Aging in Place

Today, January 1, 2011, the first of the baby boomers turn 65. To assist them in planning for their future, caring for their parents, spouses, family and/or friends, the following post examines different ways people can age in place. If you know of other resources, information or have different ideas, either post them to the comment section below or e-mail them to margoc@tds.net

It is important to recognize that many seniors, and those living with chronic condition(s), also serve as caregiver for spouses, family members and even grandchildren. For resources and information on this topic, go to the Caregivers section of the blog.

AGING IN PLACE OPTIONS
There are a growing number of ways people can remain in their community, surrounded by the people and things that they treasure. Some approaches require a move initially, others do not. Below are the current ways seniors can age in place.

• Senior Community/ Senior Co-Housing: Cooperative-style housing community of seniors who share some expenses, skills and visions. Variations of this type of living arrangement include a group of people purchase a very large home and sub dividing it into apartments; building a number of homes in a cluster under the leadership of a corporation or builder. Generally, they do not provide formal services. If need becomes to great, the person can hire outside assistance, such as a personal care attendant, or will need to enter assisted living or nursing home care. Depending on location, this approach most likely will require a move.

Staffing: Generally none. Meetings are held regularly to determine need and to act accordingly.
Financials: Owners pay for their homes, some places do have rentals. On-going shared expenses. Screening process required for acceptance into community.
Examples: Burlington Co housing East Village (this is multi generational)

• Continuing Care Retirement Center: Provides resources and services from independent living through nursing home level of care. Residents pay for an apartment/condo. This approach requires a move.

Staffing: Very large paid staff from administration down to cafeteria workers, including an array of medical and ancillary personnel.
Financials: Fee structures very, but in general residents pay for their apartment (town house) plus a monthly fees. Additional fees are charged for additional services such as health care.
Examples: Wake Robin in Shelburne; The Lodge at Otter Creek Middlebury

• Naturally Occurring Retirement Community (NORC)/Villages: Coordinates seniors in a given geographical area. Members remain in their homes, apartments, or condos. More and more of these types of community-based programs are being developed and so there is a potential opportunity to help create one in the community where you now live. Services provided can include:
- One phone number to call for any service
- Coordinated billing
- Pre-screened service vendors –including home health, personal care attendants
-Transportation arrangements
- Computer training and support
- Volunteer services and opportunities
- Newsletter
- Check in service
- Exercise programs
- Access to social and cultural activities
- Household and home maintenance services
- Shopping assistance
- Information and referrals

Staffing: Paid staff, numbers depend on membership and area covered
Financials: Monthly dues or yearly membership. Charges for certain services.
Examples: SAIL-Support for Active Independent Lives-in Madison Wisconsin Beacon Hill Village Cambridge at Home

BASICS FOR AGING IN PLACE
Having the following will increase the chances of aging in place:
• Financial resources, willingness to hire help and having reliable options for personal care attendants and home health in the community

• Family and/or friends are nearby, can be of assistance and are willing to be advocates. The person in need has realistic expectations of their family and friends.

• Knows community resources and accesses them appropriately.

• Location and layout of the house can be modified to meet changing needs.

• Transportation, relatively easy access to public transportation and/or to friends and family that drive. Without that ability, shopping, socializing and other important activities quickly diminish quality of life.

• The designated caregiver(s) is willing to deal with significant changes in health status, particularly relating to dementia, mobility and the ability to perform basic activities of daily living, at home.

• Being proactive and putting things in place before a major issue arises, such as identifying people that could be hired for chore services, driving, personal care etc. A plan is in place before it’s needed.

• Affairs are in order-living will, will, health and financial proxy- so family and friends know exactly what the person wants so they can be carried out with minimal problems.

