« George Carlin on Being Old | Main | REWIND THE WEEK – 20 June 2014 »

Thursday, 19 June 2014

Notes on Aging in Place

From a story on the Minnesota Public Radio website titled, The Danger of Aging in Place.

”If there’s one thing many Baby Boomers have in common, it’s this: Trying to convince an elderly parent that it’s time to leave the home they’ve spent their life in, and move somewhere that’s not so dangerous for an elderly person.”

Could such a generality possibly be true - that a large number of the 70-odd million baby boomers believe their parents need to be forced out of the homes where they are happy? The writer, Bill Collins, sure makes it sound that way.

There are all kinds of reasons this is wrong. First, the vast majority of people make it all the way to their graves successfully living on their own. I've seen numbers ranging from 65 to 80 percent.

In addition, there are nowhere near enough beds in care facilities to accommodate many more elders than are already there. And, it's boomers themselves who are becoming the people who may or may not need to leave their homes - not being the operative word in that sentence.

Although the numbers are hard to come by and too often compare apples and oranges, reasonably good statistics from several reputable sources can be deduced. They tell us that at any given time about five percent of the 65-plus population is living in some kind of skilled nursing home.

Additionally, about one-quarter of people who are 65 and older will spend some time in such a place but not permanently.

Those statistics cover the entire 65-plus population. When you count only the oldest old, the percentage of 95 and older in skilled care rises to about 25 percent.

The reason for the fuzziness of this information is that there are so many more kinds of care homes than in the past and no one is tracking or comparing them well. But I feel confident that what I found is within the realm of reality and that leaves me wondering what in the world Mr. Collins is talking about – the dangers of aging in place.

His article is mostly a long quotation from another story by a woman, Michelle Singetary, who is struggling with blaming herself over her mother's death due to a terrible home fire:

”What could I have done differently to get her to recognize that she needed more help and could no longer live on her own?” she writes.

“But my mother was strong willed, competent and in her right mind, so we couldn’t force her to relocate.”

“Competent and in her right mind.” So why did she need to relocate? In the original story, not quoted by Mr. Collins, Singetary explains that her mother had had two strokes, had trouble walking and needed help with cooking and bathing.

No doubt that can be worrisome. Nevertheless, many elders who need that kind of help but are otherwise capable, as this mother seemed to be, do quite well with regular visits from a relative or home aide, and are happier than they would be pulling up stakes late in life. Not to mention how much less expensive it is to age in place.

It is not ours to judge this terrible occurrence; we cannot possibly know all the circumstances and my heart goes out to Ms. Singletary.

What I do want to do, however, is point out the irresponsibility of the Minnesota Public Radio website posting a story with such an inflammatory headline together with a fallacious, ageist assumption in the first sentence that infantilizes elders.

Consistently, over many years, about 90 percent of all old people have told pollsters they want to age in place and the facts show that a huge majority manage to do that.

With the growth of the Villages movement and shared housing, many more will be able to do so in coming years.

The fire that killed Ms. Singletary's mother is a terrible thing, but horrible accidents happen to people of all ages and this one occurrence should not be used as evidence that aging in place is dangerous.

[Hat tip to TGB reader chlost who brought this story to my attention.]


At The Elder Storytelling Place today, Janet Thompson: Hot Pants and Go-Go Boots


Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

Bang on 100 percent agree.

I overheard a coffee shop guy lamenting the fact that his son has a long commute from off island to downtown Montreal.

He went on to rant that greedy on island home owning seniors should immediately sell up and move off island, make way for his son.

After all, seniors don't need to go anywhere.

Well good luck with that idea, sunshine.

I'll sell you my pretty, renovated dollhouse for a million bucks cash.

What do you mean you can't afford it?

I'll throw in a couple decomposing skunks.


I absolutely agree. I want to tell whoever wrote that piece to mind Your Own Business! I will make my own decisions, thank you very much!

Your last paragraph says it all, Ronni. If the person who died in a house fire was middle aged would the article imply that all middle aged people should not live alone? Life is full of perils and living alone makes some of us more vulnerable, but moving to an assisted living facility will not change that reality and different perils might lurk there.

I've made it so far and, fingers crossed, I will continue to live alone as long as I am breathing.

I work in a 55+ community of single family homes. The other day a resident came in and mentioned she was going north to convince her mother that it is time to move out of the ONLY house she has ever lived in (was an orphan). She is ok physically, but the daughter and siblings worry that the house is too much for their mother to take care of. It needs a new roof and other major repairs.
Heartbreaking on all sides.

When you put your parent in a home --- YOU feel much better. Up until then you worry about them and probably feel guilty. Only the displaced see the downside of this.

