Monday, May 30, 2016

There’s No Place Like Home

Some street art in Stock

How many of you want to live in a nursing home?  Let’s see a show of hands.

We don’t see any hands up.  Not surprising, is it?  Most people would prefer to remain at home, even when it gets difficult to do the everyday things and to take care of themselves

We begin a series of blogs that discuss how you can stay at home and what alternatives there may be to a traditional nursing home.  For those of you who are concerned about your parents or grandparents, we may be able to help you start a conversation with them about the future.

Let’s begin.  If you really do want to stay at home, it is necessary to take steps to prepare for when you need help.  And you want to do it now, even while you continue to hope that you will be healthy and independent forever.

Defining the Plan

 We have identified five issues that need to be part of a plan for staying at home:

·      Getting the important people in your life on board with your plan
·      Making your home accessible or deciding to move
·      Being willing to use services when you need them
·      Deciding among possible housing choices if you decide to move
·      Understanding why staying at home is the right choice, if you can manage it.

We will take you through the first two points in this blog, and then return to the remaining points in subsequent blogs.

Getting the Important People in Your Life on Board with Your Plan.

Staying at home depends on having an advocate in a health crisis, who can intervene in the almost automatic process of transferring older patients from hospital to nursing home.  So the first step is determine who can act as a decision-maker for you in a crisis and involve that person or persons in your plan. For some of you, that will be your spouse or partner and/or children.  But it doesn’t have to be family, if you don’t think you can rely on them for one reason for another or do not have family to turn to.  Friends can step into this role.  We have known people who create a network of friends as well as professionals such as care managers to look out for their future needs.  Whoever you select as an advocate, that person won’t necessarily do the care that you will need to stay at home, but will help arrange care and make sure it is actually delivered to you.

The next step is to ask the person you have identified if they are willing to work with you on developing and implementing your plan to stay safely at home.
If you do not discuss what you want with your family or with the persons who will be your advocate, you may find out too late that they do not agree with your plan to stay at home.  Then when there is a crisis, they will take the path of least resistance, which is a nursing home or assisted living facility.  Everyone will be telling them that it’s the right thing to move you to a nursing home—your family, the doctor, the nurse, the social worker.  They will all say it’s not feasible, practical or safe for you to go home, or it will place too much burden on caregivers.  Your advocate has to understand that there is a realistic alternative to nursing home care and that there is a plan that can be put in place.

Make Your Home Accessible or Move?

The next part of the plan is to evaluate if your home is a place you could continue to live if you had a health crisis or became disabled.   This is something you need to do now, not when there is a crisis.  Steve had a graduate student whose grandparents lived in an old farmhouse in the country.  Every morning her grandfather chopped wood for the wood-burning furnace that heated the house.  The grandparents resisted all the efforts of their children to put in modern heating and in other ways make the home more accessible.  When the crisis came—the grandmother had a stroke—they were moved to assisted living in town.

Take a good critical look at your house.  No matter how much you love it, could someone with disabilities live there?  Can you get into the house without going up steps?  Is it possible to live entirely on one floor?  Is there an accessible bathroom, with room for a wheelchair to navigate in and an easy to access shower with a seat in it?  Are you near transportation and medical and home care services, in case you need them?  Do you live near enough to the person who has been designated to help you carry out your plan?

Sometimes issues involving limited accessibility can be fixed.  A remodel can create a first floor bedroom and accessible bathroom.  Other quirks your home may have also may be fixable.  Hopefully, you don’t have a wood-burning furnace.  But if the house cannot be made accessible or the location is wrong for getting help, it may be time to move. 

Whether you decide to move or to stay and remodel, it’s important to start planning now. If you move now, you’ll have more choices in where to go, what type of place to get.  And if you move to a new city or town, you will be able to make new friends and identify activities that you enjoy in your new community.  And you’ll have a home that could accommodate you when you need help.

Many of you are shaking your heads, and saying to yourselves, “Yes, but I’m not ready.  I love my home.”  Here’s the risk.  People delay and delay with this decision, until it is too late.  It may be that for a variety of reasons it’s more comfortable to stay where you are now and you’d rather not think about what could happen in the future.  We all stubbornly insist to ourselves that we will always be able to take care of ourselves, and don’t have to think about these things.  This may be the time to survey the important people in your life about their opinion of your current living situation.  If the consensus is that you can safely live there until the end with sufficient help, great.  But if the majority of the people in your support system see and point out the obstacles to being able to implement your plan, then it may be time to consider alternatives. 

We’re not pretending that moving is ever an easy choice.  Especially if you have been in your home for a long time and have a lifetime of memories there.  And, perhaps, a lifetime’s worth of possessions, as well.  Sometimes it helps if you allow yourself to think about which of your children or grandchildren would value the items that you cherish most, and begin making those transfers.  When Judy’s mother and father were getting ready for the move to State College, from a home they had lived in for 35 years, Judy’s mother started by asking each of her children and grandchildren what they wanted.  One granddaughter wanted her dining room set, another her set of china.  Mom found it gratifying to find out that they wanted these things, and by giving them away before she made the move, she had less to take.  Next she decided to bring only a few valued pieces of furniture to the new place, because it was much smaller, and she wanted to start with a fresh decorating palette.  She brought the chairs and a sectional they she and Dad used most, and the bedroom set from the guest room that was familiar to all of the children and grandchildren.  And she brought the artwork they had collected and surrounded themselves with.  This gave them a familiar environment in the new home, but with some new pieces to fit the space.  And it means that when the end comes, there is a manageable amount of her possessions to deal with.

Judy and I love our house, which is big enough for all of our children and grandchildren to have plenty of space when they visit.  It is even accessible for the most part.  But we also know that in the future the grandchildren will be less interested in visiting, and that it will then really be too big and require more upkeep than we may be able to do in the future.  So we have begun formulating a plan:  sometime in the next five or six years, we will move to a smaller, easier to maintain one-story house (but with a bigger kitchen—you have to have priorities) and nearer to children.  And, being perfectly honest here, we will have to get rid of massive amounts of belongings that we have accumulated.  Maybe we’ll do what Judy’s mother did and offer the kids first choice, then discard the rest.

In our next blogs we will continue our exploration of the other important steps to staying at home.

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