WAYS TO INCREASE CHANCES OF AGING IN PLACE
• USE COMMUNITY RESOURCES: Know what resources exist, what services they provide and how you can go about obtaining their services should you need it. Community groups that might be most useful include:
- Meals on wheels
- Home Health and hospice
- Council on Aging or Area Agency on Aging
- State Disability
- Transportation
- Senior Center
- Community Action Agencies
- Independent Living Center 713-520-0232 or www.ilru.org
- Eldercare Locator: Connects older Americans and their caregivers with sources of information on senior services. 1-800-677-1116 weekdays, 9:00 am-8:00 pm
- State and Local Health Department Call 202-371-9090 or check the front pages of your local phone book.
- A condition specific organization, such as the Diabetes Association, Cancer Society
- Department of Veterans Affairs

If you are not familiar with area resources, call 2-1-1 or go on-line to your state’s 211 website. They can help with food, housing, employment, health care, counseling and much more. Most sites include a Special Topics area where you can select Older Adults and People with Disabilities or Senior Citizens.

• TRANSPORTATION: This is a major stumbling block for many people as they age, particularly those in rural communities. Consequently, many seniors are reluctant to give up their license and drive much longer then they should. There are classes and resources (see below) to help people safely remain on the road.

If there is no public transportation, and driving is no longer an option, identify sources of mobility assistance. Those participating in CCRCs and NORCs generally have this built in to the program. There are programs that that provide both paid and volunteers to assist with shopping, going to medical appointments etc. Identify services before you are in need of them.

Resources
- Senior Drivers: Foundation for Traffic Safety: You can measure your driving skills/needs as well as learn where to go for education and training to keep you a safe and smart driver and how to plan for continued mobility.
- AARP Driver Safety Program
- Eldercare Locator 1-800-677-1116 weekdays, 9:00 am-8:00 pm

• CASE MANAGER: This person can help to coordinate the medical and social services you might need. There are a variety of places that offer this service including: social work department of hospital or clinic where you receive care; local aging organization; CCRC; NORC; or condition specific organization. You can also hire a professional geriatric care manager.

Resources
- National Association of Professional Geriatric Care Managers
- Eldercare Locator 1-800-677-1116 weekdays, 9:00 am-8:00 pm

• AN ADVOCATE: Having someone that knows what you want and can see that it happens is very important. As outlined in the Legal Matters section, it is important to find someone that you trust to serve in various legal positions. Further, a good “friend with a pen” can help advocate for you not only at medical appointments and hospitalizations but also in dealing with service personnel and other matters. It makes a difference if you can talk things over with a trusted friend or family member, particularly before you make important decisions.

• RELIABLE HELP: Like transportation, this is a deal breaker as to whether someone can remain at home. Before you need it, start planning for it. This means identifying potential caregivers, chore service providers, personal care attendants etc. Your local Council on Aging, senior center, CCRC, NORC or senior housing are all places to have a list of potential caregivers. NORCs generally offer a screening service as part of their program and can provide discounts for their preferred aids, housekeepers, personal care attendants etc.

You can hire caregivers privately or go through an agency. There are advantages and disadvantages to both. The primary advantage of hiring privately is that it will be cheaper. However, this makes you their employer, opening up a variety of issues. Further, if they become sick or change jobs, you don’t have a staff to fall back on.

Once reliable help is identified, it is key to start using them as soon as there is indication of need. Many elders wait too long and run into problems. Having the finances to pay for them is another issue. Since it is generally cheaper to keep someone in their home, many states have programs to help make this possible. Find out about these services from your local aging resources (senior center, Council on Aging etc.).

Resources
Hiring a Caregiver for In-Home Care

Hiring and Management of Personal Care Assistants for Individuals with Spinal Cord Injury: There is excellent information in this pamphlet, which is relevant to any condition.

What every caregiver needs to know about hiring in-home caregivers

Rewarding Work: Provides information on people available in your community who are available to do personal care.

Eldercare Locator: A public service of the U.S. Administration on Aging connecting you to services for older adults and their families. They can also be reached by phone 1-800-677-1116, M-F from 9 am-8 pm EST.


• A SAFE AND SECURE LIVING RESIDENCE: Living in a house, apartment or condo that is easy to access and move around in is essential. Senior living facilities have many features already built in. However, changing needs may mean making modifications. The majority of homes can be modified.

Resources
National Resource Center on Supportive Housing and Home Modifications: Click on their "Safety Checklist and Assessment Instrument."

