving role.

Older Women Living Life in Ways Older Men Will Not

Women in most developed countries outlive men by 5 to 9 years; although men do get old—women get older; for that reason aging and care giving are mainly women’s issues.

So two ideas have been established with the maiden voyage of this blog:
1. As a society (and globally) we’re getting older
2. We want to continue to stay in our beloved homes as we age (aging in place)

These two points were reinforced by an experience I had today visiting a friend in a nursing home. Prior to August, 2007, my friend who is now 93 years old had been living independently in her home with some limited outside assistance.

A series of falls in the home caused her family to place her in a care center/nursing home and sell the dwelling she had lived in for over 50 years. This was a sad situation to watch because her home was her reason for living—as she had expressed this to me on many occasions, including today.

This is a tough situation for everyone involved and I have watched her mental status change rapidly since the move. In the longevity literature this is known as “transfer trauma” when an elderly person is moved from their home the affect is often mental decline. She manages to make the best of the situation and has an unsinkable spirit.

At one point she grasped my hand with her blue-veined-arthritic hands and told me how good it was to touch me, then smiled and looked intently in my eyes. I knew innately what she meant…

I worked my way through nursing school in nursing homes and have spent the last 23 plus years as a nurse. I know the touch of healthcare providers can be instrumental, that is, purposeful, with the objective to accomplish a task. This doesn’t mean they lack empathy or caring, (which might be the perception on the receiving end) it just means many tasks must be accomplished by shifts end and that is often the focus.

Care givers have to be strategic like chess players thinking several moves ahead to anticipate and meet challenges. Caring touch is not mutually exclusive to getting things done, but it can be a casualty to efficiency.

The touch of a loved one or a dear friend has a different quality, it’s palpable, and this was her deeper meaning. It brought to mind a powerful account by Carobeth Laird, a writer who after surgery ended up in a nursing home. Her book “Limbo” is an anthropologist-like account of nursing home life.

Here are several of the main themes from Limbo (1979): A Memoir About Life in a Nursing Home by a Survivor.
Institutional Time: Nursing homes are run for efficiency, not for individuals, shower two times a week, inescapable routines, feelings of residents in an institution verses tenants in their homes
A Room of My Own: Privacy sacrificed, you can’t self-regulate the quality or quantity of stimulation, no intimacy due to shared space
Loss of Identity: Loss of meaningful routines, status stripped away, out of touch with “the world of the living”
Loss of Meaningful Objects: Personal items locked up, limited room decor
Culture and Place-bound: Lack of cultural sensitivity in meals and customs
Aged Not Entirely Human: Talked about in the third person, timeless monotony experienced by “inmates” and just existing, like those that belong to that category of persons under authority who must perform necessary functions in the assigned time
Exposure to Constant Death Turn Over: Residents disappear without explanation

A recent research study, “Aging in Place in America,” commissioned by Clarity® and The EAR Foundation examined the attitudes and anxieties of the nation’s elderly population. The study found that seniors fear loss of independence and moving into a nursing home over death.

Baby boomers also fear for their parents with particular concern about their emotional and physical well-being should they have to enter a nursing home.

The issues brought to light in Laird’s book are stereotypical concerns about institutional care settings. Her experience occurred over three decades ago and although much has changed since then, much has stayed the same.

The good news is the percentage of elderly living in nursing homes has declined. According to recent census data only about 7.4% of Americans aged 75 and older lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990. The downturn reflects the improved health of older adults and the fact that more choices of care available to them.

Seniors and baby boomers prefer aging in place because they desire mastery over their lives and the simple pleasures of being home.

My 93 year old friend reminded me today of the importance of “home” in our lives. As I walked out of the security door and heard it lock behind me I recalled a line from the Eagles:

“Every form of refuge has its price.”