Could “Aging in Place” be an Option for You or Your Loved One?

You’ve probably been part of conversation when this topic has come up:

“I don’t want to leave my house.  I’ve lived here for (insert number here) years.  I don’ want to go to a nursing home and I don’t want to go to one of those assisted living places with all those old people.”

Depending on your family situation, your finances and a realistic look at support systems for your loved one(s) involved, Aging in Place may be a viable option.  As with any conversation with a loved one, any discussion of relocation, or any big decision you’ll want to treat the person with dignity, encourage independence, and keep safety top of mind.

Instead of moving to a skilled nursing facility (SNF) or to an assisted Living facility (ALF), Aging in Place allows seniors to live in their own home as they age.  They can remain as independent/autonomous as possible while being in an environment that is safe, comfortable, familiar and provides the support systems they need.

Each individual, their preferences and their living situation is unique.  As with every option, there are advantages and disadvantages.

Advantages of Aging in Place:

• The senior can remain in their home where they can be independent and things are familiar. Whatever routines they have can be maintained.  They can make their own choices.
• This option may be more cost effective. (It may, however, have some hidden, yet necessary costs).
• They don’t have to prepare for a move, complete the move and settle into a new place.
• They can stay connected to their neighborhood, and they can keep their friend groups.
• They may choose their own caregivers rather than utilize “staff” of a large facility.

Disadvantages of Aging in Place

• Because they have caregivers coming into their homes, and have everything they need in their home, they can become isolated and lonely.

!!! Dr. Vivak Murthy, US Surgeon General, on May 2, 2023 said:

“Widespread loneliness in the U.S. poses health risks as deadly as smoking up to 15 cigarettes daily, costing the health industry billions of dollars annually…”

!!! According to the Alzheimer’s Society: “Social isolation can increase a person’s risk of dementia by about 60%.”

• Some homes are not an ideal set up for safety for seniors. For example, the bathroom may have a tub rather than a roll-in shower, doorways may not be wide enough to accommodate a walker, or perhaps the main bedroom is upstairs.
• If they need medical assistance, they must call for help rather than have trained staff nearby.
• The home needs to be maintained.
• Lack of consistent care giving staff can cause stress to both the senior and their family.

Considerations for both Aging in Place and Other Facilities:

• A good quality of life, independence and safety are primary goals
• A health care advocate or surrogate is a good idea
• Situation, whether at home or at a facility, still requires oversight. For example medications, nutrition, doctor visits, mobility issues.
• EMERGENCY PREPAREDNESS:
  Current list of contacts
  Current list of medications
  Power source for CPAP
  Power source for Oxygen/Oxygen Concentrator
  Back-up battery for power recliner
  Carbon Monoxide (CO) detector
  Smoke Detector
  First Aid Kit
  Narcan/Naloxone if narcotics are in use 

Looking more closely at Aging in Place:

Let’s start inside the house/apartment and go room by room:

 

Bathroom – this may be the most expensive room to renovate to make it safe and accessible.

Some adaptations are at the Do-It-Yourself level, while other renovations require a professional.  To find qualified professionals, look for certified disability contractors, ADA certified builders, and /or accessibility contractors.  This is not a situation to skimp on quality.  The goals are safety, preservation of dignity and comfort, and accessibility.  Preventing falls is of paramount importance.

Some of the easier fixes include:

Grab bars – in shower, near toilet
Portable shower chair – with backrest if possible
Handheld shower head – can be very helpful if someone is assisting the senior in the shower
Towel bars – make sure they are easily accessible from the shower/sink
Magnifying mirror for shaving or make up application
Faucet handles which are “lever style” can make turning faucet off and on easier

More complicated fixes:

Raised toilet
Raised toilet seat – some seats fit neatly over the existing toilet; some require installation of a new “comfort level” toilet.
Easily accessible toilet paper holder.  Reaching can cause falls, strained back.
Lighting – should be bright, and have task lighting.  Night lights/motion sensor
lights can be beneficial at night.
Walk in/roll in shower or walk in tub – lots of personal preference here.  Must

Be sure doors are wide enough to accommodate walkers, wheelchairs and allow for an aide to maneuver around in shower.
Shower and/or tub should have no-slip floor/base. Consider getting an anti-scald valve on shower faucet. Ensure there is adequate clearance around toilet, sink and shower.  This allows for cleaning and room for emergency personnel in the event of a fall.Flooring should be non-slip.  Any mats should be non-skid and non-slip.  Bear in mind bath mats could be trip hazards. Emergency call button/Medical Alert System

Don’t forget to regulate the temperature in the bathroom. Sometimes undressing, showering, drying off, and getting dressed can take a long time, and a nice warm bathroom ensures comfort for the senior.

Kitchen – renovating a kitchen for Aging in Place can also be expensive.

• Have an easily accessible fire extinguisher.
• Non-slip flooring, especially adjacent to the sink. Opting for a non-skid mat could be an alternative; the downside is it could be a tripping hazard.
• If you have pets, beware of wet spots (near their water/feed bowls), which could cause slips and falls.
• Lighting should be bright and supplemented with appropriate task lighting.
• Motion sensor lights/night lights can be helpful when getting that midnight snack.

Sink:

• Lever-style faucets
• Adequate knee space for those in wheelchairs

Countertops:

• Adequate knee space for those in wheelchairs
• Rounded edges

Appliances/Dishes/Utensils:

• Store where they are easily accessible and don’t require reaching or getting up on a footstool.
• Grab bars can also serve as towel holders.