Rebuilding Together: Home Safety Checklist

“Feeling Right at Home: The booklet is also available for free by calling 1-888-817-6331

State’s Independent Living Center 713-520-0232

• COMMUNICATION DEVICES (Lifeline): Use a personal emergency alert system, such as Lifeline or Medical Alert. Talk to your local hospital, phone company, senior center, people you know who have them, to find out the service that is going to be right for you. These devices can be worn as bracelets or around your neck. Some even come with GPS coordinates, so that if you are taking a walk and fall, emergency personnel will know exactly how to reach you. CCRCs generally have some aspect of this service built into their housing, e.g. help pull cords in the bathroom.

• ASSISTIVE DEVICES: Take full advantage of technology and products that help with activities of daily living. Whether it’s a cane, a “grabber” to help you reach high shelves or put on your socks, a high toilet seat or an easy to use cell phone, there are hundreds of devices on the market to help simplify life for you. There are a number of ways you can find out more about such items:
- Talk to a physical therapist or occupational therapist. Note-many times they will charge for such visits.

- Go to an area pharmacy that carries medical supplies. Pharmacies in or near a hospital offer a lot of devices and they have knowledgeable staff to help you. In general, they do not charge for their time.

- The exhibit areas of wellness fairs, condition specific organization meetings (e.g. Parkinson’s Disease Association), clinics and hospitals will often include a variety of nifty gadgets to make life easier. At a Parkinson’s Disease conference I attended, the “schwag” included; specially designed pens; devices to help open doors and jars; shoe horns with a long handle so you didn’t have to bend down; special pill caddies and more

Resources
Assistive Devices section of Medline Plus

• MAXIMIZE HEALTH AND WELL-BEING
This blog’s focus is on well-being, so be sure to look through past posts for additional tips, particularly the Care for the Whole Person Handout
- Social Connections: Stay involved with family and friends; participate in celebrations and enjoy the company of others on a daily bases. Encourage family and friends to stop by, try not to eat alone. Join a senior center if one exists in your community

- Recreation and Exercise: Key to aging well is staying fit and healthy as possible. Take a walk. Join a gym (many offer discounts to seniors); use a treadmill or elliptical trainer; practice yoga etc.

- Volunteer

- Learn something new

- Develop or use your spirituality and/or faith

- Take a Break

- Take medications as prescribed

- Keep medical appointments

- Get sufficient sleep and rest. Taking a nap in the afternoon can give you energy for activities later in the day.

- Eat a well balanced diet

Resources
National Institute of Health (NIH) Senior Health

Taking Charge of Your Health

• LEGAL MATTERS: Wills, power of attorney (both financial and medical), planning for your and your family's future in the event something should happen to you, are issues which should not be put off until a crisis situation occurs. Planning is best done when you can take your time and think things through clearly. Getting appropriate advice and input from family as well as a professional (i.e. lawyer, social worker) is also important. Outlined below are some of the items that you need to consider. Be advised that this is not legal advice. It is recommended that you consult with a lawyer as you make your plans.

- Will: legal document that describes what you want done with your possessions and other affairs after you have died.

- Living Will (Advanced Directives): gives directions about your medical care in case there comes a time when you are no longer able to communicate because of your illness. It allows you to express your wishes regarding the use of life support systems and the prolonging of life when critically ill. Once this document is completed, make sure that it is on file with your medical provider and hospital where you are most likely to receive care. Make sure your power of health attorney has a copy and members of your family who might be in a position to speak on your behalf if you are unable to do so.

- Durable Power of Health Attorney: document allows the person you name as your agent the authority to make any and all health care decisions for you when you are no longer capable of making them yourself.

- Power of Attorney: gives someone else the authority to make certain kinds of decisions and do other things for you, such as use money from a bank account, pay bills if you are unable to do so, and collect public assistance. Be aware that once this document is signed, the agent named has immediate access to all financial information.

- Legal guardian (who would care for a child or other dependent adult if you were unable to do so).

Most states have some form of legal aid, including senior legal aid. Check with 211 and/or your local office on aging.

FINANCIAL MATTERS: A number of older Americans are experiencing a financial pinch they hadn’t planned on. The current economic situation has devalued savings and investments to the point that many seniors will continue to work, even if part time, well into their 70s and beyond. Some have experience a variety of health or other issues that have reduced savings and available income. Regardless of the reason, a higher percentage of older Americans are living below the poverty level.

