By Mark Friedman
We can buy cream to reduce wrinkles. We can undergo plastic surgery to alleviate sagging jowls. We can do a tummy tuck to minimize our figure. But no matter what we do, there is one undisputed fact we cannot avoid – we will continue to grow older. That is the one thing over which we have no domain. But we can exert significant control on where and how we grow older.
The Centers for Disease Control and Prevention (CDC) defines aging in place as “the ability to live in one’s home and community safely, independently, and comfortably, regardless of age, income, or ability level.” This can include bringing in care and making home modifications, such as installing walk-in showers and access ramps. It can be providing access to healthcare services and transportation options, as well as establishing a strong network with social connections. In short, the goal of aging in place is to enable older adults to age on their own terms and remain in familiar surroundings.
But who is the ideal candidate to age in their home? There are questions that must be considered, such as their current situation vs. their future needs. Will there be minor “upgrades” or a complete
“upgrade” as the years pass by? How much will that level of support they now need now increase in the future? And who can help provide support to them (family, friends, or professional caregivers)? Who will pay for services?
This is also where health enters the picture and the question of how long that person will stay healthy and independent (hearing, eyesight, mobility)? How will they manage changes to their health and evolving needs? Does the individual have any chronic conditions or disabilities that may affect their ability to live independently at home? Can they navigate their home safely, including stairs, narrow doorways, and uneven surfaces? How is their cognitive health; can they manage daily tasks, remember important information, and make sound decisions regarding their health and safety? Do they have any conditions that could affect their cognitive function, such as Alzheimer’s or another type of dementia?
Good health is important, but only in the context that it allows you to safely undertake activities of daily living (ADLs), such as bathing, dressing, toileting, eating, and maintaining personal hygiene. You must evaluate the ability to independently perform the daily living activities that most of us take for granted, such as using the telephone, preparing meals, managing household finances, taking medications, doing housework and laundry, going shopping, and managing transportation.
One must also consider the home environment. Is it suitable and safe for aging, or can it be made suitable? Consider factors such as accessibility, narrow doorways, stairs, safety features, and potential modifications that may be required to accommodate any physical limitations. Pay particular attention to the bathroom, kitchen, and bedroom. Unless you want to see an 80-year old shoveling snow, find out who is responsible for all the care and maintenance of the home, including gardening and snow removal. Are there family members, friends, neighbors or community resources nearby to provide ongoing support or on an as-needed basis? And, most importantly, are those you depend on aware of your needs and expectations?
Everything we discussed so far is paramount to safely aging in place, but much of it comes with a cost. A plan for successful aging must evaluate both the senior’s and decision maker’s financial situation, and determine if resources exist to support aging in place. Consider the costs associated with home modifications, healthcare expenses, and any potential long-term care needs (e.g. in-home, transportation support, etc.) Do they have transportation options? Can they easily access essential services, such as healthcare providers, grocery stores, and community resources, via public transportation or ride-share services?
These questions can seem overwhelming, and in some cases feel insurmountable. But they are key in assuring that the person aging at home is put in the best position possible to thrive in their environment, safely and securely.
