Thursday, September 24, 2015

There’s No Place Like Home – Part 1

If you ask people the question, “Where would you rather be, at home or in a nursing home?” the response will come back overwhelmingly “At home!” 

If that’s you, you should read on.  Because if you really want to stay at home, it will take more than clicking your heels together three times, while you chant, “There’s no place like home.”  If you are going to succeed, you need to put plans in place now.  Otherwise, when a crisis develops, your children or next of kin or a case worker from some government agency will swoop down and pack you off to the nearest nursing home.  That crisis may be many years off, and we know it’s hard to think about a time when we are not fully in control of our lives, but this is the time to start planning.

Why It’s Good to Stay at Home

Let’s start with why it’s good to stay at home.  There are the obvious reasons.  You have created a place where you are comfortable, and you get to make all of your own decisions.  Your home reflects who you are, and you like being around all the furnishings, tchotchkes, and photos that are rich with memories.  But more than that, people really do better if they can stay at home.  There is no one telling them when to get up and when to go to bed.  They can stay more active, doing all the little things around the house.  When people don’t have beds to make or meals to prepare (or even heat up food in the microwave), they tend to decline in daily functioning.  This can happen at home, too, but having routines helps keep people involved and active longer.  They are in control of their life and that helps them keep going, too.

What It Takes to Stay in Your Current Home

While it is easy to imagine staying in your home, it is harder to think about what your life would be like if you become frail or disabled in some way.  The key to staying at home is making it possible to continue living there even if you become limited in the things that you can do.  That’s where planning comes into play.

We have organized our discussion around 3 questions.  The answers to these questions will help you decide if you want to remain in your current home, move to another home, or move to housing designed for older persons that take care of these potential problems for you.  We will address in the next blog some other issues about staying in your own home, and in later blogs the pros and cons associated with other housing choices.

1.     Is your current residence the right kind of place for you to live for a time when you might have difficulties getting around? 

Take a cold, hard look at your home.  Some homes are frankly not good places to grow old.  We love our house, but it is not a house that can be adapted to meet our needs should we become less mobile or, ultimately, frail.  Here are some of the points to consider.  Can you live all on one level without going up and down stairs? (This could be important if someone fractures a hip.)  Are there steps to get into the house? (A few steps can be modified by adding a ramp, and sometimes a wheelchair elevator can be added.) Is there a walk-in shower that is big enough to accommodate a seat or wheelchair?  Are there other potential hazards or quirks in the house that cause problems?

Here’s a little exercise to try:  Imagine that your friend’s 95 year old grandmother is coming to your house to visit.  She has recently had hip surgery and she uses a walker.  What obstacles will she encounter?

While you’re looking at your house through the lens of your much older self, there are probably things you can change and update that will make your house more age-friendly.  You may have been putting off remodeling a bathroom anyway.  Do it now, but make it accessible, with rails and a walk in shower.  If the washer and dryer are in the basement, can you move them to the main floor?  There are other changes that you might be able to make that make the home safer and more accessible.  But if the house requires too many changes, this may be the time to think about making a move to a place that would provide more accessibility and safety. 

2.     Is your home likely to require more work and more repairs than you are willing to make? 

Like people, all homes age and develop problems.  If you live in an older home, you know how constant the problems are.  Even after extensive remodeling our old house still springs an occasional leak or something breaks. We are on a first name basis with the plumber, electrician and a contractor who does the bigger jobs. 

Many older people defer maintenance on their homes, or put patches on problems that will only then recur.  They may feel that since they don’t expect to live too many more years, they won’t get their value from a new furnace or a remodeled kitchen or bathroom.  But if the heat goes out in the middle of a northern winter or the AC goes out during a Florida summer, that may be when family says “It’s enough,” and hauls you off to the nearest old age home.  If you have an older home that requires a lot of upkeep, and you don’t want to have to do it, then you might consider moving now or in the near future to a newer, lower maintenance residence, or to a retirement community that takes care of at least a portion of the maintenance.

Even if your home is currently in good shape now, you will inevitably need to make upgrades and repairs in the future.  Are you willing to do the ongoing upkeep, especially if it means hiring someone to do work that you can't do or are no longer able to do, or investing significant amounts of money?  That will be what is needed to keep your home comfortable and safe.

We’ve seen over the years that one of the real keys to staying at home is finding a handyman (or woman) for the small jobs.  Older people who have someone to do the little things like replacing the light bulbs in a high ceiling or cleaning out the gutters have a sense of ease about their home.  Unfortunately, a good handyman can be hard to find.

3.     Will you have access to services if you can no longer drive? 

How far is your current home from essential services--the grocery store, your doctor’s and dentist’s office and other vital services?  We would like to think that we will be able to drive forever, but that is usually not going to happen.  Are there alternatives to driving where you live?  In some ways, being in a city with good public transportation seems to be ideal, although there may come a time when you can no longer safely get on or off of a bus or train.  Many communities have transportation for Seniors, although most often it is not nearly as convenient as driving oneself. 

Looking through Our Future Lens

We plan to continue to live independently, that is, we do not plan to go to a retirement community or skilled nursing facility.  What we know from our work in those settings is that the same services and even nursing care can be provided at home, and that the cost is actually similar.  In order to carry out this plan, we will make one more move, this time to a somewhat smaller home that is all on one floor with handicapped capabilities, and that is somewhat near one of our adult children.  When one of us needs care, the other will supervise the services provided in the home.  Later, the children will take over the supervision for the remaining parent. 

It may seem cold or harsh to consider all of the possibilities, but by facing them squarely now, making provisions for an optimal living situation, and making our wishes clearly known to our children, it increases the likelihood that we can carry out our plan to live independently.  Without this advance planning, decisions will have to be made during a crisis, when the choices are often fewer, and when emotions are running high. 

A Final Note

One last note about public transportation.  We have spent a lot of time in Sweden over the past 25 years because of Steve’s work there.  One thing we have noticed is there are always a lot of older people out and about.  One reason is the busses.  When a bus comes to a stop, it does a little curtsy, lowering gently to curb level so there is no big step to climb up to board.  A person with a walker or a wheel chair can also easily roll on.  It’s kind of cool and it does seem to help older persons to get around.  Of course, an extensive bus system helps, too.

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