Aging in Place             "Aging in place" is growing older without having to move. According to the Journal of Housing for the Elderly, it is not having to move from one's present residence in order to secure necessary support services in response to changing need. Some 70% of seniors spend the rest of their life in the place where they celebrated their 65th birthday.

"Aging in Place" Topics What is "Aging in Place" What is a "NORC" Why Aging in Place Aging and Your Home Caregiver Advice and Long Term Care Resources Changes Related to Aging Home Assessment Senior Difficulty Checklist Additional items to review Safety Related Items Low Vision Checklist Fire Safety Checklist Safe Drinking Water Remodeling Your Home Possible Assistance Needed Pointers For Hiring Personal Care Help Resources For Aging in Place Home Care and Hospice Care Long Term Care Remodeling Services Patient Lifts Wheelchair Options and Accessories Pet Door Bug Blocker Other Resources

What is "Aging in Place"

We are using the term "aging in place" in reference to living where you have lived for many years, or to living in a non-healthcare environment, and using products, services and conveniences to enable you to not have to move as circumstances change. More recently "Aging in place" is a term used in marketing by those in the rapidly evolving senior housing industry. CCRCs, (Continuing Care Retirement Communities), by definition offer the chance to age in place, but first you must move to their community to "start aging". Multi-level campuses market "Independent Living", "Assisted Living" and perhaps Alzheimer's care and Skilled Nursing in one location, and claim to offer the opportunity to "age in place." But again you must move there first. In many cases you must also move from one wing of the campus to another to receive the increased services.

Here we address issues and needs related to "aging in place", without first relocating.

What is a "NORC

A NORC is a community or neighborhood where residents remain for years, and age as neighbors, until a Naturally Occurring Retirement Community develops. A NORC may refer to a specific apartment building, or a street of old single family homes. Residents would just have stayed and just aged.

It is possible to band together and develop, or seek help to develop, access to services to aid those needing assistance, thereby retaining the highest quality of life for all residents as they age.

Fair housing laws provide for a complex with 80% of its residents over 55, to become officially age restricted. Another classification for restricted age is for 100% of residents to be above the age of 62, but this is rare in an evolving NORC.

For many years the law required an age restricted community to offer significant amenities and services if it was age restricted. That is no longer the case, but to compete, and attract residents, we still see most age restricted communities offering amenities and services to serve their residents.

Significant amenities and services may include:

Why Aging in Place

A significant concern as people grow older is that they may have to leave their home. This would mean leaving behind a comfortable setting familiar community and many memories. In addition a certain amount of control is lost when one leaves home. This "control" provides the underpinning to our feelings of dignity, quality of life and independence. One's home is a strong element in that sense of security.

Most American seniors desire to stay in their homes for the rest of their lives. In fact an AARP survey found this number to be greater than 80% of seniors. This "stay at home" approach is also known as "Aging in Place" Several reasons are cited for this strong Aging in Place preference. These include:

	Comfortable Environs			Feelings of Independence
	Convenience to Services			Familiarity
	Safety and Security			Proximity to Family

"Aging in place" successfully requires planning. To accommodate physical, mental, and psychological changes that may accompany aging, physical changes should be made in your home.

Changes Related to Aging

Contrary to popular belief, most American seniors live independently while maintaining strong relationships with family and friends. Their personalities remain relatively stable throughout their lives. Depression occurs less in uninstitutionalized seniors than among young adults.
Normal age related changes do occur. These may include:

Hearing impairment

Failing vision,

Osteoporosis.

Increased likelihood of arthritis, diabetes, heart disease, and hypertension,

Mental process changes

• speed at which information is processed
• speed of responding to changes in the environment
• long term memory decline
• word finding ability declines

Visual decline

• decreased reading speed
• seeing acuity in dim light
• reading fine print
• sensing peripheral changes

These changes may lead to difficulties in interacting with one's living environment. These include:

Decreased mobility and dexterity

Decreased strength and stamina

Reduced sensory acuity: vision, hearing, thermal sensitivity, touch, smell

However some functions tend to remain the same with advancing age and changes differ between people. While seniors tend to process new information slower, daily social and occupational functioning ability remains stable. Most language related skills also tend to remain stable with age. Most notably, creativity and wisdom continue at strong levels.

