f14

1. Concept of Home

Most people have a social connection to home. Home signifies independence, family connection, familiar routine, and comfort, because it is a territory we have each  built. I relate to this when I go in vacation. It is so much fun to travel but after two weeks or so I want to be home. Where one lives also defines, to some extent, who we are. For example, it might reveal :

 

1. Did you know that 75-80% of elders own their own home, and live alone?
   
1. It's true. Most older adults own their own homes. Many would like for someone to come and live with them, but most are not willing to give up their own dwellings. In fact, the ownership rate is higher for older adults than it is for other age groups. However, the cost of maintaining that home is higher (Can you guess why? read on).
   
   In surveys of older adults, they overwhelming note that they want to age in place. This means to live where they have always lived. When caring for older adults who want to age in place, the goal should be to assist them with staying in their own home for as long as possible. 
   
   What might keep elders from being able to live in their own homes until they die? Well, lack of adequate assistance with ADL's, inability to navigate safely in the home, and costly repairs are a few examples. Because the houses of older adults are usually older too, roofs, plumbing, fences, etc., need more frequent repairs . Often these repairs are not made because of lack of someone to do the work.  However, the most common reason elders must leave their own homes is inability to get up unassisted at night to use the bathroom. One can often find daytime caretakers, but reliable and adequate nighttime help is both costly and difficult to  find. 

Did You Know?

Many elderly take diuretic pills (commonly known as water pills) to help control blood pressure and other heart conditions? The effect of this medication is frequent trips to the bathroom to urinate. That's what the drug is supposed to do-- pull excess fluid out of the body. 

This pill can mistakenly be given in the evening resulting in multiple trips to the bathroom all night long. It exhausts both the elderly person and the caretaker. So, be sure to ask the doctor if diuretics or water pills can be given in the morning, and check to see if you can delay a dose for a special outing or special occasion day.

back to top

 

2. Problems With Aging in Place:
   
1. When a spouse dies, the surviving spouse may have financial problems. Often they lose the income from the their spouse's pension (defined benefit retirements often stop at death) and reductions in Social Security( a surviving spouse only is only entitled to 50% of benefits ) and other forms of income can place a hardship on maintaining independent living.
   
2. An aging home along with decreases in income can also reduce funds available for older homes in need of costly repairs.  Trying to find reliable and professional house repair persons also becomes an issue. Too often, unscrupulous contractors cheat unsuspecting older adults out of cash and leave repairs undone. 
   
3. Family homes can suddenly become too large to take care of. Many elderly close up entire top floors or rooms of their homes because they are no longer accessible and/or too costly to heat and maintain. In Nevada City, where I was a public health nurse for many years, I often found frail elderly living in their kitchens and dinning rooms during the winter. The entire house had become to large to navigate, heat, and maintain.  
   
4. Aging in place can also become an issue with failing health and increased needs for assistance. Live-in helpers are almost impossible to find in most communities, and the cost of 24-hour custodial care (help with ADL's) can run $10-$25 per hour. Do the math! At $10.00 per hour that's $240 per day, or more than $7,000 per month. 
   
5. Homes where the elderly raised their families often are in older neighborhoods that have deteriorated. The fear of crime keeps many elderly indoors. These neighborhoods also lack activities in which the elderly can be involved. These factors often create a sense of isolation for elders in their own homes and feelings of loneliness. In most instances elders looking for a live-in helper out number helpers available for hire. 
   
6. Because deteriorating neighborhoods can also increase the chance of crime it may not be safe for some elders to age in place. 

 

II. Environmental Needs When Aging in Place:

1. Service

Elders may need help with everyday livings skills (ADL's) to remain at home. There are a variety of programs to assist. These include Older American Act programs (remember the aging network and the Area Agencies from week one's handouts?). Services might include: home delivered meals, lifeline (the "help I've fallen" buttons), chore workers, homemakers (for meal prep and housecleaning), utility bill and weatherization programs.

To find a specific service, call the local Area Agency on Aging or the California 800 elder care locator number: 800-677-1116. You can also use an internet search engine using the key words "elder care locator" and the city where you want services.

2. Safety

Older homes may need adaptations to prevent accidents and to prolong independence.

1. Physical Needs: Aging bodies often can adapt to an environment and remain independent with assistive devices and someone to assist coordination of their use. These include:

Please refer to your handout

1. Home safety checklist

back to top

3. Relocation Patterns

Younger people simply think of skilled nursing as the only option for  elders leaving their homes but over the last 20 years there has been an increase in the options that bridge the gap between home and a nursing home (nursing homes are also referred to as a skilled nursing facility or SNF, because the facility offers nursing care and not just custodial or ADL care).

 

A. Typical Relocation Patterns While Active:

 

1. First Move - (age 60 or more)
   The first move is usually to a rural area or vacation spot to be closer to recreational amenities or retirement communities, or to be closer to preferred climates. When these elderly relocate, they often leave long-time neighbors and support systems.
   
   This population may also engage in seasonal moves. Elders who go south for the winter to escape the cold are referred to as snowbirds. When they move north in the summer to escape the heat, we refer to them as sunbirds. 

 

2. Second Move - As functional ability declines, elders typically move to the suburbs or city to be closer to family or children, and to be closer to hospitals and services. Ties to familiar neighborhoods and dependence on children are often motivating factors. If an elder has been even lightly confused, the confusion may increase when relocated. For this reason, consider all possibilities before relocating a confused older adult. 

 

3. Third Move -This move is typically to a higher level of care or Long-Term Care (LTC) as health deteriorates and frailty increases. Types of long-term care are discussed below. 
   

2. Long-Term Care Defined

Traditionally LTC was defined as skilled nursing care and meant that one was institutionalized. Today it includes all the services and care an elderly person may need during the end stages of life. These services can be provided in a facility (institutionalized care) or in the community (non-institutionalized care).

back to top

 

2. Skilled Nursing and Medical - skilled services usually are medically necessary care that is prescribed by a doctor and implemented by a hospital's or private agency's home care divisions. 

Sometimes, home care can fill in between moves and keep an elder in his/her home longer. After an illness that requires a hospitalization, Medicare will pay for home care with a physician's orders.

They will not pay for custodial care (long-term-care with ADL's), but short-term rehabilitation needs only. Many elders assign their Medicare benefits to an HMO. They often gain prescription coverage, but lose the extended home care options provided by Medicare.

Home care can include a nurse, physical therapist, occupational therapist, social worker and homemaker (they cook and serve meals and do light housekeeping and help with ADL's). IADL's typically are covered, too.

3. There is a wide range of non-medical services designed to assist those who find it difficult to function independently due to illness or injury or just gradual diminishing capabilities.

 

3. Hiring Help
   back to top

	Supervise their work personally when possible.
	Protect valuables and banking accounts. Although most home-care workers are hardworking  and honest people, some strangers have been known to carry off the assets in an elder's  home one spoon at a time. It is often too late by the time someone notices that the house  is becoming sparse.

 

3. If you hire help not from an agency:

 

	Recruit through a public agency such as a college, church, senior center, or community center.
	Ads in newspapers are risky! One can be open to unscrupulous thieves and elder abusers.
	Tap into local community-based long-term-care services for referrals such as:  the Area Agency services,  Friendly Visitor Program, Telephone Reassurance, or public health agencies.