Independence Versus Safety: Housing Options in Later Life
"Embedded in most of our rules and regulations is the idea that Long Term Care should aspire to be the best possible quality of life as is consistent with health and safety. But ordinary people may prefer the best health and safety outcomes possible that are consistent with a meaningful quality of life."*
This juxtaposition is at the heart of the dilemma of safety versus independence that haunts many family members and caregivers when it comes to the question of whether older adults can continue to live safely in their own home, or whether family should consider alternatives. What do you do when mom starts leaving the stove on, when dad can no longer see well enough to drive safely, and you start to wonder if it is wise for them to go down those steep basement steps every time they need to do laundry?
"Aging in Place"
Research has shown that most seniors who own their own homes prefer to "age in place." Many different types of assistance, from housework and meal preparation to personal care and medication monitoring, can be provided through social service or private home care agencies. There are also agencies offering medical or nursing services, but these tend to be costly. Medicare and most health insurances will not cover "custodial" care (help with bathing and dressing, chores, or supervising someone with memory problems), which is often precisely what is needed. Seniors who are low income may be eligible for COPES, a Medicaid program that pays for a variety of services tailored to help keep the individual living as independently as possible, but COPES does not provide 24-hour care.
To ensure continued safety in the home, people often consider retrofitting, which includes adding grab bars and rails, building ramps, widening doorways, and installing lifts or other types of equipment to accommodate disabling medical events that limit mobility. General contractors usually carry out this type of renovation. There may be limited financial help available for some minor home repairs; check with Senior Services of King County for specific programs. AARP has developed the Certified Aging-In-Place Specialist (CAPS) program to help homeowners who need to remodel their home to address accessibility issues. You can find more information in the home design section of the AARP web site.
If living at home becomes risky, there are a number of options to consider. All have their pros and cons. Assisted living facilities are the choice of some individuals and couples. Assisted living offers the advantages of the opportunity for activities, socialization and congregate dining, while residents still retain privacy in their own rooms or apartments and can choose the level of help they need from within the suite of services that the facility offers. On the downside, they can be very expensive, vary considerably in the kind of assistance they offer, and the industry remains largely unregulated. Assisted living facilities do not offer skilled care, and generally require a certain amount of independence on the resident's part.
Adult Family Homes
Adult family homes are smaller, licensed to provide care to up to six residents, and can provide a more homelike atmosphere. Many specialize in dementia or other severely disabling conditions. Placement agencies can be very helpful in selecting either the right assisted living or adult family home, by matching up the senior's needs to the home that offers it.
Nursing homes are designed to provide help to people who require 24-hour care, including those who require too much skilled assistance or supervision to stay at home. Check out the Nursing Home Compare resource of the Medicare website to look at inspection reports for skilled nursing facilities in your area, and information on how to choose a nursing home. The drawback with most mainstream nursing homes is that they tend to homogenize services, and their necessary emphasis on safety regulations can infringe on individual needs.
Whatever type of living arrangement you are looking into, it is crucial to thoroughly research your options ahead of time. Senior Services of King County is a good place to start for information on selecting different living arrangements, or maintaining the current home of you or your family member. You can also talk with Crisis Clinic's Caregiver Specialist to help you look into different options that address your unique needs.
* Kane R.A. "Long-term care and a good quality of life: bringing them closer together." Gerontologist 41: 293-304. 2001.
Amanda Woodland is the Caregiver Specialist for the Crisis Clinic
Photo: Ken Hammond