If I am in my right mind-- I think it should be my choice if I want to suffer consequences if there are any.

In my condo complex I have seen two, make that three, different people removed to a safer environment against their wishes. It was very sad. All three begged to stay and were told it was for their own good. How can this happen?

Lots of solid stats in this post reaffirm my belief our last years should be spent where we want to be whenever that is possible.

I am reminded of the book, IN AN INSTANT: A FAMILY'S JOURNEY OF LOVE AND HEALING by Bob and Lee Woodruff. The part of the title has always intrigued me, because life can and does change in an instant. I applaud your blog. You covered everything perfectly....

The reason I put myself in assisted living is because, at the time, I needed it. I was recovering from a serious illness and needed the security of such a facility. Now, that I am much better,I can't leave because I can't afford to. I would love to be in an apartment of my own in some decent neighborhood but, around here, that is impossible. What we really need is less nursing and more affordable places for seniors to "live in place".

Aging is a dangerous sport no matter where we live. But the alternative is no fun at all.

The widespread availability of technology that lets the younger generation see an aging relative through various types of video calls should make it much easier to leave elders where they want to be.

I live in an upscale community where complaints about seniors hanging on to their homes rather than selling to young families are on the rise. I wonder if the inability to imagine becoming old is grounded in fear or selfishness or ???

As you asked so succinctly,
Ronnie: what makes Michelle Singletary's mother's death an aging-in-place issue? People of all ages do die in home fires.

@Kathy, An excellent example in your comment. The old woman's children worry that their mother's house is too much for her to keep up. They refer to the need for "a new roof and other major repairs."

Roofs don't last forever. That's why roofing contractors make a comfortable living. Did it occur to the woman's children to check into how much a new roof would cost?

Thanks for defending the principle of self-determination. I plan to hear Michelle Singletary speak at the annual meeting of the American Library Association next week.

Excellent topic, excellent comments! If parents had the same attitudes about these children during their teen years, no one would stay out past 8 pm, drive a car or probably even play sports or learn to swim!

We all should head over to the original article at MPR and repeat these thoughts. If enough do, maybe the writer will pay attention.

Sorry, folks. I'm disappointed no one can see the caregivers' perspective at all.

Insistence on staying in a falling-apart, cluttered home while struggling with multiple medical issues will wear your children, especially long-distance daughters, down to the bone. We live in a culture crazed with a kind of pseudo-independence (raised your own wheat or produced your own electricity lately? I suspect not), so part of this is probably inevitable.

But if you are sure you can manage, then--manage. Fix the roof, get the house cleaned, and give your kids a break. If you can't afford or handle these things, then make some decisions while you still can about what is most important to you--and let the rest go.

What can your life still be, going forward, and what memories do you want to leave your kids with?

I'm rather confused by today's story. Several weeks ago, I heard Michelle Singletary being interviewed on NPR on Here and Now. I think it was still very soon after the fire, but at that time, her purpose in speaking out was to educate families about the importance of putting things in writing, communicating wishes regarding things like DNR's, financial arrangements, medical POA's, and other personal directives, and making sure that documentation was in place and that one or more reliable people have everything needed to deal with these issues. At the time of the interview, Ms. Singletary indicated that her mother was still alive, but had been badly burned and, especially at the time of the fire, was unable to communicate and had made no advance preparations of any kind. For some time, Singletary and her siblings were unable to get any access to medical information or to provide much input into decisions regarding her mother's care, and had a terrible time dealing with all sorts of things. Keeping in mind that Michelle Singletary is an intelligent, educated woman who has written books on financial advice, with a public radio syndicated show of her own on the topic, it should have been much easier for her to to work her way through the morass, and yet it was clear that she had been overwhelmed by the experience. Not surprising as she had not only had the details of medical care and finances, but the trauma of how badly injured her mother was and the horror of the accident. I had not heard that her mother had died, and I'm sorry to hear it now. I did get the impression that part of the problem with the difficulties faced by Ms.Singletary and her siblings is that her mother had functioned so independently so successfully for so long that no one had apparently felt the need to get into her business when she did not welcome it. Having gone through this fairly recently with in-laws who actually had shared a fair amount of their information with us, I completely agree with Ms. Singletary about the importance of having things in place before something horrible like this happens.

I am 74 and live in a two storey single family home that has become rather ramshackle due to lack of money for all but the most urgent repairs. Took out a reverse mortgage to pay for repairs several years ago and the money has now been used up. The house insurance and taxes etc, increase every year but my income does not. I do not want to age in place! I do not have enough money to live in a nice senior community but have just too much in savings to qualify for section 8housing. My children all live thousands of miles away and have shown no inclination to have me move in with any of them or have me move nearer to them. They still see me as good old competent capable Mom and as I have no health problems they feel they do not need to worry about me!
Will have to make some decisions soon about where to live but have yet to come up with any solution.

