Aging in Place
An AARP study shows that over 80% of U.S. residents over 45 say they want to remain in their own homes even when they need assistance. Another study, by Clarity and the EAR Foundation shows that 26% of older people fear losing independence and 13% fear moving to a nursing home much more than they fear death.
The major factors enabling aging in place according to an AARP report are:
- Convenience of living close to or within walking distance of services needed.
- Transportation: Increased mobility options can reduce reliance on transportation by personal car.
- Affordable and accessible housing.
According to data from the Center for Retirement Research at Boston College, most of today’s retirees don’t move away from home. They tend to stay within 20 miles in order to remain close to family and friends.
According to an AARP report most retirees today don’t tend to move. Older adults currently represent about 13% of the population. More than half (51.2% ) live in just nine states. Those being California, Florida, New York, Pennsylvania, Illinois, Ohio, Michigan, and New Jersey
Of the 80% of adults 65 and older living in metropolitan areas, 64% live outside the principal cities of those areas. Older adults are the most geographically stable of any age group, and most who do move remain in the same county. According to the Administration on Aging only 3.7% of older people move, as opposed to 13.1% of those under age 65.
A large part of aging in place, getting the care you want in the place you want it, and other aspects of planning for the future would benefit from a certified nurse life care planner, a certified case manager, and nurse advocate input and intervention. Look for certification with someone in these capacities.
Certification is a level of protection that should be considered in all areas concerning aging. The article below speaks to this with regard to construction and remodeling planning as well.
Mark Miller of www.RetirementRevised.com writes: I always cringe when magazines and cable TV networks run stories on the “best places to retire.” The usual approach is to crunch data about a variety of livability factors such as the cost of housing, taxes and the average number of sunny days per year. Follow the data crunchers and you’ll soon be packing up to live a long, low-cost and sun-tanned life someplace you’ve never heard of–with no friends, family or community connections in sight. It’s a classic case of “garbage in-garbage out.”
The flip side of the coin on “best places” is “aging in place”–a notion often misunderstood as simply “staying put.” But author and retirement expert John Nelson urges people considering the “where to live” question to think more holistically. “We tend to think of aging in place as staying where we lived during our working years, but that might be an abysmal place to spend retirement,” says Nelson, co-author of What Color is Your Parachute?
“Instead, think of aging in place as finding the residence that will allow you to stay there as long as possible, no matter what happens. Most of us will move at some point in retirement. If we’re smart about it, an easy early move can prevent a difficult later move. We can make it proactive and positive, instead of reactive and negative.”
An AARP survey found that 89 percent of Americans would like to live in their current homes as long as possible–and the number rose to 95 percent when people over age 75 were asked the question. But that same AARP survey shows that most people aren’t doing the proactive thinking Nelson recommends. Just 16 percent said they had made any modifications to their homes that would make it possible to stay as they age.
For those interested in staying in their homes.
According to a survey from the Hartford and the MIT AgeLab, half of boomers plan to stay in their current home as they age; however most have not made a plan to make their home more usable as physical abilities change.
The Hartford survey revealed that as far as adults ages 46-65, are concerned, 77% have talked to their spouse or partner about future housing needs but only 29% have made a plan, and 96% of those surveyed were aware of changes they could make to their current home to make it more livable as they age, but only 26% have made such changes.
Some of the things you should consider in preparing your home for your retirement years:
- Check doors for the width to allow for wheelchairs
- Remove thresholds
- Include as many different sources of light as possible
- Make showers and tubs easily accessible and in some cases remove the tub and replace with a shower that has no curb. Install grab bars and grips.
- Removing throw rugs especially in the bathroom
- Assuring sturdy handrails on both sides at steps
- Good lighting and switching especially at stairs, halls, and entries
- Securing or removing carpets at stairs
- Soft path lighting for nighttime mobility
Consider transportation options if you can no longer drive. How will you get to shopping areas, the homes of family and friends, the doctor’s office, etc.?
Throughout the country, 55 "village" programs are up and running, providing a range of low-cost home, medical, shopping, and social services and activities to senior members. Another 120 are in the works. And there are hundreds of other organized efforts to structure services to older residents of what are called "naturally occurring retirement communities." Their common goal is to help people stay in their homes through their 70s and 80s and, in a growing number of cases, into their 90s. Check out this article: money.usnews.com/money/blogs/the-best-life/2011/01/28/senior-villages-take-root-as-movement-matures
1-800-HomeCare.com has become one of the most respected resources for locating a professional home care provider and is the referral source to use for all of your home care needs. Their network members offer comprehensive home health care services that enable patients to stay in the comfort and security of their homes during times of recuperation, disability, and chronic or terminal illness.
