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Aging in Place Defined

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.

Naturally Occuring Senior Communities Divider

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.

Some 27% of seniors live in a NORC.

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:

  • Social and recreational programs
  • Continuing education programs
  • Information and counseling
  • Outside maintenance and referral services
  • Emergency and preventive health care programs
  • Meal Programs
  • Transportation on a schedule

  • Aging in Place  Why

    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
    Aging Comfortable Environs
     
    Aging Independently
    Convenience to Services
     
    Familiarity
    Aging Convenient Serives
     
    Aging with Familarity
    Safety and Security
     
    Proximity to Family
    Aging Secuirty
     
    Aging with Family
    s

    "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.

    Gerontology Changes Divider

    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 in Your Home

    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.

    Aging in Place Home Assessment

    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.

    Walk-In Bathtubs can aid people with limited mobility, seniors, and the disabled. Some include the therapeutic benefits and luxury of a whirlpool tub, with the safety, accessibility and simplicity of access. Perfect for those with limited mobility who wish to enjoy the freedom of living comfortably at home

    Walk-In-Tub

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    Safety Related Items Divider

    Additional items to review

    Aging Safety ChecklistSafety 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.

    Aging in Place Low Vision

    Aging Low Vision Issues 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.

    Aging in Place Fire Safety

    Aging Low Vision Issues 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.

    Safe Drinking Water Divider

    Water Quality Plus 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 for Geratrics Divider

    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.

    General
    Adapt lower floor of home for possible one level living
    Increased incandescent general and specific task lighting
    Easy garage or parking access
    At least one entry is without steps
    Doorways 36" wide with off-set hinges on doors
    Levered door handles instead of knobs
    Electrical outlets at 18 inches instead of 12
    Easy to open or lock patio doors and screens
    Light switches at 42" instead of 48
    Adjustable controls on light switches
    Luminous switches in bedrooms, baths and hallways
    Strobe light or vibrator-assisted smoke and burglar alarms
    Lower window sills especially for windows on the street
    Programmable thermostats for heating and cooling
    Contrast colors between floor and walls
    Color borders around floor and counter-top edges
    Non skid flooring
    Matte finish paint, flooring and counter-tops
    Non-glare glass on art work
    Peep hole at a low height
    Incorporation of emergency response system installed or wearable

    Bathroom

    Lever faucets and faucet mixers with anti-scald valves
    Temperature controlled shower and tub fixtures
    Stall shower with a low threshold and shower seat
    Grab bars at back and sides of shower, tub and toilet or wall reinforcement for later installation
    Bathrooms with turn around and transfer space for walker or wheelchair (36" by 36")
    Higher bathroom counters
    Telephone jack
    Installation of medical response device

    Kitchen

    Kitchen cabinets with pullout shelves and lazy susans
    Easy to grasp cabinet knobs or pulls
    Task lighting under counters
    Cooktop with front controls
    Side by side refrigerator
    Adjustable upper shelves and pull out lower shelves
    Variety in kitchen counter height - some as low as table height (30 inches)
    Gas sensor near gas cooking, water heater and gas furnace
    Color or pattern borders at counter edges

    Living Room

    Seating at least 18 inches off the floor
    Chairs with sturdy arm

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    age in place Divider

    Make Your Home Aging-in-Place Friendly

    As we age we don’t hear so well, we sometimes forget or get confused and we can even outlive doctor’s predictions about our longevity. So as long as we persist in growing older, why not arrange our homes to accommodate our reality. Incorporate memory triggers into the way we arrange cabinets and counters, Add soft fabrics to muffle background noises, change appliances to better accommodate our short-comings and make our homes senior-friendly.

    Universal Design: A Step-by-Step Guide to Modifying Your Home for Comfortable, Accessible Living
    The book, Universal Design: A Step-by-Step Guide to Modifying Your Home for Comfortable, Accessible Living by Barbara Krueger and Nika Stewart is a good place to start.With the book as a guide you can plan ahead for years before you critically need the advantages offered by the ideas in the book.
    s

    Also visit: the Universal Design Living Laboratory:A National Demonstration Home at http://www.UDLL.com by Rosemarie Rossetti, PhD

     

    age in place Divider

    Possible Assistance Needs

    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.

    Services can provide:
  • Outdoor home maintenance and gardening
  • Indoor home maintenance
  • Heavy and/or light cleaning and housework
  • Driving

    Trips to the grocery store

    Other shopping trips

    Home delivery of groceries

    Transportation to doctors appointments

  • Homecare

    Meal preparation

    Bathing and dressing

    Personal care assistance

    Home nursing

  • Emergency call/response systems

    In your home

    To wear on your person

  • hiring help for seniors divider

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    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:
    1. How many years have you been in home care?
    2. What were your duties for your last 2 patients?
    3. What is your favorite duty while taking care of a patient?
    4. What is your least favorite duty?
    5. 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
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    Long Term Care

    Resources For Aging in Place

    Insurance, Long Term Care

    Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, and other physical activities. Long-term care insurance can help pay for such care in the future. To help protect your financial independence, as you grow older, many Long Term Care Insurance providers have plans that offer comprehensive benefits as well as a proven track record of claims payments and financial stability. You should review all your options carefully.

     

    Medicaid does not give you choices! Learn How to Protect your Loved Ones with Long Term Care Insurance

    Aging in Place Services

    Remodeling Services

    Bathroom

    Walk-In Tub
    Walk-In-Tub

    Patio Sunroom

    Kitchen

    Save Energy Replace Old Windows

    Wheelchairs Patient Lifts

    Wheelchair Options and Accessories

    - 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

    - Options and Accessories

    Wheelchair options and accessories make a wheelchair more suitable for a person’s specific illness, injury or condition.

    Medicare covers options and accessories for wheelchairs when a patient has a wheelchair that meets Medicare coverage guidelines, and the options or accessories are necessary for the patient to perform normal daily activities.

    For an option or accessory for a manual wheelchair to be covered, a written signed and dated order must be received by the supplier before a claim is submitted to the DMERC. If the supplier bills for an item without first receiving the completed order, the item will be denied as not medically necessary. Also, supporting documentation for the medical need of this item must be on file.


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    Wheelchairs Patient Lifts

    Pet Door Bug Blocker Stop Mosquitoes

    • Patio pet doors provide a great way to provide pet access next to your existing sliding doors. Once installed, the screen door can not be shut all the way or pet door access is blocked. Until the Bug Warden™ arrived, the only option was to close the screen door to the point where the patio pet door starts, leaving a bug gap between the edge of the partially opened screen door up to 3" wide
    by over 6 feet tall...over 200 square inches of mosquito, fly and other pest access. The Bug Warden™ blocks bugs from entering the bug gap by adhering to the side of the exterior face of the patio pet door and extending out a soft flexible material to provide a bug blocking seal with your screen door.

    In some locales it's really important that bugs not have a way into the house. But until now, nobody has come up with a good way of solving this problem. Learn More

    Aging in Place Resources

    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.

     

    The following 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.

    Aging Divider

    We welcome inquiries from providers of services and products who wish to join seniorresource.com