I actually disagree with you. I live in a suburb that is probably 65% retirees and not wanting to leave is a huge problem. My neighbour fractured her skull living on her own, totally refused to leave. Her daughter was forced to quit her job and leave her husband to come from the U.S. here to Canada to look after her mother.

And yes I do see it as selfish to have young people commuting well over 1 hour each way in my area to get to work while these bungalows are filled with 1 senior who refuses to move.

For some reason you paint seniors as victims when in reality many of them are not all that altruistic themselves.

I will move into a centrally located condo when I am on my own. I want to go now but my husband is afraid of cities, grew up in the country.

The woman with two strokes, who has trouble walking and needed help with cooking and bathing needs to either move out or have funds for 24/7 help and stop playing the victim card.

I loved your post, Ronni. Especially that you pointed out that most people live "at home" until death.
One thing to remember is that if we live to be old-old, we aren't going to be as able to drive and swim and shop-til-we-drop as once (or now) we do. And so we, as well as our relatives, need to not be horrified with the changes that come with "lack of ability, energy or giving a hoot" Old age is a new landscape where things slip and slide and we have experiences both good and bad.
And that is ok. We are not alone in going through those experiences. While a devastating housefire is not common, most of us as we age will experience things we did not anticipate. And that is ok. As my sister said before she died, "I finally figured out that life is not about survival. It is about experience." I thank all who share their experiences with us. It does help.

I agree with Cathy Johnson - I read Michelle Singletary's financial column in the Washington Post. Michelle was raised by her grandmother, not her mother, and she was raised with frugal and common sense money-related values. Her comments must be taken in context, and THEN we can have a discussion about about aging in place without so much...Bill O'Reilly-ness?

Ronni-I was anxiously awaiting your response to the article. When I read it, I had a knee-jerk reaction to some of the assumptions contained in it. The first thing that came to mind was "I'll bet Ronni Bennett would have something to say about this!"

For the record, I generally enjoy Bob's bog posts. And I think the entire issue comes down to informed decision making. No one should be forced to move anywhere as long as they are competent and making an informed decision, no matter anyone else's opinion about the decision. If that is not the case, then some intervention may be necessary---but as minimal an intervention as needed to ensure the person's physical well-being

I am reluctantly aging in place---and aging, and aging. My condominium, when I was a young 59, was a beautiful home with a lovely greenbelt view and an"upside down" configuration to take advantage of that view. Now my physical limitations make a personal hell of those stairs which must be climbed (up or down) to bring in groceries etc or take out trash & recycling or to get that widget that is down when I am up or up when I am down.

After many years, the things I loved---all that carefully chosen furniture, the thousands of books and the once precious decor---now are just so much crap to me along with the no longer loved junk in the garage.The upkeep effort, even with house cleaners and handymen, is a constant irritation. The weight of all this "stuff" is simply overwhelming. To be blunt, I hate my home. But every time I consider the effort it would take to dig myself out from under it and find a small downtown apartment, I tend to (almost literally) fall apart and, like Scarlet O'Hara, vow to think about it another day. Like another commenter, I get little help from my children, only one of whom lives anywhere near me. I would love it if someone would swoop in and manage the effort it would take to clear things to the bare walls and help me move out of this "place."

I have taken care of all the paperwork, including will and trust, advance directive, pre-paid cremation, and power of attorney, and all these things together with other necessary documents are in one readily accessible safe box. So if I end up sprawled on my stairs ("I've fallen and I can't get up") my family will be able to find everything they need to hold an estate sale and otherwise dispose of all my worldly goods. But I will never get to live in that clean, well-lighted, sparsely furnished, tiny home of my current dreams. So for some people, "aging in place" is what they want and a choice they should have. For others of us, it's more like "take this place and shove it."

Safety is important but it's not the only thing in life, as most of us who have reached 75+ recognize. I'd much rather live on my own in my (perhaps not 100% safe) one-story manufactured home than exhaust our relatively modest savings paying huge bucks to an assisted living facility or nursing home to run my life.

If I become totally disabled and can no longer perform the basic "ADLs" for myself, well then, maybe it's time for Plan B! Or, maybe I'll see things differently than I do now. The last thing either my husband or I want is to be a burden to family, and, within our available resources, we've tried to be proactive so that doesn't happen.

Meg, there are professionals who can help you sort out your "stuff", get rid of what you don't want and oversee your move. If your kids won't or can't help, maybe they can chip in to hire a pro so you CAN live in a more suitable place. I considered this when we moved last year, but we managed on our own--this time. At 84 and 77, respectively, it wasn't easy and it wasn't fun, but we did it.