In addition to physical changes, seniors experience social changes that may be disruptive. These include: isolation from family and friends, loss of peers children living far away and a changing neighborhood

The majority of seniors learn to adapt to their changing situations and lead happy and productive lives. Read more about changes related to aging.

Aging and Your Home

The aging process is blamed for many problems seniors may encounter with daily activities. However quite often it is the home creates the difficulties. Most residential housing is geared to young healthy adults. Builders do not take into account age-related conditions such as reduced mobility or limited range of reach. Hence, dwellings do not support the physical and sensory changes that older adults encounter as they age. What appear to be insignificant home features can have significant effect: for a person with even minor aging issues.

Many seniors avoid home modifications and helpful technology items designed for people with disabilities,.because these products have an industrial appearance. No one wants to have their home look like a hospital. Consumer demand and computer technology have pushed institutional products to be redesigned to be more acceptable in the home. Some of these include:

Chairs designed for easier in and out

Enhanced high and low frequency tones for doorbells and telephones

Grab bars and hand rails with decorator colors

Hospital type beds with wooden headboards and footboards

Items that are easier for arthritic hands to handle,

Larger print for declining eyesight

On/off buttons with color contrasts

Walkers in bright hues

The National Center for Injury Prevention and Control (NCIPC) states that falls are the number one cause of home injury, and studies suggest that a significant proportion of all falls are due to environmental factors
The three leading causes of home injuries, according to the NCIPC, are: falls, burns and poisoning. Seniors are especially susceptible to these types of injuries. Most falls are caused by environmental factors such as a home not truly suited for a person with elderly issues. Burns are caused primarily from fires. Older adults are killed in home fires at twice the rate of society as a whole (National Association of Home Builders [NAHB], 1990) Poisoning is mostly caused by medicine non-compliance: older adults are six times more likely than other age groups to suffer adverse medical reactions (Alliance for Aging Research, 1998).

One of the bigger challenges is to identify safety issues that may be unique to an individual based on their particular aging status and conditions. While research via books and the internet can help focus on such issues the use of a good checklist in assessing the home environment is helpful.

Home Assessment

It is important to do a thorough assessment of the home to assure that it can properly handle an elderly or infirm individual. The following table provides a summary of items to review and or consider.

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Additional items to review

Safety Related Items

Successful "aging in place" requires identifying and correcting any safety pitfalls. These may include many things some of which were noted in the table above. However, preventing falls must be a major focus to assure a safe environment. Further discussion of safety related items can be found here.

