Older and Wiser

The last two “Older and Wiser” articles defined types of long-term care residential facilities for older people and described a process for learning about them. This is the first of a few pieces to explore at-home choices for older people.

Why home?

Even when confronted with significant new physical or cognitive limitations, most people will seldom enthuse over moving into a group-housing situation for seniors – unless, perhaps, one is fortunate enough to be looking at an attractive townhouse or apartment.

A bedroom and a bathroom (perhaps shared) in a large building? It may be necessary because of circumstances. It may be acceptable or even what many people consider “nice,” but it will not feel like home – or will only after months or years.

Multiple reasons drive our interest in staying home, whether actually confronted with the situation of age-related limitations or contemplating what life may be like in the future. We like our stuff, our space, our neighborhood. It’s daunting to think about moving. Home is dependable. It’s a state of mind. “Home is where the heart is.” “I’ll be home for Christmas.” “Lassie, come home.”

A theme running through most peoples’ reasons for wanting to stay home comes down to one word: control. It’s human nature to want to be in control of our day-to-day existences.

Some adults don’t get the opportunity to exercise much control over their lives, even in younger years – for example, in cases of economic deprivation, chronic disability, an abusive partner, or a dangerous culture.

But those of us fortunate enough to have avoided these types of hardships get to exercise significant authority over our own lives and, perhaps, never more so than when it comes to our homes. We choose them in the first place; we fix them up; we decide how we’ll spend our time in them. Even the law recognizes the special nature of home, conferring privacy rights on our at-home activities that we do not enjoy elsewhere.

The mere consideration of leaving home – if it’s because of age-related limitations – may seem to an older person a form of admission that he or she has lost the ability to control all the aspects of daily living. And that may be tantamount to a loss of self-esteem. Things may seem even grimmer if a child or someone else is urging a move; the process of ceding control to others has begun. What’s next?

Public policy favors home

Fortunately, we’re living in a time when aging experts, including health care providers and others, recognize that staying home may be the best option for many aging people, as long as they can live safely. New products and services to make this happen are constantly coming to market.

Some governmental policies also are beginning to encourage at-home options, based on studies showing that taxpayers may pay less for elderly people staying at home, even with some types of in-home care, than taxpayers pay for seniors in assisted living and nursing homes.

Questions to consider

Although the direction of favoring at-home, versus institutional, living is a positive development, we need to evaluate the opportunities for our elders and for ourselves with a healthy dose of realism. Here’s a sampling of questions to consider about staying in our current homes – assuming that it’s fairly likely that, at some point, we’re likely to suffer a diminishment of physical and cognitive abilities.

Livability, ease-of-use. Will I be able to maneuver among at least the essential rooms of my home, such as bedroom, bathroom, living room, and kitchen? If stairs become difficult or impossible, can I sleep and use a bathroom on the ground level? What easy and affordable changes could be made now that may preclude issues down the road? For example, the addition of grab bars to a bathroom and the purchase of a toilet riser are inexpensive solutions to common problems associated with aging.

Affordability. Given how my assets, income, liabilities, and expenses are likely to change, is it likely that I will be able to afford this home five/10/20 years from now? Will it be worth it, financially, to stay here?

Support network. Where are my family members and friends likely to be living during the next several years? Even if they’re close by, will they be able and willing to help me in ways I may need help? What about other types of support in my area? Not just people to deal with such matters as medical needs and nutrition – but people to do things with and laugh with.

Transportation. If I am no longer able to drive, what options exist for me to get around and to obtain the things I need to continue to live at home?

Proximity to medical facilities. If I would need to go someplace for regular medical care (for example, some type of therapy), what are the ways to do that from my current home?

Spouse issues. What would be the challenges and benefits of staying home if, for example, one spouse experiences a significant health decline while the other remains healthy?

Limiting others’ burdens. If I stay in my home and then encounter a physical disability or some other limitation that forces me to move rather suddenly, might I be saddling my relatives and friends with difficult burdens to deal with my house and my stuff? Even if I don’t have to make such a sudden move, would staying in my home somehow entail financial sacrifices for my children or others because of responsibilities they might have to undertake on my behalf? What steps can be taken now to avoid those sorts of problems?

Another type of home. What would be the pros and cons, short- and long-term, of a move to another type of home? From, say, a two-story farm house to a small ranch or to an apartment? From Door County to, say, Milwaukee or the Twin Cities – or Florida or Mexico? Would it be smarter to just make some renovations to my existing home?

The Waltons?

In a recent New York Times “The New Old Age” blog entry (“Who’s Moving In Now?” 8/4/2014), Paula Span writes about recent increases in multigenerational households, citing Census Bureau and Pew Research data. Pew Research reports that the number of Americans living multigenerationally doubled from 1980 to 2012. Those analyzing the data say it’s mainly younger people moving in with their elders, often due to economic necessity, not older people moving in with their children.

Recent immigrant populations also tend to live multigenerationally more frequently than other Americans. Span thinks most seniors favor independent living. She writes that, while personal factors and family dynamics, not just economic trends and immigration patterns, drive the establishment of multigenerational households, “I don’t see a replay of The Waltons for American seniors anytime soon.”