There is a company that offers a wireless, hands-free safety system in case something goes wrong. This system provides real-time remote activity monitoring keeping all parties in touch all day, every day, even when there are great distances between the person(s) being monitored and those doing the monitoring. For more information check www.BeClose.com
There are several companies that provide quality in home care and assistance. Check www.homeinstead.com/Pages/home.aspx and www.villageseniorcare.com/
According to another AARP study most seniors surveyed were unaware of technologies, such as medication reminders, home activity sensors, electronic pillboxes, and fall detection devices that would help them to remain healthy and save as they lived there.
Laurie Orlov, of www.ageinplacetech.com notes that this same survey indicated that they would be willing to use them if they existed. In the near future, Certified Aging in Place Specialists (CAPS) will add an advanced training program that will add assessment and introduction of those needed home technologies.
That suggests too many of us are living in what some experts have dubbed Peter Pan housing - homes designed for people who will never get old. I’m the first to admit that baby boomers actually don’t think we will get old. But if you are willing to admit that you might actually age, you should get familiar with universal design. The term refers to a set of architecture and design principals geared to providing suitable living environments for a diverse range of people. For people who are aging, universal design encompasses everything from the height of countertops and electric sockets to usability of faucets, door levers, switches, and appliances. Some of the best ideas include wide, no-elevation entrances, comfort height toilets, lever door handles, safety grab bars and better lighting.
Universal design can be used in remodeling or in new home construction. Jan Cullinane put universal design principles to work when she and her husband built a new home recently in northern Florida. Cullinane, 54, is co-author of The New Retirement: The Ultimate Guide to the Rest of Your Life, Cullinane sought out a builder she could work with to install features like non-skid tile, curb-less showers, levered doorknobs and even an elevator that connects the three floors of the house. “Universal design isn’t really for old people–it’s really an idea that works for all people,” she says. If you’re building a new home or considering remodeling, look for builders, architects and designers who’ve been certified as aging-in-place specialists (CAPS) after taking special training.
You can find state-by-state listings of CAPS specialists at the websites of AARP and the National Association of Homebuilders. Consider whether your community offers the key aging-in-place amenities, such as one-stop shopping locations, shuttle services, age-appropriate fitness and community centers, and even something as basic as sidewalks.
What is Independent Living and How Much Should it Cost?
Perhaps the home you have been living in has a lot of stairs, a large yard and a steep hill that are becoming cumbersome. Maybe it's the home that once housed your growing family and you simply do not need the extra space and burden of housekeeping. These are often situations which make a person consider alternative living arrangements. For many, it they are not in need of assisted living, do not want or need the care or supervision of a grown child and want to maintain their independence and privacy as long as possible. Independent Living communities may be an ideal choice.
Among the various levels of senior living, independent living options are the least restrictive, supervised or regulated. Independent Living communities are structured settings which are designed for older adults, usually 55 and over. As the name implies, residents in independent livingsettings are able to fully care for themselves. In some setting, like continuing care communities, independent housing is the first step intransitional programs, while others like subsidized apartments are designed for those with limited incomes.
Continuing Care Retirement Community
The continuing care retirement community is a transitional setting that generally offers three distinct levels of care within the same community,independent living, assisted living and skilled nursing care. Most CCRCs are designed for those who are still able to live well independently but wantthe security of knowing their needs will be met as they age and may need more care. Some facilities also offer memory care settings for those withdementia.
The cost of CCRCs may be viewed by some as excessive. Most charge an initial, one-time entrance fee which varies based upon several factors includingaccommodations and care needs. These fees can range from $100,000 to $1 million in some areas. In addition to the entrance fee, most require monthlyservice fees or rent. Again, these are variable and may change as the level of care increases. The advantage: Most facilities have contractualobligations which ensure the resident maintains their residency even when their funds run out.
The Independent Living arm of the CCRC offers the same advantages of living in a private home but may provide some additional amenities, such asassistance with lawn care and other home maintenance chores. There is also comfort in knowing that higher levels of care can be provided within thesame community.