Senior Low Vision

Over one million Americans aged 40 and over are currently blind and an additional 2.4 million are visually impaired.
The leading causes of vision impairment (low vision) and blindness in the U.S. are diabetic retinopathy, age-related macular degeneration, cataract, and glaucoma.
-- DIABETIC RETINOPATHY is a common complication of diabetes. Retinal blood vessels can break down, leak, or become blocked, affecting and impairing vision over time. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime, and risk increases with age and duration of diabetes. People with diabetes are encouraged to seek annual dilated eye exams. Currently, laser surgery and a procedure called a vitrectomy are highly effective in treating diabetic retinopathy. Research into pharmaceutical treatment options is continuing.
-- AGE-RELATED MACULAR DEGENERATION is a condition that primarily affects the part of the retina responsible for sharp central vision. There are two forms of AMD -- dry AMD and wet AMD. Because AMD often damages central vision, it is the most common cause of legal blindness and vision impairment in older Americans (AMD rarely affects those under the age of 60). While there is no generally accepted treatment for dry AMD, laser therapies to destroy leaking blood vessels can help reduce the risk of advancing vision loss in many cases of wet AMD. Research sponsored by the National Eye Institute has recently shown that a combination of zinc, vitamins C and E, and beta-carotene may also reduce the risk of advanced AMD by 25 percent.
-- CATARACT is a clouding of the eye's naturally clear lens. Most cataracts appear with advancing age. Scientists are unsure what causes cataract. The most important factor is increasing age, but there are additional factors, including smoking, diabetes, and excessive exposure to sunlight. Cataract is the leading cause of blindness in the world, and affects nearly 20.5 million Americans age 40 and older. By age 80, more than half of all Americans develop cataract. Cataract is sometimes considered a conquered disease because surgical treatment that can eliminate vision loss due to the disease is widely available. However, cataract still accounts for a significant amount of vision impairment in the US, particularly among people age 65 and over who may have difficulty accessing appropriate eye care.
-- GLAUCOMA is a disease that causes gradual damage to the optic nerve that carries visual information from the eye to the brain. The loss of vision is not experienced until a significant amount of nerve damage has occurred. For this reason, as many as half of all people with glaucoma are unaware of their disease. About 2.2 million Americans age 40 and older have been diagnosed with glaucoma, and another two million do not know they have it. Most cases of glaucoma can be controlled and vision loss slowed or halted by timely diagnosis and treatment. However, any vision lost to glaucoma cannot be restored.
Those affected by low vision often become depressed, are prone to falls and resultant injuries, and many are socially isolated. There are several things that can be done to assist those with low vision.

Several tips for handling low vision situations can be found here.

Senior Fire Safety.

The physical and mental impairments that tend to accompany aging tend to reduce older adults' reaction times and place them at a higher risk for causing fires, and thus at a higher risk of fire injury.
Disabilities present additional fire risks and concerns for the elderly. Many Medicare enrollees re unable to complete at least some of the normal activities of daily living (ADL) necessary for a degree of self-sufficiency.
Economic and social concerns also contribute to the fire risk for older adults. Most live on fixed incomes and many live in poverty. Hence, they may be unable to afford to make necessary home improvements that could substantially reduce their risk of fire.
Several tips for addressing senior fire safety can be found here.

 Is Your Drinking Water Safe?

Illness and disease can come from many types of contaminants in drinking water. Water may come from a lake, a river, an underground aquifer, a public water utility, even bottled water. All these sources may be contaminated by impurities. These contaminants may include chemicals like pesticides, heavy metals such as copper and lead, human and animal waste, and even disinfectant-products introduced during water treatment. Your health may be impacted by these impurities.

To help you make a quick assessment of the water quality in your area, our sister site Water Quality Plus, presents the status of the following contaminants in an easy to understand format.

• Inorganic Contaminants
• Lead & Copper
• Organic Contaminants
• Disinfectants
• Microbiological Contaminants

Visit the site now and see your water quality, www.waterqualityplus.com.

Remodeling Your Home

There are a number of items to consider when remodeling your home. You may wish to consult a professional early in your evaluation process. No one is going to make all of the modifications, but be wise regarding those you focus on. i.e. if you already know your eyesight is failing, focus on modifications that benefit poor, or poorer eyesight the most. If you have arthritis that impairs mobility, focus on modifications that cater to your anticipated increasing mobility limitations.

To "age in place" one should be aware of community help and services available to deal with increasing frailty or age related problems. They may also be needed in the event of illness.

Pointers for Hiring Personal Care Help

Non-medical in home support services provide an opportunity for frail or ailing people to stay in their home and perhaps maintain a more independent lifestyle than a group home might offer.

Agencies can provide experienced caregivers who can assist these seniors in a number of ways. Reputable agencies are bonded and insured and their employees are covered by workers compensation and are regularly supervised. Caregivers may work for a client a few hours per day or 24 hours seven days a week. They prepare meals, do housekeeping, medication reminders, run errands, manage incontinence, give baths and help clients transfer. They also provide valuable companionship and encourage clients to exercise and participate in activities. They are a help when a caregiver lives at a distance, or with the frail senior, and just cannot be do all the services necessary.