There are resources to help. A good case manager can help identify financial resources should you need them. The best strategy is to know your community resources and use them. Senior center, Council on Aging, community action agencies, local clinic and/or hospital where you are going for care are all places to learn more about what financial assistance might be available to you.

Experts say elder financial abuse will be the "Crime of the 21st Century" as the growing senior population becomes a target. Regrettably, many seniors are victimized by their own relatives or caregivers—people they generally trust.

Financial exploitation takes many forms. Warning signs include:
• Obtaining unauthorized access to an elder’s Social Security checks, pension payments, checking or savings account, credit card or ATM; identity theft
• Withholding portions of checks cashed for an elder
• Charging an elder excessive rent or unreasonable fees for basic care (e.g., transportation, food, or medicine)
• Scams (e.g., bogus sweepstakes, lotteries) that use deception, scare tactics, or exaggerated claims to get money from elders
• “Conning” by con artists who make their living preying on others and "befriend" elders
• Calls from telemarketers selling worthless, over priced, or nonexistent products
• Unfair or misleading home equity agreements that cause elders to lose their homes
• Unscrupulous home repair contractors
• Inappropriate financial products and services
• Fraudulent lifelong care offers in exchange for money or property
• Use an elder’s property or possessions without permission
• Forging an elder’s signature
• Coercing an elder to sign a deed, will, or power of attorney
• Pressuring an elder to give a "gift"
• Claiming to have found money and offering to split it with an elder if he or she first pays some amount as a sign of good faith
• Convincing an elder his or her child has been injured or is in jail and needs money
Elder Financial Protection Network

Resources
Senior Community Service Employment Program: This federal program assists seniors who are looking for work or are entering the workplace for the fist time.

Government Benefits, Grants and Financial Aid

Tax Counseling for the Elderly

US Department of Housing and Urban Development Information for Seniors (includes information on reverse mortgages)

Elder Financial Protection Network

BE AWARE OF FRAUD: Older people, and those with chronic/life threatening conditions are often the target of fraud. There are well-seasoned criminals intent on taking people’s life savings. Whether it’s health care treatments, investments, Medicare or even real estate, keep in mind the following:
- Fraud seldom looks outlandish
- Be wary of anecdotes and testimonials
- “Get rich quick” are scams
- If it sounds to good to be true, it probably is
- Be very wary of telemarketers

Protect Yourself: Take steps to protect yourself from financial exploitation and abuse:
• Plan ahead to protect your assets and to ensure your wishes are followed. Talk to someone at your financial institution, an attorney, or financial advisor about the best options for you.
• Never give personal information to anyone who phones you.
• Never pay a fee or taxes to collect sweepstakes or lottery "winnings."
• Never rush into a financial decision. Ask for details in writing and get a second opinion.
• Consult with a financial advisor or attorney before signing any document you don’t understand.
• Get to know your banker and build a relationship with the people who handle your finances. They can look out for any suspicious activity related to your account.
• Check references and credentials before hiring anyone. Don’t allow workers to have access to information about your finances.
• Pay with checks and credit cards instead of cash to keep a paper trail.
• Feel free to say "no." After all, it’s your money.

• You have the right not to be threatened or intimidated. If you think someone close to you is trying to take control of your finances, call your local Adult Protective Services.

Exploiters and abusers often are very skilled. They can be charming and forceful in their effort to convince you to give up control of your finances. Don’t be fooled. Trust your instincts. If something doesn’t feel right, it may not be right. If it sounds too good to be true, it probably is. Elder Financial Protection Network

Resources
Fighting Fraud Against Older Consumers

They Can’t Hang Up: Five Steps to Help Seniors Targeted by Telemarketing Fraud

Telemarketing Frauds Tips from the National Consumer’s League’s National Fraud Information Center

National Fraud Information Center

RESOURCES FOR AGING IN PLACE
Age in Place Council Check website for local chapters

Aging in Place Initiative

Naturally Occurring Retirement Community: Aging in Place-Provides excellent resource information about the various aspects of aging in place.

Aging in Place Technical Assistance Guide by Partners for Livable Communities