Well, I think many of us aging people are like Meg describes her own dilemma.
I don't think it has much to do with finances. The dilemma is a lot of us lose our "decision making strength" as we age or become ill. We can just look at the dirty dishes and be overwhelmed as to where to begin! And people cannot help us unless we can direct them and we cannot direct them if we are overwhelmed!
I am 70 and this is the first year I have been unequal to actually directing help....so I just let lots of stuff "go". It is not being old as much as it is being ill.
Even our kids have trouble helping us if we have no concrete plan to give them. Besides if our kids "recognize" how infirm we really are, they will have a meltdown knowing they are next generation up and not young anymore. Scarey when the big folks in your life start crumbling! Sometimes they "look away".
Meg has done a fine job of organizing what needs organized and signed....and now, Meg, I think you should cut yourself some slack and just experience today and continue to put off decisions that are less important. Scarlet knew a lot about making it through the tough times! "I'll think about it tomorrow."

Note re moving: we did hire a moving company for the furniture, the books we kept, and other heavy stuff--we're way beyond our U-Haul days!

Suggestion: If you don't have the stamina to seek out an apartment or condo, get someone else (a pro) to do it for you. Usually, a good real estate agent can put one in touch with a rental expert. I was quite pleased with the apartment that was awaiting me when I moved from out-of-state.

Most of the comments and suggestions seem to assume that those who would like to move for one reason or another have enough money to move, pay rent , pay someone to help with doing this! Some of us, me included do not have this option. Bernie Madoff stole my savings so I am not able to do what I had planned, move from an inconvenient house to a nice small apartment.

I wrote that I am happy aging in place....what choice do we gave - our savings is gone and rev. mtg. spent....but thanks to a grant was able to put a custom made stair lift in our house to faciliate the laundy and shopping etc. of two old farts. I still would rather be here with the repairs that are needed and not done then somewhere being ruled by agendas & assoc,

I'm puzzled by why it's such a headache to get driving taken care of. Why isn't there some kind of quick, reliable, relatively affordable national business that provides drivers (to doctor's offices, stores, volunteer work, etc.) A taxi is too scary. The bus is too difficult. It seems like it would be a great part-time job.

Shelly, there are usually volunteer agencies who will furnish trips to the doctor and grocery store. In my city I make use of them for medical trips. There is also a Van that picks up the disabled and will take them anywhere they need to go for a very low fee.

I make use of both of these forms of transportation. I have even taken the Van to the airport.

People should check with their local agencies on aging to find out what is available.

I should add that the volunteer program also will find someone to do basic housecleaning or vacuuming and some yard work, although those volunteers are not plentiful so you have to wait for weeks for help.

Great comments...providing encouragement, ideas and attitude for moving forward. At 71, I have only recently realized my limitations are increasing, and that's fully realized. But I can still 'jump', take some risks and after the adjustment, will live as I choose. I'm one who needs change and challenges, getting out of the box, be they risky or safe; they're on a different scale as aging comes aboard, however.

For now, it's reaching simplicity. I found a worthy donation place who will pick up every week. So 3-4 items (clothing, books, etc) are chosen daily to go into the box. In addition to getting rid of stuff(crap!), the satisfaction of accomplishment, tho small, feels good and promotes further, difficult choices to promote move on.

Also appreciated the "...life is about experience, not survival.." and that's worth remembering when times are good or tough!


I've been in the situation where I and sibs had to intervene with our mom. She wasn't eating properly, should not have been driving, wasn't taking her meds or paying local taxes. She did not want any intervention, but we had to. I've been paying attention to stories of others in my shoes, and I've come to the conclusion that most of us act on behalf of our elders when crisis hits. We see the signs, but for a long time, we don't want to intervene. In retrospect, I can see that our mother made several bad decisions re her own health care in the years before we acted. I believe that many elders fear any change at all, and that can impair good judgment. Every case is different, of course.

After our mom entered assisted care, I noticed how much better she looked, and how much better, for a time, she was doing cognitively.

Correction: Will live MORE as I choose, all things relatively considered!

When I forced my mother to move out of her home, my guiding principle was balance: balance with what was good for her, good for my sister, and good for me.
The only way she could stay at home and have all the home maintenance dealt with was if my sister and I did it. Hire a roofer? Did that. A/C contracter? Yup. Cleaning lady? Yup. Yard maintenance? Yup. My sister was raising two kids and I was working FT.
When my sister started to have trouble coping w/ the stress, I insisted my mother move.
I'd do it again.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Related Posts