In a study titled, “Study of Independent Living Residents and the Communities in Which They Reside, ” published by American SeniorHousing Association, it was found that there are several advantages to residing in a CCRC such as:
- Promote active lifestyles
- Support social involvement
- Ensure proper medical care
- Provide good nutrition
- Encourage overall wellness
- Are good for younger seniors
Some areas to consider when choosing a CCRC:
Contractual Obligations: There are three basic types of contracts which can be entered into when choosing a CCCRC. Each community may have variations of these and should beconsidered based upon impending care needs. They include:
- Life Care or Extended Contract: This is the most expensive option, but offers unlimited assisted living, medical treatment and skilled nursing care without additional charges.
- Modified Contract: This contract offers a set of services provided for a set length of time. When that time is expired, other services can be obtained, but for highermonthly fees.
- Fee-for-Service Contract: The initial enrollment fee may be lower, but assisted living and skilled nursing will be paid for at their market rates.
Traditional vs. Refundable Entrance Fees: While the entrance fee varies based upon the services needed and the accommodations selected, the type of entrance fee is often up to the resident.There are generally two types: Traditional and Refundable. The traditional fee tends to be less expensive, but is non-refundable; whereas therefundable fee is more costly but can be prorated if the resident ever needs to leave the facility or passes away.
Accommodations: In some communities there are several choices for independent living accommodations, from three bedroom cottages and condominiums to one bedroomapartments. This is often a personal preference, but may be dictated by health care needs and by the entrance fees and monthly service fees associatedwith the various options.
Accreditation: Is the community accredited by the Commission on Accreditation of Rehabilitation Facilities and the Continuing Care Accreditation Commission in 2003(CARF-CCAC). CARF-CCAC is the nation’s only accrediting body for Continuing Care Retirement Communities and other retirement communities that meet itsstandards of excellence in three critical areas: governance and administration; financial resources and disclosure; and resident life, health, andwellness. Accreditation is a rigorous voluntary process involving self-evaluation by the organization’s staff, residents, and board of directors. Italso entails a meticulous on-site review by trained CARF-CCAC evaluators. The CARF-CCAC’s accreditation program is based on the belief thataccreditation promotes and maintains quality and integrity in the retirement community industry
Miscellaneous Fees: Although most of the room and board needs will be covered by the entrance fees and monthly services fees, there will inevitably be more charges thatwill creep up. Be sure to speak with the community administrators about realistic costs that may be associated with the community.
Sustainability: Will the facility be around in 10-15 years? You don’t want the hard earned money that was invested into the community to be lost because of pooradministration.
Much like CCRCs, retirement communities offer private, independent living residences. The communities, which are designed for those 55 and over, offervarious types of accommodations. From single-family homes, townhouses, mobile homes, or condos, residents often have the choice of renting or buying.Outside of mortgage or rent, there may be fees for community organizations or elective services like housekeeping, lawn care or clubhouse dues.
The biggest advantage of a retirement community may very well be the socialization and camaraderie provided by being in a community of other retirees.Lasting friendships and support systems help prevent loneliness and depression which often affect aging adults, especially after the death of a spouse.
Often these types of settings are ideal for those who do not feel the need (of have the funds) for a CCRC.
On a smaller scale, senior apartments offer many of the same amenities as retirement communities. One or two bedroom apartments with full kitchens andbathroom allow for seniors to remain independent. These 55 and over complexes usually are able offer handicap accessible accommodations for those whomay need to use a wheel chair or walker for mobility.
Often there are on-site activities such as exercise classes, cooking classes, group activities and meals. Some apartment complexes offer visitingphysicians and medical services while others may offer visiting beauticians or other personal services.
The rent for these units is often much less than that of a townhouse or condo in a retirement community and often includes most of the maintenance.This is an ideal setting for someone who is no longer able or wants to care for home maintenance or lawn care. Some of apartments may also offersubsidized rent based upon income.
As the name implies, subsidized housing, offers independent living at reduced rates based upon income levels and disability. These housing options aresubsidized by the Department of Housing and Urban Development (HUD) and may still require a portion of the rent to be paid privately.
Usually structured like apartments or townhomes, these facilities often have waiting lists and strict criteria for residency. It is important to note,that some areas have extremely long waiting lists and you should plan accordingly if you think this may be an option for you or a loved one.
Regardless of the type of independent living you choose, there are some questions to consider when finding the place to call home:
- Do you like the facility’s location and outward appearance?