Non-medical homemaker services are often confused with licensed home healthcare agencies. Some of these agencies also offer non-medical care, but generally they offer nursing types of services on an intermittent short-term basis. The client usually has a medical need that requires the expertise of a RN, physical therapist or some other medical specialty. In home supportive companies often work hand in hand with home healthcare companies to help their clients.

In home support services range from $13 to $20 dollars per hour and $140 to $200 dollars for 24-hour care. Long term care insurance policies can be helpful in meeting some of this cost . People who cannot afford this cost may hire people privately for less money. However, they are taking a risk and will have to manage these caregivers with no professional assistance. However, reality sometimes dictates that this is the only viable choice.

Whether you hire an agency to send you a helper or hire one directly - read on:

Interview the candidate and/or the agency.

• Inquire if there is a charge for the interview.
• Get 3 work references for the candidate.
• Get client references for the agency.
• Is the care provider or agency bonded.
• Obtain the Department of Motor Vehicle print out from their driver's license.
• Do a Felony Background Check or know that the agency has conducted one. An Investigating Service will do this for a small fee.
• Ask for proof of provider (or agency) worker's compensation insurance.
• Ask for proof of care provider (or agency) full professional liability insurance.
• If the care provider is unable to work one day, will the care provider (or agency) provide a substitute care provider?
• Among other questions, ask:
  • How many years have you been in home care?
  • What were your duties for your last 2 patients?
  • What is your favorite duty while taking care of a patient?
  • What is your least favorite duty?
  • On a scale of 1-10, 10 being best, how do you rate your:
    • Cooking skills?
    • Housekeeping skills?
    • Personal care?
    • Ability to following directions?
    • Flexibility?
    • Ability to work with other family members visiting or living in the home

Remodeling Services

- Patient Lifts

Patients Lifts offer caregivers the ability to utilize mechanically assisted transfer. Using patient lifts help prevent occupational injuries associated with repeated manual lifting. Transfers are difficult on both the caregiver and the patient's body. Patient lifts allows for transfers from beds, wheelchairs, showers and bathtubs. While you might first encounter a patient lift in a hospital, there are affordable options made for your home. The following is a rough overview of your choices when it comes to patient lifts. 1. Manual Patient Lifts: a bit of a misnomer, these lifts use hydraulics. o Pros: o Cons: Economical Greater portability No motor to maintain or power More effort required of the caregivers part 2. Powered Lifts: uses a motor to power transfer. o Pros: o Cons: Less effort and strain, simply press a button to lift and lower the patient Quiet and smooth transfer the patient Remote controlled allows easier patient transfer Cost - 3x to 4x manual lifts Less portable 3. Overhead Ceiling Lifts: Attaches a track and lifting mechanism to the ceiling o Pros: o Cons: Most stable Extensive initial set-up Not transportable Patient Lift information provided by 1-800-Wheelchair

1-800-Wheelchair: We make buying lift chairs and patient lifts easy.

- Options and Accessories

Other Resources

ElderFriends a volunteer-based friendly visitation program, designed to help keep elders living in the community, in their own homes and remaining independent for as long as possible

Meals on Wheels Association of America is one organization providing nutritional meals to shut-ins or ailing seniors with low incomes.

America's Second Harvest can locate a nearby food bank for low income seniors.

Equipment to Help Seniors

Food and Nutrition Information Center Provides credible, accurate, and practical resources for nutrition and health professionals, and consumers.

Information and videos about diseases and ailments of aging and accepted treatments or meds.

Senior Day Care

Care Pathways is a resource for extensive care related information. It is written from the perspective of professional RNs.

Financial Resources to assist in Aging in Place

Insurance Resources

Find Home Care, Home Help and Community Based Resources for your state/area.

CCRCs, Congregate, Independent Living and Assisted Living offer opportunities they refer to as "aging in place" after one relocates to their community, since they offer levels of increasing care, although most do not include nursing home level care within their communities. Continuing Care Retirement Communities (CCRCs) also offer the opportunity to "age in place" once you have relocated to their community with a guarantee to that effect.

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