Storage:

• Label shelves, baskets, bins, and/or boxes used for storage in the pantry.
• Use lower cabinets for frequently used items and upper cabinets for rarely used, lightweight, and decorative items.
• An Occupational Therapist can often suggest ergonomic tools specific for issues of dexterity, grip strength, and ease of use.
• Store knives with knife guards rather than a countertop “knife block.”
• Ensure food safety:
  • Practice good handwashing technique.
  • Use caution storing leftovers.
  • Unload refrigerator and freezer items immediately when returning home.
  • Use a rapid-read/instant-read food thermometer.

NOTE: Seniors should be cautious about wearing loose-fitting, flowing clothing while near a stove. Long sleeves and flowing bathrobes can easily catch on fire.

Bedroom

• Lighting should be bright and adjustable. Switches should be easily accessible and should not require reaching out of a bed or chair to operate.
• Nightlights/Motion sensor lights are quite useful.
• Do NOT run electric cords where they could be trip hazards.
• Use caution when plugging items into extension cords.
• Non-slip flooring. Beware of carpets and/or area rugs that could be trip hazards.
• Bedding should be off the floor to avoid trip hazards.

Bed:

• Identify a comfortable easy-in and easy-out bed height.
• Bed rails may be helpful. Some bed rails are easily movable and adjustable.

Windows:

• Ensure locks are easy to operate.
• Simple window treatments can reduce glare and provide privacy. Avoid cords dragging on the floor.

Furniture:

• Should be easy to sit in/on and easy to rise from. Chairs with arms are easier to get out of.
• A chair or bench for dressing can be helpful. It is more stable than sitting on the bed, especially when putting on socks and shoes.
• Allow plenty of room between furniture pieces.
• Check for clutter or obstacles that could cause falls.

Storage:

• Closets and drawers should be easily accessible.

• Frequently used items should be stored at waist or chest level.

• Provide a space for mementos, photographs, and personal items. (Storing items in a glass-front cabinet can keep items from becoming dusty.)

• Emergency alert system should be near the bed and easy to grab at night.

• Provide a place to charge a cell phone.

Living Room

Furniture:

• Arrange furniture so it is easy to navigate around, including for those using walkers, crutches, and wheelchairs.

• Sofas and chairs should have comfortable, firm cushions and arms to make getting up easier.

• Recliners should be placed so when they are fully reclined they don’t interfere with pathways or doorways. NOTE: Power recliners should have a battery backup in the event of a power outage.

• Have a place where TV remotes can be stored and easily reached when needed.

• Lighting should be bright and adjustable. Switches should be easily accessible and should not require reaching from a sofa or chair to operate.

• Placing a lamp on a timer may reduce the need to manually switch it on and off.

• Non-slip flooring. Beware of carpets and/or area rugs that could be trip hazards.

• Provide a place to charge a cell phone.

Hallways:

• Ensure adequate lighting.
• Install motion sensor lights.
• Maintain wide hallways, clear of obstructions.

Garage

• No-step entry. If you have a step or two, install a stable railing or grab bar.
• Non-slip flooring. There are coatings available that can be applied to a garage floor to make it slip-resistant and easy to clean.
• Lighting should be bright; include task lighting as needed.
• Workbench – appropriate height, lighting, and storage. Install multiple outlets for power tools.
• Vehicle access – Make sure there is room to enter and exit the vehicle on both sides.
• Ensure the garage door is safe and functional.
• Always lock the door from the garage into the house.
• Install outdoor lighting on either side of garage door(s).
• Keep a fire extinguisher in the garage.

Now, let’s go outside.

Entrance:

• No-step (flat) entrance
• Sturdy railing or grab bars on both sides of entry
• Easily accessible mailbox
• Lighting at the front door
• Peephole in the front door
• Ensure house numbers are easily visible from the street.

Sidewalk/Path/Walkway should be flat, clear of obstructions, and non-slip.

• Watch for, and treat, mold growth, which can make sidewalks hazardous and slippery.
• Watch for puddles and clear snow as appropriate. Beware of wet slippery leaves.
• Use adequate lighting along walkways.

Home Maintenance:

• Pest control
• Lawn and yard maintenance
• Gutters
• Roof
• Siding and Paint
• Tree health
• Fence maintenance

Safety and Security:

• Appropriate door and window locks
• Low bushes
• Motion sensor security lights

Summary

There is a lot to contemplate when making a transition with one of the choices being Aging in Place. Ideally, the discussion should occur before the health and safety of your loved one becomes a crisis. It’s important to consider several factors to find the best fit for the needs of your loved one and yourself.

Assisted living typically offers a community setting with support services available such as help with daily activities, meals, and social activities. This option can be great for those who appreciate the idea of companionship and structured care. It’s a more social environment and can help residents feel engaged and connected. Please note: According to seniorliving.org, “the estimated 2024 median cost for assisted living is $5,511 per month.” In most cases, Medicare does NOT pay for assisted living; Medicaid may pay, but this varies from state to state. Scrutinizing the financial aspects is a big part of the decision-making process.

On the other hand, Aging in Place allows individuals to stay in their own homes as they age, maintaining independence within a familiar environment. While this choice can provide comfort and autonomy, it might require some modifications to the home and the arrangement of outside help for needed services such as housekeeping, meal preparation, or health care. NOTE: Expenses of renovation are an important factor to consider when thinking about Aging in Place or moving to Assisted Living.

Ultimately, the decision depends on personal preferences, health needs, financial considerations, and the level of independence desired. Involvement of family members early on in the discussions can be beneficial as everyone is “on the same page.” Like many things in life, it’s a compassionate balance of safety, comfort, dignity, and quality of life as our loved ones, and we as caregivers, adapt to the future.