- Is the facility convenient for frequent visits by family and friends?
- Is the facility near a shopping and entertainment complex?
- Can the resident access a medical complex easily?
- Is public transportation available?
- Are you welcomed with a warm greeting from the staff?
- Does the staff address residents by their names and interact with them during your tour?
- Do you notice the residents socializing with each other and do they appear content?
- Can you talk with residents about how they like living there and about the staff?
- Is the staff appropriately dressed, friendly and outgoing?
- Do the staff members treat each other in a professional manner?
- Are visits with the residents encouraged and welcome at any time
- What percentage of the apartments has been rented and is occupied?
- Is there a waiting list? If so, how long do they estimate it will be for a unit to become available?
Living Area and Accommodations
- Is the floor plan well designed and easy to follow?
- Are doorways, hallways and rooms accommodating to wheelchairs and walkers?
- Are elevators available for those unable to use stairways and handrails to aid in walking?
- Are floors of a non-skid material and carpets conducive for safe walking?
- Does the residence have good lighting, sprinklers and clearly marked exits?
- Is the residence clean, free of odors and appropriately heated/cooled?
- Are the common areas in general attractive, comfortable and clean?
- Is there an outside courtyard or patio for residents and visitors and can they garden?
- Does the residence provide ample security and is there an emergency evacuation plan?
- Are there different sizes and types of units available with optional floor plans?
- Are single units available and/or double occupancy units for sharing with another person?
- Does residence have furnished/unfurnished rooms? What is provided or what can they bring?
- May they decorate their own rooms? Is there adequate storage space?
- Is a 24-hour emergency response system accessible from the unit with own lockable door?
- Are bathrooms private with handicapped accommodations for wheelchairs and walkers?
- Do all units have a telephone and cable TV and how is billing handled?
- Does kitchen unit have refrigerator/sink/cooking element and can food be kept in their units?
- May residents smoke in their units or are there designated public areas?
Moving In, Contracts, and Finances
- What’s involved with the moving in/out process?
- Is there a written statement available of the resident rights and responsibilities?
- Is a contractual agreement available that clearly discloses healthcare, accommodations, personal care, supportive services, all fees, as well asadmission and discharge provisions?
- Find out what the payment schedule is and if residents own or rent their unit?
- How much is the monthly fee? How often can it be increased and for what reasons?
- What happens if funds are depleted and full payments can no longer be made?
- Is there any government, private or corporate programs available to help cover the costs?
- What additional services are available if the resident’s needs change? Is staff available to coordinate these services?
- Is there a procedure to pay for additional services such as skilled nursing care or physical therapy when the services are needed on a temporarybasis?
Health and Personal Care Services
- What health and personal care services are available? Who provides these services/what are their qualifications
- How are medical emergencies handled?
- Is there a staff person to coordinate home care visits from a nurse, physical or occupational therapist, etc. when needed on temporary basis?
- Are housekeeping, linen service and personal laundry included in the fees, or are they available at an additional charge? Are on-site laundryfacilities available and convenient?
- Are pharmacy, barber/beautician and/or physical therapy services offered on-site or nearby?
Social and Recreational
- What kinds of group/individual recreational activities are offered?
- Does the facility schedule trips or go to other events off premises?
- Do residents participate in activities outside of the residence in the neighboring community?
- Are there supplies for social activities/hobbies (games, cards, crafts, computers, gardening)?
- Are religious services held on the premises or arrangements made for nearby services?
- Are there fitness facilities, as well as regularly scheduled exercise classes?
- Are residents’ pets allowed in the residence? Does facility have pets?
- Are meals provided?
- What about special diets; does a qualified dietitian plan or approve menus?
- Are residents involved in menu planning and may they request special foods?
- Does dining room environment encourage residents to relax, socialize, and enjoy their food?
- Is there flexibility in the dining schedule? Are snacks available?
- How many meals are included in the fee? If a resident becomes ill, is tray service available?
- Can residents have guests dine with them for an additional fee? Is there a private dining room for special events and occasions, if desired?
Independent living is the ultimate goal for most aging adults, whether it is in their home they have owned for 50 years or an apartment they have justmoved in to. The choices may be dictated by funds, or by personal choice, but ultimately home is where the heart is.
This information was provided by Assisted Living Today, an online resource dedicated to providing valuable information about various aspects of elderly living and elderly care.